CHRONIC CONSTIPATION

People mean many things when they say they have constipation. Infrequent passing of stools, difficulties in voiding, sense of incomplete voiding are all suggestive of constipation. The normal reference range for bowel movements is very varied. Some people have bowel movements three times a day; others, only one or two times a week.

Medically, constipation is defined as fewer than three bowel movements in a week. Constipation may be considered severe, when there is less than one bowel movement in a week.

Infrequent stools with no other complaints is rarely abnormal. Women are more affected than men. The elderly and children are however most prone to constipation.

• Hard, difficult to pass stools which require straining or manual removal with fingers - felt     more than 25% of times.
• Stools infrequent, less than three times a week.
• Sensation of incomplete voidance.

Other symptoms that a person with constipation may feel are:

• The abdomen may seem bloated, distended or crampy.
• The bowel sounds may seem enhanced.

Many factors contribute to development of constipation. Different people will have different set of causative factors.

• Insufficient fiber intake in diet.
• Not chewing the food properly / eating hurriedly.
• Reduced water intake.
• Various medications
• Iron supplements
• Antidepressants, tri-cyclic anti-depressants.
• Anti-convulsants
• Diuretics
• Stopping cigarette smoking.
• Abuse of laxatives.
• Medications containing calcium and aluminium.
• Endocrine disorders like - under active thyroid.
• Any severe illness like stroke, paralysis.
• Major changes in life like pregnancy, old-age or traveling.
• Psychosomatic causes like depression and anxiety neurosis.
• Biochemical imbalance ' low potassium levels in blood.
• Lead poisoning.
• Conditions that obstruct the normal passage of the stools within the intestines ' foreign bodies in intestines, strictures, adhesions, tumors, etc.
• Abdominal surgeries.
• Weakened pelvic floor muscles.
• Constipation can occur sometimes as part of a condition called 'irritable bowel syndrome' where it alternates with diarrhea.

A proper clinical history and physical examination usually suffices to diagnose constipation. The presence of hard stools, difficulty in eliminating them and feeling of incomplete voiding of stools usually indicate the presence of constipation. Very hard, small, pellet-like stools which are eliminated with a lot of difficulty certainly indicate constipation even if stool occurs every day.

In very severe constipation of long standing, a physical examination may reveal the presence of hard lumps over the abdominal surface.

Other tests that your doctor may advice are:

• Anorectal function tests - identify constipation caused by abnormal functioning of the anus or rectum.
• Sigmoidoscopy or colonoscopy.
• Colorectal transit study - shows how well food moves through the colon.
• Defecography - evaluates completeness of stool elimination, evaluates rectal muscle contractions and relaxation and abnormalities in the anal canal or the rectum.
• Barium enema X-rays of the abdomen to detect the presence of any foreign bodies or other structural abnormalities within the intestines.
• Tests to rule out an under active thyroid.

A proper clinical history and physical examination usually suffices to diagnose constipation. The presence of hard stools, difficulty in eliminating them and feeling of incomplete voiding of stools usually indicate the presence of constipation. Very hard, small, pellet-like stools which are eliminated with a lot of difficulty certainly indicate constipation even if stool occurs every day.

In very severe constipation of long standing, a physical examination may reveal the presence of hard lumps over the abdominal surface.

Other tests that your doctor may advice are:

• Anorectal function tests - identify constipation caused by abnormal functioning of the anus or rectum.
• Sigmoidoscopy or colonoscopy.
• Colorectal transit study - shows how well food moves through the colon.
• Defecography - evaluates completeness of stool elimination, evaluates rectal muscle contractions and relaxation and abnormalities in the anal canal or the rectum.
• Barium enema X-rays of the abdomen to detect the presence of any foreign bodies or other other structural abnormalities within the intestines.
• Tests to rule out an under active thyroid.

Constipation is a condition easier to prevent than to cure. Tackling the problem at its onset can prevent many years of discomfort and sufferings.

• Have more fibers in your diet. 25 to 30 grams of daily intake can prevent constipation. Fibers help retain water in the stools thus making them softer and easier to expel.
  • Whole grain cereals and breads
  • Dried fruits, such as prunes and raisins
  • Popcorn, nuts, and seeds
  • Beans and legumes
  • Raw fruits and vegetables
• Drink plenty of fluids, preferably water. 8 glasses a day will help. Have more if you are physically active. Prune (manukka) juice, and other fruit drinks are known to normalize bowel motility.
• Cut down on soft drinks and alcohols. Dehydration is a major contributor for hard, lumpy & irregular stools. Overuse of colas, alcoholic and caffeinated products can contribute to constipation. They are dehydrating agents.
• Check your medicine closet. Identify your routine medications that may contribute to constipation. Let your doctor help you find an alternative.
• Don't curb your natural tendencies! Do not ignore your body's natural urge to defecate. Over time, your body will stop having these natural urges and constipation will set in. Train your child to void himself when he has the urge, even if he'd rather play.
• Stop the regular use of laxatives and enemas. Their long-term use can aggravate constipation. If you must take laxatives, then try starting with very low doses. Avoid randomly self-medicating oneself.
• Exercise, Exercise, Exercise!! Physical inactivity can certainly make bowel movements very sluggish! People tend to cut down on physical activities as they age, for many reasons. Walking is a great way to exercise and prevent constipation.

Changes in living and diet can alleviate the symptoms of chronic constipation. An under active thyroid disorder or mood disorders like anxiety neurosis will require treatments specific to them.

A major part of treatment consists of adding more fiber and fluids in the diet; engaging in more physical activities and modifying the stress factors that contribute to constipation. Constipation not improving with life-style changes is managed with

• Laxatives
• Enemas

However, long term use of laxatives can cause further symptoms of distention and bloated feeling, not to mention an ever increasing dependence on them.

1) Abhayarishta         20 ml HS

2) gulkand                1-2 tsf HS

Pnachkarma

Basti                        Dashmul Kadha
C/i before completion of 4 months of pregnancy