Constipation

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Finding a good herbalist

The recommendations in this article are entirely suitable for a person to use themselves but, if there are other issues that need attention and you know that you need further help, there may be a great deal of benefit to you to go to whatever lengths necessary to find a good herbalist and there's some suggestions on how you might go about finding such a person here

Consequences

The more a person has problems in this area the more they realise that the consequences of not regularly clearing their bowel can be significant, even severe.

Pain, discomfort and bloating can be immediate and obvious consequences but constipation can also contribute to deeper troubles within the whole body, especially the health of the joints, the muscles and the skin. Many people, especially as they get older, learn to associate their general well-being with the health of their bowels because they consistently notice that they feel better when things are working well, and worse when they aren't.

We humans are one particular kind of mammal, a peculiar one in many ways, no doubt, but just like others in many of the ways that most count, including that our digestive systems need to expel their wastes on a regular basis or our health will suffer.

Really, it is essential to have at least one good bowel motion a day however many doctors in the conventional system tell their patients that it is perfectly normal to go every few days, or even just once or twice a week. It is true that such constipation is common, but it is not normal or healthy.

In practice it can be seen that there are two main issues at the heart of this common problem. One is usually very simple to remedy, the other usually requires more care.

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Atonic constipation

Atonic constipation is usually easy to remedy. 'Atonic' simply means that there is a lack of muscle tone in the bowel. Waste products may therefore remain there overlong because there isn't a sufficient amount of movement from the muscles to push the material through. Fortunately, like other muscles, it is possible for them to become 'fitter' by getting enough fibre for them to work on with strong, regular contractions.

The Prescription

Plantago husks - 2-4 heaped tsps, 1-2 x daily

Plantago husks are also known as Psyllium hulls, they are differentiated here because ideally we want the slightly larger and coarser husks than the more finely ground psyllium powder, which is often what's available commercially.

Plantago is a most unusual substance in that it can be used for both constipation and diarrhoea. It does this by having a gentle, bulking effect on the stool that can be of much help in creating a steadier wave of 'peristalsis' i.e. the muscular contractions of the small and large bowel that propel food and wastes forwards.

The technique of taking the husks is important. The best way is to rapidly stir them in as you gradually fill a glass of water that is running at an easy drinking temperature. As soon as the cup is full the Plantago should have been mixed in and you then drink it down in one go. Speed is the essence of success with this method, because it prevents the Plantago having time to thicken. When you get it right it is really no harder than drinking a glass of water and, as it has no taste, easy to do it as often as you need.

The large dose range, from as little as 2 tsps once a day, all the way up to 4 tsps twice a day, is because the person must experiment with what works best for them and there is no other way to do this than to go up and down until there is a level that is clearly working. Generally, I recommend a person start at 3 tsps, once a day, and then go up or down from there. More about Plantago husks here

What has often been observed is that, once the person gets the right level of Plantago that is regularly helping them to clean out their bowel, they may be able to reduce or even stop their treatment and that things continue to work well. This depends, no doubt, on them having enough fibre from fruits and vegetables in the diet to give the muscle something to grip hold of, and work off but it can clearly be seen that a person has the ability retrain the muscle of their bowel to be better toned; i.e. to cure ' atonic'' constipation.


Plantago psyllium

Gentian Drops

For many people, the regular use of a sufficient amount of Plantago may be all they need to cure atonic constipation. However, if the lack of tone in the bowel is being caused, or contributed to, by a poor upper digestive function, another common problem that is shown by there being indigestion, then one of the best of all herbal medicines to help is Gentian root.

Only tiny amounts are necessary to give a powerful effect and, like the Plantago husks, their regular use over a period of weeks has frequently been seen to bring about an improvement that continues even when the medicine has been finished.

The best method to use Gentian, and a recommendation to consider combining it with another great digestive tonic, Ginger, is written up in detail here


Gentiana lutea (Gentian)

Cleansing formula

Dandelion root 100mls
Burdock root 100mls
Red Clover flowers 80mls
Juniper berry 80mls
Barberry 80mls
Celandine 40mls
Poke root 10mls
Licorice root 60mls

If a person has suffered from constipation for some time, it is highly likely that their system in general and their liver in particular will need an overall cleanse and the above formula is a typical example of what we might use in practice.

This would make 550 mls of herbal extracts which will fit into a 500ml amber pharm bottle. None of these herbs have a direct laxative effect, though many people experience significant increases in bowel activity once they start using them, rather they are some of the most potent blood, liver and kidney cleansing herbs in Nature. The Licorice root is there to help the other herbs blend well together and to make it more palatable than it would be otherwise. Peppermint extract could be used instead if a person had high blood pressure or an aversion to the taste of Licorice.

