Constipation can be either a result of infrequent bowel movements, difficult stool passage, or a combination of the two. In either case, the result is unsatisfactory defecation.
The causes of constipation are many and varied, potentially stemming from decreased intestinal motility due to the use of medications, low fiber diet, lack of exercise or stress.
It is important to realize that “normal” bowel movements can be different, for different people. While some people defecate daily, others may go three times a day, or three times a week.
It is not uncommon for healthy people to have nearly runny stools, while others have firm and well-formed stools.
Lastly, it is critical to note that while constipation happens to nearly everyone at some time or another; it could be a sign of illness, such as irritable bowel syndrome.
As a result, prolonged or unexplained constipation should be discussed with a qualified healthcare practitioner.
The mainstays of herbal therapy involve the use of preparations capitalizing on bulking and laxative activity.
As a result, herbal preparations that are high in fiber may be expected to provide fecal bulk, while those with gastrointestinal stimulant properties may serve a laxative role.
Both approaches have long histories of use in traditional medicine. Treatment with the correct herbal preparation can be helpful in achieving either of these goals.
While a variety of herbal preparations can be useful in the treatment of constipation, it is advisable to use them under the supervision of a qualified healthcare practitioner.
Herbs have the potential to interact with other herbs, medications or supplements, so oversight is suggested.
Herbs with the Most Promising Supportive Information for Treating Constipation
Herbal products that could be useful in the treatment of constipation generally fall into two categories of laxatives: bulk-forming laxatives and stimulant laxatives.
Bulk Forming Herb
Flaxseed
Flaxseed (Linum usitatissimum) is the seed product of the Linum usitatissimum plant.
While the oil extracted from the seed has several medicinal uses, the actual seed can be used to treat many disorders of the gastrointestinal tract, to include constipation. Flaxseed is an excellent source of dietary fiber, as well as omega-3 fatty acids.
The fiber in flaxseed, which is critical to its effect in treating constipation, is mainly found in the seed coat. As an additional benefit, flaxseed may be useful in lowering cholesterol and blood pressure.
A 50-gram daily dose of crushed or ground flaxseed should be an effective dose in the treatment of constipation, administered, as needed.
J. Xu, Ph.D., et al., of the Department of Product Processing and Nutriology, Oil Crops Research Institute, Chinese Academy of Agricultural Science, report that flaxseed has been used for centuries as a traditional Chinese medicine to treat constipation.
To validate this historical use, they set out to characterize the role of flaxseed meal in facilitating fecal output in constipated and normal, control mice. After supplementing the rodent’s food for 14 days with varying amounts of flaxseed, constipation was chemically induced.
The motility of the intestines, the frequency and volume defecation were then assessed. Results obtained demonstrated that all doses of flaxseed significantly increased the intestinal transit rates, shortened the time to defecation, and increased the stool frequency and volume.
The investigators concluded that flaxseed might be a useful laxative to facilitate fecal output under both normal and constipated conditions.
A. Tarpila, Ph.D. and S. Kivinen, Ph.D., from the Department of Biomedical Sciences, University of Tampere, in Finland, conducted a clinical trial with 55 irritable bowel syndrome patients with constipation.
Subjects received either psyllium or ground flaxseed every day for three months. Their results showed that the patients assigned to receive flaxseed experienced significantly fewer issues with constipation, bloating and abdominal pain than those who received psyllium.
Further, in the three months following completion of the formal study, those receiving flaxseed had even further improvement. The researchers summarized that flaxseed was a useful preparation for relieving constipation.
Although flaxseed is generally considered safe for oral ingestion, it might trigger some side effects in some people, like affecting triglyceride levels, lower blood sugar levels, and allergic reactions.
Because insufficient information exists on the use of flaxseed in pregnant or breastfeeding women, it should not be used in women who are pregnant, may become pregnant or are breastfeeding.
Psyllium
Psyllium (Plantago ovata) is a fiber derived from the seeds of a plant called desert Indianwheat or blond psyllium that is most commonly found in India. The fiber can also be obtained from the seeds and seed husks of black psyllium (Plantago psyllium, Plantago afra) and French or sand psyllium (Plantago arenaria).
On each plant, up to 15,000 seeds can be found. Covering these seeds is a husk, from which psyllium is derived.
When psyllium comes into contact with water, it immediately swells and turns into a mass that assists in the transit of waste through the intestinal tract.
The soluble fiber contained in psyllium has some potential uses, with the most common role as a bulk-forming laxative. It is also used to lower cholesterol and treat intestinal problems.
Psyllium’s bulk-forming activity increases the volume of stool, facilitating its transport through the bowel. The larger stools press against the walls of the large intestine, triggering the contractions that are felt when defecation is at hand.
