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In the Pregnancy, Psyllium Powder Consumption Could Significantly Prevent Constipation

1 Department of Gastroenterology, Hitit University Corum Training and Research Hospital, Corum, Turkey
2 Department of Gastroenterology, Gulhane School of Medicine, Ankara, Turkey
*Corresponding author: Murat Kekilli, Department of Gastroenterology, Hitit University Corum Training and Research Hospital, Corum, Turkey. Tel: +90-3642230300, E-mail:
Annals of Colorectal Research. 2(1): e14461 , DOI: 10.17795/acr-14461
Article Type: Letter; Received: Aug 26, 2013; Accepted: Nov 9, 2013; epub: Mar 30, 2014;

Keywords: Pregnancy; Constipation

Dear Editor,

We read with great interest the recently published article by Ghahramani et al. (1). The authors found that in the third trimester of pregnancy, psyllium powder consumption could significantly prevent constipation, hemorrhoid and anal fissure. Although the authors discussed their findings comprehensively, we feel that there are some additional issues to be clarified.

In their study methodology, the authors mention the outcome of using psyllium at normal pregnant is effective to prevent constipation, but their diagnostic criteria do not meet the criteria of Rome III, which is universally accepted (2). In Rome III criteria for constipation , the patient must include two or more criteria for diagnosis (Straining during at least 25% of defecations, lumpy or hard stools in at least 25% of defecations, sensation of incomplete evacuation for at least 25% of defecations, sensation of anorectal obstruction/blockage for at least 25% of defecations, manual maneuvers to facilitate at least 25% of defecations (eg, digital evacuation, support of the pelvic floor), Fewer than 3 defecations per week, loose stools are rarely present without the use of laxatives). Therefore in this study, if we apply these criteria, the difference between these two groups may be lower than their results. And another important criterion in the diagnosis of constipation is the exclusion of irritable bowel syndrome (IBS), which is a prominent artifact of this study. Constipation dominant IBS is a misleading cause of constipation in pregnancy, and this disease might be an exclusion criterion.

From this point of view, we think that it would be worthwhile if the authors took into consideration of inclusion and diagnostic criteria of constipation with the respect to Rome III criteria.


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  • 1. Ghahramani L, Hosseini SV, Rahimikazerooni S, Bananzadeh AM, Namavar Jahromi B, Samsam A, et al. The effect of oral Psyllium Herbal Laxative Powder in Prevention of Hem-orrhoids and Anal Fissure during Pregnancy, a Randomized Double Blind Clinical Trial. Ann Colorectal Res. 2013;1(1):23-7.
  • 2. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130(5):1480-91. [DOI] [PubMed]