Second Follow-up: The treatment was progressing favourably. Bowel movement frequency was good with six and then four stools passed per week. The stools were soft and easy to pass. The participant still perspired during her sleep, but it was a bland perspiration instead of sour. She was able to focus better although under much academic pressure. She was in the fourth academic term at the time, where she was busy with assignments, semester tests and final exam preparations. During this demanding periodshe reduced her fluid intake and frequently skipped meals. This explain the straining on initiation of the bowel movement and consequent return of constipation.The participant disclosed that at the beginning of the study she had only taken the remedy in the first week as she had been very busy and had forgotten to take it during the second week. This could have explained why the improvements were not as dramatic in the second week of the study. As such, increasing the frequency of the prescription would not have been necessary. The participant was given Mercurius solubilis30cH, 10 drops taken once daily.
Third Follow-up: A deterioration was observed in the symptoms of constipation. The frequency of bowel movements had decreased since the third week of treatment, from six times in week three to only three times in week six, but still better than only one bowel movement a week that she presented with initially. Her stools had become hard again and the anal fissures had reoccurred because of the return to a hard stool. On a general level, her energy had increased and so had her appetite. The dysmenorrhoea which had decreased from 15/10 to 6/10 the previous month, had completely vanished on her last menstruation. The continued improvement in general symptoms asserted that the remedy was well indicated.
The deterioration in her presentation of constipation may have been due to the fact that she was barely eating during this period. It may have also been that the potency of the remedy was insufficient to cause a lasting effect, and as such a 200cH might have been better suited. However, as the 30cH potency had produced significant improvements, the participant was advised to continue with the same prescription for a further week in order to establish whether the remedy will ameliorate the constipation again since the stress of the examination was over and she was back to eating consistent meals.
Overview of Case 3: The participant experienced dramatic improvements in all aspects of her constipation as well as in her general wellbeing from the start of the treatment. The dysmenorrhoea had completely resolved by the end of the study. Her energy levels were enhanced and her appetite had a general improvement after some interim fluctuation. Bowel movement frequency, successful defecation attempts, stool form and ease of evacuation fluctuated slightly during the course of the research study, with the most decline occurring in the final two weeks. The anal fissures had returned in the fourth and fifth week respectively as a result of the regression in stool form and subsequent difficulty on evacuation. At the conclusion of the study the participant reported that she had passed stool almost daily, having ten bowel movements across eight of the ten days since. The stools were much softer (Bristol score of 3) with barely any straining. The anal fissures had healed, her appetite was good and she was able to eat a larger portion.
Graph 3: Stool Frequency of case 3
Graph 3: Stool Form and Ease of evacuation for case 3
The stools became increasingly softer, from a baseline score of 1 (separate hard lumps) it improved to a score of 2-3 (firm and sausage-shaped). Although the participant appointed a score of 1 (separate hard lumps) to most of the bowel movements in the second and third week of treatment, during the consultations she described the stools as being soft balls, passed easily. This description does not entirely conform to the score of 1, which is characterised by hardness of stool and difficulty in passing the stool. In the last week the stools became hard again, scoring 1 (separate hard lumps). The straining decreased from a score of 2 (straining throughout the bowel movement) to 0 (no straining) but then got worse again from week three onwards scoring a 1 (straining only at the beginning of the bowel movement).
The research comprised of ten case studies.The average age range of the participants was between 21-28 years, with two participants over the age of forty. The study sample was of asymmetric gender distribution, with a female to male ratio of 8:2.Majority of the participants were of black ethnicity (seven), with two Indians and one Caucasian.