J.W. McRorie, MD et al., of the Procter & Gamble Company, Cincinnati, Ohio, and the Oklahoma Foundation for Digestive Research, conducted a clinical trial that enrolled 170 constipated patients.
Subjects treated with either 5 grams of psyllium twice daily, for two weeks, or 100 mg of docusate sodium (a pharmaceutical laxative), twice daily for two weeks. Patient stools were collected and assessed.
Compared to baseline, subjects who took psyllium had increased water content and total stool output relative to those that took docusate sodium.
Further, bowel movement frequency was higher in the psyllium-treated patients. The authors concluded that psyllium was superior to docusate sodium and has greater overall laxative efficacy in subjects with chronic constipation.
Most sources suggest that a teaspoon or two of psyllium, 2-3 times daily, taken with plenty of liquid (at least 240 mL, per dose) is usually an effective treatment for constipation.
It should not be given to children less than two years of age. The biggest potential safety issue associated with the use of psyllium is the case where it is not taken with an adequate amount of liquid. This could lead to blockages further down the digestive tract as the plant material swells.
Other Bulk-Forming Medicinal Herbs for Constipation
- Fenugreek – (Trigonella foenum-graecum)
- Barley – (Hordeum vulgare)
Stimulant Laxatives
Cascara Sagrada
H. Sorter, MD and colleagues of the Department of Gastrointestinal Surgery at Michael Reese Hospital, in Chicago, reported in 1949 that Indians in California used the bark of the Cascara tree (Rhamnus purshiana) to treat cases of constipation.
As a result of this traditional use, preparations made from cascara were widely available and considered to be, at the time, one of the most effective laxatives available.
In 2002, the U.S. Food and Drug Administration determined that the herb was too potent to be safely used and banned it from laxative preparations.
With this in mind, the decision to use Cascara Sagrada to treat constipation should be made in consultation with a health care provider.
Since it is not commercially available in all geographic regions, to use Cascara segrada, one can obtain dried, year old bark (critical that the material is aged at least a year to allow toxic substances to be neutralized) and prepare a decoction by boiling a teaspoon of well ground bark in 3 cups of water for 30 minutes. Strain and cool to room temperature before drinking 1-2 cups per day.
Cascara Sagrada should not be used by individuals with gastrointestinal problems, pregnant or nursing women. Cascara Sagrada has also been known to occasionally cause allergic reactions.
Senna
Senna (Cassia acutifolia, Cassia angustifolia, Cassia senna, Cassia alata ) is a large and widespread family of plants containing many distinct species. Senna grows across a diverse range of habitats and appears as herbs, shrubs or trees.
All told, there are over 350 species of Senna, with nearly 80% found on the North American continent. While no Senna species are known to grow in Europe, several species have long been used there for their medicinal qualities, including its potential to treat constipation.
V. Thamlikitkul, MD and colleagues at the Faculty of Medicine, Siriraj Hospital, Mahidol University, in Bangkok, Thailand, noted that Cassia alata Linn has good utility as a medicinal plant, with claimed efficacy as a laxative.
They concluded that the plant contains a type of phytochemicals called anthraquinones that are active in causing a laxative effect. To try to confirm this activity, they conducted a clinical trial that enrolled 80 patients who had been constipated for at least 72 hours.
A total of 24 subjects received Cassia alata Linn, 28 received an alternative treatment, and 28 patients received placebo. The treatments all formulated as a 120 mL liquid, infused with the respective ingredients, were administered at bedtime.
Patients were evaluated during the ensuing 24 hour period. Success was determined by whether or not the patient defecated during this time interval. In the placebo group, 18% of patients had a bowel movement, while 83% of those receiving Cassia alata Linn passed stool.
Minimal side effects such as nausea, upset stomach abdominal pain, and diarrhea were reported in 25% of patients. The authors conclude that the result noted was clinically relevant.
Senna can be used in various populations for the treatment of constipation. For adults, a typical dose is about 50 mg of standardized supplement or ¼ teaspoon of liquid leaf extract once or twice daily.
Alternatively, 3-6 pods steeped in a cup of warm water can be administered every 6-12 hours.
Senna is relatively safe for most people when used for short-term treatment of constipation. Nonetheless, it can cause stomach discomfort, cramps, and diarrhea.
Senna should not be used for more than two weeks at a time. Longer term use may cause dependence, can change the proper balance of some chemicals in the blood, and harm the heart, liver or muscles.
Aloe Vera
The aloe plant found in most subtropical and tropical locations has been traditionally used for thousands of years to heal a diverse collection of conditions, to include constipation.
Throughout the 18th and 19th centuries, it was one of the most commonly prescribed herbs and is still widely used today.
Aloe juice is a bitter, yellow liquid obtained from the skin of the Aloe leaf. This liquid acts as a powerful and effective laxative.
