CONSTIPATIN

Constipation is the infrequent and difficult passage of stools.
Constipation is a common, often frustrating, anddifficult to manage problem in the elderly. Approximately 25% of all Americans over 65years old experience constipation.
Ayurvedic therapies are very effective treatments forconstipation.

In Ayurveda, constipation is called vibandha. The word vibandhais derived from “vi”prefixed to “bandh,” meaning that which is especially bound (in the intestine) or obstructed. Its synonyms are purishasanga, purishanaha(both meaning the accumulation of feces), vishtambha(obstruction),kricchravitka, alpavitka(both meaning the passing of a small quantity of stool), and anaha (bloated abdomen due to accumulation of stools). Constipation is derived from Latin, “con” meaning together and “stipare,” meaning to cram or pack.

CAUSES:

The following are some of the most common causes of constipation, according to conventionalmedicine:

1. Improper diet — The most common cause of constipation may be a diet high in
animal fats and refined sugar but low in fiber found in vegetables, fruits, and
whole grains.

2. Not enough liquids — Liquids like water and juice add fluid to the colon and
bulk to stools, making bowel movements softer and easier to pass. People who
have problems with constipation should drink enough of these liquids every day,
about eight 8-oz glasses. Other liquids that contain caffeine (e.g., coffee and cola)
seem to have a dehydrating effect.

3. Lack of exercise — Lack of exercise can lead to constipation, although doctors do not know precisely why. For example, constipation often occurs after an accident or during an illness when one must take bed rest and cannot exercise.

4. Changes in life or routine — During pregnancy, women may be constipated
because of hormonal changes or because the heavy uterus compresses the intestine.
Aging may also affect bowel regularity, because a slower metabolism results in less intestinal activity and muscle tone.
5. Ignoring the urge to have a bowel movement — People who ignore the urge to
have a bowel movement may eventually stop feeling the urge, which can lead to
constipation.

6. Laxative abuse — People who habitually take laxatives become dependent upon
them and may require increasing dosages until the intestine becomes insensitive
and fails to work properly.

7. Travel — People often experience constipation when traveling long distances,
which may relate to changes in lifestyle, schedule, diet, and drinking water.

8. Fissures and hemorrhoids — Painful conditions of the anus can produce a spasm
of the anal sphincter muscle, which can delay a bowel movement.

9. Specific diseases — Diseases that cause constipation include neurological disorders, metabolic and endocrine disorders, and systemic conditions that affect organ systems. These disorders can slow the movement of stool through the colon,
rectum, or anus.

10. Mechanical compression — Scarring, inflammation around diverticula, tumors,
and cancer can produce mechanical compression of the intestine and result in
constipation.

11. Irritable bowel syndrome (IBS) — Also known as spastic colon, IBS is one of the most common causes of constipation. Some people develop spasms of the colon that delay the speed with which the contents of the intestine move through the digestive tract, leading to constipation.

12. Nerve damage — Injuries to the spinal cord and tumors pressing on the spinal
cord can produce constipation by affecting the nerves that lead to the intestine.

13. Medications — Many medications can cause constipation. These include pain
medications (especially narcotics), antacids containing aluminum, antispasmodic
drugs, antidepressant drugs, tranquilizers, iron supplements, anticonvulsants
for epilepsy, antiparkinsonism drugs, and antihypertensive calcium channel blockers.

14. Problems with colon and rectum — The peristaltic activity of the intestine may
be ineffective and result in colonic inertia or outlet obstruction. Intestinal obstruction, scar tissue (adhesions), diverticulosis, tumors, colorectal stricture, Hirschsprung's disease, or cancer can compress, squeeze, or narrow the intestine and rectum and cause constipation.

Physical examination:

The important aspects are abdominal palpation and rectal examination. Palpation may reveal the craggy mass of a neoplasm, faecal retention (especially in the thin patient) or a tender spastic colon.

The perianal region should be examined for localised disease. The patient should be asked to bear down to demonstrate perianal descent, haemorrhoids or mucosal prolapse. Perianal sensation and the anal reflex should be tested. Digital rectal examination is mandatory, and may reveal a rectal tumour and faecal impaction, as well as testing for rectal size and tone. If there is a history from infancy, a normal or narrow rectum suggests congenital megacolon (Hirschsprung's disease) but, if dilated, acquired megacolon.


The rectal examination:

The most important first step is to do the examination.
Method
Explain to the patient what will happen.

