A Narrative Review on the Natural Remedies Used in the Prevention and Symptomatic Treatment of Constipation in the Middle East
AbstractConstipation is a common issue in developed and developing countries. On account of the multifactorial nature of this bowel problem, it has been indicated that current conventional treatments have limited efficacy and a higher incidence of side effects. This article aims to review various natural remedies that have proved to be effective in the prevention and/or treatment of constipation and is an attempt to provide a framework for a better understanding of the pharmacology of these herbs. Treatments were identified from electronic databases such as ISI Web of Knowledge, PubMed, and Scopus. Out of 103 studies found via electronic search, 49 studies fulfilled the eligibility criteria and were included in this review. Anthraquinone, saponin, and fiber-rich plants may increase the frequency of defecation through their bulking and/or stimulant laxative effects. The intake of some herbs or their isolated purgative active constituents can be useful in constipated patients. However, if the patient has tried natural remedies for more than three days without success, it is preferred to refer to a physician to know the underlying cause of constipation.
Jani B, Marsicano E. Constipation: Evaluation and Management. Mo Med. 2018;115(3):236–40.
Forootan M, Bagheri N, Darvishi M. Chronic constipation: A review of literature. Medicine (Baltimore). 2018;97(20):e10631.
Andrews CN, Storr M. The pathophysiology of chronic constipation. Can J Gastroenterol J Can Gastroenterol. 2011;25 Suppl B:16B-21B.
Müller-Lissner S. The pathophysiology, diagnosis, and treatment of constipation. Dtsch Arzteblatt Int. 2009;106(25):424–31.
Bassotti G, Villanacci V, Creţoiu D, Creţoiu SM, Becheanu G. Cellular and molecular basis of chronic constipation: taking the functional/idiopathic label out. World J Gastroenterol. 2013;19(26):4099–105.
Palit S, Lunniss PJ, Scott SM. The Physiology of Human Defecation. Dig Dis Sci. 2012;57(6):1445–64.
Takano M, Sumikoshi Y, Hiratsuka J, Sato S, Okada M. [Various phases of defecation disorders in anal diseases]. Nihon Daicho Komonbyo Gakkai Zasshi. 1972;25(2):104–5.
Naseer M, Poola S, Uraz S, Tahan V. Therapeutic Effects of Prebiotics on Constipation: A Schematic Review. Curr Clin Pharmacol. 2020;15(3):207–15.
Bashir A, Sizar O. Laxatives. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021.
Liu LWC. Chronic constipation: current treatment options. Can J Gastroenterol J Can Gastroenterol. 2011;25 Suppl B:22B-28B.
Ramos CI, Andrade de Lima AF, Grilli DG, Cuppari L. The Short-Term Effects of Olive Oil and Flaxseed Oil for the Treatment of Constipation in Hemodialysis Patients. J Ren Nutr. 2015;25(1):50–6.
Iizuka N, Hamamoto Y. Constipation and herbal medicine. Front Pharmacol. 2015;6:73.
Lever E, Scott SM, Louis P, Emery PW, Whelan K. The effect of prunes on stool output, gut transit time and gastrointestinal microbiota: A randomised controlled trial. Clin Nutr Edinb Scotl. 2019;38(1):165–73.
Wang X, Yin J. Complementary and Alternative Therapies for Chronic Constipation. Evid-Based Complement Altern Med ECAM. 2015;2015:396396.
Weber TK, Toporovski MS, Tahan S, Neufeld CB, de Morais MB. Dietary fiber mixture in pediatric patients with controlled chronic constipation. J Pediatr Gastroenterol Nutr. 2014;58(3):297–302.
Stacewicz-Sapuntzakis M, Bowen PE, Hussain EA, Damayanti-Wood BI, Farnsworth NR. Chemical composition and potential health effects of prunes: a functional food? Crit Rev Food Sci Nutr. 2001;41(4):251–86.
