HOME REMEDY FOR CONSTIPATION

Before discussing the home medicines available for the treatment of constipation the symptom undoubtedly needs to be defined. For it is an indisputable paradox that one man’s constipation can be another’s diarrhoea.

Some people consider that they are constipated if they do not have their bowels opened at least three times a day, producing a complete and satisfying result on each occasion. Others, more accustomed to gentler activity, will only complain if their once a week routine is disturbed. Those who would like to compare their own bowel habits with the statistical norm might be interested to know that over half of the general population have their bowels open only once a day – most commonly just after breakfast. The majority of the population perform between three times a day and three times a week but there are many whose habits fall outside these purely arbitrary borders.

Clearly, therefore, it is not possible to produce any precise definition of constipation. All that can be said is that if an individual’s bowels are appreciably more sluggish than is normal for him or for her then he or she is constipated!

Inevitably, it’s the type of food that is eaten that is most frequently responsible for the development of a constipated bowel. It is, after all, perfectly logical that what is eaten should have a vital influence over what is excreted. Too many cakes, chocolates, sweets and puddings will slow things up, as will too much strong tea, I’m afraid.

Similarly most bouts of constipation can be successfully reversed by a carefully organized dietary programme. It’s helpful to eat plenty of fresh fruit (oranges are particularly good), green vegetables and salads. And it’s useful to-drink plenty of fluids – particularly fruit juices. Wholemeal cereals may also help to keep things moving. It should already be clear that the vast majority of people who take laxatives do not need them. Many simply have bowels which need to be emptied less frequently than their owners consider seemly. And many more, who have acquired sluggish bowels, could solve their problems permanently,, easily and safely merely by changing their dietary intake.

The only genuine indication for the use of a laxative is a persistent change in the frequency with which the bowels are emptied which cannot be explained or rectified by a dietary change and which is not accompanied by any other unexplained symptom such as pain, intermittent diarrhoea or the passing of blood.

It is sometimes necessary to use laxatives after an operation, after childbirth or during some long-term illness which necessitates bedrest and makes normal activities impossible. It may be wise to use a laxative when the addition of fresh fruit, wholewheat cereals, bran and plenty of fluids has not solved a persistent and perhaps even uncomfortable problem. But it should never be forgotten that the unwise over-enthusiastic use of ‘opening’ medicines can cause bowel damage, sometimes with the result that laxatives become a long-term necessity.

Bulk-forming laxatives

Laxatives in this group work in a natural way to stimulate the bowel and I therefore recommend them. Foods such as wholemeal cereals and fruits give the muscles of the bowel something to get to grips with, thereby encouraging muscular activity and resultant bowel emptying. The bulk-forming laxatives work in the same way.

When available as granules or tablets they need to be taken with plenty of water; they swell inside the bowel and work within twelve to twenty-four hours. However, cereals such as All Bran, Weetabix and Shredded Wheat, muesli such as Alpen, and bran tablets work in precisely the same way and can be just as safe and effective.

Medicinal laxatives designed to work in this way usually contain bran, methylcellulose, psyllium, agar, sterculia or ispaghula husk. Scotts Husky Wholemeal and Bran Biscuits contain bran; Fjbogel, Isogel and Vi-Siblin are preparations of ispaghula husk; Blandlax contains a cellu- lose product (together with magnesium hydroxide); Celevac contains methylcellulose, as do Cellucon and Cologel; and Normacol contains sterculia. Psyllium is a major ingredient of Metamucil, and Innerfresh contains agar. These products are all safe and effective.

Lubricants

Lubricants, which assist the passage of faeces by easing the way and softening the stools are fattening since they consist of oils which may be digested. Lubricant laxatives are particularly useful for painful anorectal disorders since they produce a smooth and easily passed stool and patients with anal fissures or piles may find them particularly helpful. Some, however, may find the occasional leakage of fluid from the back passage annoying and embarrassing.

Liquid paraffin, which is available under several brand names, works well but it is messy and may interfere with the absorption of vitamins A, D and K – all of which are fat-soluble vitamins. Liquid paraffin is sold as Liquid Paraffin Emulsion BP and is also available in mixture with other substances. It is, for example, available together with magnesium hydroxide as Cremaffin and as Mil-Par.

Well-known products such as Dulcodos(which also contains bisacodyl) contain lubricant materials. Dioctyl sodium sulphosuccinate, which is present in both Dulcodos and Nor/nax, is also used to soften ear wax and as a spermicide.

Stimulants

Stimulants or irritants, which act directly on the bowel wall and urge it into activity, can be dangerous and should be used very carefully. They may cause griping pains.

The biggest-selling product in this group is undoubtedly Senokot. Senokot consists of senna, as do a number of other products, including Bidrolar, Boots Senna Laxative Tablets, Heatberclean, Heatberlax Constipation tablets, Pru-Sen and another big-selling product, California Sjrup of Figs. It is important to note that products such as Potter’s Lion Cleansing Herbs which are advertised as being purely ‘herbal’ and which are said to ‘contain no drugs whatsoever’ do, in fact, contain senna leaf. The advertising material for Potter’s Lion Cleansing Herbs claims that senna leaf is ‘probably the simplest and most harmless natural laxative’. Senna is, in fact, a fairly powerful stimulant purgative.

