The herb senna has been used as a laxative or anti-constipation agent for hundreds and perhaps thousands of years. It is found in temperate zones, a...
The herb senna has been used as a laxative or anti-constipation agent for hundreds and perhaps thousands of years. It is found in temperate zones, and written records in the Middle East date back hundreds of years detailing its use in the form of a brewed tea for fighting stomach troubles. Senna is used even now although it comes in more diverse forms such as pills or tablets. The tea form is still available of course.
One question on everyone’s minds is whether senna is a worthy competitor to the other constipation remedies. However, senna does not have the privilege to be an interesting object of study for drug companies because it cannot be protected by a patient as it is a natural, noninvented substance. So the question as to whether it shows activity or not is left up to scientific studies as well as anecdotal evidence.
The verdict is that anecdotes as well as small scale science studies vindicate senna’s role as a natural laxative for constipation remedies. The key to senna’s efficacy lies in the preponderance of the sennoside compounds, which are a group of related chemicals that induce bowel movements. Despite senna’s success as a natural agent, some people may feel that they want more opinions in combating idiopathic chronic constipation. Are other treatments available.
Fortunately for those who actively seek remedies, several non-prescription strategies and a number of medicated methods are available. The standard line of therapy suggested by physicians without other information is high fiber therapy. Such therapy involves targeting every day foods with high fiber or consuming nutritional supplements containing fiber.
Some might judge the effort to eat fiber-rich foods to be excessive. A widely taken approach is to try out fiber supplements. Extracted from specialized plants like the plantago, these nutritional agents are offered in powdered form and are put into with liquid water to form a quaffable solution. As is common with diet treatments, it may require about half a month until the sufferer and his or her physician are able to assess success.
A number of laxatives are used by sufferers with chronic constipation. Prime examples of classes of these compounds are the osmotic laxatives that effect alterations in water resorption, and stimulant laxatives that appear to impact intestinal smooth muscle. Osmotic laxatives exert the increased water content in the gut which from medical reports apparently can assist in natural intestinal contractions.
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There is a reason why constipation remedies are amongst the most popular over-the-counter (OTC) medications. It has been estimated that approximately 10-30% of the U.S. population suffers from this ailment, and most people do not see a physician. Those who do receive some help, but given that there is disagreement even among physicians as to what constitutes constipation, the efficacy of medical advice varies. Even effectiveness of medication is nonuniform from patient to patient.
A non-profit organization known as Rome published a set of criteria pertaining to chronic constipation. Although not uniformly followed, many consider this set of criteria to be the gold standard in diagnosing what is commonly known as idiopathic constipation (without known cause). Physicians and patients would benefit from looking up the guidelines and explanations in the Rome publications. They help dispel some misunderstandings about what it means to be constipated.
Even if a patient is diagnosed properly, there are no standard constipation treatments. This is because most constipation is of unknown origin. Diseases without known origin are known as “idiopathic”, and can be treated only in a general way which may not target the underlying problem. People with idiopathic constipation constitute about 70% of all patients.
For those selecting the best treatment method, a number of non-prescription paths and a number of pharmaceutical strategies are available. Amongst the non-pharmaceutical methods, foremost is increased fiber therapy. Such therapy involves eating a lot of typical foods that are fiber-rich or taking in nutritional supplements containing fiber.
Some may reach the conclusion that the time required to attain a sufficient fiber diet becomes overwhelming. One solution to this problem is to take a look at psyllium nutritional supplements. Psyllium comes in the form of powders that are mixed with water to make convenient drinks. Primary care givers suggest that the timing given to this sort of intense fiber therapy usually requires around ten to fourteen days for its complete effectiveness to kick in.
There are many laxatives in use by patients with constipation. A pair of such medications are stimulating and osmotic agents. Osmotic agents absorb water out of the internal tissue into the intestinal lumen which promotes acceleration of transit of contents. Stimulating laxatives make the intestine increase its activity.
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Chronic constipation is an affliction that is believed to affect around 20% of the total population here in the U.S. Most of the sufferers experience a particular form known as idiopathic constipation. The fancy term means nothing other than “that without known cause”. Our lack of knowledge is not coincidental, for we understand little about the biological, hereditary and diet-related causes of constipation.
