Constipation

Constipation is a condition of the digestive system where an individual has hard faeces that are difficult to expel

As many as one in five people experiences chronic constipation, a condition that’s even more common in women as they get older. It’s something that can easily creep up on you if you’re not paying attention, with many factors, from diet to other health conditions, contributing to the problem. 

Signs and Symptoms

• A feeling that not all stool has passed
• Bleeding from rectum
• Blood in stool
• Constant pain in the abdomen
• Fever
• Fewer than three bowel movements a week
• hard, dry, or lumpy stools
• Inability to pass gas
• Losing weight without trying
• Lower back pain
• Stools that are difficult or painful to pass
• Vomiting

Causes

• The slow movement of stool through your colon
• Delayed emptying of the colon from pelvic floor disorders especially in women, and colon surgery
• Functional gastrointestinal disorders, such as irritable bowel syndrome

Medicines and dietary supplements

• Antacids (containing aluminium and calcium)
• Anti-cholinergics and antispasmodics
• Anti-convulsants—used to prevent seizures
• Calcium channel blockers
• Diuretics
• Iron supplements
• Medicines used to treat Parkinson’s disease
• Narcotic pain medicines
• Anti-depressants

Changes in Lifestyle

• Pregnancy
• Old age
• Travelling
• when you ignore the urge to have a bowel movement
• Change in medicines
• if you change how much and what you eat

Dietary Changes

• Not eating enough fibre
• Not drinking enough liquids or dehydration
• Not getting enough physical activity

Diseases and Conditions

• Celiac disease
• Disorders that affect your brain and spine, such as Parkinson’s disease
• Spinal cord or brain injuries
• Metabolic disorders, such as diabetes
• Imbalance of hormones, such as hypothyroidism
• Inflammation linked to diverticular disease or proctitis
• Intestinal obstructions, including anorectal blockage and tumours
• Anatomic problems of your digestive tract

Medicines

Anti-depressants such as amitriptyline, and imipramine; Anticonvulsants such as phenytoin, carbamazepine, Iron supplements, and Antacids with aluminium may cause constipation.
Ayurvedic medicines containing Guggulu and Sallaki as ingredients may contribute to constipation. In such patients, usually, Triphala Churna is administered to nullify the side effect.

Herbs 

Ripe Falsa fruit – Grewia asiatica
Fox nut – Euryale ferox
Jamun fruit
Kupilu – Nux Vomica

Diagnosis

In addition to a general physical exam and a digital rectal exam, doctors use the following tests and procedures to diagnose chronic constipation and try to find the cause:

• Blood tests: Blood tests can specifically point out thyroid-related problems, such as low thyroid.
• Sigmoidoscopy: In this test, the doctor examines your rectum and the lower portion of your colon.
• Colonoscopy: This test allows your doctor to examine the entire colon with a flexible, camera-equipped tube.
• Balloon expulsion test: This test measures the amount of time it takes for you to push out a balloon that has been filled with water and placed in your rectum.
• Anorectal manometry: This test allows your doctor to measure the coordination of the muscles you use to move your bowels.

Tips to prevent constipation

The following can help you avoid developing chronic constipation.

• Include plenty of high-fibre foods in your diet, including beans, vegetables, fruits, whole grain cereals and bran.
• Eat fewer foods with low amounts of fibre such as processed foods, dairy and meat products.
• Drink plenty of fluids.
• Stay as active as possible and try to get regular exercise.
• Try to manage stress.
• Don’t ignore the urge to pass stool.
• Try to create a regular schedule for bowel movements, especially after a meal.
• Make sure children who begin to eat solid foods get plenty of fibre in their diets
• Avoid removing bran from the flour because the bran is an insoluble fibre that clears off the intestines and relieves constipation.
• Avoid refined foods like white flour, bread, pasta, pizza, white rice, etc.
• High-protein foods like cheese, red meat, and soybeans can cause constipation, so these must be taken with a bowl of salad and lots of liquids.
• Meat is constipating and should be avoided.
• Disturbing psychological factors should be removed, and meals should be taken in a relaxed and calm atmosphere.
• The food should be warm and freshly -prepared, as cold and stale food slows down the digestive power.
• Having excessively cold food like ice cream or chilled drinks reduces bowel movement.
• Avoid excess coffee and tea. Some people will not get bowel movement urges unless they have their coffee or tea. This advice is not applicable to them.
• Milk and dairy products if you are feeling constipated, consider cutting down on milk and dairy products.
• Avoid excessive spicy food, heavy non-veg, and fried food.