Cascara, rhubarb and aloes have similar action to products based on senna. Bisacodyl, a member of the same group as senna and cascara, is best known as Dulcolax or Diilcodos. They all work in about six to twelve hours and should be taken the night before for a result the morning after. Dulcolax Suppositories act in twenty to sixty minutes.

Castor oil, which is sold as Castor Oil BP, is a time-honoured stimulant laxative which works in two to six hours. It should be given on an empty stomach since it has to be digested before it can work. It acts on the small intestine and has a very dramatic effect in even modest doses. There is not much point in taking more than 20-30 ml. If given to a pregnant woman it may start off a premature labour so its use should obviously be avoided in these circumstances.

Another well-used stimulant is phenolphthalein for which, according to Drugs of Choice 1978-79, ‘there are no medical indications’. This extremely well-established substance is one of the most commonly used ingredients in laxatives sold for use at home. The following products include phenolphthalein: Agarol, Boldolaxhie, Bonornint Laxative Chewing Gum, Brooklax Chocolate Laxative, Carter’s Little Liver Pills, Delax, Ex-Lax Junior, Ex-Lax Pills, Ex-Lax Tablets, Faw-Lax Laxative Tablets, Feen-a-mint, Juno Junipah Tablets, Kest, Nylax , Peplax, Reg-u-letts and Sure Shield Laxatives.

Generally speaking, stimulant laxatives should be kept for emergencies and never used repeatedly. People whose bowels are ‘addicted’ to stimulants are the exception to this rule.

Salts

Salts keep water in the bowel. They tend to be rather drastic since they work very quickly and can produce watery diarrhoea within an hour or two, and they need to be used with extreme caution. The main danger of using salts as purgatives is that they can produce an imbalance of salts in the body. Compounds containing sodium sulphate (such as Juno Junipah Salts) are among the fastest acting. Magnesium hydroxide {Milk of Magnesia) is one of the mildest of the saline cathartics. It is also one of the top-selling laxative products as is

Andrews Liver Salt – a combination of citric acid, sodium bicarbonate, magnesium sulphate and sucrose. Other health salts such as Eno Fruit Salt, Epsom Salts {Magnesium Sulphate BP), and Glauber Salts {Sodium Sulphate BP) have a laxative action.

Lactulose

Available most commonly as Duphalac this remedy is mild, natural, slow and rather expensive. It consists of a sugar which cannot be used like other sugars in our bodies but which is passed through into the large bowel. There it provides small bacteria with a feast and is broken down into acids which stimulate bowel movement. The usual initial dose is 10-20 g and lactulose may take two to three days to work. In high dosage it may cause nausea, diarrhoea and wind.

Mixed blessings

There are a number of laxatives on sale which contain several different constituents. Among the most exotic mixtures are Beechams Pills which contain ginger, coriander, hard soap, aloes, rosemary oil, juniper oil, anise oil, capsicum oleoresin, ginger oleoresin and light magnesium carbonate; Bile Beans which contain cascara, jalap, peppermint oil and ginger, capsicum oleoresin, colocynth, aloes, cardamom fruit, ipomoea resin, sodium tauroglycocholate, powdered gentian and liquorice; Bo/do Tablets which contain cascara, fucus, uva ursi extract and boldo extract; Brandreth’s Pills which contain cascara, aloes, guaiacum resin, capsicum and hard soap; George’s Special Pills for Chronic Constipation which contain podophyllum resin, ginger, gambogex, jalap, colocynth, aloes, curd soap and caraway oil and Pjlatum Regulators which consist of a mixture of senna, cascara, aloin, colocynth, ginger oleoresin, peppermint oil and hard soap.

Many of these ‘mixed blessings’ contain small amounts of very powerful laxatives. Jalap and podophyllum, for example, are drastic purgatives which may cause severe irritation to the bowel if used in large quantities. These substances have been largely replaced by other laxatives on their own but still appear in mixtures.

Traditional Syrup of Figs consists of figs, rhubarb, senna, cascara and sucrose.

Suppositories

There is a great deal of support behind the use of suppositories in France and other European countries across the Channel. In Britain suppositories are still considered rather nasty and distasteful by most people. Some even complain that it is impossible to expect a medicine to work if you push it into your anus. Laxatives given by suppository are, however, effective and quick to work. Glycerin suppositories which act simply by dissolving and easing the way for hard stools are gentlest. Dttlcolax is also available in this form.

Enemas

Enemas can be allowed to run into the bowel by gravity, or they can be pumped into place. They may be given entirely for their laxative effect or for other medicinal purposes. Many varieties of enema are available. These remedies are, however, best prescribed and used by experts.

Conclusion

If you take regular doses of laxatives you’re likely to suffer from colic, wind and watery diarrhoea. As your bowels become insensitive to normal demands and require stimulating more and more often, so laxatives may induce chronic constipation. They should, therefore, be used with great care.

If you feel that you are suffering from constipation try adjusting your diet before resorting to medicinal compounds. If that fails then I suggest a bulk-forming laxative as the most natural way to stimulate bowel activity. If you have some other favourite use that.

And if then, after five days, your constipation has not resolved visit your doctor for advice. Do not persist for more than five days with any laxative medicine.

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