Constipation and its Management according to Ayurveda

Constipation is a common complaint; the word constipation carries a different meaning for different individuals. Constipation has been used to describe infrequent defecation, straining with defecation, the passage of firm or small-volume faeces, painful defecation, and a sense of incomplete evacuation or lack of urge for defecation. If not treated or if treatment is delayed, it can lead to further problems such as fissures, fistulas, piles, lack of appetite and indigestion. Though the disease of constipation has not been discussed separately in Ayurvedic texts, Constipation is mentioned in Ayurvedic texts by the name of Vibandha meaning obstructing or binding of stool.

According to "Amarkosha" Vibandh is a synonym of Anaha.

DEFINITION OF ANAHA-3, 4

When the vitiated Vata (Apana) in the body (Pakvasaya) becomes accumulated in the region of a person's belly (Kuksi) and moves neither upwards nor downwards, then this condition is termed Anaha. According to Susruta, Anaha means, Aama (undigested food) or Shakrt (faeces) gradually accumulating inside the alimentary canal and obstructed from going out by the aggravated vata and not coming out in their routs (upward for Aama and downward for Pureesh); this is known as 'Anaha'.

TYPES OF ANAHA- 5

Susruta has mentioned two types of Anaha based on its cause or Udbhavasthana 1- Amaja Anaha 2- Pureeshja Anaha

In Anaha produced by Aama (undigested food) there will be thirst, running in the nose, burning sensation in the head, pain and heaviness in the stomach, nausea and obstruction to belching. We can compare pyloric obstruction to Amaja Anaha.

Stiffness (loss of movement) of the waist and back, non-elimination of faeces and urine, pain in the abdomen, fainting, faecal vomiting, dyspnoea and also symptoms of Alasaka, will be present in Aanaha caused by faeces. We can compare intestinal obstruction to Pureeshaja Anaha.

ETIOLOGICAL FACTOR OF VIBANDH- 6

(B)- Physical factor- 1- Dietary factors, lack of roughage, abuse of laxatives 2- Lack of water intake 3- Ruksha, Vishtambhi, Guru, Kashaya rasa pradhana foods 4- Inhibits the urge for stool 5- Excessive use of tea or coffee 1. 6-Uses of narcotics 6- Lack of exercise 7- Irregular timing of lunch or dinner 8- Due to pregnancy

SAMPRAPTI- 7

ACCORDING TO MODERN- 9

Lack of fibre or fluid intake

Slow-transi, Irritable bowel syndrome, Chronic intestinal pseudo-obstruction

Colonic carcinoma, Diverticular disease, Hirschsprung's disease

Obstructed defecation, Anorectal disease (corn's, fissures, haemorrhoids)s

Drugs Opiates, Anti-Cholinergics, Iron supplements Calcium antagonists, Aluminium-containing antacids

Diabetes mellitus, Hypothyroidism Hypercalcaemia, Pregnancy, Depression

TYPES OF CONSTIPATION

This is constipation due to an inadequate diet and lifestyle; there is no underlying organic disease and the condition responds to improvement in diet or the use of bulking agents.

An occasional patient, usually a young woman, will fall to respond to a high-residue diet, indeed this may exacerbate symptoms. These are a reduction in propagative motor activity in the colon together with inappropriate contraction of the pelvic floor muscles on straining. The condition usually begins in childhood or adolescence and is resistant to all treatments. The diagnosis is made on the history and confirmed by motility studies. Treatment is difficult; saline laxatives may help but subtotal colectomy may become necessary in some patients.

Constipation due to weakness of muscles of the colon and rectum

Constipation due to an obstruction in the intestinal wall

Due to excessive tonicity of the intestinal wall.

SYMPTOMS OF CONSTIPATION- 10, 11

1- Loss of appetite 2- Anorexia and indigestion 3- Headache 4- Flatulence 5- Pain in the abdomen and discomfort 6-  3 bowel motions per week. 9- Hard or lumpy stool  25% of the time.

COMPLICATION OF CONSTIPATION- 12

1- Faecal impaction 2- Faecal incontinence 3- Stercoral ulcers in rectum/colon 4- Acquired megacolon/mega rectum 5- Haemorrhoids 6- Chronic abdominal pain 7- Sigmoid volvulus

Remove the obstruction of Apanavayu and Amaj vikara. Deepan-Pachan and Vatanulomana dravya shoud be used.

1- Snehana, Abhyanga and Swedana 2- Administration of virechana, and Anuvasana basti.

PATHYA & APATHY

There are several drugs in Ayurveda that either single or in combination use laxatives or purgatives. There are two types of virechana drugs-

a- Anulomana (Aperients)- Drugs which expel out flatus and faeces after proper digestion and thus remove the obstruction are known as Anulomana. Exp. - Hharitaki b- Sramsana (Laxatives)- Drugs which expel the faeces and other wastes with or without proper digestion are 'Sramsana'. Exp. - Aragvadha c- Bhedana (Purgatives)- Drugs which break up The faecal mass and expel it out forcibly are known as 'Bhedana'.

