MEDICINAL HERBS AND CONSTIPATION

Constipation (or difficulty in having a bowel movement) is a very common, not to say banal, disorder which poisons the lives of many people (quite often women) and which is difficult to cure.
It is a relative disorder because, if the average digestive transit time of food is around 36 hours, for some people it is normally a day and for others 3 days.

Constipation can be considered when the excretion of feces is chronically irregular over time while the diet is regular with periods when the materials become hard, dry, difficult to defecate; this is accompanied by abdominal heaviness, bloating with gas, headaches, lack of appetite.

We can distinguish (a little artificially because the categories can overlap):

Constipation linked to an organic disorder or true constipation

The activity of the large intestine or its terminal part is disturbed.

The colon may lack tone or on the contrary be too spastic. In both cases the progress of feces is disturbed.
Contractions of the colon allow feces to be compacted and move forward to the rectal ampulla.

If the contractions are disordered they become inactive (hence the constipation).
This situation is often encountered in the case of irritable bowel syndrome which is a cause of "false constipation" because this mechanical constipation is accompanied by an abundant secretion of mucus which gives the appearance of diarrhea. .
The materials then take the form of small balls in the middle of a mucous liquid that is sometimes very abundant and more or less tinted. The urge to defecate can be urgent but often ineffective.

For more info see " irritable bowel syndrome or spastic colitis or mucous colitis

The colon may be too big (up to megacolon).

The anal sphincter too "tight", too spastic, difficult to relax and thus disturbing defecation.

Constipation secondary to acquired organic injury or disease.

Cancerous or non-cancerous narrowing of the colon.
Neurological disorder (paraplegia, tetraplegia, Parkinson's etc.)
Medications (many neuroleptics or antidepressants)
Drug addiction (especially opium and opiates, but also cath or betel nut)
We can also mention "endocrine constipation" "of the woman who evolves irregularly with the periods, or during pregnancy, or after childbirth.

Constipation linked to an unhealthy lifestyle:

The most common (food and drink, lack of exercise, stress)

In all cases, herbal medicine, and plants in general, can be useful to allow better regulation of intestinal transit and facilitate defecation, but the first two categories require a medical assessment and appropriate treatment (laxatives are often dangerous in the event of megacolon or stenotic affection of the colon, spastic or irritated colon (irritable bowel syndrome) requires a medical consultation; no self-medication in these cases.

It is more and more frequent in "modern" societies

Food is often the cause

• too rich in calories and in almost entirely assimilable foods (not enough waste): made from very fatted white flour (bread, pasta, pastries, biscuits), ubiquitous refined industrial sugars, industrial fats (oil, margarine), polished rice , vegetables selected for their fine flesh, watery fruit...
  
• too low in fiber and non-assimilable substances that add volume to the faeces
  

Interestingly, diet-related constipation is a fairly recent phenomenon; traditional societies where food is more "natural" do not often use laxatives which are moreover few in their pharmacopoeia, on the other hand people purge themselves more often to "wash the inside" (the bad food storage conditions cause food poisoning and intestinal parasites are also very common)

Lack of regular physical activity

We no longer walk, we often sit or lie down, physical work is reduced, postural and abdominal muscles are no longer solicited

Stress is frequent,the pace of work, long trips cause the physiology to go wrong. We tend to eat badly and quickly, to not drink enough plain water but coffee, tea or "soft drinks" full of caffeine which are diuretics and cause the elimination of water from the food bolus by the urine instead of bowel.

To improve intestinal transit, you can:

• modify your diet by choosing appropriate plant foods and, if the constipation is stubborn,
• use laxative medicinal plants or extracts of these plants with laxative properties
  
  

IN FOOD

It is necessary to increase the intake of dietary vegetable fibers, that is to say mainly by:

• cellulosic fibers (cellulose and hemi-cellulose) that come from plant cell walls. These fibers are most often insoluble in water but can trap, absorb a lot while increasing in volume at the same time; these cellulosic fibers are not easily fermentable but as a part is nevertheless digested by colonic bacteria there is the possibility of gas production: carbon dioxide, methane, volatile fatty acids, pectins found in fruit pulp, hemicellulose and polymers soluble neighbors (polysaccharides) which are much more fermentable and absorb a little less water,
• lignin (component of wood), not very abundant in the "modern" human diet, not at all metabolized by the body
  

Where are these fibers found?

IN wholemeal and semi-wholegrain CEREALS,
examples: wheat (durum, soft, rye, etc.), oats, barley, corn, rice, millet, as well as in buckwheat.

