A Physician-Patient’s Reflective Case Study Presenting New Hypotheses in Constipation Management

Dr. Qaisar J. Qayyum

Chief Editor, Noor Journal of Complementary and Contemporary Medicine, Clinical Assistant Professor, Oklahoma, USA.  Email: chiefeditor@njccm.org

Abstract

Constipation affects nearly one-third of individuals over age 60. While general advice often includes increasing fiber, water, avoidance of offending drugs and physical activity, these strategies are frequently ineffective in older patients with comorbidities or frailty. This article outlines a low-risk, clinically observed protocol combining regularly timed defecation with early morning hydration, lemon-honey infusion, bed-based exercises, and topical coconut oil. Consistent improvements in one older individual (also the author) over six months revealed novel insights involving hydration timing, honey storage material, sensory activation, and perianal microtrauma healing.

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Introduction

Chronic constipation remains a highly prevalent issue among older adults, with rates estimated at 33% in adults over 60 years of age [1]. The elderly are especially vulnerable due to age-related changes in colonic motility, polypharmacy, sedentary lifestyle, and impaired fluid intake. While conventional advice, fiber, fluids, and laxatives, may suffice in healthier populations, they often fail or cause discomfort in frail elderly patients.

This article presents a practical case-based protocol developed and tested by the author, a physician experiencing age-related constipation, over a six-month period. The approach incorporates:

• Timed defecation

• Timed hydration prior to defecation

• Lemon-honey infusion (with glass-stored honey)

• Supine lower body exercises

• Topical virgin coconut oil for sphincter tone modulation

  
  

Some elements of this protocol introduce novel clinical hypotheses not widely explored in mainstream gastroenterology literature. The integration of personal observation, physiologic rationale, and reflection make this a valuable autoethnographic case study for further research.

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Case Overview:

Managing Constipation in Later Life: A Physician’s Self-Experimentation Case Report

The subject, a physician in his late sixties with diabetes, hypertension, and coronary artery disease, had struggled with persistent constipation, characterized by infrequent, hard stools and incomplete evacuation. Standard remedies, including fiber supplements and stool softeners, provided only intermittent relief and often led to bloating or unpredictability.

Over a six-month period, the subject self-tested and refined a multi-step daily protocol. All elements were chosen for safety, affordability, and physiologic plausibility.

Subjective improvements included:

• More regular and complete bowel movements

• Less straining

• Marked reduction in sensation of rectal pressure or incomplete evacuation

  
  

Description of the Protocol

1. Timed Early Morning Hydration (60–70 Minutes Before Attempted Defecation)

One glass of 500 ml of room-temperature water was consumed immediately upon waking, 60–70 minutes prior to planned defecation.

• Hypothesis: The delayed window allows water to reach the colon, softening stool, rather than simply stimulating upper GI motility.

• Clinical Benefit: Timing hydration ahead of evacuation consistently improved stool consistency and reduced straining.

  
  

2. Lemon and Honey Mixture (Without Water) – Glass-Stored Honey

Instead of traditional lemon water, the patient consumed a thick emulsion of:

• 1 tablespoon of honey (stored in a glass bottle)

• 1 teaspoon of fresh lemon juice

• No water was added; the consistency was intentionally kept thick.

• Observation: Plastic-stored honey was noticeably less effective. Glass-stored honey reliably softened stool and triggered defecation more consistently.

• Possible Mechanisms:

  • Leaching of microplastics or degradation of honey bioactives in plastic [2]

  • Electrostatic or enzymatic alterations

  • Changes in flavor profiles known to affect TRP receptor activation (discussed below)

4. Topical Virgin Coconut Oil Application Post-Defecation

After each bowel movement and daily after showering, a small amount of virgin coconut oil was rubbed to the anus and perianal area.

• Rationale: Repeated microabrasions caused by hard stool likely trigger increased sphincter tone.

• Hypothesis: Soothing the skin and local tissue may interrupt the cycle of:

  • Minor trauma → increased tone → impaired evacuation → more trauma

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Clinical Insights and Emerging Hypotheses

A. Hydration Timing Enhances Colonic Access

• Rather than stimulating upper GI motility reflexively, hydration 60–70 minutes before attempting to evacuate may allow water to directly reach and soften colonic contents.

• This strategy departs from the classic "drink water and go" model, suggesting a physiological delay between hydration and colonic benefit.

  
  

B. Container Material Affects Honey’s Clinical Efficacy

• Subjective reporting showed that glass-stored honey outperformed plastic-stored honey.

• Food science literature supports this, noting increased enzymatic degradation and flavor loss in plastic containers [2].

  
  

C. Neurogenic Modulation and TRP Channel Involvement

A noticeable softening of stool and urge to defecate occurred within 5–15 minutes of ingesting the lemon-honey mixture. This rapid onset suggests mechanisms beyond delayed osmotic action and points toward sensory-neurogenic modulation.

One plausible mechanism involves TRP (Transient Receptor Potential) channels, which are known to mediate chemosensory input from the oral cavity and upper gut to the enteric nervous system. These channels are sensitive to a variety of stimuli such as heat, acidity (as in lemon), osmolarity (as in honey), and certain natural compounds. Their activation can initiate neural reflexes that influence gut motility, secretion, and visceral sensitivity, even before the ingested substance reaches the colon.

In particular, TRPV1 and TRPA1 subtypes have been studied for their role in modulating gastrointestinal responses to chemical and thermal stimuli. Lemon juice, due to its citric acid content, and honey, through its high osmolarity and sugar content, may synergistically activate these pathways, resulting in prompt peristaltic stimulation/secretomotor responses.

