Severe Constipation, Decreased Bowel Motility and Hyponatremia. Health, Medical, Prescriptions and Natural Remedies.
(This article is written in response to a question asked in another of my articles, "Food and Natural Remedies that Help Relieve Constipation".)
This is the question:
"Is There Any Treatment For Chronic Constipation That Is Unrelieved By Laxatives?
I have suffered with constipation since I was a child. I drink plenty of fluid, in fact, I was drinking so much water that I developed hyponatremia. I am a vegetarian and eat lots of fresh fruits and vegetables. I did have a colonoscopy and was diagnosed with " severe decreased bowel motility". At the time, the doctor ordered cholchicine to cause diarrhea. I never tried it, I was fearful of the side effects. Are there any new medications or treatment options. This is a horrible way to live. Thank you."
The following is my response:
First, what is Hyponatremia? Hyponatremia is a condition in which the body has an electrolyte disturbance causing severely low levels of sodium in the body's natural fluids, especially in comparison to the amounts of fluid consumed. The result of which is that the body fails to eliminate excess fluid.
There may be many different causes for Hyponatremia, including drinking an excess of water (such as if one suffers from Polydipsia, often as a result of diabetes) as well as other underling medical conditions, including but not limited to different forms of cancer, congestive heart failure and hormonal imbalances such as SIADH.
Symptoms of Hyponatremia may include nausea, severe weakness, muscle cramps, memory loss, irritability, confusion, fainting, seizures, coma and in severe cases, death. Those who are most likely to get Hyponatremia often include athletes, especially long distance and marathon runners, who may be drinking too much water without replacing the lost sodium. (1) The elderly and those who are mentally ill might also suffer from the disease as they may be unable to adequately understand and respond to their thirst. The common misconception that people should drink at least ten glasses of water a day may also play a role, as this is often unsafe for many people.
There are three primary ways in which Hyponatremia is caused:
- Hypervolemic Hyponatremia - Often the result of heart, kidney or liver failure, this occurs when excess water dilutes the amount of sodium concentration.
- Hypovolemic Hyponatremia - This is when both water and sodium levels are low. Athletes are more in danger of Hypovolemic Hyponatremia if they may drink more water without replacing sodium or other electrolytes.
- Euvolemic Hyponatremia - This occurs when fluid levels are normal but it is combined with abnormally low levels of sodium. This is often the result of certain medications, cancer or chronic illnesses.
In Chronic hyponatremia, sodium levels tend to decrease gradually over several days or weeks. Symptoms of Chronic hyponatremia tend to be mild or moderate, sometimes with few if any symptoms.
With Acute hyponatremia, sodium levels drop suddenly and can lead to coma and death.
Treatment for Hyponatremia may be as simple as cutting down on water intake, especially if no other underlying medical conditions are discovered. For others, switching to healthy sports drinks (including but not limited to coconut water) can be beneficial as these will contain electrolytes, thus helping to maintain a balance between fluids and sodium. Certain pharmaceuticals, such as Vasopressin Receptor Antagonists, may also be used, especially if the patient has congestive heart failure or cirrhosis of the liver. In addition, these have also been shown to help the regulation of plasma osmolarity and blood pressure. Studies showing the effects of Vasopressin-Receptor Antagonists on heart patients have been positive.
Decreased Bowel Motility is another, fancier term for severe constipation. It is defined as having fewer than one bowel movement per week. Contrary to what many believe, there is absolutely no evidence that toxins accumulate in the colons of those who are chronically constipated, nor does this increase the risk of cancer.
That being said, constipation (especially severe constipation) can cause extreme discomfort, including discomfort during sex. It can also lead to bloating, hemorrhoids and be a miserable symptom of Irritable Bowel Syndrome (IBS). Some people alternate between episodes of constipation and diarrhea. In addition, it may lead to a bowel obstruction. It is imperative to determine if the severe constipation is part of an ongoing chronic problem or a sudden, acute condition. In the case of the latter, it is important to see a doctor immediately as it could be due to a serious illness, such as a tumor in the colon or certain cancers.