IN GREEN VEGETABLES ,
examples: spinach, cabbage, cooked or raw salad, leek (the broom of the intestine), cardoons, green beans, and in the tropics, amaranth, hibiscus (canaque cabbage), leaves of ARACEAE (taro , callaloo), Chinese cabbage, green beans.

IN FIBER OR SKIN VEGETABLES,
examples: carrots, beets, rutabagas, pumpkin, Jerusalem artichokes, turnips, tomatoes, peppers, eggplant, yams, taro, sweet potato, breadfruit (uru), cassava.

IN DRIED VEGETABLES ,
examples: beans, lentils, peas, chickpeas, pigeon peas, mung-bean... but these vegetables are very fermentable and not very hygroscopic

IN RAW or DRIED FRUITS ,
examples: citrus (orange, grapefruit, pomelo), pear, apple (without the skin which can cause constipation), plums, prunes, figs, dates, table grapes, strawberries, but also wild fruits, strawberry tree, blackberries, raspberries, and in the tropics, raw, cooked, dried bananas, guava (without the skin), pineapple, mangoes.

IN ALMONDS ,
examples: walnuts (juglans regia), almonds from the sweet almond tree, para nuts, macadamia nuts, cashew nuts, and of course coconut flesh that can be nibbled, grated, dried.

Some plants are useful both in cases of constipation and diarrhea (eg carrots), others seriously constipate mainly because of the tannins they contain (often in their skin), they can sometimes be recognized by their astringency; beware of grapes (spitting out the skins and seeds), apples, pomegranates, but also olives (green and black) ; in the tropics of guavas, cythera plums, rose apples .
According to the WHO, to ensure regular intestinal transit, it would be necessary to absorb 30 g of dietary fiber per day, their consumption has other beneficial effects on health; several epidemiological surveys show that mortality from cardiovascular disease is lower in regular fiber consumers than in the rest of the population; there is talk of a decrease in the absorption of cholesterol in the intestine as well as a decrease in blood sugar in diabetics.

Hygieno-dietetic measures are sometimes not enough to make constipation disappear, we are led to use laxative preparations based on cellulosic fibers, mucilages, stimulating-irritating substances for the colon, choleretic plants, vegetable oils.

WHEAT BRAN

It is the envelope of the grain of wheat, it represents 18% of the weight of the caryopsis (grain), contains mineral salts in abundance but difficult to assimilate because in the form of phytate (salt of phytic acid) and proteins (17% of the weight).
Example of dosage : 2 to 3 teaspoons (more if you can bear it) per day mixed (or sprinkled) with food (mash, soup, porridge, sauce) or a dessert.

You can also find bran tablets, granules, bran-enriched bread, bran-enriched crackers in stores. It is of course preferable to use "organic" wheat bran, because the various treatments with pesticides (during cultivation and storage) strongly impregnate the outer parts of the wheat grain.
Bran can cause flatulence at the start of treatment, it is best to start with half a dose and gradually increase the amount of bran daily.

DRIED FRUITS

As a cure for a few days: prunes, pears, apricots, figs, dates 5 to 10 fruits left to swell in both cold and hot water, to be consumed as preferred in the morning or evening while drinking the water with it.

ALMONDS

Very easy to make in tropical regions: 1/2 grated coconut in the evening or in the morning, whole with its juice

The mucilage absorbs a lot of water, swells, and thus increases the volume of faeces (also softening them) facilitating their progression in the large intestine (colon) and triggering the exemption reflex (defecation).

STERCULIA GUM

It is an exudate obtained by wounding (by incision or burning) tropical trees of the genus Sterculia (sterculiaceae) native to Asia (India) or Africa.
This gum is not very soluble in water, but absorbs a lot of it by swelling considerably, it is not absorbed or degraded in the digestive tract (it is therefore found intact in the large intestine), it does not cause gas in general.
Sterculia gum-based laxatives can be found in pharmacies.

PSYLLIUMS, ISPAGHUL

Psyllium afra = Plantago afra
Psyllium arenaria = P. indica = P. racemosa = Plantago arenaria
Plantago ovata = Plantago psyllium
Plantago lanceolata
Plantago majorP. afra and P. arenaria are PLANTAGINACEAE from around the Mediterranean. P. ovata comes from India but also grows in Europe.

The seeds of these Plantaginaceae are small (2 to 3 mm), they contain lipids, proteins, sterols, sometimes alkaloids and especially 10 to 30% of mucilage, very hydrophilic, which as in the gum sterculia increases in volume in gorging itself with water, causing the materials to swell, which stimulate colonic intestinal peristalsis, thus facilitating intestinal transit and exemption.
There are many pharmaceutical specialties containing Psyllium-Plantago seeds but they can also be taken as they are.

