9 Misunderstandings About Constipation
Nov 29, 2023
Myth 1: Defecation frequency is the most important indicator for diagnosing functional constipation
Fact: The most common symptom of functional constipation is difficulty in defecation. Defecation frequency is not the most important indicator for diagnosing functional constipation.
Constipation is a symptom (group) characterized by difficulty in defecation and/or reduced defecation frequency, and dry and hard feces. Defecation difficulties include straining to defecate, difficulty in defecation, a feeling of incomplete defecation, anorectal blockage, time-consuming defecation, and the need for manual assisted defecation.
Myth 2: Functional constipation and IBS with constipation (IBS-C) are two different diseases
Fact: Functional constipation and IBS-C are not two completely different diseases, but different manifestations of the same disease spectrum and can be converted into each other.
The Rome IV diagnostic criteria for IBS are recurrent abdominal pain, occurring at least 1 day per week in the past 3 months, accompanied by 2 or more of the following:
①Related to defecation;
The attack is accompanied by changes in defecation frequency;
The attack is accompanied by changes in stool properties.
Symptoms have been present for at least 6 months before diagnosis, and symptoms for the past 3 months must meet diagnostic criteria.
Because functional constipation and IBS have different diagnostic criteria, they are often considered to be two different diseases. Both functional constipation and IBS-C can cause defecation disorder symptoms. Therefore, the Rome IV diagnostic criteria propose that functional constipation and IBS-C are different manifestations of the same disease spectrum.
Myth 3: Colonoscopy is necessary to evaluate functional constipation
Fact: Functional constipation can be diagnosed based on symptoms and a colonoscopy is not necessary to evaluate functional constipation.
The diagnosis of functional constipation is mainly based on symptoms, but it is not a diagnosis of exclusion. For patients with alarm signs, auxiliary examinations should be selected to rule out organic diseases if necessary.
Myth 4: Functional constipation is caused by slow colonic transit
Fact: Functional constipation is divided into four types: slow transit, outlet obstruction, normal transit, and mixed.
Symptomology has a certain reference value for classifying chronic constipation, but a clear diagnosis still requires intestinal motility and anorectal function testing. Relevant studies have shown that fecal properties are related to colon transit time, and the correlation between defecation frequency and colon transit time is still controversial.
Myth 5: Abdominal bloating in functional constipation is caused by constipation
Fact: In addition to constipation, visceral-somatic reflex abnormalities should be of concern in abdominal bloating with functional constipation.
In addition to constipation, volume-mediated viscero-somatic reflex abnormalities can cause abdominal distension. Under normal circumstances, the human diaphragm is in a relaxed state and the abdominal muscles are in a contracted state after eating. If the visceral-somatic reflex is abnormal, the diaphragm contracts and decreases, and the abdominal muscles relax and bulge, causing abdominal distension.
This type of abdominal distension can be treated through electromyography-guided respiratory directional biofeedback, which uses the visual guidance provided by electromyography signals to enable patients to effectively control chest and abdominal muscle activity, thereby improving abdominal distension.
Myth 6: Laxatives are addictive and most functional constipation can be corrected through lifestyle changes
Fact: Lifestyle changes are only effective for a minority of patients. Most patients (especially those with moderate to severe constipation) require aggressive drug treatment. Not all laxatives are addictive.
While moderate physical activity and increased fluid intake can relieve symptoms of constipation, most studies show that lifestyle changes alone are effective in only a minority of patients. In addition, it is necessary to correctly understand laxatives. Not all laxatives lead to dependence. Volumetric laxatives and osmotic laxatives are safe and effective for long-term use. Some patients with chronic constipation require low-dose maintenance treatment.
Myth 7: All dietary fibers are equivalent for constipation
Fact: Constipation patients should choose non-fermented or low-fermented soluble or insoluble fiber. In addition, some fruits can also improve constipation.
The World Health Organization’s definition of dietary fiber: carbohydrates that are not digested and absorbed by the small intestine.
Dietary fiber that can improve constipation includes soluble non-fermentable fiber (such as psyllium) and insoluble low-fermentable fiber (such as wheat bran). In addition, research shows that some fruits such as prunes, kiwis, mangoes, figs, etc. also have laxative effects.
Myth 8: The goal of constipation treatment is to have a bowel movement every day
Fact: Constipation treatment aims not to have a daily bowel movement but to return to pre-constipation baseline bowel movements.
The current clinical trial efficacy endpoint for constipation is patients achieving three complete spontaneous bowel movements per week. Clinicians should understand the patient's previous defecation baseline, and the treatment goal is to restore the baseline. If too much emphasis is placed on daily defecation, the patient's symptoms may be aggravated.
Myth 9: A long colon can cause constipation
Fact: There is no evidence that a long colon is associated with symptoms of constipation.
Clinically, it may be mistakenly believed that a long colon will cause excessive absorption of water in the colon, thus causing constipation. However, in reality, normal values for colon length are not consistent across studies and are highly heterogeneous. Relevant studies have shown that there is no significant difference in colon length between the constipation patient group and the control group, and there is no relevant evidence that colon length is related to constipation symptoms.
Natural Herbal Medicine For Relieving Constipation-Cistanche
Cistanche is a genus of parasitic plants that belongs to the family Orobanchaceae. These plants are known for their medicinal properties and have been used in Traditional Chinese Medicine (TCM) for centuries. Cistanche species are predominantly found in arid and desert regions of China, Mongolia, and other parts of Central Asia. Cistanche plants are characterized by their fleshy, yellowish stems and are highly valued for their potential health benefits. In TCM, Cistanche is believed to have tonic properties and is commonly used to nourish the kidney, enhance vitality, and support sexual function. It is also used to address issues related to aging, fatigue, and overall well-being. While Cistanche has a long history of use in traditional medicine, scientific research on its efficacy and safety is ongoing and limited. However, it is known to contain various bioactive compounds such as phenylethanoid glycosides, iridoids, lignans, and polysaccharides, which may contribute to its medicinal effects.
Wecistanche's cistanche powder, cistanche tablets, cistanche capsules, and other products are developed using desert cistanche as raw materials, all of which have a good effect on relieving constipation. The specific mechanism is as follows: Cistanche is believed to have potential benefits for relieving constipation based on its traditional use and certain compounds it contains. While scientific research specifically on Cistanche's effect on constipation is limited, it is thought to have multiple mechanisms that may contribute to its potential to relieve constipation. Laxative Effect: Cistanche has long been used in Traditional Chinese Medicine as a remedy for constipation. It is believed to have a mild laxative effect, which can help promote bowel movements and induce constipation. This effect may be attributed to various compounds found in Cistanche, such as phenylethanoid glycosides and polysaccharides. Moistening the Intestines: Based on traditional use, Cistanche is considered to have moisturizing properties, specifically targeting the Intestines. Promoting hydration and lubrication of the Intestines may help soften tools and facilitate easier passage, thereby relieving constipation. Anti-inflammatory Effect: Constipation can sometimes be associated with inflammation in the digestive tract. Cistanche contains certain compounds, including phenylethanoid glycosides and lignans, that are believed to have anti-inflammatory properties. By reducing inflammation in the intestines, it may help improve bowel movement regularity and relieve constipation.