After inspection with the patient in the left lateral position and with knees drawn up, a lubricated gloved index finger is placed over the anus.
Ask the patient to concentrate on slow deep breathing. With gentle backwards pressure the finger is then inserted slowly into the anal canal and then into the rectum (it helps patient comfort if they push down or squeeze to accommodate the finger). Rotate the finger anteriorly to feel the prostate in males and the cervix in females. The finger will reach to about 7-8 cm with gentle thrusting into the perineum. Gently withdraw the finger and examine the whole circumference of the rectum by sweeping
the finger from posterior on both sides.

Points to note:

any pain,

e.g. fissure, proctitis, excoriation from diarrhoea (a rectal examination will not be possible in the presence of a fissure)
induration
from a chronic fissure or fistula in the anal canal the sphincter tone the nature of the faeces (? impaction) the rectal wall carcinoma is usually indurated, elevated and ulcerated a villous adenoma has a soft velvety feel

posteriorly— the sacrum and coccyx

laterally—the side walls of the pelvis

anteriorly_ cervix and pouch of Douglas in the female
prostate and rectovesical pouch in the male

Single drugs for constipation:

Aloe vera (Aloe):

Barbaloin or aloin derived from the inner sheath cells of Aloe leaves is a laxative. In vitro studies have revealed the inhibitory effect on sodium and potassium pump and chloride channels at the colonic membrane. Aloe anthroquinones were reported to enhance large-intestinal propulsion and water secretion in rats and mice. Randomized controlled trials have documented its potency as a cathartic in chronically constipated adults.

Plantago ovata (Psyllium):

The ground seeds or husks of psyllium are used in dietary supplements for increased fiber, cholesterol reduction, and laxative activity. In a randomized double-blind placebo study, psyllium was found to be effective for stool frequency and consistency in patients with chronic constipation. In an open study, conducted in patients having manifestations of irritable bowel syndrome with constipation, psyllium showed good results.


Cassia senna (Senna):

Senna leaf contains 1.5 to 3% hydroxyanthracene glycosides, mainly sennosides A and B, which are rheindianthrones, and smaller amounts of sennosides C and D, which are rheinaloe- emodin-heterodianthrones.
Modern human studies have investigated the use of senna for the following:
1. Treating severe constipation
2. Treating chronic constipation in long-stay elderly patients
3. Managing morphine-induced constipation
4. Improving colonoscopy preparation with lavage
5. Managing constipation in the immediate postpartum period
6. Managing postoperative constipation in anorectal surgery
7. Treating disorders characterized by slow intestinal transit time or constipation
8. Using as a laxative for terminal cancer patients treated with opiates


Rheum officinale (Rhubarb):

The active chemical constituents of rhubarb are anthraquinone glycosides, aloe-emodin, and physcion. Experimental studies have revealed that the laxative effect is due to the inhibition of water and electrolyte reabsorption in the large colon and to a stimulant effect on intestinal motility. Clinically, it is used to soften stool in anal fissures and hemorrhoids and is used postoperatively for anorectal surgeries. It is also effective as a cathartic and therefore used for colonoscopy preparations.


Prunus persica (Almond):

The leaf decoction of almond is used traditionally as anthelmintic and laxative. An experimental study has revealed that the aqueous extract of leaves exhibits cholinomimetic activity, which may result in its laxative effect.


Terminalia chebula (Chebulic Myrobalan):

T. chebula is a commonly advocated agent in Ayurveda for improving gastrointestinal motility. Charles Foster rats were administered T. chebula (100 mg/kg/day for 15 days orally), metoclopramide, or atropine, which established prokinetic and antikinetic activities, respectively. T. chebula was found to increase the percent of gastric emptying. The enhancement of gastric emptying was comparable with that produced by metoclopramide. This indicates that T. chebula can be a useful alternative to the prokinetic drugs available today.


Cassia fistula (Indian Laburnum):

The seeds and dried pulp in the pod of this fruit act as a purgative. The flowers soothe the eyes and the pods suppress acidity, making it useful in treating constipation associated with burning pain in the stomach (pitta type). The water extract is also used for treating constipation in pregnant women, children, and elderly persons. The pulp, prepared from its fruits, is a laxative used in the treatment of constipation.


Mallotus philippinensis (Indian Kamala):

The kampillaka plant is excellent in treating constipation associated with worm infestation as it first kills worms and then, due to its purging effect, gets rid of them. A powder made of kampillaka is especially useful. Sometimes worm infestation causes itching of the skin. At such times, taking kampillaka powder at night in the dose of only 500 mg to 1 g is useful.


Ricinus communis (Castor):
Castor seed oil is a harmless laxative in small doses. In large doses it is and can be safely used throughout the year.