Constipation is defined as bowel movements that are infrequent or difficult to pass. At any one time between 6 and 30% of the population may report constipation1 and as a rough benchmark the “normal” frequency of bowel movements for an adult is 3-12 per week. At some stage, most people will experience constipation and its causes are many and varied.
In my own practice, the primary causes are stress, depression, a lack of exercise, water, dietary fibre or oil, not necessarily in that order. In its chronic form, constipation is usually a symptom rather than a disease, and in addition to the above, it may also be associated with anorexia, autonomic neuropathy, the use or overuse of prescribed, OTC or other drugs, hypothyroidism, IBS, diverticular disease, obesity, delayed defaecation urge, pregnancy, anorectal fissures or haemorrhoids, diabetes, scleroderma or spinal cord injury, to name just a few.
Dealing with the cause of the problem is obviously the best method of managing constipation but where the cause cannot be determined, the constipation fails to respond to initial treatment or it’s occurred without any notable concomitant pathological symptoms, homeopathy is worth considering. Over many years of treating this disorder, I and several noted authorities2-10 have found that great relief can be offered to sufferers of constipation by a small group of homeopathic remedies, the main prescribing features of which are outlined below.
This remedy is often very useful with children and the elderly and is associated with constipation that may last for days or weeks, and is due to dryness and inactivity of the intestines where stools accumulate and are very difficult to evacuate, often reducing the desire for a bowel movement. Inactivity of the bladder may also be seen here as well as general dryness of mucus membranes and skin, debility, and a sluggish metabolism. Great straining is required to pass hard and dry stools, which may also be clay-like and stick to the rectum, and these symptoms often guide the homeopath to prescribe Alumina. Confirmatory symptoms include a sore rectum and a need to strain to facilitate a bowel movement. Evacuation is often preceded by painful urging. The sufferer may also have very little appetite, only swallowing small amounts of food at a time, and an aversion to meat. Symptoms are worse in the morning, worse on waking and from inactivity and better in the evening and on alternate days.
Bryonia is characterised by irritability and dryness of mucus membranes. The constipation sufferer who will commonly respond to Bryonia may complain of hard, dry, thick brown stools that may look burnt or bloody and they’ll often have little or no desire to pass them. There’s usually accompanying weakness, hunger, irritability, a dry mouth, thirst, particularly for large quantities of cold water, nausea a bursting or splitting headache, as well as sticking or tearing abdominal pain or colic. Symptoms are worse in the morning, from hot weather, moving the head or any sort of motion, and are better from rest.
Stools here are not passed without significant straining and the appearance of the stools are quite characteristic- hard, large, lumpy stools that are joined together by slimy strings or threads. The sufferer may be chilly and overweight and may appear nervous, fidgety and timid. There may be a history of itching or burning skin disorders, burning haemorrhoids, rectal prolapse or anorectal fissures. Symptoms are worse from warmth, and better from drinking warm or hot milk.
Nat mur stools are dry and crumbling and as with several other remedies mentioned here, dry mucus membranes are often seen in this remedy picture. There may be bleeding from the rectum or anus with burning and stitching pain following a bowel movement. Weakness and depression may be evident and the sufferer may also experience blinding headaches. Symptoms are worse from mental exertion and better from cold bathing and abstaining from food.
There’s often an association here between constipation and the overuse of alcohol, coffee or other stimulants, as well as mental overwork, stress or a lack of exercise. Frequent and ineffectual urging to stool is usually seen here- sufferers feel an urge for a bowel movement and on doing this often only pass a small amount of faecal material, leading to a sense of incomplete evacuation. The sufferer may be overly sensitive or irritable, nervous and chilly and may be prone to liver congestion, congestive headaches and itching haemorrhoids. Symptoms are worse from mental exertion, after eating and in cold weather, and better from rest and in damp or wet weather.
