There is often a dietary component to this condition e.g., low fluid intake or lack of fibre in the diet. This should be addressed in considering treatment. As has been noted before always consult the appropriate practitioner as severe constipation may be a sign of impaction which requires rapid treatment.
This is a remedy to consider in severe constipation where there is no urging to pass a stool. People who require this remedy are those who hold onto the toilet seat and groan with the effort of trying to force a stool out. The typical symptoms are no desire or ability to pass stool. The rectum is completely inactive and seems paralysed. The patient has to make an enormous effort to pass stool. Even to urinate they have to strain at stool. The stools when passed are hard, knotty and mucous covered. Alumina is a remedy of great dryness and patients requiring it are much worse for dry foods. e.g., starches. This picture can be brought on by the use of aluminium cooking utensils and overuse of aluminium containing indigestion tablets or anti perspirants.
This is another remedy to consider when there is no desire to pass a stool. It is useful in chronic constipation especially associated with headaches. Typical symptoms are no desire or urging, with several attempts before a result. There can be an unsatisfactory stool after much straining, i.e., feeling as if could pass more but cannot. There can be abdominal distension with rumbling yet obstinate constipation. There is a burning pain in rectum lasting for a long time after a stool is passed. The stools when passed are hard, dry, dark as if burnt, and usually large. Bryonia patients are irritable, want to be left alone, and in peace. They are thirsty, as this is another ‘dry’ remedy.
Good for stubborn constipation especially in children. The patient is not bothered by the constipation and indeed can feel better when constipated. The stools when passed can be hard, and light even white like chalk. They can contain undigested material and can be accompanied by a rotten egg smell. Children and babies may have a milk or dairy intolerance and be chubby, sweaty, sour smelling, and be slow to teeth and walk.
Alternating constipation and diarrhoea, even on alternate days. There can be obstinate retention of stool, and irregularity of bowel action generally. There is often a sharp pain as if of glass or a razor blade in rectum, and bleeding can accompany the stool when passed. Patient is generally irritable, hates fuss, wants to be on own, and is aggravated by consolation. They do not want to eat fats and show marked desire or aversion to bread, also salt. They are usually thirsty.
The most notable symptom for constipation with this remedy is the severe splintery sticking pains in the rectum that can last for hours after a stool, (even a soft easily passed stool). The pain feels as if the rectum is tearing. There is great straining for very little result. There are often haemorrhoids (piles) that bleed easily.
Unlike the previous remedies that have very little or no urging or desire to pass a stool, in patients needing this remedy there is constant desire or urging but no results. A small stool may be passed but it feels as if there is more left behind and the evacuation of the bowels is incomplete. (A “never done” feeling.) There can also be tearing pains and patient may feel as if he has piles. There can be bright red bleeding with stool. This remedy is very well indicated in sedentary people or businessmen who indulge in too much rich food and alcohol. They are often extremely irritable. The key to the constipation is irregular peristalsis.
This is the remedy to think of in unconquerable constipation (lasting 6-weeks!) Peristaltic action has completely ceased. There is faecal impaction and this remedy is to be considered for intussusception (also Nux vomica, Plumbum). There can be reverse peristalsis and faecal vomiting. If there is any movement in the right direction the faeces may protrude but then recede back into the rectum. When people requiring this remedy do have a bowel motion the stools are hard round black balls.
Consider for obstinate, habitual constipation especially of older people. The patient cannot strain at stool and cannot expel faeces. There can be impaction of faeces. There is urging and terrible pain from constriction and spasm of the anus. When a stool is passed it is like sheep dung. (Balls of faecal matter in a conglomerate mass.) Physical exertion may help the constipation. There may be radiating abdominal pains. Although mostly indicated for constipation of older people it can be very effective in stubborn constipation with colic of infants.
With this remedy there is a great deal of urging, but the patient cannot expel the stool; it may protrude and slip back (bashful stool). Stools are generally small quantities of hard lumps which are hard to pass. Straining maybe so intense as to make the abdomen sore and causing sweating on the head. The stool maybe so painful when passed that the patient will hold back from passing it because of the pain, which can be sticking and splintery in nature. This remedy to be considered for women who are constipated before and during their period.