Constipation (Vibandha)

Vibandha is one of the Apatarpana-janya-roga (Undernutrition : which leads to emaciation of the body) and in it's treatment, drinks prepared of roasted corn flour, alcohol, honey and sugar which help in the elimination of feces.

Vibandha refers to bowel movements that are infrequent or hard to pass. It is usually used to indicate fewer bowel movements, solidified hard stools, painful defecation and feeling of bloating, abdominal discomfort or incomplete elimination.

• According to Ayurveda the body is mainly composed of Dosha, Dhatu and Mala.

• Purisha (Stool) and Mutra (Urine) are the waste products of Anna (food) i.e., consumed food formed at the end of the process of digestion and metabolism termed as Malas.

• The waste products formed are removed from the body which is brought by a process called excretion.

• If it remains for a longer time in the body have tendency to vitiate the normal Dosha by causing srotas-sanga (Srotas : Channels, Sanga occurs when excessive tissues of toxins block the system of these channels) called Vibandha (constipation) and any unwanted thing in the body can be considered as Shalya causing pain due to obstruction in Purisha vaha srotas (Large intestines).

• This is brought about by numerous causative factors; among them three major causes are dietary, mental and lifestyle factors.

Vibandha (constipation) is not described as a separate disease entity in Ayurveda, however it mimics the symptoms of the following conditions:-

1. Udavarta (Retention of feces, flatus, urine)

2. Anaha (Obstruction)

3. Admana (Distension)

4. Mala-avastamba (Hardness of feces) due to the pratiloma gati (reverse flow) of Apana Vata (one of the sub-type of biological humor of Vata Dosha)

Clinical Features

1. Passage of hard stools

2. Abdominal pain/discomfort or bloating

3. Strain while passing stools

4. Headache

5. Malaise

6. Feeling of incomplete evacuation

Complications

Chronic stage of constipation might lead to:-

1. Bowel obstruction

2. Hemorrhoids

3. Rectal Prolapse

4. Hernia

5. Spastic Colitis

6. Laxative Abuse : A large number of people self medicate with Laxatives for constipation. This is not a good practice if it is used for a longer period of time, this can alter physiological functions of the intestines.

7. Excessive straining may have adverse effects on cerebral, coronary and peripheral arterial circulation resulting in syncope, ischemia and transient ischemic attacks.

Constipation is an acute or chronic condition characterized by dry and hard infrequent stools that are painful or difficult to pass.

Contributory and correctable causes

1. Insufficient dietary roughage

2. Lack of exercise

3. Suppression of defecatory urges arising at inconvenient moments

4. Inadequate time for full defecation

5. Prolonged travel.

Treatment as per modern

The basic aim of treatment is to find out the cause and manage it

1. Dietary adjustment

Fiber supplementation is the first line therapy for normal or slow transit constipation (Vegetables, fruits, mucilage, corn and cellulose)

This adjustment is suitable for simple constipation and not for obstructive constipation and fecal impaction.

2. Behavioral therapy:

Habit training is important to achieve regular defecation.

The patient is advised to attempt defecation after meals when colonic motility is maximum.

Once postprandial defecation is regular, the laxative is gradually withdrawn.

3. Drug Treatment: Laxatives and its type

• Osmotic laxatives: It does soften stool and increases the bowel movements by drawing water to the bowel thus helping in overcoming occasional constipation.

• Stimulant Laxatives: The use of stimulants causes the pushing of stool outside by its property of contractions of the intestine. Sudden bowel movement and discomfort and cramps are the common side effects seen.

• Bulk-forming (fiber) laxatives: It should be taken with more quantity of water to avoid side effects and bloating, as it contains fiber which uses the water in your intestines helping in making stool bulkier.

• Stool softeners: It is usually advised in a patient in whom straining should be avoided, it helps in softening dry and hard stools by increasing fluid in the stool.

• Lubricant laxatives: It is usually given in patients having a blockage in rectum and anus, which helps the stool retain fluid and pass out without difficulty.

4. Surgery

In a condition of strictures and/or obstruction surgery is required as in Hirschsprung's disease. Surgery may also be the choice of treatment in defecatory disorders with rectocele, intussusception, and rectal prolapse.

Treatment as per Ayurveda

Line of treatment : Ch.Ch(28/90)

1. Nidana Parivarjana : Avoiding etiological factors like incompatible diet, irregular food habits, Low fiber diet, stress, inadequate fluid intake should be avoided.

2. Samshodana Chikitsa (Bio- Cleansing therapies) followed by Shamana Chikita (Palliative therapies) should be advocated. Mentioned below are the therapies:-

• Snehapanam: Internal Oleation

• Swedana : Full body steam

• Virechana: Purgation

• Vasti : Enema

• Phalavarti : Rectal Suppositories

Virechana and Vasti should be decided by Ayurvedic Physician after accessing the patient's condition.

In the treatment of Vibandha (constipation), purgation eliminates pitta.

