The actual definition of constipation is difficult to nail down.  Traditional medical texts say it’s not necessary to have a bowel movement every day and suggest that as little as three a week fall within the normal range.  Herbalists, on the other hand, are of the opinion that one to three bowel movements per day is closer to what should be considered the norm.  Each meal that enters the stomach triggers reflex movements in the colon and can lead to a bowel movement.  There are many factors that can slow the digestive process down such as fat in the diet, stress, and inactivity during the day time.  However, it is normal to have at least one bowel movement a day upon rising in the morning or following the morning meal.  Constipation that comes on suddenly or persists may require a visit to the doctor to rule out serious causes such as intestinal obstruction, hypothyroidism, or side effects from medication.

It’s important not to resort to laxatives if you feel you do not have regular bowel movements, as laxatives–both chemical and herbal–are a common cause of chronic constipation.  While occasional use is considered safe, habitual use can lead to dependence, which not only damages the bowel, but upsets the body’s mineral balance.  When dependent on laxatives, it’s important to discontinue use slowly so your digestive system has a chance to readjust.

Self Help

There are simple, practical steps you can take to help treat chronic constipation:

• Eat more fiber.  Fiber increases the bulk of the stool and binds water, thus making the stool softer.  The best sources of fiber are fresh fruits and vegetables.  Incorporate psyllium products or soluble fiber such as oat bran and guar gum, which are easily digested, into your diet
• Set aside a specific time each day (usually after breakfast or dinner) for having a bowel movement
• Do not resist the urge to have a bowel movement
• Exercise daily
• Do not use enemas regularly
• Drink eight glasses of warm or hot water daily; according to Chinese medicine warm or hot water relaxes the intestines

Western Treatments

When the need for treatment for chronic constipation escalates to needing the care of a physician, there are a number of treatments that Western medicine resorts to, spanning from normal laxatives, to suppositories, to surgical intervention.  Each treatment has varying degrees of side effects an unappealing consequences to the patient.

Currently, a great deal of research is being done on each section of the intestine, as each part of the organ has a network of nerves that controls its muscles.  Much of this research involves neurotransmitters (chemicals that nerves use to communicate with each other).  This research is allowing scientists to develop drugs that stimulate and inhibit various nerves in the colon that propel colonic content.  Such drugs have great potential in the treatment of constipation.  The first of these drugs is currently in clinical trials and will be available soon.  How effective they’ll be over how much of the population remains to be discovered.

A Case Study in TCM Treatment

A 51-year-old woman presented with a conventional diagnosis of IBS.  Her main complaint was chronic constipation, which was only relieved by drinking senna tea.  She reported that all kinds of food gave her indigestion, which started as a burning in the throat and then turned into nausea and bloating twenty minutes after eating.  She also complained of insomnia which was relieved somewhat using Elavil (Amitriptyline), the dosage of which had just recently been increased. Traditional Chinese diagnosis revealed that her pulse was wiry, and tongue normal-colored and dry. She also appeared to be a worrier. She was prescribed an herbal tea containing taurine, magnesium glycinate, biota seed, White Peony root, tang kuei root, fu shen sclerotium, bupleurum root and others. She was also given an herbal formula which combined, among others, poria sclerotium, coix seed, barley shen qu, magnolia bark, angelica root and pueraria root. Dietary recommendations involved avoiding fruit (which can ferment in the stomach, causing bloating) for one week, exercising (light aerobics), and going for a walk after each meal. After reading about the side effects of Elavil (including indigestion and constipation), she became concerned and began reducing the dosage under the direction of her doctor over a period of three months, while incorporating the herbs. Under this regimen, all symptoms gradually improved.