Oh H-G, Lee H-Y, Seo M-Y, Kang Y-R, Kim J-H, Park J-W, et al. Effects of Ficus carica paste on constipation induced by a high-protein feed and movement restriction in beagles. Lab Anim Res. 2011;27(4):275–81.
Mehmood MH, Rehman A, Rehman N-U, Gilani A-H. Studies on prokinetic, laxative and spasmodic activities of Phyllanthus emblica in experimental animals. Phytother Res PTR. 2013;27(7):1054–60.
Noureddin S, Mohsen J, Payman A. Effects of psyllium vs. placebo on constipation, weight, glycemia, and lipids: A randomized trial in patients with type 2 diabetes and chronic constipation. Complement Ther Med. 2018 Oct;40:1–7.
Kajla P, Sharma A, Sood DR. Flaxseed-a potential functional food source. J Food Sci Technol. 2015;52(4):1857–71.
Surjushe A, Vasani R, Saple DG. Aloe vera: a short review. Indian J Dermatol. 2008;53(4):163–6.
Cirillo C, Capasso R. Constipation and Botanical Medicines: An Overview: Constipation and Botanical Medicines. Phytother Res. 2015;29(10):1488–93.
Scott SM, Knowles CH. Constipation: Dried plums (prunes) for the treatment of constipation. Nat Rev Gastroenterol Hepatol. 2011;8(6):306–7.
Lever E, Cole J, Scott SM, Emery PW, Whelan K. Systematic review: the effect of prunes on gastrointestinal function. Aliment Pharmacol Ther. 2014;40(7):750–8.
Gill SK, Lever E, Emery PW, Whelan K. Nutrient, fibre, sorbitol and chlorogenic acid content of prunes (Prunus domestica): an updated analysis and comparison of different countries of origin and database values. Int J Food Sci Nutr. 2019;70(8):924–31.
Stacewicz-Sapuntzakis M. Dried plums and their products: composition and health effects--an updated review. Crit Rev Food Sci Nutr. 2013;53(12):1277–302.
Bouchoucha M, Faye A, Savarieau B, Arsac M. Effect of an oral bulking agent and a rectal laxative administered alone or in combination for the treatment of constipation. Gastroenterol Clin Biol. 2004;28(5):438–43.
Odes HS, Madar Z. A double-blind trial of a celandin, aloevera and psyllium laxative preparation in adult patients with constipation. Digestion. 1991;49(2):65–71.
McRorie JW, Daggy BP, Morel JG, Diersing PS, Miner PB, Robinson M. Psyllium is superior to docusate sodium for treatment of chronic constipation. Aliment Pharmacol Ther. 1998;12(5):491–7.
Ashraf W, Park F, Lof J, Quigley EM. Effects of psyllium therapy on stool characteristics, colon transit and anorectal function in chronic idiopathic constipation. Aliment Pharmacol Ther. 1995;9(6):639–47.
Sun J, Bai H, Ma J, Zhang R, Xie H, Zhang Y, et al. Effects of flaxseed supplementation on functional constipation and quality of life in a Chinese population: A randomized trial. Asia Pac J Clin Nutr. 2020;29(1):61–7.
Hanif Palla A, Gilani A-H. Dual effectiveness of Flaxseed in constipation and diarrhea: Possible mechanism. J Ethnopharmacol. 2015;169:60–8.
Dahl WJ, Lockert EA, Cammer AL, Whiting SJ. Effects of flax fiber on laxation and glycemic response in healthy volunteers. J Med Food. 2005;8(4):508–11.
Xu J, Zhou X, Chen C, Deng Q, Huang Q, Yang J, et al. Laxative effects of partially defatted flaxseed meal on normal and experimental constipated mice. BMC Complement Altern Med. 2012;12:14.
Baek H-I, Ha K-C, Kim H-M, Choi E-K, Park E-O, Park B-H, et al. Randomized, double-blind, placebo-controlled trial of Ficus carica paste for the management of functional constipation. Asia Pac J Clin Nutr. 2016;25(3):487–96.
