Diarrhoea

Dr. G. P. Agrawal, MB, BS, Athnair

Now is the season for diarrhoea and dysentery. People living in hot and temperate climates are affected most by this condition, which is also known as summer diarrhoea. Where the symptoms are long standing, it is called chronic diarrhoea, and can have many causes.

What happens in diarrhoea?

Frequency of stools is known as diarrhoea. Normally, ten litres of fluids reach the intestines as food, drinking water and internal secretions each day. Out of this, 99% is re-absorbed; only 1% passes out in the stool. But when it is either not re-absorbed or there is excessive secretion of fluid into the intestinal lumen, the enlarged volume of fluid causes increased motility of the intestinal wall and the unabsorbed material is passed out as watery, loose stools.

Diarrhoea is not itself a disease, but is a symptom which occurs in many different conditions. For example, food poisoning, overeating, simple indigestion, irritable colon syndrome, dysentery, colitis and even cancer of the bowel can all cause diarrhoea.

Causes of diarrhoea

There are two types of diarrhoea:

  • Acute: This is a short term illness.
  • Chronic: This is a long term symptom, lasting for weeks, months or years, and may worsen or improve with changing seasonal conditions.

Causes of acute diarrhoea include:

  1. Infections, toxins, poisons and drugs.
  2. Psychogenic stress is also an important factor, e.g. pre-examination diarrhoea in college students. Some of these patients may develop an irritable colon syndrome later on in life.

Causes of chronic diarrhoea generally lie in specific organs and can be classified as:

  1. Gastric disturbances
  2. Neoplasm (cancer)
  3. Hepatobiliary disorders
  4. Pancreatic disorders
  5. Small intestinal disturbances
  6. Colonic disturbances
  7. Rectal disease
  8. Metabolic disorders
  9. Drug induced diseases
  10. Post operative causes

Clinical signs

Frequent loose motions, abdominal cramps and pains, mild to severe fever, vomiting, excessive thirst and cramps in the legs are the most common symptoms in causing mild to severe acute diarrhoea. In chronic diarrhoea, along with frequent loose motions, other important associated findings may include:

  • - Weight loss
    - Malabsorption
    - Arthritis
    - Skin manifestations
    - Fistula and sinus formation
    - Severe abdominal pain
    - Nocturnal diarrhoea

Along with clinical assessment of signs and symptoms, laboratory examination of fresh stool for blood, pus, amebae, and bacteria such as staphylococci, salmonella and claustridia, is usually indicated.

Management of diarrhoea

  1. Restriction of solid food for 24 to 48 hours.
  2. Bed rest.
  3. Consumption of enough boiled water to replace lost fluids. In severe cases parenteral fluid replacement (intravenous glucose or saline) may be instituted where there is a threat of dehydration, especially in children.
  4. Application of heat to the abdomen.
  5. Medicines which suppress intestinal motility and remove infection include:
  • a) Detoxicated tincture opium (D.T.O.)
  • b) Lomotil 2 to 5 mg. four times per day
  • c) Binding agents like kaolin and pectin
  • d) Chemotherapeutic agents where needed.

A mild bout of diarrhoea is usually short lived and self-limiting. It may come at a time when we have eaten unwisely or in excess, or when digestion and thermo-regulation have been temporarily disturbed. It represents an attempt by the body to restore good health. It is wrong to suppress such a bout of simple diarrhoea with medicines which block the natural purifying reaction of the body. The best treatment is to simply rest, fast for one or two meals and drink boiled water. As symptoms diminish, food can be recommenced, beginning with liquid broth or light khichari. Usually this is enough to correct the situation. However, if the diarrhoea continues or worsens, or high fever, vomiting or dehydration supervene, it is an indication that a more severe acute infectious process is underway, possibly even typhoid or cholera. In this situation, a physician can make the diagnosis and prescribe a suitable antibiotic agent.

A proper medical diagnosis is also the first step in the treatment of chronic diarrhoea. This usually involves examination and culture of stool specimens in a pathological laboratory. Treatment can then be instituted according to the cause and site of origin of the disease.

Poor digestive power

One of the most common causes of chronic diarrhoea is poor digestive power. This produces hypoacidity, flatulence and indigestion, and is often the root cause of the low energy state which results in dysentery and amebiasis. In the long term, chronic mucus colitis may supervene and where there is major psycho-emotional stress involved, the disorder is known as ulcerative colitis. Yoga asanas, shatkriyas and relaxation play an important role in the treatment of colitis, in conjunction with dietary regulation and fasting, conventional chemotherapeutic drugs and purification of the water supply.

