American Journal of Gastroenterology

January 04, 2005 04:00 ET

Review Identifies Misconceptions about Constipation and Its Treatment Showing Popular Beliefs Are Not Based on Evidence



JANUARY 4, 2005 - 04:00 ET

Review Identifies Misconceptions about Constipation
and Its Treatment Showing Popular Beliefs Are Not
Based on Evidence

BERLIN, Germany--(CCNMatthews - Jan 4, 2005) -

Independent Review of Available Evidence for Popular Beliefs on
Constipation Published Today

Results from an extensive, independent review into existing evidence on
chronic constipation and the treatment thereof are published today in
the American Journal of Gastroenterology showing that many of the
popular and strongly held beliefs surrounding this disorder are not
evidence based.

The review was undertaken by four leading experts, from Europe and the
US, in the field of gastroenterology and the results of their findings
are presented in the 'Myths and Misconceptions About Chronic
Constipation' paper. The purpose of the review, conducted over a
five-month period, was to examine all documentation and available
evidence of widely held beliefs, some of which originate even from the
16th century B.C., concerning various aspects of constipation and the
quality of evidence used to support these beliefs. These concepts
encompass pathophysiology and treatment of constipation, all of which
are widely held in both the medical and lay communities.

Professor Muller-Lissner, Germany, lead author of the paper on behalf of
his co-authors, Professors Wald, US, Kamm, UK and Scarpignato, Italy
comments, "We are delighted to be able to present these findings to both
the medical community and more importantly to constipation sufferers who
have been misled into thinking that they are the major cause of, and
especially to blame for, the symptoms of this sensitive disorder. We
hope that in publishing this paper, we can move medical thinking forward
to accept the realities of this condition and accordingly recommend
appropriate treatments rather than exacerbate symptoms and sufferers'
fears by providing mis-information."

Key findings reported in the paper are as follows:

Lack of dietary fibre has often been championed as a cause of
constipation, with fibre supplements being readily recommended to help
relieve symptoms. The authors conclusively agree that a diet poor in
fibre should not be assumed to be the cause of chronic constipation. In
fact, they found that while several groups of patients may be helped by
a fibre-rich diet, those with severe constipation actually develop
worsening symptoms when increasing dietary fibre intake.

Increase in fluid intake is also a long-held myth associated with
providing relief from constipation and again the paper found no evidence
to support this claim. The authors believe this misconception is derived
from observations that comparatively small changes to the water content
of stools lead to considerable changes of consistency which are thought
to be related to the total water intake. However, these small changes
are insignificant in comparison to the total amount of fluid exchanges
taking place in the intestinal tract. Various studies examining
variances in fluid intake in both healthy subjects and those who were
constipated concluded that there is no evidence that constipation can be
successfully treated by increasing fluid intake, unless there is
evidence of dehydration.

Reduction in physical activity has been linked to increased symptoms of
constipation and the paper concludes that it is indeed relevant in
elderly sufferers. However, these findings need to be put in context
with other likely cofactors, such as medications, diet and personality.
Intervention programmes to increase physical activity may help to
improve symptoms, but these are less effective in young, severely
constipated sufferers.

Much unfounded controversy has been generated over the years regarding
laxative-use in treating constipation, resulting in unnecessary fears
relating to proactive use/recommendation by both consumers and
healthcare professionals. The paper discusses these misconceptions:

-- Damage to the colon: Claims that laxatives cause damage to the colon
are not supported and the findings highlight that these claims have been
based on poorly documented experiments

-- Colorectal cancer: There are no data to support the claim that
stimulant laxatives are an independent risk factor

-- Electrolyte disturbance: Any theoretically possible electrolyte
disturbance by stimulant laxative use can be minimised with appropriate
drug and dose selection

-- Tolerance to stimulant laxatives: Tolerance is shown to be uncommon
in the majority of users and found to occur only in the most severe
patient group

-- Rebound constipation: There is no evidence for the occurrence of
rebound constipation after stopping laxatives

-- Addiction: There is no potential for addiction to laxatives,
although they may be misused by psychiatric patients

In conclusion, the paper recognises that the use of stimulant laxatives
in the management of constipation symptoms is safe.

Sex hormones are also incorrectly believed to play a key role in causing
constipation. This is based on the observation that constipation is more
common in boys but between the ages of 15-50 it is more prevalent in
women. Furthermore, women also report changes in bowel function during
different stages in their menstrual cycles. Having reviewed the
evidence, the paper found that sex hormones only play a minimal role in
otherwise healthy women, although they may play a role during pregnancy
when the changes in hormone levels are much greater.

The paper also concluded that there is no evidence to support the
outdated notions of:

-- Autointoxication, an ill-conceived theory that has been long-since
abandoned by the scientific community should have no place in clinical
practice today.

-- Dolichocolon, a term used for an elongated colon, has been
implicated in the past as a cause of constipation but was shown to lack
any supportive evidence.

Notes to Editors

For further information please visit the American Journal of
Gastroenterology website, or contact:

Prof. Stefan Muller-Lissner Prof. Michael Kamm
Park-Klinik Weissensee St Mark's Hospital
Humboldt University Watford Road
Schoenstrasse 80 Harrow
13086 Berlin HA1 3UJ
Germany United Kingdom
Tel: +49 30 9628 3600 Tel: +44 20 8235 4160
Mail: Mail:

Prof. Carmelo Scarpignato Prof. Arnold Wald
School of Medicine & Dentistry University of Pittsburgh
University of Parma Division of Gastroenterology
Via Volturno 39 Mezz Level, C Wing, PUH
43100 Parma 200 Lothrop Street
Italy Pittsburgh, PA 15213
Tel +39 0521 903863 USA
Mail: Tel: +1 412 648 9115


1. Muller-Lissner SA, Kamm MA, Scarpignato C, Wald A. Myths and
Misconceptions About Chronic Constipation. American Journal of
Gastroenterology 2005;


Contact Information

    Prof. Stefan Muller-Lissner
    Humboldt University, Berlin
    Tel: +49 30 9628 3600
    Prof. Michael Kamm
    St Mark's Hospital, Harrow
    Tel: +44 20 8235 4160
    Prof. Carmelo Scarpignato
    School of Medicine & Dentistry
    University of Parma
    Tel +39 0521 903863
    Prof. Arnold Wald
    University of Pittsburgh
    Division of Gastroenterology
    Tel: +1 412 648 9115