Lee H-Y, Kim J-H, Jeung H-W, Lee C-U, Kim D-S, Li B, et al. Effects of Ficus carica paste on loperamide-induced constipation in rats. Food Chem Toxicol Int J Publ Br Ind Biol Res Assoc. 2012;50(3–4):895–902.
Badgujar SB, Patel VV, Bandivdekar AH, Mahajan RT. Traditional uses, phytochemistry and pharmacology of Ficus carica: a review. Pharm Biol. 2014;52(11):1487–503.
de Witte P. Metabolism and pharmacokinetics of anthranoids. Pharmacology. 1993 Oct;47 Suppl 1:86–97.
Ishii Y, Tanizawa H, Takino Y. Studies of aloe. V. Mechanism of cathartic effect. (4). Biol Pharm Bull. 1994;17(5):651–3.
Leung L, Riutta T, Kotecha J, Rosser W. Chronic constipation: an evidence-based review. J Am Board Fam Med JABFM. 2011;24(4):436–51.
Cao Y-J, Pu Z-J, Tang Y-P, Shen J, Chen Y-Y, Kang A, et al. Advances in bio-active constituents, pharmacology and clinical applications of rhubarb. Chin. 2017;12:36.
Chen J-Q, Li D-W, Chen Y-Y, Tao H-J, Pu Z-J, Zhang J, et al. Elucidating dosage-effect relationship of different efficacy of rhubarb in constipation model rats by factor analysis. J Ethnopharmacol. 2019;238:111868.
Gao C-C, Li G-W, Wang T-T, Gao L, Wang F-F, Shang H-W, et al. Rhubarb extract relieves constipation by stimulating mucus production in the colon and altering the intestinal flora. Biomed Pharmacother Biomedecine Pharmacother. 2021;138:111479.
Gong X-H, Li Y, Zhang R-Q, Xie X-F, Peng C, Li Y-X. The synergism mechanism of Rhubarb Anthraquinones on constipation elucidated by comparative pharmacokinetics of Rhubarb extract between normal and diseased rats. Eur J Drug Metab Pharmacokinet. 2015;40(4):379–88.
Peterson CT, Denniston K, Chopra D. Therapeutic Uses of Triphala in Ayurvedic Medicine. J Altern Complement Med N Y N. 2017;23(8):607–14.
Gantait S, Mahanta M, Bera S, Verma SK. Advances in biotechnology of Emblica officinalis Gaertn. syn. Phyllanthus emblica L.: a nutraceuticals-rich fruit tree with multifaceted ethnomedicinal uses. 3 Biotech. 2021;11(2):62.
Baliga MS, Dsouza JJ. Amla (Emblica officinalis Gaertn), a wonder berry in the treatment and prevention of cancer. Eur J Cancer Prev Off J Eur Cancer Prev Organ ECP. 2011;20(3):225–39.
Stott C, Graaf L, Morgan P, Kittscha J, Fairbrother G. Randomized controlled trial of laxative use in postcolostomy surgery patients. J Wound Ostomy Cont Nurs Off Publ Wound Ostomy Cont Nurses Soc. 2012;39(5):524–8.
Motaharifard MS, Jafari Z, Paknejad MS, Oveidzadeh L, Karimi M. Prevention and treatment of constipation in children from the perspective of Iranian traditional medicine. J Integr Med. 2016;14(6):429–35.
Submission of a manuscript implies: that the work described has not been published before; that it is not under consideration for publication anywhere else; that its publication has been approved by all co-authors, if any, as well as by the responsible authorities – tacitly or explicitly – at the institute where the work has been carried out. The publisher will not be held legally responsible should there be any claims for compensation. Authors wishing to include figures, tables, or text passages that have already been published elsewhere are required to obtain permission from the copyright owner(s) for both the print and online format and to include evidence that such permission has been granted when submitting their papers. Any material received without such evidence will be assumed to originate from the authors.
This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge. This work is licensed under a Creative Commons license (CC-BY). However, the license permits any user to read, copy, redistribute and and make derivative the material in any medium or format for any purpose, even commercially.