Our ignorance is one reason why there are so many constipation treatments. Some of these are pharmacological (e.g. bulk and osmotic laxatives), some are “natural”, and others are not reputable at all. Associated with these treatments are a host of myths associated with constipation. These myths usually try to explain constipation in terms of our day-to-day activities and habits.
For example, one particular myth is that walking can help constipation because it stimulates the muscles that push food along the gastrointestinal tract. The constipated, slow movement is due to lack of physical activity. However a controlled study by some academics at a UC Irvine laboratory showed that there was no difference in constipation between a group that exercised an hour a day for 6 weeks versus a group that did not. Most people exercise less than an hour a day.
A second myth is that adding more fiber to the diet can cure constipation. The myth sounds quite reasonable as fiber is one of the major nutrients promoted by the FDA. Unfortunately, a review by researchers Fox-Orenstein and co-workers demonstrated that fiber therapy worked in about a third of all people. While normal amounts of fiber are necessary, for the large part constipation sufferers already get that amount and have constipation for other reasons.
There is also a myth that drinking more water helps “bulk” up stool which reduces constipation. But this is also revealed to be a myth by a recent physician review (Muller-Lissner et al) that showed numerous studies that drinking the 8 or more recommended glasses of water each day had little to no impact on constipation. These physicians did point out that truly dehydrated people may suffer from constipation, but for most of us water is not the reason for our elimination problems.
Finally, there are many advertisements that advocate colon cleansing as a way to holistically and naturally remove toxins from the body that can cause constipation. There is virtually no evidence for this claim. In fact, the American Cancer Society as well as several other medical associations have spoken out explicitly against claims made by many manufacturers of the efficacy of colon cleansing.
We are lucky that many of the myths are largely harmless. The first three considered here, walking and running, ingesting fiber and taking in more water are not harmful to the body in moderation.
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People often wonder about natural versus non-natural medical treatments. Non-natural treatments are typically formulated by a pharmaceutical or biotechnology company and have passed through stringent FDA trials to establish their efficacy. Some medications that go through this process are universally effective, whereas others only work for a certain segment of the population. Therefore the question for a patient is whether he or she fits into the responsive segment of the population.
For natural medications things become even more difficult to understand. First of all, most natural treatments have not gone through clinical trials. This is because it is expensive to design, set up and run a trial, and there are few companies willing to spend money on something that is not patentable. Natural products are not “invented” in the normal sense, and therefore do not enjoy the lucrative protective of a patent-based monopoly.
The verdict for natural medications rests upon two pieces of knowledge: one must establish whether the natural agent is broadly useful for any ailment in question, and also whether it is useful for a particular patient. Fortunately there are real examples of natural agents that have been shown to confer some benefit through years of research. These include vitamin D for certain kinds of cancer, green tea and omega 3 fatty acids for controlling cholesterol. On the other hand, there are agents that have been shown to have little benefit despite widespread public recognition. These include goji berries and acai berries, as well as copper and vitamin A.
So it is clear that there really is a very broad spectrum useful and useless drugs, with no clear pattern that one can tell by their popularity (all natural treatments mentioned above are wildly popular) nor by their accepted status as a biological compound (e.g. vitamin D is useful for ailments but A is not). In the following we discuss a few natural treatments that have been shown to be at least somewhat useful for people suffering from constipation.
Amongst the non-medication remedies, the first is increased fiber therapy. A plausible path to put into action this line of therapy is to emphasize grains and fruits with the most fiber content. Prunes are a great choice, carrying not only fiber but also sorbitol which has beneficial effects.
Some might judge the focus to find fiber-rich foods to be draining. A reasonable answer to this issue is to take a look at psyllium nutritional supplements. These are pulverized grain that are liquified with water to make convenient drinks. As is true with supplement-based treatments, it might require approximately half a month until the constipated subject and his primary care doctor can judge efficacy.
There are many laxatives in use by people with constipation. The best specimens of these compounds are the osmotic laxatives which exert their effects through modulation in water absorption, and stimulant laxatives that seem to impact intestinal smooth muscle. Osmotic laxatives have the effect of increasing water retention in the gastrointestinal tract which from small studies reports apparently is able to assist in movement of intestinal matter.
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The label most associated with constipation is the word ‘idiopathic’, which simply means ‘that which does not have a known cause’. Patients who suffer from constipation do have a number of options if they wish to diagnose constipation. However, many of these methods are narrow in scope and cannot diagnose all causes of constipation generally.
