Effect of an herbal capsule on chronic constipation among menopausal women: A randomized controlled clinical trial

Document Type : Original Research Article


1 Department of Midwifery, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran

2 Department of Traditional Medicine, Faculty of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

3 Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran

4 Department of Midwifery, Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran


Objective: Chronic constipation is frequently observed in postmenopausal women. An herbal combination including clover plants, Roman anis or Anisone, green anis or fennel, green raisins, Alhagi maurorum, violets, Terminalia chebula, senna and golqand has been introduced in traditional books as an effective laxative. Thus, the present study aimed to assess the effectiveness of the combined herbal capsule on chronic constipation in postmenopausal women.
Materials and Methods: This triple blinded, randomized placebo-controlled trial was conducted on 64 postmenopausal women. Individuals were randomly assigned to combined the herbal capsule and placebo groups. The herbal capsule included cloves (4 units), Anise and Anison (6 units each), violet flowers (12 units), Terminalia Chebula and fresh green raisins (25 units each), senna leaves, Alhagi maurorum, and Golqand (50 units each). Constipation questionnaire and the individual’s assessment of constipation symptoms scale were used for data collection.
Results: The mean frequency of bowel movements in the herbal capsule group was significantly higher than the placebo group (mean difference=4.2; 95% confidence interval: 0.3 to 4.5; p<0.001). Straining during defecation, stool amount, incomplete defecation, sensation of obstruction during defecation, and need for manipulation to facilitate removal of stools were significantly reduced in the herbal capsule group compared to the placebo group (p<0.001). The amount and consistency of defecation was also improved in the two study groups, but a significant difference was observed between the groups (p<0.001). The mean score of constipation symptoms in the herbal capsule group was significantly reduced compared to the placebo group (-15.4; -11.5 to -19.29; p<0.001).
Conclusion: Consumption of herbal capsules improved chronic constipation in postmenopausal women.


