When The Bowels Grumble

Words: Dr Rajgopal NIDAMBOOR

Constipation is a common digestive disorder. It is the classical outcome of wrong eating habits and sedentary lifestyle. The problem is most often under-diagnosed, since most folks prefer to try a lot of unwanted medications, rather than report for treatment. What’s more, the belief that constipation leads to accumulation of toxins in the blood also results in a significant abuse of laxatives.

Constipation typically presents with having difficulty in bowel movement, or when your bowel movements are irregular. The stools, as a result, may be hard, and difficult to pass without straining. Or, you may feel like you need to have another bowel movement, even after you’ve had one.

It is also interesting to note that a large number of people mistakenly believe themselves to be suffering from constipation, if they do not have a bowel movement, every day. The medical definition of the disorder is — having less than three bowel movements a week. In addition to this, having hard stools, or straining at stool, also constitutes constipation.

The most common causes of constipation are poor intake of fibre, also fluids, ignoring the urge for stools when it comes, ‘purging,’ with purgatives, and thyroid problems, among others.

Constipation affects two per cent of the global population and people of all ages. It is, of course, more common among children and the elderly [above 65 years]. Statistics suggests that nearly 40 per cent of people in the age group 65-75 experience chronic [long-term] constipation. Constipation also tends to be more common among women as compared to men. The male-female ratio is 1:3. Constipation is common during pregnancy and after childbirth too.

Symptoms

  • Bloated feeling and discomfort in the abdomen
  • Lethargy
  • Unsatisfied feeling after passing stools; or, a sense of incomplete evacuation
  • Rectal fullness needing manual evacuation of stools in long-standing cases.

Diagnosis

This is primarily done on the basis of symptoms in a clinic consultation. Apart from this, certain tests like barium enema, colonoscopy, sigmoidoscopy, and thyroid tests to find out the actual causes, if any, or rule them out, for constipation may sometimes be required.

Treatment

Ayurveda

Background. Functional constipation has no underlying organic cause. It is difficult for allopathic treatment to resolve it in the long-term due to its side-effects and undeniable outcome. Thus, a naturally balanced and compatible formulation needs to be validated.

Objectives. The current study aimed to assess a poly-herbal Ayurveda formulation in the management of functional constipation.

Material & Methods. This study was for 28 day-two armed, randomised, open labelled, prospective clinical study. 60 clinically confirmed cases of functional constipation patients were randomised to receive orally either two teaspoonful of PP/JLN/107/09-10 syrup, or one teaspoonful of 5-6gm of Isabgol powder. Results were analysed as per Rome II Criteria and other associated symptoms, like headache, acidity, belching, barborgysmy, flatulence and abdominal distension, or bloating, were recorded on VAS score.

Results. PP/JLN/107/09-10 scored over Isabgol on four out of six parameters of Rome II Criteria, viz., frequency of bowel movement, straining at defaecation, lumpy hard stool formation, feeling of incomplete evacuation, feeling of ano-rectal blockage and manual manoeuvres [p<0.001]. The trial drug showed comparable effects [p>0.05] in reducing the mean scores of associated symptoms, like headache, acidity, belching, borgorgysmy, flatulence and abdominal distension. The trial drug was also found to provide statistically significant results in more number of parameters in comparison to Isabgol.

Conclusion. PP/JLN/107/09-10 was found to be effective and safe in reliving functional constipation.

  • Dr P Rugved, P K Gupta, et al. “A Randomised, Comparative, Open Clinical Trial for Evaluating the Efficacy of PP/JLN/107/09-10 Syrup in the Management of Functional Constipation.” Journal of Ayurveda and Integrated Medical Sciences, 2020, 5[06], 43-50. 

Homeopathy

Background. Constipation is the term describing either infrequent bowel movements, difficult evacuation of stool, hard stool, or a sensation of incomplete defaecation. The effects of constipation compound from impacting on the person’s physical health to effecting their moods and influencing their social life. Most conventional treatments strive to treat only local symptoms and do not address concomitant symptoms of constipation. Alternative treatment options, such as homeopathy, offer a more holistic approach and can be adopted; however, further research is needed to establish its effectiveness in treating constipation.

Purpose. The aim of this study was to determine the efficacy of individualised homeopathic treatment on chronic constipation in adults.