(a) Laxative or aperients - milder action, elimination of soft but formed stools. (b) Purgatives or cathartic - stronger action resulting in more fluid evacuation.

All purgatives increase the water content of feces by: (a) A hydrophilic or osmotic action, retaining water and electrolytes in the Intestinal lumen. (b) Acting on intestinal mucosa to decrease net absorption of water and electrolyte; intestinal transit is enhanced indirectly by the fluid bulk. (c) Increasing propulsive activity as primary action - allowing less time for absorption of salt and water as a secondary effect. However, certain purgatives do increase motility through an action on the myenteric plexuses.

Laxatives, even herbal laxatives, should be used with caution. Other natural remedies should be tried first. The gentlest remedies for constipation include increased movement and exercise, certain yoga

ACKNOWLEDGEMENT

The Author is thankful to my guide Dr. D. S. Agrawal sir and the authorities of S. A. M. C. & Hospital Indore (M. P.) for providing facilities to present this article.

1. Dr. Shah Siddharth N. API textbook of medicine The Association of Physicians Of India, Mumbai ed.-7th. 2003 page no-554 2. Dikshit Bhanu ji 'Ramasrami' Commentary of Amarakosh Chaukhambha sanskrit sansthan varanasi, ed- 4th 2001, Kand-2nd, chapter-6, verse-55, page no.-283 3. Sharma P. V. Charak samhita Chaukhambha orientalia, Varanasi, re-edition-2008, vol-1st, Sutrasthana, Chapter-18 verse-32, page- 129. 4. Prof. Murthy K. R. Srikantha. Sushrut Samhita Chaukhambha Orientalia Varanasi ed- 2008, Vol-3rd, Uttara Sthana chapter-56 verse-20, page- 373. 5. Prof. Murthy K. R. Srikantha. Sushrut Samhita Chaukhambha Orientalia Varanasi ed- 2008, Vol-3rd, Uttara Sthana chapter-56 verse-23-24, page- 373. 6. Prof. Sharma Ajay Kumar A textbook of Kayachikitsa Chaukhambha Orientalia Delhi,ed.-2014, vol-2nd, chapter-53 page no.- 766. 7. Prof. Singh Ramharsh Atext book of Kaya-chikitsa Chaukambha sanskrat Pratishthan, Delhi,Re-ed.-200, Vol.-2nd, chapter-11, page no.- 217. 8. Prof. Sharma Ajay Kumar A textbook of Kayachikitsa Chaukhambha Orientalia Delhi,ed.-2014, vol-2nd,chapter-20, page no.- 256. 10. Prof. Sharma Ajay Kumar A textbook of Kayachikitsa Chaukhambha Orientalia Delhi,ed.-2014, vol-2nd,chapter-53, page no.- 767. 11. Dr. Shah Siddharth N. API textbook of medicine The Association of Physicians Of India, Mumbai ed.-7th. 2003 page no-554. 12. Dr. Shah Siddharth N. API textbook of medicine The Association of Physicians Of India, Mumbai ed.-7th. 2003 page no-557. 13. Prof. Sharma Ajay Kumar A textbook of Kayachikitsa Chaukhambha Orientalia Delhi, ed.-2014, vol-2nd,chapter-53, page no.- 767. 14. Swami Ramdev 'Yoga sadhana va yoga chikitsa rahasya' Divya prakashana, Haridwar, re-ed.-2004, page no.-42-62. 15. Prof. Sharma Ajay Kumar A textbook of Kayachikitsa Chaukhambha Orientalia Delhi,ed.-2014, vol-2nd,chapter-53, page no.- 769. 16. Sharma P. V. Charak samhita Chaukhambha orientalia, Varanasi, re-edition-2008, vol-1st, Sutrasthana, Chapter-25 verse-40, page- 168. 17. Prof. Murthy K. R. Srikantha Sarangadhara Samhita Chaukhambha Orientalia Varanasi ed-6th, 2006, Purva khanda chapter-4/3-6, page- 17. 18. Tripathi K D Essentials of Medical Pharmacology, Jaypee Broyhers medical publishers New Delhi, ed.-5th 2003, section-3, verse-11, page no. 610. 19. Prof. Sharma P. V. Dravyaguna-vijyana, Chaukhambha Bharati Academy, Varanasi, 2001, Vol-2, page no- 755, 170, 441, 419, 417, 414, 430, 428

Assistant Professor P.G. Dept. of Rasa Shastra and Bhaishajya Kalpana (S.A.M.C.H. Indore M. P.)