Severe constipation can be caused by many factors: These include but are not limited to hormonal imbalances, hypothyroidism, dehydration, lack of fiber, lack of exercise, certain medications as well as the problems listed above. Often a simple increase in physical activity can ease constipation, such as increased walking and less sitting. Diets which include more fiber, including whole grain breads and fiber supplements may also be beneficial, as can taking more magnesium. It is important to remember that small lifestyle changes, such as allowing more time to walk/climb stairs and eat a healthier diet can make a huge difference in relieving constipation.
*** Answering the Question *** (This is a direct response to the reader though it offers some important advice for anyone who is in a similar situation).
I am going to be blunt. Your doctor prescribed Colchicine for a reason. It sounds as though you were doing the usual, healthy things to relieve your severe constipation and it did not work. In your case, you even ended up with Hyponatremia, I'm assuming because you were making yourself to drink more water in order to help force a bowel movement. As I stated above, Hyponatremia can be serious and even fatal. This is not something you want to take lightly. Something in your body is not working as it should and your doctor is trying to help. Yes, Colchicine does have certain side effects. Drinking too much water also has side effects, as you have learned, as do many "natural remedies".
Most of the side effects for Colchicine are rather mild, including some gastrointestinal upset, anemia and possibly neutropenia, which is a decrease in a certain type of white blood cell. The severity of the neutropenia is in direct correlation to the possibility of infection, including severe infection. Still, most people on Colchicine do not have these side effects. Most of the more severe problems with Colchicine is due to an overdose of the drug. It would be beneficial to have routine blood work done in order to make certain that you are not having these problems.
Colchicine is a "toxic natural product" derived from plants, so it should most certainly be taken with caution and under the supervision of a doctor. This is not something I say lightly. Still, it is also being investigated as an anti-cancer drug. I doubt your doctor would have recommended this if other options were working for you. It might also benefit you to look into taking milk thistle in order to better assist your liver function and eliminate toxins from your body.
Regarding Prune Juice: For most people, prune juice is an excellent natural way to relieve constipation. In addition, it is loaded with antioxidants and is an excellent source of potassium, which is often used in addition to other treatments for managing Hyponatremia. For those people who are not eating enough fruits and vegetables, prune juice can be an excellent choice for adding these nutrients to the diet. However, it has been shown to be ineffective (less effective than saline laxatives) for helping those with severe constipation.
In addition, larger amounts of prune juice can cause electrolyte imbalances and even kidney problems. This is the last thing you would want if you are already having problems with Hyponatremia. You might also want to ask yourself what you think prune juice will do for you that all of the other fruits and vegetables which you are eating are not doing for you.
Again, you are saying that you have a healthy diet and are still constipated. Clearly,a dietary change of adding another fruit or fruit juice to your diet is not going to work magic. As you have had the problems with Hyponatremia, I would not recommend prune juice for you as it may make this condition worse. In other words, take that advice with a grain of salt - literally in your case.
On a final note: Anyone who is familiar with my writing understands that I am a strong advocate for natural health and natural remedies. I have had severe side effects from some medications. I strive to stay abreast of the latest Commission E findings. However, I am not an MD, nor are any of your other respondents of which I am aware.
By all means, get a second opinion, especially from a Gastroenterologist as they specialize in the problems which you are having. If you are hearing the same advice and being prescribed the same medications, please listen. One thing which I cannot stress enough is that you should voice any concerns you have to your doctor. He/she may be able to prescribe a different medication or better explain why your medication was chosen. Your doctors are not in the business to cause you harm. If natural diets and remedies were working for you, you would not have had the problems of which you write.
(1) Anatomica, the Complete Medical Reference. Albertine, Kurt H. P 376
All sources are referenced or linked to above.