Treatment

In the majority of cases, constipation resolves itself without any treatment or risk to health.

The treatment of recurring constipation can include lifestyle changes such as doing more exercise, eating more fibre, and drinking more water.

Usually, laxatives will successfully treat most cases of constipation – but should be used with care and only when necessary. In more difficult cases, the person may need a prescription medication.

It is important to understand the cause of constipation – there could be an underlying illness or condition. Some people with recurring constipation use a daily diary where they record their bowel movements, stool characteristics, and other factors that may help both the doctor and patient devise the best treatment.

Some gastroenterologists comment that there are people who do not allocate enough time for their defecation. Set aside enough time to allow your toilet visit to be unstressed and uninterrupted, and do not ignore an urge to have a bowel movement.

• Laxatives: Several types of laxatives exist. Each works somewhat differently to make it easier to have a bowel movement. The following are available over the counter:
• Stimulants: These make the muscles in the intestines contract rhythmically. These include Correctol, Dulcolax, and Senokot.
• Lubricants: These help the stool move down the colon more easily. These include mineral oil and Fleet.
• Stool softeners: These moisten the stool.
• Fibre supplements: These are perhaps the safest laxatives. They are also called bulk laxatives. They include FiberCon, Metamucil, Konsyl, Serutan, and Citrucel and should be taken with plenty of water. If you want to buy bulk laxatives, then there is an excellent selection online with thousands of customer reviews.
• Osmotics: These facilitate the movement of fluids through the colon. These include Cephulac, Sorbitol, and Miralax.
• Saline laxatives: These draw water into the colon and include milk of magnesia.
• Chloride channel activators: These require a prescription and include lubiprostone (Amitiza).
• 5-HT-4 agonists: They increase the secretion of fluid in the intestines and speed up the rate at which food passes through the colon. They include Prucalopride.

If constipation does not respond to any treatment, as a last resort, surgery to remove part of the colon may be undertaken. In the procedure, the segment of the anal sphincter or rectum that causes the constipation is removed

Natural remedies- (Diet & Lifestyle Advice)

There are a few ways to ease the symptoms of constipation without using medication.

These include:

Increasing fibre intake:
People with constipation should eat between 18 and 30 grams (g) of fibre every day. Fresh fruits and vegetables and fortified cereals have high fibre content.

An apple or banana each day is helpful. Bananas should be ripe (bright yellow

Have a mid-morning soup, preferably prepared with spinach and tomato.

Drinking water:
Drink 7-8 glasses of water each day, preferably lukewarm in winters and room-temperature water in summers

Regular exercise:
Take daily morning and evening walks for at least 20-30 minutes each This can help to make bodily processes more regular, including the passing of stools.

Routine:
Having a place and time of day where you can put aside time to visit the bathroom without forcing a stool.

Bulking agents:
Adding these to your diet can help soften stools and make them easier to pass. Examples of bulking agents include wheat bran.

Avoiding holding in stools:
Responding to your body’s natural urges to pass stools when they happen is key to reducing the impact of constipation.

Elevate your feet:
Place your feet short platform, such as a step, and make sure the knees are above hip level while passing stools. This can reduce constipation.

Home Remedies

• Take one tablespoon of castor oil at bedtime until you get relief.
• Develop a habit of drinking water in the morning. Start with 2 glasses of water, and increase intake up to 6 – 7 glasses. It is more beneficial if this water can be stored in a copper container overnight.
• Soak 3-4 dried figs after washing them overnight in water. Eat them first thing in the morning, and also drink the water in which they were soaked. They should also be taken in the evening. Try this treatment for 3-4 weeks.
• Apply 3 to 4 drops of lukewarm castor oil over the navel at night in kids. It will help in clearing the bowel movements in kids (of age 1- 3 years) in the morning.
• Apply lukewarm sesame oil to the navel during taking bath and put a towel (which is dipped in warm water) on the lower abdomen.