Three of the participant’s sought intervention prior to the study due to their constipation but with limited benefit. All ten participants had previously tried various forms of management strategies, comprising either over-the-counter laxatives, herbal constipation teas, drinking hot water daily or fibre supplementation. In these cases, the management strategies mentioned above were ineffective or only offered partial and/or temporary assistance. Concomitant symptoms of pain, discomfort and bloating were not relieved. Most participants were unhappy with the results of such strategies and thus did not persevere with them. This emphasises the results found on a study that was conducted suggesting that patient satisfaction levels with many first-line management strategies for constipation are at best only partially favourable.5
Although this research study had a short duration, all ten participants expressed satisfaction with the treatment over the course of the study.Every participant claimed to have benefitted from the study, with their symptoms of constipation being partly relieved or completely resolved. Most of the participants also exhibited improvements in other aspects of their general health and expressed that they experienced an enhanced state of wellbeing. Although majority of the participants in the study were not following a particularly healthy diet, no dietary advice was given during the course of the study and participants were requested not to alter their usual diet. Even though the participants responded positively to the remedy, it does not discard the importance of correcting the diet. A poor diet encumbers optimal health and functioning, and could pose as an obstacle to cure in many health conditions.10,15
It was observed that only three of the participants adhered to the minimum recommended intake of two litres of water daily, and only four participants were engaged in some form of physical activity on a regular basis. Insufficient fluid intake and a sedentary lifestyle contribute to the incidence and severity of constipation.16 Treatment outcomes may be enhanced if these factors are addressed simultaneously.
All initial prescriptions were in the 30cH potency, with the dosage instruction of 10 drops taken once daily. This method of prescribing ensured uniformity of the initial administration of the remedy, in order to limit treatment variables. The 30cH potency was decided upon as a good balance, as it was deep acting enough to also stimulate a response on the general and mental-emotional level, whilst limiting the possibility of aggravations. Participants were instructed to continue with the remedy until the completion of the study, after which they were advised to use the remedy only as needed. The approach of a continued administration of the remedy throughout the six-week period was adopted to exclude the possibility that a lack of improvement in the symptoms of constipation could be ascribed to insufficient administration of the remedy. This method did not adhere completely to the principles of classical prescribing, which directs that if dramatic improvements are seen (as in Case 2, 3, 4, 6,7, 8 and 10) the remedy should be discontinued so as not to interfere with the curative action produced by the administered dose. A second dose should only be administered if improvements diminish and the original symptoms reappear.10It is a possibility that with regard to Case 6 and 8, the continued dosing after a dramatic improvement had occurred could have been the cause of the relapse in some symptoms.Homeopathic remedies are often considered to take a long time to work. However, it was observed that all ten participants experienced improvement within the first week of taking the remedy, with seven participants experiencing an improvement the very next day.Eight different homeopathic remedies were prescribed, demonstrating the highly individualised presentation of constipation.
The graph below represents the stool frequency across six weeks for each participant, comparing an extrapolated pre-study frequency to the frequency during the study period. The pre-study figure was obtained by multiplying the baseline weekly figure by six to determine an expected frequency across six weeks. Case 4 is an exception, being almost on par for pre-study and during study frequency; however, with this case the participant did not refer to stool frequency but rather to stool form, ease of evacuation and completeness of evacuation.
Limitations of the study
The study duration was short and no long-term follow-ups were conducted to determine the long-term efficacy of the treatment. The sample size was small. More weight could be given to results if a larger sample was used. There was no control group to make comparison to and therefore the validity of the study is very low. As such no conclusive statements can be made.
Individualised homeopathic case studies are very time consuming, such that a larger sample creates difficulty.The Bristol Stool Form scale and Ease and Comfort scale were not sensitive enough to adequately represent ameliorations in some cases, as seen with three participants (Case 3, 5 and 8). There was limited control over external factors that could have an influence on bowel functioning. Although participants were requested not to change their diet and eating patterns or make any significant lifestyle changes, it was not always possible and such changes had an impact on the bowel movements.
Individualised Homeopathic approach treated the participants as a totality and this was witnessed with a favourable progression in participant’s psychological and physical symptoms of constipation, as well as an increased state of general wellbeing. Participants were consequently pleased with the improvements that had occurred.
Acknowledgements: The authors would like to thank the researcher for conducting case histories.
Authors’ Disclosure Statement: The current study was financed by the University of Johannesburg (UJ). The contents of the work are solely the responsibility of the authors and do not represent the official views of UJ. The authors have no conflicts of interest related to the study.
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