Constipation
Research
Alternative
& Complementary Therapies
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Colonic Hydrotherapy
& Constipation
The Health Education Council, National Advisory Committee on Nutrition
Education (September 1983) reported that 85% of the population have slow bowel movements
with as many as 40% of the population in the United Kingdom being regularly constipated.
When the colon does not function properly, other eliminating organs (e.g., skin, kidneys,
lungs and lymph) become overloaded and subsequently they too become affected.
The Colonic International Assocation advises that
constipation is "helped by the resultant detoxifying effect of colonic
hydrotherapy" (1). However, it is doubtful whether colonic hydrotherapy will be
effective in the long term if used alone, without consideration to diet and other
causative factors. Even the Colonic International Association itself recommends that
Colonic Hydrotherapy "is best used as a complementary technique to other therapies.
By improving elimination, response to dietary, homœopathic, herbal, manipulative and
other therapies is markedly improved."
That said, colonic hydrotherapy can help relieve long-term
blockages and stimulate the colon to start working more efficiently.
(1) Health Improvement through Colonic Hydrotherapy -
Colonic International Assocation
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Hypnotherapy
& Constipation
It is interesting to note that more and more medical studies are
confirming that stress and psychological disturbances are often related to chronic
constipation. Many psychologists concur with the chinese system of medicine which
associates 'inability to let go of past hurts or memories, or difficulties in coming to
terms with grief and loss' as a common factor in patients with chronic constipation.
In fact, in one study it was said to be "a powerful
determinant of outcome, shaping (the patients') response to treatment.(1) Another study
revealed that "psychological treatment is feasible and effective in two thirds of
those patients who do not respond to standard medical treatment." (2)
All the evidence suggests that psychological therapies are
superior to medical management alone.(3) physical diseases including cancer, heart disease
and even skin complaints have been helped with Hypnotherapy and Psychotherapy. The power
of suggestion and mental imagery is a tool all too often overlooked but which can be of
immense help to constipation sufferers. Remember also that constipation is a stress
related condition and Hypnotherapy and Psychotherapy are both excellent aids to help
control emotional stress.
A controlled study in Europe involving 266 patients found
that psychotherapy can improve the therapeutic possibilities of drugs, diet and surgery.
Psychotherapy combined with relaxation and removal of stress were considered along with
the personality of the patient before the outbreak of chronic digestive disorders . It was
suggested that unknown emotional conflicts such as depression and mental lability may
influence the course of these diseases.
(1) Irritable bowel syndrome: assessment of psychological
disturbance and its influence on the response to fibre supplementation. Fowlie S; Eastwood
MA; Prescott R Gastrointestinal Unit, Western General Hospital, Edinburgh, U.K. J
Psychosom Res (ENGLAND) Feb 1992, 36 (2) p175-80
(2) A controlled trial of psychological treatment for the irritable bowel syndrome [see
comments] Guthrie E; Creed F; Dawson D; Tomenson B Department of Psychiatry, Manchester
Royal Infirmary, England. Gastroenterology (UNITED STATES) Feb 1991, 100 (2) p450-7
(3) Psychologic considerations in the irritable bowel syndrome.Whitehead WE; Crowell MD
Johns Hopkins University School of Medicine, Baltimore, Maryland. Gastroenterol Clin North
Am (UNITED STATES) Jun 1991, 20 (2) p249-67,
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Acupuncture
& Constipation
Acupuncture has traditionally been successfully employed in China to treat most
illnesses. There is little doubt that acupuncture is an excellent therapy for people
suffering with this condition; in 1979 the World Health organisation listed 40 major
diseases that could find relief by acupuncture treatment and diseases of the intestinal
tract were included in that number. (1)
This is not surprising since acupuncture works through the
nervous system and energy channels in the body and has also been shown to cause the brain
to release endorphines and encephalins (natural pain killers), boost the immune system and
calm the nervous system. It has also been established that all psycho-physiological health
problems (of which constipation is an associated symptom) are particularly suitable for
acupuncture treatment (2)
One study conducted at the China Academy of Traditional
Medicine in Beijing revealed that acupuncture was "very effective in the treatment of
diseases of the digestive system" with most patients benefitting from the treatment.
(3)
(1) Dr S Fulder- The Handbook of Complemnetary Medicine
(Coronet books)
(2)Mann F The Treatment of disease by acupuncture. Part 1 & 2 (Heinnemann Medical
Books)
(3)Clinical application of acupoint tianshu. Cui S Institute of Acupuncture and
Moxibustion, China Academy of Traditional Chinese Medicine, Beijing. J Tradit Chin Med
(CHINA) Mar 1992, 12 (1) p52-4
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Psyllium
& Constipation
The seeds and husks of the plant psyllium (sometimes referred
to as ispaghula) have been traditionally used by herbalists and naturopaths to help people
suffering from constipation and related intestinal disorders. When moistened, the husks
swell up to form a soft viscous mass, which helps stimulate the peristaltic movement of
the intestinal wall. However, a recent study in the Czech Republic has demonstrated that
psyllium, not only, can significantly help patients suffering from constipation, but that
it has the added benefits of helping to reduce excess body weight in cases of obesity as
well as reducing high serum cholesterol levels.
In the study, a preparation made from Plantago psyllium was administered to 63 patients
suffering from chronic functional constipation for a period of 20 days. The tolerance of
the preparation was satisfactory in 55 of the patients (87%), and 49 (79 %) reported
problem-free defecation with normalisation of stools. However, the researchers also noted
a statistically significant decline in the patients’ serum cholesterol levels and in
14 patients (25 %) a weight loss of more than 1 kg was observed. The re-searchers
concluded that psyllium may be considered suitable for the treatment and prevention of
chronic functional constipation and as an adjuvant in the treatment of
hyperlipoproteinaemia type II, in particular when associated with obesity.