Pathology of constipation as per Ayurveda

Due to the above-said unbalanced Vata factors, Apana Vata is aggravated and it is blocked in the lower part of the large intestine, which results in constipation. Depending on the grade of affliction, absolute constipation or hard stool are complained by the patients.

Ayurvedic treatment for Constipation (Vibandha)

• Mild oleation (Mridu snehana) –
  Internal oleation – Abhyantara Snehana – administering 5 – 10 grams of ghee or medicated ghee such as Sukumara Ghrita
  External oleation – oil massage with sesame oil / Maha Narayana oil

• Laxatives-Sukha virechana and vatanulomana Aushadha

• Use of Suppositories – Guda Varti

Herbs useful in mild constipation:

• Hareetaki -Chebulic myrobalan-Terminalia chebula
• Aragwadha-Cassia fistula
• Draksha-Raisins-Dry grapes-Vitis vinifera
• Patola- Trichosanthes dioica
• Katuki-Picrorrhiza kurroa
• Castor oil – Apart from constipation, castor oil in combination with other herbs is used in many diseases. For example Castor oil with Haritaki is used in treating rheumatoid arthritis. 

Herbs useful in severe constipation:

• Jayapala-Croton tiglium
• Danti- Baliospermum montanum
• Trivrit-Operculina turpethum

Ayurvedic Medicines

• Avipattikara choorna – A famous herbal powder mix, useful in gastritis, indigestion, urinary tract disorders, liver disorders, and alcoholism. Take 1 – 2 teaspoons of Avipattikar Churna (powder) with water or milk twice a day.
• Abhayarishta – Useful in piles, and haemorrhoids, relieves bloating, and constipation. Improves digestion. Take 3 -4 teaspoons of Abhyarishta with an equal quantity of water twice a day after meals.
• Swadishta virechana choorna
• Trivrit lehyam – Useful in constipation, and diseases of the heart. Also used in Virechana (Purgation treatment)
• Abhaya modaka
• Triphala choorna – Useful in eye disorders, liver and spleen-related disorders, a natural antioxidant.
• Dantyarishta – used in the treatment of haemorrhoids, constipation, gastric, intestine and spleen-related diseases.
• Drakshadi avaleha – used in jaundice, fatty liver changes, anaemia
• Icchabhedi rasa – Very powerful purgative. Used only in severe conditions
• Ashwakanchuki rasa – used in the treatment of cold, cough, bronchitis, asthma, and fever.
• Gandharvahastadi kashaya – used in the Ayurvedic treatment of Vata imbalance, bloating, constipation, and lack of taste in food.
• Anthrakutharam Gulika – Ayurvedic tablet used in bloating, constipation and other abdominal conditions.
• Sukha Virechana Vati – Also used in Panchakarma treatment
• Pancha Sakara Churna – Famous medicine in North India, also useful in indigestion. Take 1 – 2 teaspoons of Panchasakar churna with lukewarm water.
• Naracha Rasa – used in the treatment of ascites and constipation.
• Gandharvaharitaki / Triphala — Take 1 – 2 tablets of Gandharvaharitaki / Triphala with warm water at bedtime.
• Gandhak Vati — Take 1 tablet of Gandhak Vati with hot water after meals.
• Kayam Churna – a proprietary Ayurvedic medicine
• Erandabhrista hareetaki – Haritaki powder is fried in castor oil and is administered.
• Virechani Tablets –Take 1 – 2 tablets of Virechani with warm water or milk at bedtime.
• Aragwadharishta
• Patoladyarishta
• Padavaladi gana kashaya
• Rectal suppository – Phala varti

Simple remedies for Constipation

• Soak 10-15 raisins in water in the morning and consume them at night.
• 1 teaspoon of cow’s ghee should be dissolved in one cup (150ml) of warm water.
• In non-diabetic patients, 1 spoon of sugar candy can also be added (in non-diabetic patients) and taken during bedtime. This is highly effective against mild constipation.
• For those who pass the bowel like a pencil (hard) or like pellets, Gulkhand is administered during nighttime along with milk.
• The fruit pulp of Aragwadha is taken (10grams) along with water or milk. This helps to relieve even chronic kinds of constipation.
• The tender leaves of Castor (Eranda) (2-4) are taken and ground into a fine paste. To this pulp of Aloe vera is added. Consumption of this helps people, who frequently suffer from constipation.
• Regular use of aloe vera pulp in the diet prevents hard bowels.