Typically, we might use 8-10mls of such a formula, before food, twice a day for a month but note that we make our own tinctures from raw, organic material so herbs from a different practitioner or company might need a higher or lower amount than this for an optimal dosage. Also note that taking from 16-20mls of a formula like this is very much higher amount than would ever be received from a commercially available cleansing herbal formulae for the primary reason that it would be far too strong for some people and expose companies to complaint and litigation. This is just a snapshot, there are further notes on this particular formula, and associated areas, in the article on detoxification found here


8 ml dose of a cleansing herbal formula

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The Work

The 'work' for atonic constipation, i.e. what the person does to help themselves as well as taking one or more of the above herbs, is largely based around diet.

Diet is an essential part of any lasting cure for constipation. People are the experts in their own experience and I think I can safely assume that any reader who is familiar with this problem already knows the kinds of foods that are meant to help; prunes and kiwifruits leading most lists, but all other fruits and vegetables having varying degrees of benefits.

What can be seen in practice is that many people who have suffered from constipation have tried, and often really tried, to eat more fruits or vegetables but without any success, or even a worsening in some cases. This may be because they have the other kind of constipation that I am talking about next, but it also may be because they just didn't have enough fibre to 'tip the balance' and so just got more bloated with the increased material in their bowel.

Hence the almost universal recommendation to start with Plantago husks and, when they are working well, to then try to shift the emphasis away from the husks and towards fruits or vegetables. The bowel is a creature of habit. Once it becomes inactive and atonic, it tends to get stuck there, once it starts getting toned and fit, and starts moving regularly, it takes much less to keep it that way.

As well as fibre, water is also essential to good bowel health, as it is to every other part of our bodies. The best way to tell if you are putting enough in is to monitor how much is coming out.

If you are going less than every two hours then you are veering towards dehydration and your bowel, and every other part of you, will be the worse for it. However, if you are needing to relieve your bladder more than once an hour then you are overdoing it and not doing yourself, or your kidneys, any favours.

The 'sweet spot, is to be having a good 'pee' every one to two hours. If that is happening, then you are drinking the exact right amount of water for your needs on that particular day.

Exercise is only an issue in some cases, but it should at least be considered as part of the 'work' that may need to be done for a cure. Constipation is rarer in people who are highly active and more common in sedentary people. Making the voluntary, 'skeletal' muscles regularly exercise clearly helps the tone and function of the involuntary 'smooth' muscles, i.e. the ones that make the bowel work.

I might also mention at this point that all kinds of constipation are much more common in the dryer constitutions (as opposed to the damper ones) and that different kinds of exercise are well known to suit the different constitutional types more or less according to their natural preferences.

To read more about this interesting and most useful subject, start with the introduction here

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Tense constipation

This kind of problem has been given different names by different books or writers, but the common theme is that, rather than the muscle lacking tone or fitness, in 'tense constipation' the muscle has become too tight, too rigid, for the essential rhythmical muscular contractions that are necessary for wastes to be moved through and out the bowel.

It is, generally speaking, the much harder of the two types of constipation to cure. People with this kind of problem usually have a history that goes way back. Often into childhood when they held on rather than face the embarrassment of going at school. Or perhaps when they left home and were in a flatting or working situation where it was easier to block the signal and wait until the coast was clear. It doesn't take too much holding on to tension in the bowel for it to start to become the normal state of affairs.

In any case, this is almost always a problem that has deep roots and, for there to be a lasting turnaround, there must be a patient, consistent approach that isn't measured with a quick-fix mentality but by how well the gut is feeling overall and how the person is doing in their general health.

The first step is to let Nature help, and the following includes some of the best of the relaxing digestive herbs known to us.

The Prescription

GI Nervine Formula

Wild Yam 120mls
Cramp bark 120mls
Chamomile flowers 80mls
Fennel seed 80mls
Peppermint 80mls
Licorice root 80mls

To make 560mls, which will just fit into a 500ml amber pharm round. Remembering that this dose recommendation is from tinctures that we make in our clinic from dried organic herbs, so a different practitioner or company might need more or less to be equivalent, I would typically prescribe as a maximum safe and effective dose, 10mls twice a day, which would have it lasting 28 days, or 4 weeks.

None of these herbs are considered as laxatives or contain compounds that have a laxative action, they must not be taken with an expectation that they will clear out the bowel. Rather, they are some of the most potent relaxants of excess muscle tension in Nature, and at these kinds of doses, they are certain to have at least some effect on unwinding the tense and coiled up internal 'spring' that is at the root of tense constipation.

