CONSTIPATION

NORMAL BODILY RHYTHMS VARY from one person to the next, but when bowel movements become less frequent than about three per week, most health practitioners view that as a case of constipation.

REGULAR WAYS TO STAY REGULAR

There are a few easy lifestyle changes that can help make your life more regular.

1. Drink more fluids every day. This means eight to ten tall glasses of liquids such as water, herb tea and juice. Vodka and white wine don't count; any form of alcohol has a dehydrating effect. The same is true of caffeinated beverages. Milk constipates some people.

2. Make meals fibre-rich. Substitute whole wheat for white bread, brown rice for white. Experiment with different grains and beans. Eat lots of fresh fruits and vegetables. Foods particularly good at promoting regularity include figs, prunes, blackberries, bran, almonds and apples. Avoid foods made from low-fibre, highly processed grains, such as packaged breakfast cereals, biscuits and pastries.

3. Monitor your magnesium. This mineral can have a laxative effect. Good food sources of magnesium include nuts, blackstrap molasses, whole grains, soya and seafood. If you do take magnesium supplements, most nutritionists agree that you should balance them with two times as much calcium. Aim for a total daily consumption of 1,000 to 1,200 milligrams of calcium and 300 to 500 milligrams of magnesium, whether you get it from supplements or food.

0. Stay active. Exercise encourages good bowel function. You don't have to run the London Marathon. Gentle exercises such as walking, gardening and yoga can do the trick.

This is particularly true if the stools are dry, hard or otherwise painful to pass.

Constipation usually arises from inadequate fluid and fibre intake, but it can have other causes. Many medications have a constipating effect, including codeine, tranquillisers, sedatives, iron supplements, some ulcer drugs and some drugs used to ease spasms of the intestines, bladder and bronchi (the airways in the lungs). General anaesthesia can slow bowel movements. Constipation can also accompany abdominal conditions such as irritable bowel syndrome and bowel obstruction.

The number and types of laxatives on the market are a testament to just how common the problem of constipation is. Most of these laxatives have few side effects and many use the same ingredients as herbal remedies. The exception, as far as side effects go, is the stimulant laxatives; some herbal alternatives fall into this category. Most herbal laxatives loosen stools by adding bulk to improve bowel function naturally. For them to work, however, they require that you drink plenty of fluids. Otherwise, any bulking agent can further harden stools.

DRUG TREATMENT

Bulking Agents

Bran, malt soup extract, methylcellulose (Celevac), ispaghula husk (Isogel, Regulan), sterculia (Normacol). Function: add fibre to the bowel, which gives stool bulk and makes it easier to pass. Side effects: brief initial bloated feeling.

Stool Softeners

Docusate sodium (Dioctyl, Docusol), arachis oil, liquid paraffin. Function: allow stool to absorb more water, making it easier to pass.

Side effects: rare to none.

Osmotic Agents

Lactulose (Laxose, Osmolax, Regulose), magnesium sulphate (Epsom Salts, Andrew's Liver Salts), others. Function: keep water in the intestines to soften stools. Side effects: rare to none.

Stimulant Laxatives

Aloe (Potter's Cleansing Herb), bisacodyl (Dulco-lax), castor oil,

docusate sodium (Dioctyl, Docusol), phenolphthalein, senna (Manevac, Senokot), others. Function: irritate the intestinal lining to prompt bowel movements. Side effects: cramps, diarrhoea, dependence, salt imbalances.

Enemas

Phosphates (Fleet). Function: empty the bowels. Side effects: may create salt imbalances with habitual use.

HERBAL REMEDIES

Psyllium (Plantago psyllium)

Psyllium seeds and their husks are a great source of natural fibre that's easily obtainable in commercial products. You can also buy powdered seed husks at health food stores and forgo the added sweeteners, dyes, and so on. Some practitioners believe the seed husks may lodge in intestinal pockets and cause irritation, forcing the intestines to contract and expel their contents. Typical dosage: 1 tablespoon dissolved in '/ litre of water or juice. Drink immediately, because the seed husks swell quickly, creating a sludge that's difficult to swallow. Follow immediately with another glass of water.

Flaxseed (Linum usitatissimum)

This bulking agent provides a significant source of omega-3 essential fatty acids, one that is missing from the typical diet. Its benefit for constipation stems from its fibre content. The seeds can be ground and added to cereals or smoothies, or sprinkled directly on foods after cooking. Store the seeds in the freezer, because the oils in flax seeds spoil at even mildly warm temperatures. Typical dosage: 1 teaspoon of ground seeds in '/, litre of water or juice up to three times per day.

Papaya (Papaya carica)

This tropical fruit contains proteolytic enzymes, making it a natural digestive aid. Make a tea of the leaves, or purchase papaya enzymes in chewable tablets or capsules at a natural or health food shop. Typical dosage: take according to manufacturer's directions.

Cascara Sagrada (Rhamnus purshiana)

Compounds in the bark of the cascara sagrada tree are so strong that the bark must be aged before it can be used safely. Cascara sagrada is an ingredient in some over-the­counter laxatives. Typical dosage: up to two 400- to 500-milligram capsules per day; or to 1 teaspoon of liquid extract per day. Caution: do not take if pregnant or breastfeeding. Like all stimulant laxatives, it can cause laxative dependency.

Senna (Senna alexandrina)

Among the strongest of the herbal stimulant laxatives, senna products can be derived from the seed pods or the leaves; the leaves are considered safer to use. Because the compounds in senna are so potent, this herb is best used under the advice of a doctor or other qualified practitioner. Caution: do not use senna if you're pregnant or breastfeeding, or if you're taking heart medications, liquorice root, thiazide diuretics or steroids.

.........................................................................................