Yogasanas for constipation

Pavana Muktasana, Uttana Padasana, and other Asanas and exercises that put pressure on the abdomen are very useful in the treatment.

Ayurvedic Herbs

• Triphala powder or Triphala Churna:- consists of three fruits – Amla or Indian gooseberry, Haritaki (Chebulic Myrobalan) and Vibhitaki(Bellirica Myrobalan). It is a great laxative and helps to regulate digestion and bowel movements.
• Raisins (kishmish) :- are packed with fibre and act as great natural laxatives. Soak a handful in water overnight and have them first thing in the morning on an empty stomach.
• Guavas (amrood or peru):-  have soluble fibre in the pulp and insoluble fibre content in the seeds.
• Lemon (Nimbu) juice:-  is recommended by most Ayurvedic practitioners as a quick and simple remedy for constipation.
• Figs (Anjeer):-  either dried or ripe, are packed with fibre and act as a great natural laxative. For relief from constipation, boil a few figs in a glass of milk, and drink this mixture at night before bed.
• Flax seeds (Alsi):-  are known for their fibre content, and can very well help you when it comes to constipation.
• Castor oil (Arandi ka tel):- has been used for centuries as a sure shot remedy for constipation and has properties that can kill intestinal worms.
• Spinach (Palak):-  have properties that cleanse, rebuild and renew the intestinal tract.
• Oranges:-  are not only a great source of Vitamin C but also have a large amount of fibre content.
• Seed mixtures with 2-3 sunflower seeds, a few flax seeds, til or sesame seeds and almonds ground together to a fine powder can help relieve 

Diet Plan For Constipation

VEGETABLES
To Consume	To Avoid
Spinach Turnip Cauliflower Fenugreek leaves Beans Lima beans Broccoli Sweet potato Ginger garlic Bottle gourd Ridge gourd Round gourd Bitter gourd
FRUITS
To Consume	To Avoid
Kiwi Pears Plums Apples Dates Avocado Raspberries Strawberries Blackberries Blueberries Fig Lemon Pineapple Citrus fruits Prunes Apricot	Banana (if not suitable)
PULSES
To Consume	To Avoid
Black-eyed peas Kidney beans Pinto beans Garbanzo beans Green gram (Moong dal) Black gram Chickpeas
SPICES
To Consume	To Avoid
Black pepper Fennel Turmeric Cumin Coriander Thyme
Other Food Products
To Consume	To Avoid
Air-popped popcorn Almonds Pecans Walnuts Sesame seeds Pumpkin seeds Flaxseed Whole grain bread Dried fruits such as raisins, and prunes. Water Oats Fresh yoghurt (mix with mashed bananas) Coconut water Milk Moong dal khichadi	Non-Vegetarian food like meat (can be taken in limited amount) Fried foods Spicy and junk food Soft drinks Tea, Coffee, Cheese Ice Cream Biscuits Pasta Maggie Sauces

Complications

The complications of constipation can include:

• Haemorrhoids or swollen veins in the anus: While having a bowel movement if you strain often, it may cause swelling in the veins in and around your anus. In fact, chronic constipation can lead to the development of piles.
• Anal fissure: Straining to pass stools can cause tiny tears in the anus.
• Faecal impaction: Hardened stool can accumulate and remain stuck in your intestines if you suffer from chronic constipation.
• Rectal prolapse: This occurs when due to too much straining over time, during bowel movements, causes a small part of the rectum to stretch and protrude from the anus.

Indications for referral

1. Acute intestinal obstruction
2. Rectal prolapse
3. Undiagnosed bleeding from the anus and not responding to medication

Caution for laxatives

Overuse of laxatives for a long period of time eventually worsens constipation. Hence, when you have been prescribed a medicine for constipation, be proactive to change your lifestyle and diet habits, as explained above, so as to prevent dependency on medications.

Disclaimer:

All the information in this article and the whole website is only for the purpose of education. They are not intended to diagnose, prevent, treat or cure any disease. Always consult your doctor for any health issues. Self-medication is dangerous. The health claims indicated are not approved by FDA.

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