Example of dosage : 1 to 2 tablespoons of seeds that are left to swell for 1 hour in a large glass of water, to be swallowed in the morning or in the evening if possible on an empty stomach or before the meal, knowing that the effect is felt the next day.
Psyllium or Plantain seeds (including P. major) can be collected from the wild, but you need patience, the seeds are really small!

LINEN

Linum usitalissimum LINACEAE
Linseed, which is very oleaginous, also contains mucilage, the swelling index of which is half that of psyllium, but quite sufficient to produce a laxative by ballast effect.
Example of dosage : 2 to 3 tablespoons of seeds in a liter of hot water, wait until they swell (at least 6 hours), to consume in 3 or 4 times during the day.

THE MALVACEAE

Many Malvaceae are mucilaginous, these polysaccharides are found in the leaf, fruit, flower or root.
They do not really act only by ballast effect but also by thinning-lubricating the faecal bolus thus facilitating its exemption.
In addition, they are very useful emollient-softening plants for reducing the colonic inflammation that can accompany chronic constipation, especially when it is old and has been poorly treated by too aggressive laxatives.
In temperate countries we can cite mallows, marshmallows and lavatera which include many species,
examples: Malva sylvestris (mallow, small to medium sized species), Althaea officinalis, A. setosa, A. rosea, A. pallida (marshmallow, hollyhock, slender plants with a remarkable flower stem).

These plants or their extracts are found in many pharmaceutical specialties. You can also use fresh or dried flowers and leaves in infusions, or mixed with food (soup, spinach, mashed potatoes)
example : a handful for 1 liter of boiling water, infuse 10 minutes, drink at will

You can also use the roots which contain a lot of mucilage (but it is less convenient).

In tropical regions:

• OKRA, the fruit of Hibiscus esculentus, especially when immature, contains a lot of mucilage; it is cooked in water, its glutinous aspect is not always appetizing but it is a classic remedy without toxicity for gastrointestinal disorders. The leaves of Hibiscus manihot (canaque cabbage), a plant very often grown in Melanesian gardens, are a good dietary supplement that provides protein and mucilage in addition to being pleasant to the taste; this easy-to-grow plant (by cuttings) deserves to be better known and spread;
• More incidentally, the flowers of other Malvaceae : Hibiscus rosa-sinensis (decorative hibiscus), H. tilliaceus (Polynesian burao) are also very mucilaginous and emollient.

THE SEAWEEDS

Polycellular marine algae (thallus) generally contain a "flexible" structure which is not made of cellulose or lignin but of various polymers (derived from alginic acid, fucans, galactans) which very often are capable of forming gels with water, are virtually unassimilable, infermentable by colonic bacteria and non-toxic. All these properties (very interesting in the agro-food industry) also make it possible to incorporate them in preparations aimed at laxatives by ballast effect, or to reduce hunger a little in weight loss diets.

One can of course consume a little seaweed in one's diet, but this habit has not yet become commonplace in the West. If the Fucus, Laminaria and some other pheophyceae and rhodophyceae can be consumed to promote intestinal transit, limit the caloric content of food or provide mineral salts and trace elements, in practice we rather use the polysaccharides of rhodophyceae (floridae or red algae) and simplifying a bit: carrageenans and agar-agar.
Carrageenans are found among others in many gigartinales (including Chondrus crispus in cold temperate regions); in the tropical seas, "wild" seaweed is harvested and many are also cultivated, such as Euchema spinosum.
Agar-agar is mainly found in gelidial algae of the genus Gelidium (example: Gelidium corneum on the Atlantic coast) or Pterocladia and other gigartinales (example several species of Gracilaria in Europe or the Caribbean ).
All these algae are small in size.
There are pharmaceutical specialties based on or containing carrageenans or agar-agar.
It is also possible to harvest these algae and prepare them; just dry them in the sun after washing with fresh water to whiten and clean them; they keep well.
They can be consumed in the form of desserts, dairy products or directly in food (in very small fragments, powder or flakes).

Examples:

• a tablespoon or 5 g of dry seaweed in 1/2 to 1 liter of water, boil for a few minutes and leave to cool (gel), flavoring according to taste,
• one to two teaspoons of agar-agar powder in food or in a dessert.

Irritant (or anthraquinone or anthracene) laxatives, sometimes called stimulant laxatives, are very effective but should be used as a last resort and for a short time because their prolonged use can cause "laxative disease": serious colonic irritation, with electrolyte disorders of body fluids including hypokalaemia (beware of drug interactions, especially with digitalis and antiarrhythmics).
Let's recall their mode of action .

