Int roduct ion
A number of studies have reported constipa-tion-type symptoms during the luteal phase of the menstrual cycle (D avies, 1998). Signifi-cantly: longer whole gut transit times (D avies et al., 1986; Wald et al., 1981); lower stool wet and dry weights (M cBurney, 1991); harder stools (D avies et al., 1986); more well-formed stools (D avies et al., 1986, 1993) and a lower frequency of defecation (D avies et al., 1993) have all been reported. T here is clearly some evidence of reduced motility in the luteal phase, resulting in altered stool properties. M oreover, it is probable that these changes are mediated via elevated serum progesterone levels although the mechanism of action has not been elucidated (Vlitos and D avies, 1996). F urthermore, changes in eating habits may be of some importance. A trend has been observed for sucrose intake to be higher in the luteal phase than during the bleed, follicular phase or at ovulation (G ong et al., 1989). C onversely, mean dietary fibre intake was significantly lower during the last four luteal days than in the first four days of the bleed (D avies et al., 1993). In the light of the fore-going it seemed reasonable to ascertain if an increase in non-starch polysaccharide (N SP) intake, by way of a palatable drink, was of symptomatic benefit in the treatment of con-stipation-type symptoms premenstrually.
M et hods
Subjects in this study were a subset from a larger study on the influence of ispaghula husk on bowel habit (D avies et al., in press). T hus a total of 57 menstruating women (50 C aucasian, five N egro, one O riental and one other) were included in the evaluation. T he mean age of subjects was 25 years (range 18-45 years) and the mean body mass index was 22 (range 14 -34).
All 57 women had taken part in a three-month study which involved them in main-taining a record of their bowel habit and menstrual status during three 28 day phases: pre-treatment, treatment and post-treatment. T hroughout the study volunteers had been instructed to keep to their “usual” pattern of eating, but to take an orange flavoured drink containing 3.5g ispaghula husk (F ybogel® O range, Reckitt & C olman) after breakfast
335 Nutrition & Food Science
Number 6 · November/December 1998 · pp. 335–337 M CB University Press · ISSN 0034-6659
Ef fi ca cy of ispa ghula
husk in t he t re a t m e nt
of pre m e nst rua l
const ipa t ion-t y pe
sy m pt om s
Jill Davies
Peter Dettmar and
Roger H oare
The authors
Jill Daviesis Professor of Nutrition and Head of the Nutrition Research Centre at South Bank University, London, UK.
Peter Dettmaris Global R&D Category Director – Gastrointestinals and Technology Research, Reckitt & Colman Products, Hull, UK.
Roger Hoareis a Consultant Statistician, Hull, UK.
Abstract
It is w ell documented that w omen are prone to constipa-tion-type symptoms premenstrually. An increase in non-starch polysaccharide intake of 5.9 g/d in the form of palatable drink has proved to be of symptomatic benefit during the premenstrual phase of the cycle resulting in a significant increase in stool frequency, significant decreas-es in straining at the end of defecation and feelings of incomplete evacuation and the production of less w ell formed stools.
and again after the evening meal during the treatment phase.
D ata analysis was focused on days 24 to 28 inclusive of the menstrual cycle for each of the study phases and bowel habit parameters considered in the diagnosis of constipation (T hompson et al., 1992) namely: frequency of defaecation, straining, feelings of incomplete evacuation and stool form. F requency of defaecation per 24 hours, percentage of motions per subject with straining at both start and end of defecation, incomplete evacu-ation and each category of stool form were compared between the pre-treatment, treat-ment and post-treattreat-ment phases using a two-way analysis of variance followed by pairwise comparisons using D uncan’s multiple range test. Where assumptions of this parametric analysis were violated an equivalent non-parametric test, i.e. the F riedman two-way analysis by ranks, was used.
Result s
F requency of defecation per 24 hours during the premenstrual stage of the cycle for each of the study phases is shown in Table I. T he mean number of motions per day was found to be significantly higher in the treatment phase than in both the pre-treatment and post-treatment phases.
Straining at the start and end of defecation during the premenstrual stage of the cycle for each of the study phases is shown in F igure 1. T here was marginally less straining at the beginning of defecation during the treatment phase than in pre- and post- treatment phases and this did not achieve statistical signifi-cance. T here was significantly less straining at the end of defecation during the treatment phase (P < 0.001) and the post-treatment phase (P < 0.01) compared with the pre-treatment phase.
Feelings of incomplete evacuation during the premenstrual phase of the cycle (F igure 1) were significantly less in the treatment phase compared with the pre-treatment phase (P < 0.01).
