Natural "Bowel Recipe" More Effective Than Fiber Supplement in Reducing Straining

Emma Hitt, PhD

October 23, 2006

October 23, 2006 — A "bowel recipe" consisting of wheat bran, applesauce, and prune juice appears to be more effective than a commercial psyllium fiber supplement in reducing straining in women with pelvic floor dysfunction, according to new research findings.

Joseph Schaffer, MD, chief of gynecology at the University of Texas Southwestern Medical Center in Dallas, presented the findings at the 2006 scientific meeting of the American Urogynecologic Society in Palm Springs, California, on Friday.

"We wanted to evaluate these 2 approaches because we use this bowel recipe in our clinical practice and have found it to be very effective, but little research had been conducted," Dr. Shaffer told Medscape.

Patients with pelvic floor dysfunction often experience chronic constipation, which is believed to be a risk factor for pelvic organ prolapse, the researchers note in their abstract.

In the current analysis, 86 patients were randomized to receive 1 of 2 treatments, and 48 patients returned diaries containing entries for every bowel movement during the 6-week study period.

Patients meeting Rome II criteria for constipation were randomized to receive 4 tablespoons per day of the "bowel recipe," consisting of 1 cup of unprocessed wheat bran, 1 cup of applesauce, and 1/4 cup of prune juice, or 1 teaspoon per day of psyllium (Konsyl) mixed in 8 oz of water.

For 6 weeks, patients made entries into a diary describing stool consistency, need to strain, sensation of complete evacuation, pain/bloating, need for digital decompression, and laxative use for each bowel movement.

Previous results from the same researchers presented at the 2006 Society for Gynecologic Surgeons meeting in April indicated that the 2 approaches were equally effective in lowering constipation scores in 53 evaluable patients, as determined using a final Constipation Scoring System questionnaire.

The diary entry findings reported in the current analysis suggested that patients using the bowel recipe did not strain 80% of the time compared with those taking the psyllium fiber supplement, who did not strain 43% of the time ( P = .007). No significant differences were noted in the other symptoms recorded by the patients.

"We found that straining decreased but there was no decline in stool consistency, so this suggests that patients do not need as much fiber as is commonly recommended," Dr. Schaffer said. Both treatments contained about 6 g of fiber per serving as opposed to about 12 to 14 g, which is often recommended. "We used 6 g because the higher doses of fiber can be very difficult to tolerate and several measures of constipation improved with the lower dose."

Dr. Shaffer also pointed out that the bowel recipe is significantly cheaper than the psyllium fiber supplement. The cost for the bowel recipe for 6 weeks was $8.65, whereas the cost for 6 weeks of psyllium supplement was $16.72.

"We have numerous products on the market, but little evidence-based research regarding the use of these supplements," noted Holly E. Richter, MD, PhD, professor and division director of the Department of Obstetrics and Gynecology at the University of Alabama at Birmingham. "This study shows, at least in the very short term, that using "natural" dietary components as opposed to a packaged supplement helps decrease straining with bowel movements."

Dr. Richter noted that her department uses a similar bowel recipe as well as other typical fiber supplements such as FiberCon and Citrucel. "One product does not work for all and it may taketime to find a supplement that works for a particular patient. If these types of supplements do not help, we may use more aggressive treatments, such as glycol-based products or enemas," Dr. Richter told Medscape.

According to Dr. Richter, the best way in which to evaluate patients with pelvic floor dysfunction — for example, whether to use bowel transit or electromyelography studies to rule out transit dysfunction or pelvic floor dyssynergia — remains unclear. "Working closely with our gastroenterology colleagues may help advance the science," she said. "We also need longer-term outcome studies to see if the benefits of the bowel recipe are maintained."

The authors report no relevant financial relationships.

AUGS 2006 Scientific Meeting: Paper 31. Presented October 20, 2006.

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