This mechanism is consistent with prior hypotheses involving orally mediated TRP activation in other contexts, including mustard (6) ingestion for leg cramps, where chemosensory signaling was proposed to induce systemic neuromuscular effects via cranial and enteric reflex arcs [5].

While not yet established in mainstream constipation guidelines, such TRP-mediated effects represent a compelling target for further exploration, particularly in interventions that rely on small quantities of potent, natural substances.

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Additional Hypothesis: Sphincter Tone as a Feedback Loop

While sphincter spasm is a known response to anal fissures, this case suggests a subclinical loop:

• Hard stool → microabrasions of the anal canal

• → Increased sphincter tone as a protective response

• → Reduced evacuation and increased stool dehydration

• → Further hard stools and worsening constipation

This feedback loop is not widely discussed in literature but could represent a missing physiologic contributor in chronic constipation.

Proposed Disruption:

Gentle perianal rubbing of virgin coconut oil seems to help break this cycle by soothing tissues, reducing local irritation, and allowing for sphincter relaxation and improved defecation dynamics.

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Conclusion

This reflective case study introduces a simple, home-based regimen for managing chronic constipation in elderly individuals, emphasizing:

• Key Clinical Insights and Emerging Hypotheses

  • Fixed Timing of Defecation to Promote Predictability

    Establishing a regular morning schedule for bowel movements may entrain the gut to respond more reliably, aligning with circadian regulation of colonic motility.

  • Hydration Timing as a Modifiable and Underexplored Variable

    Deliberate early morning fluid intake—60 to 70 minutes before attempted defecation, may directly influence colonic stool hydration, offering a non-pharmacologic mechanism to ease stool passage.

  • Impact of Storage Material on Natural Product Efficacy

    Preliminary clinical observations suggest that honey stored in glass may retain greater properties than that stored in plastic, possibly due to preservation of enzymatic or antioxidant activity.

  • Sensory-Gut Signaling via TRP Channels or Similar Receptors

    Rapid onset of gastrointestinal response following ingestion of lemon-honey mixture may be mediated by sensory receptors such as transient receptor potential (TRP) channels, which are known to activate enteric neural circuits and modulate motility.

  • Anal Sphincter Tone as a Reinforcing Element in the Constipation Cycle

    Recurrent passage of hard stool may cause microabrasions in the anal canal, triggering a protective increase in sphincter tone. This heightened tone can impair evacuation, promote further stool dehydration, and perpetuate a self-reinforcing cycle of constipation, an underrecognized mechanism in current literature.

  • Topical Use of Virgin Coconut Oil for Perianal Soothing and Healing

    Application of a small amount of virgin coconut oil around the anal area after defecation and bathing may help reduce irritation, promote local healing, and disrupt the feedback loop of sphincter hypertonicity. This low-cost intervention offers potential benefit with minimal risk, particularly in elderly or post-surgical patients.

Each of these interventions has demonstrated individual effectiveness when applied in the context of a balanced diet. However, the author sees added value in combining them, particularly when single interventions yield suboptimal responses. Although this report is based on a single-subject experience, the clinical insights and observed synergies may serve to generate hypotheses for larger studies and support safe, patient-centered experimentation in routine practice.

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Acknowledgment:

This article was written with AI assistance. All claims are supported by credible, peer-reviewed references, which were validated for accuracy and authenticity. The AI synthesized information were reviewed by authors, ensuring scientific integrity throughout. In the event of any inadvertent errors, the responsibility lies with the AI/authors, and corrections will be made promptly upon identification. I would like to express my sincere gratitude to Dr Tahira Khalid, for her thoughtful review and invaluable feedback. Her expertise and guidance have played a pivotal role in refining and enhancing this article.

Conflict of Interest Statement:

The author is the developer of a herbal formula and the owner of Dr. Q Formula/Insulinn LLC. However, this affiliation has not influenced the content, analysis, or conclusions of this article

Author’s Note on Scope and Intent:

This article does not advocate the replacement of evidence-based conventional care modalities. All complementary interventions are intended to supplement, not supplant, standard clinical practice, and are implemented within a physician-governed, ethically reviewed, and fully documented medical framework.

Reference List

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2. Rao SSC, Brenner DM. Constipation in the older adult. J Am Med Dir Assoc. 2015 Dec;16(12):1026–1033. doi:10.1016/j.jamda.2015.06.011. PMID: 26347017.

3. Riezzo G, Chiloiro M, Clemente C. Gastrocolic reflex: Pathophysiological background, clinical aspects, and therapeutic considerations. Clin Res Hepatol Gastroenterol. 2012 Dec;36(6):605–610. doi:10.1016/j.clinre.2012.03.006. PMID: 22819011.

4. Ahmad S, Mishra RL, Kumar R, Bhat TA, Yousuf B, Sharma A, et al. Effect of packaging material on storage stability of honey. J Food Sci Technol. 2019 Jun;56(6):2930–2938. doi:10.1007/s13197-019-03733-3. PMID: 31198325.

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6. Hanna Saadah. Yellow Mustard for Nocturnal Leg Cramps: A Case Report with Hypothesis of TRP Channel Involvement. Noor J Complement Contemp Med. 2024;1(1). Available from: https://www.njccm.org/post/yellow-mustard-for-nocturnal-leg-cramps-a-case-report-with-hypothesis-of-trp-channel-involvement