The term constipation is used to describe the slow movement of unduly firm contents through the
large bowel leading to infrequent passing of small hard stools. Thus "constipation" may indicate
several different signs among which are:

• bowel movements which do not occur daily


• dry stools


• difficult defaecation


• abnormal shape of stools.

Views on what constitutes constipation vary widely. It is not infrequent to hear doctors saying,
quite wrongly, that it does not matter if one has a bowel movement only twice a week. On the
other hand, some naturopaths believe that it is normal and desirable to have up to four bowel
movements a day.

The quantity of stools passed varies from culture to culture. In rural Africa about 400-500 g of
stools are passed by an adult. In contrast, in Western countries an adult passes about 80-120 g of
stools a day.1(407) Similarly, the transit time of the stools in the bowel averages 1.5 days in rural
Africa and 3 days in Western countries. Interestingly, constipation has affected Western societies
for a long time. Jonathan Swift (the author of "Gulliver's Travels") wrote a book entitled "Human
Ordure" describing various types of stools he had observed in Dublin in 1733. He said: "The fifth
type [of stools] are those voided in small, firm, round Balls, Buttons or Bullets ... I have
observed these [types] to flourish mostly about Colleges, Schools and most places of publik
Education."2(408) His description fits perfectly the type of stools passed by those who suffer
from constipation today.

Normally, the bowels should open every day and the stools should be light-brown in colour,
roughly cylindrical in shape and a few inches long.

Aetiology

The main aetiological factors are as follows:

Diet

Diet is of course an important cause of constipation. Excessive consumption of hot foods dries
up the fluids of Stomach and Intestines and may cause constipation by drying up the stools so
that they cannot be moved properly.

Conversely, excessive consumption of cold foods may block the Spleen function of