What Is Constipation: Causes, Symptoms & Treatment

Ayurveda acknowledges that the digestive tract is the very first place for any physiologic imbalance to offer early warning signs that something is amiss in the bodily functioning. Daily bowel movement is important to clean the colon and the whole body by removing toxins. Thus any changes in the diet & lifestyle regime impart the mirror image in the stool evacuation. Constipation is one of the very common gastrointestinal disorder experienced by most people at some time during their lifetime that refers to slow bowel movements of faeces through the large intestine that is infrequent, dry to pass due to over-absorption of the fluid leading to solidified hard stools with painful defecation and feeling of bloating, abdominal discomfort or incomplete elimination.

The classical definition of constipation as per ROME II criteria & Bristol stool scale, that marks the presence of any two or more of the following symptoms for at least 3 months: 

1. Infrequent passage of stool bowel movements/week) 
2. Hard stools 
3. Straining at stool 
4. Incomplete evacuation

What are the Causes of Constipation

Constipation has several root causes, the primary is an excessive amount of dryness in the body due to vata dosha which results in dryness of the colon, thus impairing the colon’s job to resorb water from the faecal matter before passing it out of the body, resulting in much drier stools due to lack of moisture, without adequate lubrication & inadequate contraction of bowel walls to expel the stools along with the anal canal leads to constipation. The following risk factor aids up to worsen digestive health;

1. Older age: Weak digestive system, less physically active & poor diet in old age results in vitiation vata leading to digestive complaints like hard stool.
2. Female gender: Pregnant women, hormonal changes in the preceding days of menstruation lead to slow transit of colon.
3. Less physical activity: No physical exercise or workout leads to lethargy and slow digestion.
4. Low fibre intake: Improper dietary habits with less fibre, including junk, fried & spicy food increases the risk of constipation.

Constipation is often a result of poor & insufficient dietary roughage, suppression of defecatory urges, poor fluid intake and lack of physical activity, although it can be caused by many things such as ageing, certain medications or diseases and prolongs travel

To highlight the causative aetiology of constipation, it occurs mainly due to the following factors:-

1. Dietary: Low fiber intake, Inadequate food as per season & nutritional value
2. Motility: Slow transit due to less immobility & lack of exercise, suppression of defecatory urges arising at inconvenient moments, inadequate time for full defecation, Irritable bowel syndrome or any obstruction.
3. Structural ailments: Anatomical or structural problem within the digestive system also contribute to constipation like megacolon e.g., Congenital or acquire, anal fissure, bowel stricture, bowel obstruction etc. 
4. Defaecatory ailments: Obstructive anorectal conditions like fissure, piles.
5. Metabolic disorders: Diabetes mellitus, pregnancy, hypocalcaemia, hypothyroidism.
6. Others: Ageing, stress, prolonged travel, certain medications like antacids, anti-psychotic drugs, aspirin, anti-hypertensive drugs, iron and calcium supplements etc.

What are the Symptoms of Constipation

Constipation is the ailment due to defect in the functioning of the large intestine, the main site of absorption of water content & passing the stools towards rectum through muscle contraction, leading into associated symptoms like;

How to Manage Constipation

A: Preventive measures

The basic preventive aspect revolves around dietary adjustments and behavioral suggestions. Advisable dietary & lifestyle recommendation as per Ayurveda includes;

1. Implement a daily regime by following the hunger, eating appropriate quantities of food with adequate time between meals.
2. Fibre supplementation is the first-line therapy, hence consumption of whole cereals, wheat bran, old rice, brown rice, light & easily digestible roughage diet. 
3. A healthy dietetic plan that emphasizes green gram, garlic, hingu, seasonal fruits like citrus fruits, grapes, amla, haritaki, pippali, shunthi, green leafy vegetables, beans, legumes and lukewarm water.
4. Stay hydrated by taking in an appropriate quantity (2-3L/day) of fluids like lukewarm water, fresh juices that are critical to both digestion and easy bowel evacuation.
5. Practice regular exercise, daily 30 minutes walking, yoga & pranayama.
6. Avoid irregular food habits, heavy, unwholesome, excess oily and spicy food items, bakery and preserved items.
7. Avoid suppression of natural urges, excess tea, coffee, smoking & especially self-medication.
8. Try to attempt defecation after meals when colonic motility is maximum.
9. General natural remedies;
   • Warm milk infused with ghee at bedtime regulates bowel functioning.
   • A cup of raw bael fruit’s pulp with jaggery is a great source of fibre.
   • Roasted fennel seeds along with warm water ease bowel movements.
   • Liquorice root powder, a natural laxative, when infused in warm water with jaggery stimulates bowel activity.

B: Management with medications

Management of constipation revolves around correcting the underlying cause by certain herbal medications if preventive measures are not enough to treat the condition.

1. Laxatives: These help in softening of the stools & also increases the bowel movement by drawing water to the bowel thus help in overcoming constipation. Some natural laxatives are isabgol husk, haritaki, sona-mukhi, avipattikar choorna, castor oil etc,
2. Stool softeners: They usually assist in regulating bowel movements while toning the muscles of the colon & are advised in conditions where straining should be avoided, as it helps in softening dry and hard stools by increasing fluid in the stool. Triphala is the best stool softener, others are hingvastak choorna, anjeer, roasted fennel seeds, fenugreek seeds, figs and lukewarm water.
3. General Ayurvedic medications to cure constipation are: 
   • Triphala is a composite formulation of Amalaki, bibithaki & haritaki that is effective natural laxative helping in improving the digestion & metabolism. It is safe for pre-diabetic & obese patients
   • Castor oil is a stimulant laxative that aids in cleaning the intestines by increasing the contractions.
   • Include aloe-vera pulp juice in the diet as it supports healthy digestion & metabolism by balancing vata, pitta and kapha.
   • Avipattikar choorna is a safe laxative for both children and the elderly. It supports healthy elimination by balancing pitta dosha that impairs digestive fire.
   • Chiruvilvadi kashayam is advised to treat abdominal distension, bloating & also improves appetite.

Why Opt For Natural Alternatives To Treat Constipation?

An allopathic laxative drug increases secretion in the colon, adding to the bulk of the stools & destroy the intestinal flora, thus diminishing the digestive ability over time while an Ayurvedic herb increases the digestive ability by regularises the movement of air in the colon leading to healthy peristalsis.

Modern treatment has certain limitations viz;

1. Dependency i.e. habit-forming
2. Side effects like abdominal cramps, gas, bloating and pain 
3. Complications such as diarrhoea, hypovolemia and metabolic disturbances
4. Become resistant to laxative by overuse due to the diminished effect of the medicine

In a nutshell, the management of constipation consists of elimination of etiological factors by local fomentation, massage, herbal suppositories, enema. Ayurveda outlooks the process of elimination as a salient criterion of overall well-being because healthy evacuation generally pitches to the strong digestive strength which is one of the keystones of well-being and longevity.