Methodology. This was a case study research design conducted at the University of Johannesburg Homeopathy Health Training Centre. Thirteen adults between the age 18 and 50 who met the Rome II Criteria for constipation were selected for participation and ten participants completed the study. The study consisted of four consultations per participant over a six-week period. At the initial meeting, a comprehensive case history was taken and analysed according to the principles of classical homeopathic prescribing and the best suited homeopathic remedy was administered. Data collection was in the form of case studies, which were analysed and described. The Bowel Function Diary and Bristol Stool Form Scale were used to assess changes in defaecation quality and frequency and the results were represented in the form of graphs.

Results. The results of the case studies were positive and holistic. They indicated an improvement in stool frequency for all ten participants, and an improvement in stool form and ease of evacuation for the majority of the participants. The participants also reported that they experienced a better state of general and emotional well-being during the course of the research study. These results support previous findings which suggest that when an individualised homeopathic approach is correctly applied in a clinical setting, it is an effective approach for the management of chronic constipation in adults.

  • Nakhooda F, Solomon E M, and Tsele-Tebakang T. “The Efficacy of Individualised Homeopathic Treatment on Constipation,” Core/UK, February 2016. 

Homeopathy takes into consideration not only the individual’s physical symptoms, but also psychological aspects, while prescribing remedies. Thus, the individual’s habits, nature and behaviour are all taken into account. This helps to treat from the ‘root,’ rather than simply treat symptomatically.

Homeopathic remedies gently turnaround the functionality of the bowels to normal. This helps in the regularisation of bowel movements as well the formation of stools of normal consistency.

After starting homeopathy treatment, most people reduce their dependence on laxatives and purgatives successfully. However, the importance of a proper, balanced diet and regular exercise cannot be over-emphasised, when it comes to treating constipation, safely, gently, and also effectually.

For constipation with a feeling of dryness in the rectum — or, where the problem is often a result of stress, Bryonia alba is a useful remedy. Likewise, when there is pain after the bowels have moved, or when stools look like ‘little balls’ attached together with mucous, Graphites is often useful. As for frequent indigestion with gas and bloating, with a great craving for sweets, Lycopodium clavatum is most helpful. Nux vomica is another useful remedy. It suits impatient, tense, and ambitious individuals who love partying and gulping down their ‘good’ fill of alcohol, or cigarettes, fatty food, and leading a sedentary life.

Nutrition

Background. Functional constipation is a prevalent, burdensome gastrointestinal disorder whose treatment remains challenging. Probiotics have been increasingly investigated in its management.

Objective. The aim was to investigate the effect of probiotics on gut transit time, stool output, and constipation symptoms in adults with functional constipation via a systematic review and meta-analysis of randomised controlled trials [RCTs].

Design. Studies were identified by searching four electronic databases, back-searching reference lists, contacting authors, and hand-searching abstracts. RCTs that reported administration of probiotics in adults with functional constipation were included. Two reviewers independently performed the screening, data extraction, and bias assessment. Outcome data were synthesised by using weighted mean differences [WMDs], or standardised mean differences [SMDs], with the use of a random-effects model.

Results. A total of 660 records were identified of which 14 were eligible [1,182 patients]. Overall, probiotics significantly reduced whole gut transit time by 12.4 h [95 per cent CI: −22.3, −2.5 h] and increased stool frequency by 1.3 bowel movements/wk [95 per cent CI: 0.7, 1.9 bowel movements/wk], and this was significant for Bifidobacterium lactis [WMD: 1.5 bowel movements/wk; 95 per cent CI: 0.7, 2.3 bowel movements/wk], but not for Lactobacillus casei [WMD: −0.2 bowel movements/wk; 95 per cent CI: −0.8, 0.9 bowel movements/wk]. Probiotics improved stool consistency [SMD: +0.55; 95 per cen CI: 0.27, 0.82], and this was significant for B lactis [SMD: +0.46; 95% CI: 0.08, 0.85], but not for L casei [SMD: +0.26; 95 per cent CI: −0.30, 0.82]. No serious adverse events were reported.

Conclusion. Probiotics may improve whole gut transit time, stool frequency, and stool consistency, with subgroup analysis indicating beneficial effects of B lactis in particular.

  • Eirini Dimidi, et al, “The Effect of Probiotics on Functional Constipation in Adults: A Systematic Review and Meta-Analysis of Randomised Controlled Trials,” The American Journal of Clinical Nutrition, Volume 100, Issue 4, October 2014 [1075-1084].

Self-Help

  • Eat more fruits, vegetables and grains, high in fibre
  • Drink plenty of water and other liquids
  • Get adequate exercise; make appropriate lifestyle changes under professional guidance
  • Take time to have a bowel movement when you need to
  • Seek professional medical treatment.
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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