Although this was not a controlled study, it does support similar findings of previous
studies in which researchers found that 3.5 grams of psyllium taken over a course of eight
weeks reduced total cholesterol levels in twenty-six men, by an average of 15 per cent and
LDL by 20 per cent. In a trial involving twelve elderly patients, serum cholesterol levels
were reduced by twenty per cent after a period of 4 months. However, a more comprehensive,
controlled study needs to be conducted before firm conclusions can be drawn as to the
viability of using psyllium to treat hypercholesterolemia.
It should also be noted that some adverse reactions have been reported following
psyllium usage including allergic reaction (anaphylaxis) and hypersensitivity leading to
anaphylactic shock.
Weis M. Plantago psyllium — natural plant laxative and its effect on cholesterol
and triacylglycerol levels. Ceska a Slovenska Gastroenterologie (Czech Republic), 1996,
50/2(45-47)
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Biofeedback
& Constipation
It is well known that
abnormal bowel movements can be affected by the motions. Emotional stress is
considered to be one of the main underlying problems in constipation, and for
this reason, researchers in the Netherlands decided to investigate whether
biofeedback training may be a useful treatment for constipation.
Defaecation dynamics and
clinical out-comes in chronically constipated children were observed in a
randomised study comparing conventional treatment with conventional treatment
and biofeedback training.
Patients, 5 to 16 years old,
were referred to the Academic Medical Center in Amsterdam by general
practitioners, school doctors, paediatricians, and psychiatrists. The children
had to fulfil at least two of four criteria for paediatric constipation and
were included only if they had received medical treatment for at least one
month prior to the study. Patients had a medical history, abdominal and rectal
examination, and anorectal manometry at the start and end of the 6-week
intervention period.
The children in the
conventional group received laxative treatment with additional dietary advice,
toilet training, and maintenance of a diary of bowel habits. The biofeedback
group received the same conventional treatment but also received five
biofeedback training sessions. During the first 3 weeks, patients visited the
outpatient clinic weekly; two subsequent visits were twice monthly.
94 patients were randomly
assigned to conventional treatment (CT) and 98 to conventional treatment with
additional biofeedback training (CT+BF). Normal defaecation dynamics increased
in the CT group from 41% to 52% whereas the increase in the CT+BF group was
from 38% to 86%. At 6 weeks, more patients in the CT + BF group showed normal
defaecation dynamics, compared to the CT group.
Vander Plas RN.; Benninga MA.;
Butler HA.; Bnssuvt PM.; Akkermands L.M.A.; Redekop W.K.; Taminiau J.A.
Biofeedback training in treatment of childhood constipation: A randomised
controlled study Lancet (United Kingdom), 1996, 348/9030 (776-780)
Biofeedback for outlet obstruction constipation
has a varying success rate. The aim of this study was to identify which
patients are likely to respond to biofeedback.
Thirty patients with severe outlet obstruction
constipation were treated by a specialist nurse using three or four
sessions of visual and auditory feedback of anal sphincter pressures. All
patients were assessed by evacuating proctography, whole-gut transit
studies and anorectal physiology before treatment.
Two patients did not complete the course of
biofeedback. Nine patients improved. Before treatment these patients had
predominantly normal anorectal physiology and were all able to open the
anorectal angle at evacuating proctography. Nineteen patients did not
improve, of whom only three had no measured abnormality other than
inability to empty the rectum. Ten of these patients had abnormal
anorectal physiology which may have been due to previous vaginal delivery.
The report concluded that Biofeedback for outlet
obstruction constipation is more likely to be successful in patients
without evidence of severe pelvic floor damage.
Br J
Surg 1999 Mar;86(3):355-9 McKee RF, McEnroe L, Anderson JH, Finlay IG
Department of Coloproctology, Royal Infirmary, Glasgow, UK.
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Reflexology
& Constipation & Constipation
Reflexology has also been shown to be an effective alternative treatment for
chronic constipation. In a study involving 20 women aged between 30 and 60 years
of age, who had suffered with constipation for an average of 24.6 years, 15
reflexology treatments produced astounding results. Prior to the study, the
women had a bowel movement an average of only once every 4.1 days but after the
course of treatment this was increased to once every 1.8 days. At the end of the
study, 50% of the women obtained normal stool consistency whereas none had
experienced this before the treatments, 85% reported a positive change in their
digestion, and 55% were able to reduce their use of laxatives. Furthermore, over
95% of the women admitted to having other health problems before the study and
80% reported an improvement in those conditions after the reflexology
treatments.
"Sygeplejerksen" (Danish Journal of Nursing) 24th June 1992
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Ayurvedic
& Constipation
Constipation is a frequent cause of distress in
advanced cancer. A palliative care unit in Kerala, a southern state of
India, conducted a controlled trial comparing a liquid Ayurvedic (herbal)
preparation (Misrakasneham) with a conventional laxative tablet (Sofsena) in
the management of opioid-induced constipation in patients with advanced
cancer. Although there was no statistically significant difference in the
apparent degree of laxative action between the two, the results indicate
that the small volume of the drug required for effective laxative action,
the tolerable taste, the once-daily dose, the acceptable side effect
profile, and the low cost make Misrakasneham a good choice for prophylaxis
in opioid-induced constipation. There is a need for further studies of
Ayurvedic medicines in palliative care.
Pain Symptom Manage 1998
Oct;16(4):240-4 Ramesh PR, Kumar KS, Rajagopal MR, Balachandran P, Warrier
PK Pain and Palliative Care Clinic, Calicut Medical College, India.
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