In this instance, constipation is often related to the retention of faecal material in the colon. A characteristic symptom here is that stools are only produced after much straining and on emerging from the rectum they soon retreat back into it. The sufferer is often anxious, chilly with poor cold tolerance and often experiences sweating of the head and hands as well as anal fistulae and haemorrhoids. Symptoms are worse before and during menses and better for warmth or in wet or humid weather.
The person who may benefit from Opium will make reference to round, dry, black, pellet- like stools that are only passed on an irregular basis. As in the case of Silica, stools may emerge slightly and then recede back into the rectum. Sufferers often experience pain in the rectum and have little or no desire to defaecate. Most physical functions in this instance are sluggish Symptoms are worse from warmth or heat and better from prolonged walking.
The symptoms here may be consistent with intestinal paralysis. Hard, dry, lumpy, black stools or stools resembling sheep dung are a notable feature with Plumbum met. The sufferer often complains of accompanying colic and anal spasms caused by urging, and mental depression may also be seen here. One of the guiding symptoms in this instance is a feeling as if the navel is drawn backwards towards the spine by a string. Symptoms are worse from motion and better from pressure.
Veratrum album or White Hellebore is useful for those with constipation who have to strain vigorously to the point of exhaustion and a cold sweat to produce large stools. It’s often very helpful in infantile constipation and other symptoms such as mental depression or a sullen indifference, headaches, as well as coldness, weakness and vomiting, are useful in guiding the prescriber to this remedy. Symptoms are worse from wet or cold weather, and are better from walking or warmth.
The homeopathic proving picture of Aesculus contains some interesting and characteristic symptoms. A feeling as if the rectum is filled with sticks, or sharp pains that shoot upwards, may be reported here. There may be lower back pain that’s aggravated from walking or stooping. The sufferer may appear to be depressed and irritable and may complain of a burning anal pain with chills travelling up and down the back. Prolapse and haemorrhoids are often present, and these are particularly painful after a bowel movement. Stools are hard, dry and difficult to pass and there may be a feeling of fullness. Symptoms are worse from standing or heat and better from cold, and moderate or prolonged exercise.
This is a common prescription for pathology related to portal congestion. There is often sadness, weakness, a yellowing of the skin and a bearing down sensation felt internally. Constipation here is associated with bleeding and painful haemorrhoids, a feeling of fullness, and a feeling as if there were a ball in the rectum that isn’t relieved by defaecation. Pains that shoot upwards may be reported. Stools are often large and hard, or appear as dark round balls connected by mucus. There may be a history of anal prolapse. Symptoms are worse from rest or prolonged standing and better from exercise or pressure.
In this instance, Lycopodium is associated with a lack of muscular tone, eructation, bloating, flatulence, ineffectual urging. small, hard stools that are difficult to pass and after being passed there often follows a feeling of incomplete evacuation. Depression and apprehension may be observed here and the sufferer may complain of aching haemorrhoids that are very sensitive to touch. Symptoms are worse from heat and better from motion.
Constipation associated with mental or physical overwork often responds well to Calc carb. The stools here may be large, chalky and hard at first and then pasty becoming liquid. There may be sour eructations, abdominal distension and a history of anal prolapsed as well as a desire for indigestible things. Symptoms are worse from cold and better from passing flatus.
This a useful remedy where the constipation is associated with travelling. There may be an associated abdominal colic. Stools here are often described as scanty, evacuated with difficulty and being like soft clay that sticks to the rectum. Symptoms are worse from sitting or standing and better from walking.
This has been very useful in cases where atonic constipation has resulted from the overuse of laxatives. The stools here are small, hard and fragmented. There’s often a weakness of digestion and liver congestion apparent here in addition to anal fissuring, rectal prolapse and haemorrhoids. Bowel movements are associated with spasms, and a smarting rectal pain that lingers long after the passing of stools. Symptoms are worse from cold air and better for pressure or rest.
Robert Medhurst is the author of The Concordant Clinical Homeopathic Repertory, which was formed entirely from clinically confirmed remedies.
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