Constipation and CAM: Why Patients Seek Alternatives

Herbal medicine, massage, acupuncture and vitamin supplements are the most common CAM modalities
Herbal medicine, massage, acupuncture and vitamin supplements are the most common CAM modalities

The first critical literature review concerning complementary and alternative medicine (CAM) use for the management of constipation has found a high percentage of patient satisfaction, however the topic is seriously lacking in research.

The authors searched three electronic databases (MEDLINE, Academic Search Complete [EBSCO], and Allied and Complementary Medicine Database [AMED]) and Google Scholar for peer-viewed articles on CAM use for constipation in adults. 

Their search returned 35 articles, of which only four specifically focused on CAM use for the treatment of constipation; in the remaining articles constipation was just one of a number of patient conditions. 

An average of 39.2% adults with constipation used some form of CAM, however the prevalence rates ranged widely across the studies (5.4–73%). Patients who used CAM were more likely to be female than male, while there was no consistency found across age groups in the six studies which gathered the characteristics of CAM users. 

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Herbal medicine, massage therapy, acupuncture and vitamin supplements were the most common CAM modalities used. The integrative review found the average annual cost of CAM use to be $170, with acupuncture costing most (median $400) followed by massage (median $360), aromatherapy (median $120), and herbs (median $40). Based on self-reports, the three main reasons for CAM use included dissatisfaction with conventional therapy, satisfaction with a practitioner specializing in CAM, and improvements in quality of life with CAM; patients with less severe constipation were more likely to report satisfaction versus those with severe constipation.

The authors highlight the dearth and quality of studies conducted on CAM for constipation. In most of the studies constipation was just one of many indications, making the task of comparing studies and coming to any clear conclusion difficult.

One area lacking in information is the reasons for CAM preference in patients already using conventional treatments versus those who do not use conventional therapies; concurrent use can challenge a practitioner's ability to provide safe and coordinated care. The author's describe the need to close this gap in knowledge as “urgent”.

They concluded, “Further qualitative inquiry is required to help understand the motivations and barriers to effective patient communication […] to explore the consultation dynamic between patient and conventional practitioner.”

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