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Johns Hopkins Health Alert

What Works for Chronic Constipation

According to the American College of Gastroenterology, Americans make at least 2.5 million visits to the doctor for constipation each year. Because constipation is so ubiquitous and has been noted since ancient times, there are many widely held beliefs and myths about its treatments and consequences -- beliefs that have persisted, despite the absence of medical evidence to prove they are true.

In an article published in the American Journal of Gastroenterology, digestive disease experts reviewed these long-held beliefs and revealed the current evidence for and against them.

They note that there is no data to show that when stools remain in the body for a long time, which occurs when you’re constipated, that they poison the colon. Likewise, there’s no evidence to prove that cleansing the colon regularly can reverse the symptoms. (For a discussion of colon cleansing, see the article: Colonics: How Risky Are They?)

The reviewers also state that although increasing fiber intake undoubtedly makes stools bulkier and easier to pass, and increases the frequency of bowel movements, the role of fiber in the treatment of constipation has been exaggerated. Indeed, there are no studies to show that a lack of dietary fiber is responsible for chronic constipation. And too much fiber may actually make symptoms worse for some people with constipation.

Likewise, it’s been suggested that a low intake of fluids may lead to constipation, and that drinking more fluids may soften and enlarge hard, small stools, making them easier to expel. But there’s no scientific evidence for this either, and it appears that increasing fluid intake won’t help constipation unless you’re severely dehydrated.

One idea that does hold scientific weight is the link between physical activity and constipation. In elderly and sedentary people, increasing exercise may relieve some of the symptoms of mild constipation. Still, it is unlikely that stepping up activity will have much effect on severe cases of constipation.

Finally, the reviewers note that a number of misconceptions exist about the use of laxatives to relieve constipation. Urban legend says that you can get addicted to laxatives and that frequent use increases the risk of colorectal cancer and nerve damage, but the data show otherwise. When used at recommended doses, laxatives are safe and nonaddicting. Still, if you need to take laxatives for more than a week at a time, you should see your doctor for further advice.

Posted in Digestive Health on November 16, 2009

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Health Alerts registered users may post comments and share experiences here at their own discretion. We regret that questions on individual health concerns to the Johns Hopkins editors cannot be answered in this space.

The views expressed here do not constitute medical advice, and do not represent the position of Johns Hopkins Medicine or MediZine LLC, which has no responsibility for any comments posted on this site.


This is in responce to the article on chronic constipation. I just don't understand why more doctors don't recommend Metamucil. I suffered from chronic constipation for 30 years. When I started taking Metamucil every night, my life changed. No constipation and no more problem with hemmoroids. It seems like a no-brainer.

Posted by: jveney | November 21, 2009

As the article states, Metamucil does not work for everyone and can cause more pain. I myself, tried this product two times and both times it caused unbearable added pain and bloating. It was suggested that I try stool softeners (otc) and prune juice. To my happiness, they both helped me dramatically, I hope this helps someone else.

Posted by: Laurie2429 | November 23, 2009

Why do you publish such an article without comment? Extract: Colon cleansing - no supporting evidence. Fiber - no supporting evidence; may make it worse. Fluid intake - no evidence. Exercise - no evidence. Laxatives can be helpful but don't take one for more than a week.

This urgently needs a summary, and it's missing. If you have chronic constipation, cleansing, fiber, and fluids can't be relied on. Laxatives are helpful. (There are three or four kinds. Which are better? Which are worse?) Laxatives shouldn't be taken for more than a week without talking to your doctor.

THIS ARTICLE IS SUB-STANDARD. IT DAMAGES YOUR REPUTATION.

Posted by: JohnPA | November 23, 2009

I heartily agree that this article is sub-standard.

It suggests that very little can be done to effectively ease constipation, and that is absolute nonsense.

1) Stop eating cheese (which absorbs fluid from the intestinal tract). 2) Increase fiber intake. 3) Increase fluid intake.

That will probably cure 99% of the cases.

Exercise helps as well, but not as much as the first three.

Posted by: wpelton | December 5, 2009



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