Homoeopathic management of constipation

Dr Kirti Patwariya 

Abstract-
Constipation is generally described as having fewer than three bowel movements a week. Though occasional constipation is very common, some people experience chronic constipation that can interfere with their ability to go about their daily tasks. Chronic constipation may also cause excessive straining to have bowel movement and other signs and symptoms.

The infrequent passing of stools, difficulties in voiding, sense of incomplete voiding are all suggestive of constipation. Some people have bowel movements three times a day; others, only one or two times a week. Constipation may be considered severe when there is less than one bowel movement in a week. Treatment for chronic constipation depends on the underlying causes. Though Homoeopathy has significant results in treating constipation. Best results are procured with proper case taking and reportorization which will help to find a similimum remedy for a specific case which is prescribed as per law of homoeopathy.

Introduction-
Constipation is mostly defined by one or more of following symptoms: The following hard-formed stool & dry bowel movements (typically less than three per week), excessive straining, a sense of incomplete bowel evacuation, and excessive time spent on the toilet or in unsuccessful defecation. Constipation is the most common chronic gastrointestinal disorder in adults. Depending on the definition employed, it occurs in 2% to 20% of the population. It is more common in women, the elderly and children. The reasons it occurs more frequently in the elderly are felt to be due to an increasing number of health problems as humans age and decreased physical activity. Overall, the average prevalence of constipation was estimated at 16% worldwide, while a prevalence of 33.5% was attributed to adults between 60 and 110 years old.

According to the research, 13% of adult Indians report having severe constipation, and 22% of those with the illness appear to be adults. Constipation linked to specific comorbidities affects 6% of the Indian population. Chronic constipation accounts for 3% of all visits annually to pediatric outpatient clinics.

Keywords: –    Constipation, Bowel movements, Homoeopathy, Stool, Similimum.

Causes-

Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract, causing it to become hard and dry.

Chronic constipation has many causes: –

1.Mechanical/Obstructive causes–
Obstruction in the colon or rectum may slow or stop stool movement. Ex.-Anal fissure, Bowel obstruction, Colon cancer, narrowing of the colon (bowel stricture), Other abdominal cancer that presses on the colon, Rectal cancer, Rectocele.

2.Congenital causes–
Several diseases present at birth can result in constipation in Children. They are as a group uncommon with Hirschsprung’s disease (HD) being the most common. There are also congenital structural anomalies that can lead to constipation, including anterior displacement of the anus, imperforate anus, strictures, and small left colon syndrome.

3.Neurological causes-
Neurological problems can affect the nerves that cause muscles in the colon and rectum to contract and move stool through the intestine. Ex.- Autonomic neuropathy, Multiple sclerosis, Parkinson’s disease, Spinal cord injury, Stroke

4.Muscular causes–
Problems with the pelvic muscles involved in having a bowel movement may cause chronic constipation. Ex.- Inability to relax the pelvic muscles to allow for bowel movement (anismus), Pelvic muscles don’t coordinate relaxation and contraction correctly (dyssynergia), weakened pelvic muscles.

5.Hormonal causes–
Hormones help balance fluids in the body. Diseases and conditions that upset the balance of hormones may lead to constipation. Like Diabetes, Overactive parathyroid gland (hyperparathyroidism), Pregnancy, Underactive thyroid (hypothyroidism).

6.Dietary causes–
Constipation can be caused or exacerbated by a low-fiber diet, low liquid intake, or dieting. Dietary fiber helps to decrease colonic transport time, increases stool bulk but simultaneously softens stool. Therefore, diets low in fiber can lead to primary constipation.

7.Medications–
Many medications have constipation as a side effect. Some include (but are not limited to) opioids, diuretics, antidepressants, antihistamines, antispasmodics, anticonvulsants, tricyclic antidepressants, antiarrhythmics, beta-adrenoceptor antagonists, anti-diarrheal, 5-HT3 receptor antagonists such as ondansetron, and aluminum antacids. Certain calcium channel blockers such as nifedipine and verapamil can cause severe constipation due to dysfunction of motility in the rectosigmoid colon. Supplements such as calcium and iron supplements can also have constipation as a notable side effect.

8.Psychological causes–
Voluntary withholding of the stool is a common cause of constipation. The choice to withhold can be due to factors such as fear of pain, fear of public restrooms, or laziness. When a child holds in the stool a combination of encouragement, fluids, fiber, and laxatives may be useful to overcome the problem. Early intervention with withholding is important as this can lead to anal fissures.

9.Physiological causes– Pregnancy, being dehydrated, getting little or no physical activity.

Case summary: –

62 yrs. old male patients came to Opd for following complaints.