Anthracenosides are not metabolized in the small intestine but they are degraded by colonic bacteria; the substances released increase the quantity of mucus and water in the colon as well as its peristalsis, hence the laxative and even sometimes purgative effect, it is therefore necessary to count a certain delay between taking the laxative and its effect: between 8 and 12 hours.

Anthracenosides are present in many plants including CAESALPINIACEAE and RHAMNACEAE.
Examples :

• Séné and related plants from tropical regions : Cassia angustifolia (leaves), Cassia senna (leaves), Cassia alata (leaves), Cassia occidentalis (leaves), Cassia fistula (fruit pulp). Cassia pleurocarpa (leaves) European senna or baguette tree: Colutea arborescens (leaves) Buckthorn bark: Rhamnus frangula Cascara bark: Rhamnus purshianus Buckthorn fruit: Rhamnus catharticus ,
  Aloe juice:
• Rhubarb rhizome: Rheum officinalis (rhizome powder),

Many specialties in pharmacies and drugstores contain these plants or their extracts associated with each other and sometimes with antispasmodics. Their employment must be motivated and of short duration.

These are rather "mild" laxatives but to be used in short cures because they have some disadvantages related to their "acidity": oral irritation (in particular of the gums and dental necks) and minor gastric disorders.

• TAMARIND :
• KARKADE
• EDIBLE OR RHAPONTIC RHUBARB : these are plants with large green leaves (long fleshy petiole and prominent ribs), perennial with a voluminous rhizome that contains anthracene derivatives (like R. officinalis).
  Unlike Rheum officinalis, it is the fleshy petioles of the leaf that have been used, consumed in compote or jam.

These are mild laxatives essentially based on MANNITOL and SORBITOL, which are simple sugars (but polyols), little or not metabolized by the human body, and which increase the activity of the gallbladder (and perhaps indirectly that of the large intestine).

Mannitol is found in its natural state in laminaria (large pheophyceae algae) and in certain plant exudations, examples: the manna of the ash Fraxinus ornus which grows spontaneously in Europe, especially around the Mediterranean; the bark exudes this sweet substance.
In Australia the colonists found this laxative manna on the leaves of a Eucalyptus (manna gum tree or Eucalyptus viminalis); this exudate is secondary to the bite of small insects.

Sorbitol exists naturally in certain fruits, in particular ROSACEAE, including Sorbus aucuparia, but associated with tannins which make these fruits more antidiarrheal than laxative.
In practice, these mild laxatives (which can be used in children) can be found in pharmacies based on industrial polyol sugars.

It happens that functional constipation (without definite organic cause) is rebellious and becomes complicated in patients who have abused laxatives with colitis which prevents the use of many laxatives.

When we have eliminated a "psychic" cause of constipation (example: anismus) and established a diet and improved lifestyle, we can use plants for liver purposes in prolonged treatment (long term).

Examples :

• DANDELION, Taraxacum officinale and some related species, ,
• ROSEMARY, Rosmarinus officinalis,
• ARTICHOKE, Cynara scolymus,
• COMBRETUM ou KINKELIBA, Combretum micranthum, West African tree, leaves in decoction;
  5 to 10 g in 1/2 to 1 liter of water, boil 10 minutes, to consume during the day
• BOLDO, Pneumus boldus, small tree from Chile, same dosage as for Combretum, and also mother tincture, 20 to 30 drops per day.
  These plants are found in pharmacies and sometimes at herbalists.

They mainly act:

• by excitation of the gall bladder and reflex excitation of the large intestine,
• possibly also by lubricating effect of faeces (part of the oil is not digested or emulsified)

This type of laxative should not be abused in the same way as irritating anthracenoside laxatives

All edible oils can be used but it is usual to advise:

• virgin olive oil: 1 to 3 tablespoons (or more) on an empty stomach, sweet almond oil (often recommended for children): 1 to 3 tablespoons on an empty stomach (adapt to the weight of the child),
• but also coconut oil in the form of oil obtained by decantation or in the emulsified form of coconut milk,
  example : milk of 1/2 nut for a child, coconut milk of 1 nut or more for an adult, Consume once in the morning on an empty stomach.

AVOID PURGATIVE OILS, for example from EUPHORBIACEAE: castor bean (Ricinus communis), croton (Croton tiglium), medicinal (in South America and the Caribbean) (Jatropha spsp.), bancoulier (Aleurites sp. from Asia and Oceania )

• consume fiber vegetables, fruits and whole or semi-whole grains drink at least 1 liter of water a day
• do some exercise