CONSTIPATION

DEFINITION
Constipation is essentially the state in which the normal process of defecation is
hindered. It varies depending on the age, physiology, diet, cultural influences… of the
person. The incidence of constipation is very high; it is more frequent in women than in
men. An accurate definition could be given by Rome foundation, which, having collected
data about gastrointestinal disorders, created the Rome criteria: the best way to
diagnose the constipation. According to these criteria, patients have constipation when
they have suffered at least two of the following problems in the last three months:
- Lumpy, dry, or hard faeces.
- Less than 3 bowel movements per week.
- Straining when passing stool.
- Sense of incomplete defecation or obstruction.

It may get complicated with the appearance of bleeding, anal fissure, hemorrhoids…

TREATMENT
First of all, it is important to understand what types of constipations exist and which
could be their physiological causes in order to know which treatment may be better.

There are two types of constipations depending on the period of time that the patient
needs to recover completely. If it is a punctual constipation due to an eating disorder,
stress, medicine, lack of exercise, poor fiber diets…, it is a transient constipation. On the
other hand, it is a chronic constipation when the patient needs a long time to recover or
when it is a lifelong disorder. Although the chronic constipation could have its origin in
some of the causes of the transient one, it can also be produced by some diseases, such
as hypothyroidism, diabetes, irritable bowel syndrome, anxiety, depression, strokes,
cancer, etc. Furthermore, there are sometimes physiological causes related to the rectal
or abdominal muscles.
A post-recovery and preventive treatment would consist in avoiding sedentary lifestyle,
increasing physical exercise, following a balanced diet rich in fiber…

The medical treatment for constipation could be classified in the following groups (both,
allopathic and plant medicines, are shown):

Mechanic laxatives
This fiber with water absorbing properties can be extracted from algae, due to the fact
that they contain alginic acids. A group of scientists compared the behavior of a
population which drank alginic acid liquid with another one which took a placebo
beverage. It was proved that the people who took the alginic acid drink had more
depositions per day, and better softness, color and odour stools.
However, the biggest group of mechanic laxatives come from superior plants, due to
mucilage (bulk formers) and oils (lubricant action).

1. Bulking agent
Plants used:
-Seeds of Plantago (Plantago ovata, P. psyllium, P. Mayor) rich in mucilages (30%).
-Seeds of Flax (Linum usitatissium)
-Flowers and leaves of Malva (Malva sylvestris) or Malvaviscus (Althaea officinalis) by
infusion or macerated.

Mode of action: These bulking processes are caused by the hygroscopic power of its
main active ingredient (mucilage). When in contact with water, mucilages form a sticky
gel. Therefore, when they are exposed to gastrointestinal juices, they swell absorbing
water. This is the reason why stools get bigger and softer, provoking the peristaltic
movements of the intestine. These movements do not produce irritation.
A placebo-controlled trial was carried out in a population to study the effects of flaxseed
in patients with type 2 diabetes who had symptoms of constipation. It was reaffirmed
that mucilages help to constipation disorders.

Indicated for constipation, anal fissures and hemorrhoids.

Allopathic: Methyl cellulose (Metamucil®), which is a fiber supplement.

2. Lubricant action
Plant used: Fruit (olives) of Olive (Olea europea).

Mode of action: The olive oil is used as an intestinal lubricant because the fats of its
fruits coat and soften the faeces. Olives also decrease faecal water absorption in the
colon.

A cross-sectional population survey was carried out in Albacete (Spain) to relate

constipation with feeding habits. Olive oil was founded as one of the most determining
aspects due to the fact that people who usually ate olive oil in a balanced way have
lower levels of constipation than the others.

Indicated for patients who must avoid straining during defecating and as adjuvant in the
dissolution of fecalomas.

Allopathic: Liquid paraffin is the best allopathic lubricant laxative.

Osmotic laxatives
Plants used and active principles:
-Fruit of Apple tree (Malus domestica) because of its pectins.
-Fruit of Tamarind tree (Tamarindus indica) because of its pulp, it has organic acids and
salts.
Mode of action: They generate an osmotic gradient, causing the outflow of water into
the cavity of the digestive tract.
Allopathic: Lactulose and polyethylene glycol (MiraLax®), which is a high molecular
weight molecule that swells and stays in the intestine. Moreover, salinic laxatives such
as magnesium citrate are used too. Glycerine suppositories are also utilized because of
their hygroscopic and irritating action, which is caused by its excipients, sodic stearates.

Irritating laxatives
1. For large intestine.
Plants used:
-Bark of trunk and branch of cascara (Rhamnus purshiana)
-Bark of Frangula (Rhamnus frangula)
-Leaf and fruit of Senna (Cassia angustifolia)
-Leaf of Aloe (Aloin).
-Root and rhizome Rhubarb (Rheum palmatum)

Mode of action: They increase intestinal peristalsis by direct irritation of the colon
mucosa. They have a very fast action after administration. On the other hand, these
have side effects since they are very irritating.
All of them have anthraquinones and they are metabolized in the large intestine. Then,
they inhibit the electrolytes and water absorption, increasing the liquid retained inside
the faeces and stimulating peristaltic activity of the large intestine.

2. For small intestine.

Plant used: Seed of Ricinus (Ricinus communis).

Mode of action: Ricinus oil is hydrolyzed in the small intestine by pancreatic lipase,
originating glycerol and ricinoleic acid. The ricinoleic acid exerts an irritating action
directly on the small intestine, stimulating stools expulsion. Glycerol acts as a lubricant.
It is a very dangerous plant which can cause the death of a child with the ingestion of
only two seeds.
It is used to make colonoscopies with the aim of emptying the colon.

Allopathic: Phosphate laxatives is usually used both oral and rectal (enema) route.

Other allopathic laxatives

- Lubiprostone (Amitiza®) due to the fact that it activates chlorine channels,
increasing the liquid secretion into interstitial fluid.
- Linaclotide (Linzess®) has analgesic and secretive action, due to the fact that it is a
guanylate cyclase C receptor agonist.

CONCLUSION
Although Phytotherapy has an eminent role in the current healthcare framework of the
world, it should be even more prominent. In my country, Spain, phytomedicines are still
not used as much as allopathic medications, due to the fact that people are not
sufficiently informed about Phytotherapy yet. Furthermore, in Spain, phytomedicines
are sold mainly in herbalists, but not in pharmacies. The sellers are not botanicals or
pharmacists, so they are not reliable. Therefore, they do not have sufficient information
about the doses. In the case of the medicinal plants studied in this report, I think it may
be a good idea to consume these phytomedicines instead of the synthetic ones, if the
constipation is mild. If the disorder is complicated, synthetic medications should be
taken as they are more powerful and the therapeutic target is more precise, despite
having more side effects. Nonetheless, I believe that due to better chemical,
pharmacological and clinical knowledge, greater quality control, an increase in the side
effects of synthetic drugs and a greater ecological awareness of the population, lead to
the justification that more and more people become aware and consume
phytomedicines.
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