For example, the simplest way to diagnose constipation is via something called high fiber treatment. A positive response to treatment both suggests the underlying cause (insufficient dietary fiber) and the cure at the same time. People who are luckily enough to respond to high fiber therapy can modulate the diet with their physicians to find an optimal balance.
However, it is far more likely that the patient does not respond to this kind of therapy which has been shown to work for only about two thirds of all people with constipation. The next diagnostic possibilities are the tools of the radiologists which can image the colon and identify structural anomalies. Ultrasounds, or sonograms, can take live low-resolution images of the muscles of lower rectum working to move contents out. Similarly, x-ray proctograms use x-rays to take higher resolution images that show irregularities that cause problems such as pelvic floor dyssynergia.
The medical technology for uncovering other causes of constipation is still new. It is likely that advances in genome sequencing, nanotechnology, computer-aided drug design will continue to push forward the frontiers of diagnosing and treating constipation. Until then, there are a number of natural treatments that people try, hopefully settling on one that works. The following are some examples.
For sufferers interested in natural relief, there are a few choices. One of these which even doctors may suggest is the increase of dietary fiber. This can be accomplished through consuming fiber-rich foods. One kind is the prune, which is a plum with moisture removed.
Some may discover that the effort to eat good fiber foods to be draining. A reasonable answer to this problem is to consider supplements with psyllium. Psyllium comes in the form of finely crushed seeds that are mixed with water to make on-the-go drinks. Primary care givers propose that the time given to this sort of high fiber treatment usually demands around half a month for its full efficacy to kick in.
Various kinds of laxatives are available to people with issues of constipation. Among the most accepted are the broadly understood osmotic laxatives and the stimulant laxatives. They derive their names from what seems to be their mechanism of action. A popular laxative labeled Macrogol is a class of osmotic agent, as well as magnesium-based treatments like magnesium citrate or milk of magnesia.
Senna tea is a final class of constipation treatments that has become quite popular in the Western world, although its first use has been documented for hundreds of years.
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(Foreword: The following information is provided as is, and should not be construed as an endorsement of any kind of the items mentioned. Furthermore, all readers should ask for the advice of a doctor when making choices concerning health. The writer is not a doctor and is providing the article from research obtained from third party sources.)
A very recent study done by the drug company Boehringer Ingelheim has established the fraction of people worldwide affected by constipation to be 12%. A total of 13,000 people were surveyed. Other studies quote lower figures (as low as 2%!) but nevertheless even at this low figure, most of the medical establishment would agree that constipation is a widespread affliction.
One of the problems associated with statistical surveying of constipation is that it’s a poorly defined condition. This translates into an impact on diagnosis and treatment. For example, one physician might believe that having a bowel movement every three days is ok, but another physician would be alarmed at the low frequency. The source of the inconsistent opinions is that bowel movement frequency is itself highly variable from person to person. This difficulty in definition is compounded by differences in patient-reported symptoms such as difficulty or pain in passing stool, or excessive time spend on the toilet.
Diagnosis of disease is followed by the monumental goal of pinning down the primary cause in each patient. Diagnosis is easy if there are many other tell-tale signs, such as those found in patients with irritable bowel syndrome. In another subgroup, patients may suffer from nerve and muscle damage that are the culprits of constipation. But for a very large group, physicians will be unable to find a cause. In this large group, the condition is simply called “idiopathic constipation”.
Often first line therapy for people diagnosed with chronic idiopathic constipation is introduction of high fiber into diet. Recent studies show that fiber and fluids are effective in only a small fraction of patients. Because of the ease and accessibility of high fiber treatment, it is quite popular with physicians and patients. Response is expected within two weeks, at which time both parties may decide whether the diagnosis and therapy were successful.
Other types of natural treatments include both lubricant laxatives and herbal supplements such as senna. Herbal and natural supplements are not always safe. The FDA has banned some natural supplements, namely aloe vera and cascara recently, for failure on the part of manufacturers to provide sufficient safety data. However, some other over-the-counter treatments remain available.
One other option is therapy via one of the many prescription drugs for constipation. A number of these overlap with over-the-counter laxatives. A very small handful are advanced, “targeted” drugs which affect the digestive tract in specific ways. In recent times, unique approaches such as electrode-assisted biofeedback have been studied as possible medical therapies. The field of constipation remedies seems poised for great changes in the coming decade.
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