Preventive measures

Polluted water is the main cause of infective diarrhoeas. Therefore, water should be purified for drinking purposes. Most Indian villages generally depend on open well water or water from ponds, lakes or small rivers, Sometimes the only source of water is a pit dug in a dry river-bed. Therefore, the following preventive measures should be taken to avoid infections.

  1. Where there is no safe water supply, drinking water should be boiled.
  2. Water should be chlorinated and well purified with bleaching powder.
  3. Open eatables from the shop should be avoided, at least in summer when diarrhoea is more prevalent.
  4. Contamination or infection of water is commonly due to unsanitary toilet habits. Instead of using open grounds and roadsides, trench latrines should be prepared and waste covered with a little soil.
  5. Hands and feet should be washed well after toilet.

The role of yoga

Many people think that yoga is not very helpful in cases of acute or chronic diarrhoea. However, the correct application of yoga can be very effective, especially in emotional cases, where relaxation techniques such as yoga nidra help to diminish emotional stimuli from the hypothalamus. This in turn reduces the hypermotility of the colon.

The yogic shatkarmas, or physical cleansing techniques, are an important means of improving a weak digestive capacity. Shankhaprakshalana, as well as cleaning and revitalizing the digestive tract, also has a reflex action on the hypothalamus, influencing the emotional processes and relieving disease stimuli. Kunjal and vyaghra kriyas are other important practices for increasing digestive fire, and alleviating the troublesome symptoms of indigestion in the upper digestive tract.

The role of yoga in curing intestinal diseases became evident to me when I was suffering from chronic amebiasis while studying at Medical College, Bhopal. Amebiasis is prevalent in Bhopal because the lake water contains E. hystolytica in enormous numbers. For four years I was dependent on tablets, I also practised some yoga asanas, but my disease could not be cured.

However, when I began my service, I arranged a yoga camp under the direction of Bihar School of Yoga, Monghyr. The swamis gave yoga training for seven days and they also insisted we do the practice of shankhaprakshalana. This involved drinking sixteen glasses of warm salt water to wash the entire alimentary canal. After the practice of shankhaprakshalana, my whole problem went away. Only after a year was there any return of the complaint. At this time I did shankhaprakshalana again, as well as some specific asanas and pranayamas for the digestive system. This second round of yogic treatment was all that was necessary to completely eliminate the problem.

In the case of chronic amebiasis caused by E. hystolytica, shankhaprakshalana washes away all of the debris and thick mucus attached to the walls of the intestines, so causative organisms lying in the folds of the mucosa are successfully eliminated. Inflammation in the sub-mucosal layer is also relieved due to fomentation by the warm saline water. The inflammation then subsides as E. hystolytica remaining in the sub-mucosa find their way to the surface of the bowel. If shankhaprakshalana is then performed again later, all amoebae are eliminated from the colon. Thus, by following this simple procedure, a person can be completely cured of chronic amebiasis.

Recommended practices

Yoga asanas and pranayama are the best means of developing and maintaining a strong digestive power and thereby eliminating dysentery and colitis, as well as many skin diseases, menstrual disturbances and liver problems. After shankhaprakshalana has been performed, the following asanas are recommended on a daily basis:

  1. Pawanmuktasana parts I & II.
  2. Vajrasana after meals for 10 minutes.
  3. Bhujangasana, mayurasana, shalabhasana, paschimottanasana, matsyendrasana, sarvangasana and shavasana. These major asanas should only be undertaken after pawanmuktasana is perfected.
  4. Pranayamas are most useful in restoring depleted digestive capacity, particularly:
  • a) Bhastrika- the bellows breath.
  • b) Full abdominal breathing in shavasana. More advanced practices include:
    • 1. Nadi shodhana with uddiyana, moola and jalandhara bandhas.
    • 2. Nauli kriya.

Dietary recommendations

  1. Avoid all heavy foods, particularly fried foods, which overtax the digestive system.
  2. Avoid uncooked vegetables.
  3. Simple boiled vegetables and khichari are ideal.
  4. Avoid overeating. Take the evening meal around 5p.m. Try to fix a regular time for meals and do not take any snack foods in between.
  5. If diarrhoea is due to indigestion, take one light meal per day and avoid dairy products. Rice and dahi are useful when digestion is strong, but when this is not the case, the best preparation is whey.
  6. Fasting is the most effective way to alleviate any exacerbation of symptoms.