There are three types of Virechana (purgation):-

1. Sukha Virechana (easy purgation) : General herbs used - e.g; Trivrit (Operculina turpethum)

2. Mridu Virechana (mild purgation): General herbs used e.g; Aragvadha (Cassia fistula)

3. Tikshna Virechana (strong purgation): General herbs used e.g; Milk of Snuhi Plant (Achyranthes aspera)

Luke warm water is indicated in Vibandha, If Vata (air) is occluded by feces, then castor oil and oleation-therapy as indicated for udavarta (reverse movement of Vata)

Types of laxatives in Ayurveda

1. Carminative- Haritaki (Terminalia chebula) It will digest the undigested food residues by inducing or restoring normal peristaltic movement of the intestine by governing Vata, it prevents the formation of gas or helps in expulsion of formed gas by combating flatulence.

2. Laxative- Aragvadha (Cassia fistula) It hastens the elimination of undigested remains of food in the large intestine and colon by stimulating evacuation of the bowels by loosening and relaxation of bowels movements by acting on the intestinal wall, they increase the muscle contraction that moves along the stool mass. Natural stimulant laxatives are Senna, Cascara sagrada.

3. Purgative- Katuki (Picrorhiza kurroa) It is a strong laxative divided according to their nature into simple, drastic and saline purgatives, hydragogues encouraging the bowel movements by drawing water into the bowel from surrounding body tissues by softening the stool mass Catheritics- Trivrit (Operculina turpethum) This drug accelerates the defecation.

Mode of action of drug in constipation

1. Anulomana Drug: This drug helps in proper forming of excreta and also breaks the obstruction and brings them downwards is known as anulomana (aperients). Example- Haritaki (Chebulic myrobalan).

2. Bhedana: It breaks down either constipated fecal matter or the vitiated dOSHAS and expels them out is known as Bhedana (purgative) Example- katuki (Picrorhiza kurroa).

3. Rechana: The stool whether formed or unformed, is liquefied and expelled from the body by the action of a Rechana (cathartic) drug as in the case of Trivrt (Operculina turpethum).

4. Sramsana : The drug eliminates either pitta or kapha or both of them from the pitta ashaya (lower portion of the stomach and small intestine), Kritamala (Cassia fistula) is the example for this.

5. Drugs for Basti: Basti eliminates all the three Doshas present in the Pakvashaya (colon). Administration of Anuvasana basti is ideal when there is dryness and adhesion in the feces.

Conducive to body & Mind in Constipation

1. Sidhu : Refers to “molasses rum”

2. Phala varga (Friuts) : Matulunga (Citrus medica), jambira, Grape is laxative.

3. Shaka varga(Vegetables): Pushpa phala (Kushmanda), alabu, kalinda.

4. Harita varga (Vegtables consumes raw) : Plant that is used in salad form.

5. Ginger juice helps with Constipation

6. Vatahara madira (Alcoholic preparation) Sauviraka (Fermented Barley water) and Tushodaka (Fermented bean-husk water) and sour kanji (Rice water) are laxative.

7. Sauvarcala (black salt ) is light in digestion, alleviates constipation,

8. Vibandha (Constipation) is instantaneously cured by the administration of Bhallataka, Rasona (garlic) is laxative.

Lifestyle Advised

1. Consumption of light and easily digestible high fiber diet

2. Intake of warm water and avoid cold fluids

3. Practice regular exercises

4. Avoid irregular food timings, heavy, unwholesome, oily, spicy, bakery and preserved items.

5. Avoid suppression of stools and urine.

6. Avoid self medication.

Yogic Practices

1. Kurmasan : The Tortoise pose

2. Vakrasan : The twisted pose

3. Katichakrasan : Standing spinal twist pose

4. Shavasan : The corpse pose

5. Pawanmuktasan : Wind releasing pose

6. Mandookasan : Frog Pose

7. Vajrasan : Thunderbolt Pose

Note : All herbs should be consumed after consulting your Ayurvedic professional.

Consult your Yoga Trainer before doing asanas, don't try it on your own.

REFERENCES

• Charaka. Charaka of Agnivesha with Charaka chandrika teeka. Dr. Brahmanand Tripathy, Editor. Chaukhamba Sanskrit Prakashan, Varanasi. 2004. Ch.su. 1/7

• Sushruta. Sushruta Samhita. Vaidya Yadav Trikamji Acharya, Editor. 9th ed. Varanasi. Chaukhamba orientalia 2007. Uttara tantra 55/7

• Saragandhara.Saragandhara samhitha. Parshuram Pandit Shastri Vidyasagar, Editor. 6th Edition. Varanasi. Chaukhambha orientalia. p.233 20.

• Saragandhara. Saragandhara samhitha, edited by Parshuram Pandit Shastri Vidyasagar, Editor. 6th Edition. Varanasi. Chaukhambha orientalia .p.234

• Saragandhara. Saragandhara samhitha, Parshuram Pandit Shastri Vidyasagar, Editor. 6th Edition. Varanasi. Chaukhambha orientalia. P.234

• Saragandhara. Saragandhara samhitha, Parshuram Pandit Shastri Vidyasagar, Editor. 6th Edition. Varanasi. Chaukhambha orientalia,. p.230

• Saragandhara. Saragandhara samhitha. Parshuram Pandit Shastri Vidyasagar, Editor. 6th Edition. Varanasi. Chaukhambha orientalia. p.232

• Saragandhara. Saragandhara samhitha. Parshuram Pandit Shastri Vidyasagar, Editor. 6th Edition. Varanasi Chaukhambha orientalia. P.234