Alternative Therapies for Chronic Constipation

ArticleLast Updated August 20152 min read

A common disease in humans, chronic constipation (CC) is categorized as outlet obstruction constipation, slow transit constipation, or both. Outlet obstruction involves impaired relaxation and coordination of abdominal and pelvic floor muscles during evacuation, and slow transit is defined as prolonged stool transit (>3 days) through the colon. Available pharmacologic agents typically consist of bulk or stimulant laxatives; many patients find these to be dissatisfactory because of inconsistent results. Alternative therapies reviewed in this article included acupuncture, herbal medicine, moxibustion, and massage. 

Acupuncture methods include dry acupuncture, electroacupuncture, transcutaneous electroacupuncture, and auricular acupuncture. Dry acupuncture is commonly performed without electrical current on the needles. Electro- and transcutaneous electroacupuncture both use low-level electrical current either on the needles or on electrodes. Several factors influenced the reported efficacy of acupuncture: acupoint group, operative puncture technique, stimulation parameters, and treatment interval. Moxibustion is a traditional Chinese therapy used to stimulate acupoints with burning moxa made from mugwort. The only high-quality study on moxibustion showed no effect on CC. Likewise, although abdominal massage may be appreciated by CC patients, no measurable improvement was reported in several studies. Herbal medicines studied include the laxatives psyllium and Ficus carica as well as traditional Chinese herbal combinations for which there are several high-quality, placebo-controlled trials in the literature. Overall, there is good evidence supporting acupuncture and herbal medicine to treat CC, whereas higher-quality studies are needed for massage and moxibustion.

Points that are easier to access in small animals, such as ST36, are tolerated and useful for treatment of some GI diseases.

Commentary

Acupuncture is a useful treatment for various diseases, but small animal gastrointestinal disease is the most conventionally accepted category by Western veterinarians. There are points to aid in the treatment of nausea and diarrhea and to improve motility in conditions involving ileus or constipation. The commonly used point in this article, ST25, is a more difficult point to use in small animals because of the location on the animal’s undercarriage. It also requires a deep needle insertion for stimulation that may actually involve puncture of the peritoneum and/or direct bowel stimulation by needle contact; the exact mechanism of action at this point is unknown. This style of acupuncture is not practiced in veterinary medicine because of obvious risk of abdominal infection. Points that are easier to access in small animals, such as ST36, are tolerated and useful for treatment of some GI diseases.—Heather Troyer, DVM, DABVP, CVA