T he mean percentage of motions per subject in the “cracked, cylindrical” category was shown to be significantly lower in the treatment phase (28 per cent) than in either the pre- or post-treatment phases (38 per cent P < 0.05 and 42 per cent P < 0.01 respectively).
Discussion
T he significant changes in bowel habit observed in this study clearly show that ispaghula husk is of symptomatic benefit to women with constipation-type symptoms (T hompson et al., 1992) premenstrually. T he significant increase in stool frequency, decrease in straining at the end of defecation, decrease in feelings of incomplete evacuation and decrease in the passage of well formed stools during treatment with ispaghula husk demonstrate that an increase in N SP intake of around 6g/day in a palatable drink is one possible solution to the problem of premen-strual constipation.
‘… straining greatly raises the pressure w ithin the abdominal cavity and … this may be a risk factor in the aetiology of hiatus hernia, varicose veins and haemorrhoids… ’
T he observed residual effect of ispaghula husk on straining at the end of defecation is of some interest. H eaton and C ripps (1993) have reported that not only is straining more com-mon in women, but that straining to finish defecation is a sign of prolonged straining. M oreover, Burkitt (1979) postulated that straining greatly raises the pressure within the abdominal cavity and that this may be a risk factor in the aetiology of hiatus hernia, vari-cose veins and haemorrhoids.
F urther studies are needed to determine the optimum duration of treatment with ispaghula husk taking account not only bowel habit parameters but the diet as a whole throughout the menstrual cycle.
336 Efficacy of ispaghula husk in treatment of premenstrual constipation
Jill Davies, Peter Dettmar and Roger Hoare
Nutrition & Food Science
Number 6 · November/December 1998 · 335–337
Table I Stool frequency, days 24-28 inclusive of the menstrual cycle, before, during and after taking ispaghula husk
Study phase Frequency of defecation/24 hrs
(n57) M ean SD Range
Pre-treatment 0.74 0.40 0-1.8
Treatment 1.07* * * * 0.51 0-2.4
Post-treatment 0.78 0.39 0-1.6
Ref erences
Burkitt, D. (1979), Don’t Forget Fibre in Your Diet, M artin Dunitz Limited, London.
Davies, G.J. (1998), “ Constipation, fibre intake and the menstrual cycle” ,Nutrition & Food Science, Vol. 28 No 5. pp. 272-4.
Davies, G.J., Collins, A.L.P. and M ead, J.J. (1993), “ Bow el habit and dietary fibre intake before and during menstruation” , Journal of the Royal Society of Health, Vol. 113, pp. 64-7.
Davies, G.J., Dettmar, P.W. and Hoare, R.C. (in press), “ The influence of ispaghula husk on bow el habits” , Journal of the Royal Society of Health.
Davies, G.J., Crow der, M ., Reid, B. and Dickerson, J.W.T. (1986), “ Bow el function measurements of individu-als w ith different eating patterns” , Gut, Vol. 27, pp. 164-9.
Gong, E.J., Garrel, D. and Calloway, D.H. (1989), “ M enstru-al cycle and voluntary food intake” , American Journal of Clinical Nutrition, Vol. 49, pp. 252-8.
Heaton, K.W. and Cripps, H. (1993), “ Straining at stool and laxative taking in an English population” , Digestive Diseases and Sciences, Vol. 38, pp. 1004-8. M cBurney, M .I. (1991), “ Starch malabsorption and stool
excretion are influenced by the menstrual cycle in w omen consuming low fibre w estern diets” , Scandinavian Journal of Gastroenterology, Vol. 26, pp. 880-6.
Thompson, W.G., Creed, F., Drossman, D.A., Heaton, K.W. and M azzacca, G. (1992), “ Functional bow el disease and functional abdominal pain” , Gastroenterology, Vol. 5, pp. 75-91.
Vlitos, A.L.P. and Davies, G.J. (1996), “ Bow el function, food intake and the menstrual cycle” , Nutrition Research Reviews, Vol. 9, pp. 111-34.
Wald, A., Van Thiel, D.H., Hoechstetter, L., Gavaler, J.S., Egler, K.M ., Verm, R., Scott, L. and Lester, R. (1981), “ Gastrointestinal transit: the effect of the menstrual cycle” , Gastroenterology, Vol. 80, pp. 1497-1500.
337 Efficacy of ispaghula husk in treatment of premenstrual constipation
Jill Davies, Peter Dettmar and Roger Hoare
Nutrition & Food Science
Number 6 · November/December 1998 · 335–337
30
25
20
15
10
5
0
Straining to s tart
Straining to finis h
Incomplete evacuation Percentage of motions passed
Pre -treatment (n53) Treatment (n55) Pos t-treatment (n53) Key
