Add Prunes to Your Toolkit for Constipation

Abstract & Commentary

By Joseph E. Scherger, MD, MPH. Dr. Scherger is Clinical Professor, University of California, San Diego, CA; he reports no financial relationships relevant to this field of study. This article originally appeared in the June 15, 2011 issue of Internal Medicine Alert. At that time it was peer reviewed by Gerald Roberts, MD, Assistant Clinical Professor of Medicine, Albert Einstein College of Medicine, New York, NY. Dr. Roberts reports no financial relationship to this field of study.

Synopsis: Dried plums (prunes) are safe and more effective than psyllium for treating mild-to-moderate constipation.

Source: Attaluri A, et al. Randomised clinical trial: Dried plums (prunes) vs. psyllium for constipation. Aliment Pharmacol Ther 2011;33:822-828.

At the University of Oowa, 40 constipated subjects were randomized in an 8-week, single-blind crossover trial. Thirty-seven of the 40 were women and the average age was 38. The subjects took either prunes or psyllium for 3 weeks and then crossed over after a 1-week wash-out period. Fifty grams of prunes and 11 grams of psyllium were used equaling 6 grams of fiber each. The subjects maintained a daily symptom and stool diary. The study assessments included number of spontaneous bowel movements per week, global relief of constipation, stool consistency, straining, tolerability, and taste.

The subjects taking the prunes reported more complete spontaneous bowel movements per week (primary outcome measure) and stool consistency scores improved significantly compared to psyllium (P < 0.05). Straining and global constipation symptoms did not differ significantly between treatments. Dried plums and psyllium were rated as equally palatable and both were safe and well tolerated.

Commentary

Constipation is one of the most common symptoms presenting to primary care physicians. Prevention and treatment often blur into one passionate request from patients for help. Patients vary in what they have tried and what appeals to them. Having a toolkit of several effective options helps us care for more of these suffering patients.

Adequate fluid intake and daily fiber are the mainstay of prevention. My favorite is a cereal concoction I eat every day combining some regular Cheerios (oat fiber), some Fiber One cereal, yogurt, a handful of sliced walnuts and some blueberries, moistened with low-fat milk. One of my partners has her own "poop pudding" focusing more on fruit than cereal. Not everyone tolerates gluten in large amounts and some get cramps from very much fruit.

My mother struggled with lifelong constipation and drank prune juice every night with limited success. When I put her on a high-fiber cereal in the morning as a medical student, my reputation in her eyes was set for life.

This is a small comparison study that puts prunes right up there with psyllium for constipation prevention and treatment, at least among younger women. When I mentioned this study to a perimenopausal patient, she quickly said that dried apricots work better for her than prunes. I know from first-hand experience that very much dried fruit of any kind will get your intestines going. Fruit juices are mostly sugar and are to be avoided. The fiber has been largely filtered out.

Too often I see physicians resorting to a bad habit learned in medical school, the "stool softener" docusate sodium (Colace). Docusate is far less effective than psyllium in managing constipation.1

Sometimes it is the small things to us that make a big difference with patients. I enjoy telling patients I can cure their constipation if they cooperate every day. They give me looks of joy or skepticism. Usually I am effective and I wonder how much of my reputation in the community is based on that.

Reference

1. McRorie JW, et al. Psyllium is superior to docusate sodium for treatment of chronic constipation. Aliment Pharmacol Ther 1998;12:491-497.