Words: Dr Rajgopal NIDAMBOOR

Constipation defies precise definition. It usually implies a reduced stool frequency and the passage of hard small stools. It may also be considered, on empirical terms, as occurring when defaecation is inadequate and infrequent to cause the sufferer both discomfort and alarm, or induce recourse to self-medication, not to speak of medical treatment.

It would be too superfluous to emphasise that constipation is one of the most common ailments of everyday life. Witness the agony writ large on the patient’s face when they say, “Doctor, my bowels don’t seem to move even a wee bit for quite a while now…” The trouble does not end with the confession, because it happens to be just the beginning of embarrassment. In children, it may lead to a habit which is not only painful but also improper.

Constipation is a common complication of prolonged physical inactivity and bed rest. While commonly used conventional drugs, like analgesics and diuretics, may often induce the problem, it could also be caused on account of inadequate fluid intake, low residue diets, organic disorders of the colon, or rectum, and psychiatric disturbances. It needs to be emphasised to the patient that a daily bowel movement is not essential for perfect health, and that the so-called ‘self-poisoning’ theories are totally baseless, provided there is no serious physical defect.

Constipation may also be caused by a wide variety of non-gastrointestinal disorders, hypothyroidism [low thyroid state], hypercalcaemia [excess calcium] and haemorrhoids [piles]. Investigation will depend upon the group of anomalies responsible for the onset of the complaint.

Constipation in children may be an expression of psychological distress, while in the elderly a lax colon and flaccid abdominal musculature may be provocative causes. They also lead to spurious diarrhoea in both. What’s more, in children there could be a conscious, forced retention of stools, whereas in the old, manual movement of a retained mass may be needed before a normal bowel habit can be restored. Constipation, in the young and the old alike, in the absence of any organic disease, revolves around a brace of defects: the suppression of the defaecation reflex and/or absence of the habit.


  • Motility disorders. Irritable bowel syndrome [IBS]; diverticulosis [small pouches that bulge outwards through the colon, or large intestine]; megacolon [abnormal dilation of the colon] from laxative abuse
  • Intestinal obstruction
  • Anal/rectal diseases. Proctitis [inflammation of the rectum and anus]; anal fissure; mucousal prolapse.
  • Drugs. Analgesics; antacids; iron tablets; lead poisoning etc
  • Metabolic/endocrinal anomalies. Diabetes; hypokalaemia [potassium deficit]; pregnancy; haemochromocytoma [tumour of adrenal gland tissue]; porphyria [a rare hereditary disease]
  • Neurological disorders. Aganglionosis [absence of ganglia from the duodenum to the rectum]; pseudoobstruction; Chagas’s disease [a tropical parasitic disease]; spinal cord lesions; Parkinsonism; and, cerebrovascular disease.

In a normal individual, the rectum is usually empty to start with: faeces are stored in the sigmoid, or the pelvic colon, and not in the rectum as is the popular opinion. The urge to pass stool occurs as a consequence of a mass movement of the colon, when some faeces enters the rectum.

When the rectum is filled with faeces/gas/liquid, it raises the rectal intraluminal [occurring within, or introduced into the lumen] pressure to the desired extent, wherein the desire to void the rectum is felt. While the usual stimulus is obtained by drinking a cup of coffee/tea, food [postprandial], or smoking — a bad habit at that — most people prefer a glass of water, or fruit juice, for the initiation of the reflex.

While the act per se is under some degree of voluntary control, the reflex centres for defaecation have their seat of power in the hypothalamus, spinal cord and the gut. The most fascinating aspect of the process is the high degree of accuracy which can distinguish whether the increased pressure is due to faeces, liquid or gas, unless the ability is lost on account of any functional/organic defect.

The act in the adult is normally preceded by a voluntary effort comprising of squatting, or any other appropriate posture, wilful relaxation of the external anal sphincter and compression of the abdominal contents through straining mechanism. Result? A mass contraction of the colon moves its contents and transfers them into the rectum via the pelvic colon to be voided through the anus. The emptying mechanism becomes a routine, by way of habit, or practice. And, there lies its import.

Don’t Neglect The Call

Constipation is most often caused by a repeated neglect of the call to pass stools. For a variety of reasons: from overcrowding, or lack of privacy in schools, for example. And, the sequence: if the pressure which calls for voiding of stools is ignored, the sensory apparatus becomes ‘adapted’ to the reflex and the desire is no longer felt: all emphasising for a greater pressure to ensue as a launching pad for the expulsion. This will also pass off, if not obeyed, and a greater spurt in the volume is irritability of the rectum, from where the urge may no longer be felt.

More often than not, the person, distressed by the cited chain of events, takes to the easiest way out of the trouble: a cathartic/laxative/purgative only to spoil the sensory mechanism. Frequent repetition of this incoherent self-indulgence or ‘blunderbuss’ often leads to a dependence. In other words, the ‘more the better’ laxatives etc., — and, then ‘double-trouble.’

Speak to your homeopathic, or Ayurveda, physician today and say goodbye to constipation — for your optimal health and well-being.

Dr RAJGOPAL NIDAMBOOR, PhD, is a wellness physician-writer-editor, independent researcher, critic, columnist, author and publisher. His published work includes hundreds of newspaper, magazine, web articles, essays, meditations, columns, and critiques on a host of subjects, eight books on natural health, two coffee table tomes and an encyclopaedic treatise on Indian philosophy. He is Chief Wellness Officer, Docco360 — a mobile health application/platform connecting patients with Ayurveda, homeopathic and Unani physicians, and nutrition therapists, among others, from the comfort of their home — and, Editor-in-Chief, ThinkWellness360.

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