OA Wintola, Ph.D., et al., of the Department of Botany, University of Fort Hare, in South Africa reported that while aloe has been used traditionally in Africa as a laxative, there was no scientific data to support this usage. As a result, they conducted a study in constipated rats in an attempt to provide some rationale for this historical practice.
Test animals were made to be constipated with anti-diarrheal drugs, while control rats received saline. The rats were then treated with various amounts of aloe leaf extract for seven days. Their experiment showed that the extract improved intestinal motility increased fecal volume and normalized the body weight of the constipated animals.
The investigators concluded that the extract treatment acted favorably, with results similar to those obtained with a commercial laxative. They found that their results lent some degree of support to the folkloric use of aloe as a laxative.
Nonetheless, when taken by mouth, aloe can cause painful cramping, and according to the University of Maryland Medical Center, Division of Complementary Medicine is not safe to be used in this manner.
Further to that, a report from the US National Institutes of Health stated that a two-year study of the chronic oral use of aloe vera whole leaf extract showed clear evidence of cancer-causing attributes in rats, in the form of tumors of the large intestine.
Although additional work needs to be conducted to fully understand the liability in humans, primarily when used over shorter periods of time, they were unable to say that these findings are not relevant to humans.
If an individual, in consultation with their healthcare practitioner, does decide to use aloe to treat constipation, they could use between 50 and 250 mg of juice or extract per day. This treatment, certainly, is not suitable for long-term use. It may lead to abdominal pain and gastrointestinal distress.
Do not use in patients with hemorrhoids or kidney disease. Users should be prepared for prolonged, and potentially violent defecation
Other Stimulant Herbs for Constipation
- Oregon Grape – (Berberis aquifolium)
- Buckthorn – (Rhamnus cathartica)
- Rhubarb – (Rheum rhabarbarum)
- Chinese Rhubarb – (Rheum officinale)
- Culver’s Root – (Veronicastrum virginicum)
- Polypody Root – (Polypodium vulgare)
Miscellaneous Herbs Used for Constipation
- Dandelion – (Taraxacum officinale)
- Chickweed – (Stellaria media)
- Yellow Dock Root – (Rumex crispus)
- Hedge Hyssop – (Gratiola officinalis)
Supporting References
American College of Gastroenterology Chronic Constipation Task Force. An evidence-based approach to the management of chronic constipation in North America. Am J Gastro. 2005; 100:S1-S22
WebMD – 2013.
Xu J, Zhou X, Chen C. Laxative effects of partially defatted flaxseed meal on normal and experimental constipated mice. BMC Complementary and Alternative Medicine. 2012; 12:14-18
Tarpila S, Kivinen A. Ground flaxseed is an effective hypolipidemic bulk laxative [abstract]. Gastroenterology. 1997; 112:A386
Mayo Clinic, 2012: http://www.mayoclinic.com/health/flaxseed/NS_patient-flaxseed/DSECTION=safety
McRorie, Daggy, Morel, et al. Psyllium is superior to docusate sodium for treatment of chronic constipation. Alimentary Pharmacology & Therapeutics. 1998; 12: 491–497
Sorter H, Berg M, Necheles H. Constipation in the aged, attempts at therapy. J Geront. 1949; 4:121-126
Michael Castleman. The new healing Herbs: the essential guide to more than 125 of nature’s most potent herbal remedies. Emmaus, PA. Rodale, Inc. 1999.
Marazzi B, Endress PK, de Queiroz LP. phylogenetic relationships within senna (leguminosae, cassiinae) based on three chloroplast DNA regions: patterns in the evolution of floral symmetry and extrafloral nectaries. Am J Botany. 2006; 93: 288-303.
Thamlikitkul V, Bunyapraphatsara N, Dechatiwongse T, et al. Randomized controlled trial of Cassia alata Linn. for constipation. 1990; 73:217-222
Duke, James A.: The Green Pharmacy: Herbal Handbook. Emmaus, PA. Rodale, Inc. 2000,
Castelman, Michael: The new healing Herbs: The classic guide to nature’s best medicines. Emmaus, PA. Rodale, Inc. 2001
Foster, Steven and & Rebecca Johnson: Desk Reference to Nature’s Medicine. Washington DC. National Geographic. 2006.
Wintola OA, Sunmonu TO, Afolayan AJ, et al. The effect of Aloe ferox Mill. in the treatment of loperamide-induced constipation in Wistar rats. BMC Gastroenterology. 2010; 10:1-5
The University of Maryland Medical Center Complementary Medicine, 2011 http://www.umm.edu/altmed/articles/aloe-000221.htm
19. National Institutes of Health, 2012: http://nccam.nih.gov/health/aloevera.
Thordur Sturluson
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