Magnesium Sulfate-Rich Natural Mineral Waters in the Treatment of Functional Constipation–A Review

Abstract

<jats:p>Functional constipation (FC) is a chronic constipation for which no physiological, anatomical or iatrogenic origin can be evidenced. This condition has a high impact on a patient’s quality of life and healthcare costs. Since FC is frequently associated with low physical activity and a diet low in fiber and/or water, first-line recommendations focus on sufficient activity, and sufficient fiber and water intake. In case of inefficacy of these measures, numerous drug treatments are available, either over the counter or on prescription. Magnesium sulfate has a long history in the treatment of FC, and magnesium sulfate-rich mineral waters have been used for centuries for their laxative properties. The laxative effect of magnesium and sulfate has since been widely demonstrated. Nevertheless, it appears that no clinical studies aiming at demonstrating their efficacy in FC had been conducted before the 21st century. In this paper, we reviewed the clinical data reporting the efficacy of magnesium sulfate-rich natural mineral waters. In view of their reported efficacy and safety, magnesium sulfate-rich natural mineral waters may represent a natural treatment for FC.</jats:p>

Chronic constipation in adults: Contemporary perspectives and clinical challenges. 2: Conservative, behavioural, medical and surgical treatment

“…Overhydration will not improve constipation as there is no association between fluid intake and constipation [29] Nevertheless, it is worth mentioning that four randomized, double‐blind, placebo‐controlled studies have demonstrated that magnesium sulfate‐rich natural mineral waters improved stool consistency and number of bowel movements in patients with CC, in association with a very good safety profile. This effect is probably the result of an osmotic mechanism of action, and efficacy was more noticeable with a higher total concentration of magnesium and sulfate [30].…”

Effects of Sodium Chloride-Rich Mineral Water on Intestinal Epithelium. Experimental Study

“…At present, treatments using mineral waters with a TDS greater than 1 g/L are used in balneology for digestive disorders, especially for dyspepsia [ 8 , 9 , 10 , 11 , 12 , 31 , 35 , 36 , 37 , 38 ], bowel function alteration and constipation [ 3 , 4 , 14 , 15 , 35 , 36 , 37 , 39 , 40 , 41 , 42 ], biliary tract dysfunctions [ 5 , 6 , 7 , 43 ], metabolic syndrome [ 44 , 45 , 46 , 47 , 48 , 49 ], and others [ 13 , 50 , 51 , 52 , 53 ].…”

Current Overview on Clinical Management of Chronic Constipation

“…Osmotic laxatives change osmotic gradient in the intestine. As a result, secretion of water and electrolytes in the intestine is higher, ultimately volume of stool is increased and consistency is reduced [ 6 , 14 , 52 ]. They are usually well tolerated in long term use [ 32 ].…”

“…Saline laxatives, like magnesium citrate and sulfate (Ebson salt), disodium phosphate, sodium phosphate which transport water to the lumen of small and large intestine, also belong to the group of osmotic laxatives. Noteworthy, Dupont and Hebert suggest to drink magnesium sulfate-rich natural mineral water, due to its effectiveness, low costs and naturality, with the minimum daily intake of magnesium sulfate at 20 mmol [ 52 ]. Nonetheless, consumption of mineral water and other saline laxatives should be carefully considered in elderly patients or at risk of cardiovascular diseases, renal impairment, and hypertension [ 29 , 52 ].…”

“…Another group are stimulant laxatives that directly stimulate intestinal motility by Auerbach and myenteric plexus, and increase water and electrolyte secretion to the intestinal lumen [ 52 , 53 ]. Stimulant laxatives are usually prescribed as the next step in the management of functional constipation [ 43 ].…”