Constipation is defined as having a bowel movement fewer than two to three times per week. With constipation stools are usually hard, dry, small in size, and difficult to eliminate. Some people who are constipated find it painful to have a bowel movement and often experience straining, bloating, and the sensation of a full bowel.

Constipation can be a cause of life style (not eating a diet rich in fruits and vegetables, lack of exercise), changes of the structure of the colon or rectum, (fecal impaction, IBS, rectal prolapse, diverticulosis/diverticulitis) clinical depression & anxiety, the use of certain types of medications and dietary supplements: (antacids that use aluminum as an active ingredient, Pepto-Bismol, Iron supplements, Narcotics, tranquillizers, sedatives, Nonsteroidal anti-inflammatory Ibuprofen, Naproxin Sodium).

Habits, Emotional & Physical Stressors:

• Suppressing the urge to defecate leads to the contraction of the external anal sphincter and associated muscles leads to the absence of a bowel movement.
• Inadequate nourishment lack of fiber rich foods or inadequate hydration leads to increased intestinal transit time which leads to increased reabsorption of fluid in the large intestines leads to constipation.
• Chronic anxiety and acute emotional stress leads to generalized muscle tension or in the acute situation a sympathetic nervous system response leads to a decrease in intestinal motility and motor activity.
• Lack of physical activity can cause constipation physical movement stimulates the the colon parastalsis.

Western Medical causes of constipation are numerous. Here is a list:

Anal fissures, anorectal abscess, cirrhosis, Crohn's disease, diabetic neuropathy, diverticulitis, hemorrhoids, hepatic porphyria, hypercalcemia (occurs with anorexia), hypothyroidism, intestinal obstruction, irritable bowel syndrome, mesenteric artery ischemia, multiple sclerosis, spinal cord injury, uncreative colitis, Tabes dorsalis, ulcerative proctitis.

Allopathic Medicine Approach: Bulking agents (bran, psyllium and methylcellulose) are the gentlest and safest they work slowly and do not have a cathartic action. Fiber supplements are not habit forming but getting into the habit of getting regular fiber is very necessary to help prevent constipation and may be used safely on a long-term basis. Osmotic Laxative and stool softeners (Polyethylene (GoLytely, or Colyte) Milk of Magnesia, Epsom salts, Sorbitol, docusate and mineral oil) soften the stool by increasing the intestinal fluids. However, these drugs must be used carefully, as they interfere with absorption of nutrients and other drugs. Lastly, cathartics or stimulant laxatives (senna Senakot, Ducolax, X-Prep. Exlax, cascara, and bisacodyl) are used for severe cases of constipation by increasing intestinal peristalsis and intestinal fluids. However, these drugs should only be used on a short-term basis, as prolonged use will cause a serious fluid and electrolyte imbalance and a "lazy bowel" syndrome that can lead to a dependence on laxatives just to have a bowel movement.

Traditional Chinese/Oriental Medicine Approach: Use of acupuncture and herbs is effective to treat various gastrointestinal disorders, including but not limited to irritable bowel syndrome, diverticulitis, mucous colitis, nervous bowel, irritable colon, and spastic colon. Not only do they control the symptoms, they often change the underlying constitution of the body to achieve long-term results. In fact, most patients remain symptom free for at least several months after the herbs are discontinued.

Constipation has been treated with great success using Acupuncture and Herbal or Homeopathic medicines. Those with mild to moderate constipation are usually treated with herbs that moisten the intestines and regulate bowel movement. Those with moderate to severe constipation are generally treated with herbs that purge the intestines and induce bowel movement. These formulas are used as needed then discontinued when desired effects are achieved. Herbal formulas that contain Da Huang or Fan Xie Ye (Rhubarb or Sennae) should be taken with meals, as it may irritate the stomach if taken on an empty stomach. Prolonged use of formula with Da Huang or Fan Xie Ye (Rhubarb or Sennae) is not recommended, as it may increase the risk of habitual constipation and fluid and electrolyte imbalance.

Acupuncture, pharmaceutical drugs, herbal medicine, dietary therapy, and changes in life style are effective in treating constipation. The modalities of medicines utilizing cathartic stimulant laxatives should be used sparingly, and only when needed because prolonged use may cause side effects. Once bowel movement is induced, herbal therapy may be initiated to change the fundamental constitution of the body in those with habitual constipation. Lastly, diet and lifestyle adjustments are also needed to ensure regular bowel movement.

Stool Talk:

In Chinese medicine the shape & consistency of the stool is diagnostic as to what system is out of balance. Thin pencil like stools or stools that are termed sticky are indicative of Spleen Qi Deficiency while stools that look like rabbit pellets is indicative of Liver Qi Stagnation.

Shape of the Stool: Dry stools shaped like sheep-dung are due to stagnation of heat or exhaustion of body fluid. A mucous stool is a sign of excessive damp caused by spleen deficiency. Loose bowels following dry stool are due to a dysfunction of the spleen and stomach, and an imbalance between dryness and dampness. Stools which are sometimes dry and sometimes loose are usually due to liver qi stagnation and spleen deficiency. Liquid stools with undigested food are due to the yang deficiency of the spleen and kidney. Diarrhea with yellow watery stool and burning of the anus is caused by damp heat in the stomach and intestines. Formed stools with undigested food and foul smell are the result of food accumulation.

The Color of the Stool: Tarry stools are the symptoms of hemorrhaging in the spleen and stomach. Bloody and pussy stools are a sign of dysentery.

The Smell of the Stool: Sour stinking stools are due to the accumulation of heat. A rotten egg stink is due to food accumulation.

The Sensation of Defecation: A burning sensation in the anus during defecation is due to pathogenic heat in the rectum. Mild prolapse of the anus during bowel movements is the outcome of chronic diarrhea due to the sinking of qi and spleen deficiency. Tenesmus is a sign of dysentery due to qi stagnation in the intestines. Fragmentary defection is a manifestation of the liver failing to cause a free condition for qi. Diarrhea occurring soon after abdominal pain, and pain relieved after bowel movements, are signs of food accumulation. Pain not relieved after bowel movements is a sign of spleen deficiency and liver preponderance resulting in "liver-wood subjugating the spleen-earth."

Reference:

• Please check out the National Digestive Disease Information Clearinghouse for more information

• Constipation fact sheet from National Digestive Diseases Information Clearinghouse

• Biomedicine A Textbook for Practitioners of Acupuncture & Oriental Medicine. Dr. Bruce H. Robinson, MD pp 326-328. Published by Blue Poppy Press ©2007

• The Practice of Chinese Medicine, Giovanni Maciocia pp 475-491 ©1994

• Clinical Manual of Oriental Medicine 2nd Edition, Dr. John Chen ©2006

• Professional guide to Signs & Symptoms, 2nd edition ©1997; Constipation pp 179 - 181

• Wyith Institute TCM Basics

• Managing Constipation in Adults: Patient Counseling and Triage  By John Horn, PharmD, FCCP

• Department of Pharmacy University of Washington Seattle, Washington

• Family Doctor Books Preview of Understanding your Bowels