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Ginger, Paullinia Cupana, Muira Puama, and L-citrulline (COMP-4) as a Novel Natural Treatment for Severe Constipation


Gisi, Catherine MD1; Reicher, Sofiya MD, FACG1; Hou, Linda A. MD1; Fleischman, Wayne MD1; Eysselein, Viktor E. MD, FACG1

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doi: 10.14309/01.ajg.0000591572.44054.f1
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Epidemiologic studies report that about 15% of adults and 30% of people older than 60 years suffer from constipation in the United States. The actual prevalence is likely greater as many people believe their bowel habits are normal and underreport symptoms of constipation. Moreover, most recent surveys assessing current medical management of constipation show that patients are dissatisfied and believe that conventional treatments, like laxatives and colonic stimulants, are suboptimal since they can cause explosive bowel movements which are difficult to control. COMP-4, a combination of ginger, Paullinia cupana, muira puama, and L-citrulline is a novel nutraceutical that has been shown to stimulate the production of nitric oxide and cGMP in smooth muscle cells resulting in smooth muscle relaxation and possibly increases intestinal secretion. In this study, we aim to demonstrate that treatment with COMP-4 is an effective treatment for severe constipation.


Seventeen patients with constipation were treated COMP-4 (2-4 capsules per day) for 2-4 weeks. Constipation was defined as two or more of the following: the sensation of incomplete evacuation, Bristol stool score 1-2 (hard, lumpy nut or sausage-shaped bowel movements), and straining during the majority of defecations. Patients were surveyed before and after the treatment regarding their approximate number of bowel movements per week, their typical Bristol stool score, the presence of abdominal pain, and the feeling of incomplete evacuation. Statistical analysis was performed using the Wilcoxon rank test with a P < 0.05 considered significant.


Following treatment with COMP-4, the average weekly number of stools significantly (P < 0.0001) increased from 2.7+/-0.68 to 7.3+/- 1.11 (Figure 1). Prior to COMP-4, 16/17 patients reported incomplete bowel evacuation during bowel movements. After COMP-4, 10/17 patients reported complete bowel evacuation. The mean Bristol Stool Score significantly (P < 0.0001) increased from 1.5+/- 0.15 to 3.4+/-0.29 with softer and more formed stools (Figure 2). Patients also experienced a significant (P < 0.0001) decrease in abdominal pain (Figure 3).

Figure 1.
Figure 1.:
Average weekly bowel movements before and after taking COMP-4 for 2-4 weeks increased from 2.7 to 7.3 with P < 0.0001.
Figure 2.
Figure 2.:
Bristol stool score before and after COMP-4 significantly increased. Average score increased from 1.5 to 3.4.
Figure 3.
Figure 3.:
Number of patients with abdominal pain before and after taking COMP-4 for 2-4 weeks.


The combination of ginger, Paulinia cupana, muira puama, and L-citrulline improves the frequency and consistency of stools and helps relieve symptoms of constipation. The nutraceutical may be a novel agent used to treat severe constipation not responding well to other conventional treatments.

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