The action of other supplements and related research with significant results are coming into light to manage chronic constipation to the best satisfaction of the victims. However, the use of these supplements greatly varies from individual to individual, different geographical areas, and different food habits in diverse cultures globally.
Other supplements
Senna supplements are stimulant anthraquinone laxatives made from extracts of the leaves and fruits of the plant species Cassia acutifolia and Cassia angustifolio, with the active components being the sennosides. They act on the myenteric plexus of the colon, increasing peristalsis and reducing gut transit time according to the research published by scientist Wilkins and Hardcastle. Until very recently, no placebo Randomized Controlled Studies (RCTs) existed on the effectiveness of Senna supplements in chronic constipation. Evidence for senna’s efficacy was drawn from research conducted over 30 years ago, which compared senna supplements with another active comparator (psyllium; lactulose), and showed senna supplements to be as or even more effective than the active comparators in improving constipation outcomes. However, in all these RCTs, the senna supplements were combined with fibre; therefore, any potential effects cannot be solely attributed to senna. Recently, studies have been published, and both showed that senna supplements led to higher stool frequency and softer stool consistency compared to placebo. However, when these two trials were meta-analysed together, response to treatment, stool frequency, and stool consistency were no longer significant and the effect varies from person to person.
Kiwifruit supplements, administered as freeze-dried powders, contain kiwifruit-derived bioactive components, such as actinidin, polyphenols and fibre. A systematic review involving 135 people with chronic constipation showed that kiwifruit supplements had no impact on stool frequency, stool consistency, straining, use of manual manoeuvres to facilitate defecation, or bloating, but did improve the sense of incomplete evacuation and abdominal pain.
Fruits influence
Several fruits have been investigated for their effectiveness in chronic constipation, including kiwifruits, prunes, mangos, and figs. It showed that fruits resulted in a similar overall response to treatment and gut symptom response, compared to psyllium supplements. They were, however, even more effective than psyllium in increasing stool frequency, although the clinical meaningfulness of these effect sizes is limited. The fact that none of the outcomes assessed favoured psyllium over these fruits potentially indicates that certain fruits may be as effective as psyllium in improving constipation outcomes.
Kiwifruit is the most extensively studied fruit for chronic constipation. Kiwifruits are high in soluble and insoluble fibre, and have been shown to increase butyrate-producing bacteria in a human gastrointestinal model simulating mild constipation. The MRI techniques to identify kiwifruits’ mechanisms of action found that the consumption of four kiwifruits a day led to higher small bowel water retention and increased total colonic volume, compared to an isocaloric control. Kiwifruits also contain actinidin, a proteolytic enzyme, with preliminary evidence suggesting a potential impact on gut motility. A systematic review and meta-analysis identified that consuming 2–3 kiwifruits, consumed without the skin, per day to a psyllium supplement. Kiwifruits were as effective as psyllium supplements in softening stool consistency and reducing frequency of straining, and were more effective than psyllium in increasing stool frequency, suggesting kiwifruits may be an effective management option for constipation.
Prunes (dried plums) are high in fibre, including hemicellulose, pectin, and cellulose, as well as sorbitol. They increase stool weight, but not stool water, indicating that prunes increase stool bulk, rather than stool water per se. A trend in increasing bifidobacteria has also been shown when consuming prunes for 4 weeks. Prunes were as effective as psyllium supplements in softening stool consistency and reducing the severity of straining. A study involving 84 people with chronic constipation showed that prune juice also significantly softened stool consistency, compared with control, but had no impact on stool frequency, flatulence, or sense of incomplete evacuation.
The Kiwifruits may be better tolerated in people with chronic constipation, compared to prunes and psyllium, and may be a more suitable treatment option to those who experience abdominal pain and bloating symptoms. Mango has been investigated in one study only, which compared 300 g/daily mango to a psyllium supplement in 48 people with chronic constipation and showed a significant improvement in softening stool consistency
Fig paste has been investigated in a double-blind study that compared 300 g/d fig paste to a control paste containing sugar and modified starch in 80 people with chronic constipation. Fig paste resulted in significantly softer stool consistency and shorter gut transit time though no impact was found on stool frequency, abdominal pain, sense of incomplete evacuation or effort for evacuation(
Taken together, the evidence suggests certain fruits, particularly kiwifruit and prunes, which have been studied in at least two studies, may be effective in improving specific constipation outcomes.
Flaxseeds
Flaxseeds, a rich source of fibre, have been investigated in chronic primary constipation in an observational study that compared 50 g/day flaxseed flour with meals to a lactulose solution (i.e., active control). Flaxseeds led to higher stool frequency and lower global gut symptoms, compared to control, although the authors acknowledged the effect size being small and, thus, likely not clinically meaningful. Therefore, there is currently a lack of evidence supporting the use of flaxseeds in chronic constipation, which requires further research. Cereal-based foods, dairy foods, and sufficient water have also proved to relieve constipation. Rehabilitation for Chronic Constipation and Integrative Approaches are emerging techniques to effectively treat constipation.