Main Subjects

Arezoomandan R, Kazerani HR, Behnam Rasooli M. 2011. The laxative and prokinetic effects of rosa damascena mill in rats. Iran J Basic Med Sci, 14: 9-16.
Arnaud MJ. 2003. Mild dehydration: a risk factor of constipation? Eur J Clin Nutr. 57: S88-S95.
Basilisco G, Coletta M. 2013. Chronic constipation: a critical review. Dig Liver Dis, 45: 886-893.
Belsey J, Greenfield S, Candy D, Geraint M. 2010. Systematic review: impact of constipation on quality of life in adults and children. Aliment Pharmacol Ther, 31: 938-949.
Bub S, Brinckmann J, Cicconetti G, Valentine B. 2006. Efficacy of an herbal dietary supplement (smooth move) in the management of constipation in nursing home residents: a randomized, double-blind, placebo-controlled study. J Am Med Dir Assoc. 7: 556-561.
Deepak P, Ehrenpreis ED. 2011. Constipation. Dis Mon, 57: 511-517.
Dukas L, Willett WC, Giovannucci EL. 2003. Association between physical activity, fiber intake, and other lifestyle variables and constipation in a study of women. Am J Gastroenterol, 98: 1790-1796.
Eliasvandi P, Khodaie L, Mohammad Alizadeh Charandabi S, Mirghafourvand M. 2018. Efficacy of combined herbal capsule on sexual function in postmenopausal women: a triple-blind randomized controlled trial. International Journal of Women's Health and Reproduction Sciences. 7. In press.
Emami A, Fasihi S, Mehrgan I. 2013. Reference books of medicinal plants. Tehran: Andishehavar.
Ford AC, Suares NC. 2011. Effect of Laxatives and pharmacological therapies in chronic idiopathic constipation: systematic review and meta-analysis. Gut, 60: 209-218.
Frank L, Kleinman L, Farup C, Taylor L, Miner Jr P. 1999. Psychometric validation of a constipation symptom assessment questionnaire. Scand J Gastroenterol, 34: 870-877.
Gallagher P, O'Mahony D. 2009. Constipation in old age. Best Pract Res Clin Gastroenterol,  23: 875-887
Ghrairi F, Lahouar L, Amira EA, Brahmi F, Ferchichi A, Achour L, Said S. 2013. Physicochemical Composition of different varieties of raisins (Vitis vinifera L.) from Tunisia. Ind Crops Prod,   43: 73-77.
Higgins P, Johanson JF. 2004. Epidemiology of constipation in north america: a systematic review. Am J Gastroenterol, 99: 750-759.
Johanson JF, Sonnenberg A, Koch TR. 1989. Clinical epidemiology of chronic constipation. J Clin Gastroenterol, 11: 525-536.
Johanson JF, Kralstein J. 2007. Chronic constipation: a survey of the patient perspective. A Aliment Pharmacol Ther, 25: 599-608.
Kazerani H, Noorbakhsh MF. 2009. The laxative and purgative effects of taranjabin. 19th Iran Cong Physiol Pharmacol.
Ladas SD, Haritos DN, Raptis SA. 1995. Honey may have a laxative effect on normal subjects because of incomplete fructose absorption. Am J Clin Nutr, 62: 1212-1215.
Leung L, Riutta T, Kotecha J, Rosser W. 2011. Chronic constipation: an evidence-based review. J Am Board Fam Med, 24: 436-451.
Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. 2006. Functional bowel disorders. Gastroenterology, 130: 1480-1491.
Mirghafourvand M, Rad AH, Charandabi SMA, Fardiazar Z, Shokri K. 2016. The effect of probiotic yogurt on constipation in pregnant women: a randomized controlled clinical trial. Iran Red Crescent Med J, 18: e39870.
Mozaffarian V. 2012. Identification of medicinal and aromatic plants of Iran. Tehran: Farhange Moaser.
Mugie SM, Benninga MA, Di Lorenzo C. 2011. Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol, 25: 3-18.
Muhammad N, ur Rehman N, Khan H, Saeed M, Gilani AH. 2013. Prokinetic and laxative effects of the crude methanolic extract of viola betonicifolia whole plant in rodents. BMC Complement Altern Med, 13: 70.
Muhammad G, Hussain MA, Anwar F, Ashraf M, Gilani AH. 2015. Alhagi: a plant genus rich in bioactives for pharmaceuticals. Phytother Res, 29: 1-13.
Nazem E. 2010. Tooba pharmacopoeia. Tehran: Andishehavar.
Neri L, Basilisco G, Corazziari E, Stanghellini V, Cuomo R, editors. .2012. Symptom severity of functional constipation is associated to work productivity costs: a nationwide italian survey. Neurogastroenterology and Motility. Wiley-Blackwell 111 River ST, Hoboken 07030-5774, NJ USA.
Oliveira SCMd, Pinto-Neto AM, Góes JRN, Conde DM, Santos-Sá D, Costa-Paiva L. 2005. Prevalence and factors associated with intestinal constipation in postmenopausal women. Arq Gastroenterol, 42: 24-29.
Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, Gangarosa LM, Thiny MT, Stizenberg K, Morgan DR, Ringel Y, Kim HP, Dibonaventura MD, Carroll CF, Allen JK, Cook SF, Sandler RS, Kappelman MD, Shaheen NJ. 2012. Burden of gastrointestinal disease in the united states: 2012 update. Gastroenterology, 143: 1179-1187.
Picon PD, Picon RV, Costa AF, Sander GB, Amaral KM, Aboy AL, Henriques AT. 2010. Randomized clinical trial of a phytotherapic compound containing Pimpinella anisum, Foeniculum vulgare, Sambucus nigra, and Cassia augustifolia for chronic constipation. BMC Complement Altern Med, 10: 17.
Quigley E, Vandeplassche L, Kerstens R, Ausma J. 2009. Clinical trial: the efficacy, impact on quality of life, and safety and tolerability of prucalopride in severe chronic constipation–a  12‐week, randomized, double‐blind, placebo‐controlled study. Aliment Pharmacol Ther,  29: 315-328.
Sacomori C, Silveira C, Sperandio FF, Cardoso FL. 2014. Prevalence, repercussion and factors associated with intestinal constipation in women in florianópolis. J Coloproctol, 34: 254-259.
Salmoirago-Blotcher E, Crawford S, Jackson E, Ockene J, Ockene I. 2011. Constipation and risk of cardiovascular disease among postmenopausal women. Am J Med, 124: 714-723.
Santos-Jasso KA, Arredondo-García JL, Maza-Vallejos J, Lezama-Del Valle P. 2017. Effectiveness of senna vs polyethylene glycol as laxative therapy in children with constipation related to anorectal malformation. J Pediatr Surg, 52: 84-88.
Tack J, Müller‐Lissner S, Stanghellini V, Boeckxstaens G, Kamm M, Simrén M, Galmiche JP, Fried M. 2011. Diagnosis and treatment of chronic constipation–a european perspective. Neurogastroenterol Motil, 23: 697-710.
Talley NJ, Lasch KL, Baum CL. 2009. A gap in our understanding: chronic constipation and its comorbid conditions. Clin Gastroenterol Hepatol, 7: 9-19.
Versi E, Harvey MA, Cardozo L, Brincat M, Studd JWW. 2001. Urogenital prolapse and atrophy at menopause: A prevalence study. Int Urogynecol J, 12:107-110.
World Health Organization. 1999. WHO monographs on selected medicinal plants. Ravello-Salerno: WHO. p.289
World Health Organization. 2001. WHO monographs on selected medicinal plants. Ottawa: WHO. p. 376.
World Health Organization. 2005. WHO consultation on selected medicinal plants. Salerno-Paestum. p.444
Yang YX, He M, Hu G, Wei J, Pages P, Yang XH, Bourdu-Naturel S. 2008. Effect of a fermented milk containing bifidobacterium lactis dn-173010 on chinese constipated women. World J Gastroenterol, 14: 6237-6243.