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 due to lifestyle choices like not eating a diet rich in fruits and vegetables and a lack of exercise. Other causes are due to structural and/or functional changes of the colon or rectum like 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, tranquilizers, sedatives, Nonsteroidal anti-inflammatory Ibuprofen, naproxen sodium).
It is extremely important when treating constipation to rule out any organic problem that may be the direct cause of the constipation. Examples are thyroid disease, fecal impaction, bowel obstructions caused by twisting of the bowel or masses within the bowel or extrinsic pressing on the bowel.
Traditional Chinese Medicine Approach:
Use of acupuncture and herbs can be effective to treat various gastrointestinal disorders. 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.
Acupuncture helps to get the bowels moving, reduce or eliminate pain, and is helpful for the emotional effects that constipation can bring on.
A Note On Self Medicating:
Many Chinese herbal formulas and single herbs have harsh effects. These formulas are only used for a short duration and then discontinued when desired effects are achieved. Herbal formulas that contain Da Huang or Fan Xie Ye (Rhubarb or Sennae) are highly cathartic and purge the bowel. Prolonged use of these herbs are not recommended because of an increase 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.
Constipation the Emotional & Physical Connection:
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 colon peristalsis.
Acupuncture can calm you allowing for the mind and body to relax, releasing physical and emotional stress leading to a happier you and healthier bowel.
Please keep in mind that constipation may signal that something serious occurring in our body and requires a conventional medical workup to determine if there is a cause that must be handled with conventional medicine.
In Chinese medicine the shape & consistency of the stool is diagnostic as to what system is out of balance.
TCM Diagnosis of Stool Consistency:
- Liver Qi Stagnation creating heat and or exhaustion of body fluid
- Dry stools shaped like rabbit pellets or sheep-dung Type 1
- Excessive dampness caused by stomach/spleen deficiency
- Mucous stool Type 6
- Spleen/stomach disharmony with imbalance of dryness/ dampness in the bowels
- Loose bowels following dry stool Type 6
- Liver qi stagnation and spleen deficiency
- Stools which are sometimes dry and sometimes loose Type 5
- Spleen and kidney yang deficiency
- Liquid stools with undigested food Type 7
- Damp heat in the stomach and intestines
- Diarrhea with yellow watery stool, foul smelling, and burning of the anus Type 6 or 7
- Food Retention
- Formed stools with undigested food and foul
Normal is Type 2, 3, and 4.
Western 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. Only used for a very short term.
Lastly, cathartics or stimulant laxatives like (senna Senakot, Ducolax, X-Prep. Exlax, cascara, and bisacodyl) are used for severe cases of constipation by increasing intestinal peristalsis and intestinal fluids. Only use short-term because 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.
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