Even though there is already an abundant dose of both Chamomile and Fennel in the above formula, you cannot have too much of these herbs for a tense gut and it could be of further benefit to take them in a tea once or twice a day, such as with the following.

GI Tea

Chamomile flowers 50gms
Fennel seed 50gms
Caraway seed 50gms

The above amounts make 150gms of herb, enough for at least several weeks of daily use. The proportions are given so that a person can make more or less according to their needs or from what is available.

The dosage to have a pronounced effect is to pour one large cup of freshly boiled water over 2-3 hpd tsps, or about 4 grams of the herbs. Cover and allow to steep for a good 10 minutes, then strain and drink. Adding some honey may be welcome and it is best if sipped whilst hot.

The taste of this tea is very acceptable and there has been excellent feedback over the years of using it from people who say how much they enjoy it and how much they feel it benefits their digestion and general well-being. It can be safely taken by anyone from any age as often as they need or want it.


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The Work

Relaxing herbs for the digestive system are an essential beginning and then each person needs to find the way that best helps them to relax and unwind. The first step there is that anyone who is suffering from tense constipation needs to be honest about the fact that they are holding more tension in their body than is healthy. Everyone has some idea about what it is that relaxes them but it is an observable and consistent fact that the more stressed and tense a person is, the less they do the things that actually relax them!

For there to be a lasting shift, there needs to be a great deal of honesty about where things are at and about what needs to change. There will be sources of tension that need to be addressed and the internal ones (negative thinking, self-criticism etc.) are usually by far the worst of them.

Likewise, there will need to be a decided action to take on relaxing habits and pastimes. Each person knows what works best for them, for some it is active relaxation, others prefer more passive methods. There is no right or wrong way to relax, there is just what actually works.

Body-work is excellent for the tense gut, and there are a number of traditional methods that can be learned by a caring partner or that can be sought out from an experienced practitioner, but I do understand that that kind of thing is not for everyone and that the tenser a person is in their gut the harder they might find it to be touched there at all...

In any case, the most important action is to ask an open question; 'what do I really trust that actually relaxes me?' When you have your answer it is up to you as to what you do next. Some people believe that they must stay tense or everything will come apart, they cannot allow themselves to let go. Some people need for things to get just too bad, in other words they have to reach their limit, before they are ready to admit they are too tense and that things can't go on like they have been any longer, and so then they begin the long walk back to their peace and health.

Those are some broad points, there are other tools, including herbs and other practical strategies that have been seen to be of help to a great many people who are suffering from excess tension and anxiety; written up in detail here

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Laxative herbs

I have read that laxative herbs are the most widely used of all herbal remedies around the world. I believe it because I know how many people have problems in this area. However, in my practice I only occasionally need to prescribe a laxative because one or more of the above approaches, although they obviously take more time and effort, are generally successful, and then we may have a long term solution.

That said, everything has its place and, especially when treating tense constipation, sometimes you just have to give everything a good clear out from time to time. When I do give a laxative formula, I instruct my patient to work out the minimum dose that gives them an obvious purgative effect and then they are in charge of how often they take that dose.

As we are usually working on other matters that get deeper into the cause of the problem, in the majority of cases it can be seen that they need to use the laxative herbs less and less until not at all.

Senna is the most popular herbal laxative in the world, it is very strong and effective and is there to be used when needed but most herbalists prefer the gentler Cascara sagrada, aka 'Sacred bark'. This is typically how I recommend it:

Laxative Formula

Cascara sagrada 70mls
Fennel seed 40mls

Take from 2-8mls once daily as often as required. We usually start with around 4 mls and then go up or down from there. Some people get too strong a reaction at this level, and even 3 or 4 mls can be too much and they are better to just take 1 or 2 mls.

If it is too purging, and they get some griping, even with the Fennel seed added, then they can be assured that it will soon pass and that there will be no lasting harm. If needed, to help it to pass sooner and easier, they can take some Ginger tea, a recipe for which is shown here

Conversely, some people seem to need to take much higher doses to get a clear reaction, which is obviously concerning, but just means there is more work to be done. Each person needs to find what works best for them. It is much better to fully empty the bowel than the alternative, even if a laxative is occasionally required. Then, the more the person works on the cause of the issue the less they should be needed and, of course, ideally not at all.


Cascara sagrada

Please understand that I cannot personally advise you without seeing you in my clinic.
This living 'book' is my labour of love so, wherever you are, I wish you peace & good health!

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© 2011 R.J.Whelan Ltd