A systematic review by Lever E, et al determined that after reviewing a number of trials, the number of stools per week and consistency of the stool were increased by prunes more than psyllium fiber. (14)
Senna and Constipation:
Senna (Cassia senna) is an herb that contains compounds that act as an effective laxative. Senn is a common choice as one of the natural remedies for constipation. This herbal agent is approved for laxative use in adults to treat constipation. This herb has a powerful effect on the digestive system and patients should not drink senna tea or take supplements containing senna long-term because this agent may result in dependence. Senna may also reduce the absorption of drugs (Fugh).
A Safe Laxative in Post-partum Women:
The use of senna tablets immediately after giving birth resulted in treatment of constipation in over 90% of women of different races. Corresponding results for women on placebo were 51% and 59%. Side effects included minor stomach cramps in 13% of women taking senna and 4% in placebo. Senna was not reported to affect breast-feeding. (5)
A Comparison of Senna to Miralax:
Prior to a colonoscopy, thirty study subjects aged 6-21 years old were randomized in two groups: Group 1 received 1.5 g/kg of Miralax orally the day before procedure and one day of clear liquid diet, while subjects in Group 2 received two doses of senna (15 mL daily [ages 6-12] or 30 mL daily [ages 12-21]) the day before procedure with two days of liquid diet (one day full liquid and one day clear liquid diet). Of the patients taking Miralax, 88% received an excellent/good score on the Aronchick scale which measures the quality of bowel preparations with a standardized cleanliness measure. Only 29% taking the senna preparation scored as well. Therefore, the authors concluded Miralax is an effective colonoscopy preparation while senna is not. Laboratory tests did not different between groups. (6)
Caution on Chronic Use of Senna:
According to van Gorkom BA et al, chronic use of sennoside laxatives has been known to cause increased pigmentation termed pseudomelanosis coli. This author stated that this condition may increase the risk of colorectal cancer by causing an initial large amount cell death within the colon and decrease the length of colon crypts after a large dose of senna. This resulted in increased cell growth and reduction of apoptosis to restore the cells of the colon. This finding was noted by the author to explain possible mechanisms for risk of colon cancer with long term use of senna. (4) The same author also revealed research linking a possible relationship of senna to inducing colorectal cancer in lab and animal studies. (van Gorkom).
Most Commonly Recommended Treatment for Constipation:
Miralax for constipation: The most commonly recommended treatment for constipation is Polyethylene Glycol 3350, (Miralax brand) available over the counter which is an effective treatment for constipation without urgency, cramping, bloating and gas. It does not work by stimulation of bowel movements, but instead draws water into the colon to soften stool and produce evacuation in a comfortable manner. For further information, see: http://www.miralax.com/miralax/why-miralax/how-miralax-works.jspa .(10)
Polyethylene Glycol (Miralax and Go-Lytely) vs Senna:
Polyethylene Glycol (Miralax and GoLytely brands) have also been used routinely for many years to prepare patients for colonoscopy and has not been noted to result in severe adverse effects. Also, senna may not be as effective as Miralax but this may be dose dependent (6).
Fruit Used for Constipation in Irritable Bowel Syndrome (IBS):
IBS is a disorder in bowel movement that causes pain, cramping, gassiness, sudden bouts of diarrhea, and constipation. A study of 54 patients with IBS and 16 healthy volunteers found that IBS suffers who ate 2 kiwi fruit a day for 4weeks had less constipation and a general lessening of symptoms than those who didn’t. All participants were on treatment except 13 patients with IBS who were given dummy capsules for comparison. Results showed that IBS patients with constipation had better and more frequent bowel movement after consuming kiwifruits for four weeks. Results from colon transit time also revealed that patients who consumed kiwifruit had shorter colon transit time meaning lesser stagnation and better bowel movements. (9)
Laxatives and Weight Loss
The rate of obesity in the United States is at an all time high. People are searching for a magic pill to make the process of weight loss simple, easy and painless. Unfortunately there is no magic pill. Weight goes ‘on’ the same way it comes off. If more calories are consumed than are expended, weight will occur. If less is eaten than is burned, weight is lost.