He has constipation for 2 yrs. With bloating of abdomen and has only stools 3 times or fewer than 3 in a week, with no urging for defecation. Pain in abdomen which is ameliorated after stool. Consistency of stool is Hard and dry. He also has tingling sensation in lower extremities (Legs). Patients take a good diet and take regular walks. He has two sons and two daughters, and his personal relationship is good with them. Mentally patient becomes angry when someone contradicts him, and he also be afraid of poverty (Fear of Poverty). Patient is thermally chilly and thirsty, his complaints aggravate from milk, he has desire for spices which aggravate his chief complaints. Perspiration mostly on back and staining the linen.

On examination: –

• Blood pressure-120/70mmHg,
• Temperature- Afebrile 98.6-degree Fahrenheit,
• Respiratory rate- 18/min.,
• Pulse- 78/min
• Distended abdomen
• Tongue- Slightly white coated

Diagnosis – Primary Constipation.

Prescribing totality: –

1. Angry when someone contradicts him.
2. Fear of poverty.
3. Aggravation from milk.
4. Aggravation from spices.
5. Desire for spices.
6. Perspiration staining the linen.
7. Thirsty.
8. Thermal- chilly.
9. Abdominal pain ameliorate after stool.
10. No urging for stool.
11. Hard stool.
12. Tingling sensation in Legs.

Reportorial Totality:–

1. MIND – ANGER – contradiction; from
2. MIND – FEAR – poverty, of
3. ABDOMEN – PAIN – stool – after – amel.
4. RECTUM – INACTIVITY – of rectum
5. STOOL – HARD.
6. EXTREMITIES – TINGLING – Legs
7. PERSPIRATION – STAINING the linen
8. GENERAL – FOOD and DRINKS – milk – agg.
9. GENERAL – FOOD and DRINKS – spices – agg.
10. GENERAL- FOOD and DRINKS – spices – desire

Reportorial Results: –

1. Nux vomica – 10/22.       3. Sulphur – 9/17
2. Sepia – 9/17.                    4.  Spongia – 9/9

Prescription: –

Rx –   Nux vomica 30 /HS/SD

Remedial analysis: –
According to reportorial totality Nux.Vomica cover maximum rubrics with maximum marks with characteristics symptoms of constipation, distension of abdomen, hard stool, angry when contradict him, fear of poverty, desire for spices and aggravation from spices, milk aggravation, Thirsty and chilly patient.

Follow up 1 –   After a single dose of Nux. Vomica Patient has bowel movement the next day and passing small quantity of feces.

Rx- Sac lac /BD/7days

Follow up 2 –  Patient has much relief in distension of abdomen and has 5 stools in a week which more than 3 or fewer that patient has previously.

Rx – Nux vomica 30/HS/SD

Follow up 3 –

Now Patient has no distension of abdomen and daily urging for stool but passes slightly hard stool but generally patient feel good.

Rx – Sac lac/BD/7days

Conclusion –
Much research has been done till today on the management and treatment of constipation because nowadays constipation has become common because of a sedentary life and diet habits. Homoeopathy has greatly effective treatment of constipation as demonstrated by preceding case. homoeopathy gives most satisfying results on the bases of individualization of patients on their specific individual sign and symptoms as a whole person. That above mentioned medicine has a good effect on treating constipation on the bases of individualization and reportorial totality, specific remedy for specific case and dispensed in proper doses and appropriate repetition of doses.

References:-

1. Davidson’s Principles and Practice of Medicine 24th Edition.

2.https://www.google.com/search?q=prevalence+of+constipation+worldwide&sca_esv=558044001&sxsrf=AB5stBiMAGaVebmsaH3gce06z_3zYPVtbQ%3A1692342753856&ei=4RnfZIbfM5zQ2roP5eKYkA4&oq=constipation+prevalence+i+in+recent+times&gs_lp=Egxnd3Mtd2l6LXNlcnAiKWNvbnN0aXBhdGlvbiBwcmV2YWxlbmNlIGkgaW4gcmVjZW50IHRpbWVzKgIIATIFEAAYogQyBRAAGKIEMggQABiJBRiiBEiJG1AAWIkLcAB4AZABAJgB9wGgAaMKqgEFMC4xLjW4AQHIAQD4AQHiAwQYACBBiAYB&sclient=gws-wiz-serp

3. http://irmhs.com/index.php/irmhs/article/view/17
4. https://www.linkedin.com/pulse/homoeopathy-constipation-ks-gopi
5. https://en.m.wikipedia.org/wiki/Constipation.
6. https://www.homeobook.com/imp.
7. https://www.radaropus.com/products/apps/synthesis-app
8. Allen H.C. Allen’s Keynotes Rearranged and Classified with Leading Remedies of the Materia Medica and Bowel Nosodes including REPERTORIAL INDEX; Tenth edition, B. Jain publishers (P) LTD.
9. https://www.abbott.in/media-center/press-releases/indian-adults-suffer-from-constipation.html

Dr. Kirti Patwariya
MD Scholar, Department of Homoeopathic Repertory & Case Taking
Govt. Homoeopathic Medical College & Hospital, Bhopal (M.P.)