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Constipation and Diarrhea

The Large Intestine

The large intestine is wrapped in a layer of fat, which acts like a thermal blanket, helping to create heat, absorb fluids, and solidify the stool for elimination. As mentioned earlier, there is a large population of gram-negative bacteria in the intestines, which ferment soluble fibers, starch and undigested carbohydrates. This fermentation creates short chain fatty acids, which is the main energy source for the lining epithelial cells. When there are imbalances in this fermentation, caused by problems  further up the GI tract leading to increases in bad guy bacteria, putrefactive gasses can develop.  These conditions result in serious abnormal fermentation in the intestines, thus producing a large amount of endotoxin, heat and inflammation. This can cause the fluids to decrease enough to make the stool hard, causing constipation. Other common causes of constipation include poor digestion, intestinal infections, lack of exercise, not drinking enough water, lack of fiber, sluggish liver, dryness, bowel diseases, and structural or neurological abnormalities.

Whatever the cause, putrefactive gasses are harmful. In Ayurveda, they are known to be absorbed into the blood and to trigger inflammation in other areas of the body. To remove putrefactive gasses, use the diet to reduce wind, along with carminative (gas-expelling) spices, such as celery seeds, cloves, allspice, dill, fennel, peppermint, sage, cardamom, cumin, caraway, and fennel. These spices work by either inhibiting the offending bacteria, or neutralizing the offending gasses.

Constipation

After making the appropriate dietary adjustments, I treat constipation with a combination of magnesium and rhubarb-based formulas, both taken at bedtime, instructing patients to increase fluid intake. Sometimes just a few tablets of magnesium is all that is needed, and it is much less likely to cause problems than overuse of laxative.

A simple, effective bowel tonic combines dandelion root, rhubarb root and triphala. Rhubarb root is of course laxative. The dandelion stimulates the bile flow while the triphala has a general healing effect on the intestinal membranes, combining mild laxative with strong tonic effects.  I tell patients to adjust the amount they take each night until they return to proper bowel movements in the morning. In more serious cases, patients may temporarily require stronger laxatives such as buckthorn bark, cascara sagrada or senna, after which they must retrain their bowels to function properly. This is done by increasing water and fiber intake, exercise every day for at least 15 minutes, and attempt to move the bowels at a set time each morning.  Drinking some warm lemon juice can sometimes serve as an effective intermediate step after a gradual decrease in the use of laxative herbs.

TCM doctors point out that it is sometimes necessary to release tension (Qi restriction) in the intestines.  A classical TCM formula for this purpose contains rhubarb root , immature bitter orange fruit (zhi shi or Citrus aurantium) and magnolia bark (hou po or M. officinalis).  

Diarrhea

Diarrhea, defined as increased volume, fluidity, or frequency of bowel movements, can have many causes. Generally, if the cause originates in the small intestine, the diarrhea is characterized by large quantities of watery and/or fatty stools. If the cause of the diarrhea is a disease in or of the colon, the stools are frequent and often accompanied by blood, mucus, or pus. If the disease is rectal in origin, there are often frequent movements of small amounts of stool.

In cases of acute diarrhea the most important thing to remember is the need to maintain electrolyte balance, especially in children. In emergency cases with signs of dehydration, you can introduce fluids supplemented with table salt. Otherwise, use an electrolyte replacement supplement, and always remember to drink plenty of water.  There are many acceptable commercial electrolyte supplements on the market, but of you so desire you can make your own version at home.  The one I often recommend is below.

I recommend a short period of water or juice fasting for one or two days, followed by a gradual reintroduction of mild foods that are very easy to digest.  Choose foods such as rice, cooked carrots, miso soup, tapioca, potato broth, potassium broth (made with carrot, spinach, celery, and parsley), applesauce, and black or green tea. After that, choose formulas as described above based upon the cause, bacterial infection, inflammation etc.

Chronic Diarrhea

Bacterial toxins, drugs, liver ailments, various types of inflammation, or poor digestion leading to unabsorbed dietary fat or carbohydrates are the most common causes of chronic diarrhea. To treat chronic diarrhea successfully, you must first identify the underlying causes and treat them with the appropriate herbs as defined earlier. However, there are several special cases we need to mention because there are times when chronic diarrhea does not respond to direct herbal treatment.  Hidden food allergies can often cause chronic diarrhea, as can inflammatory bowel disease, two situations we will explore later in more detail. A severe intestinal infection can also be the culprit, and this will require treatment with strong herbs or antibiotics.  A stool test is often necessary to identify the infection that is causing the condition. Additionally some patients may have hydrochloric acid levels that are so low they require direct HCL supplementation. This is especially true with patients over the age of 60.  Finally, there are times when none of the usual theories help.  In these cases I use vilwa fruit, which can sometimes work wonders, very slowly.

I recommend initiating the following measures immediately to help to control the problem.

• Reduce the size of your meals, and eat five or six smaller meals throughout the day. Choose from the foods I recommended earlier. The decreased amount of food eases the strain on you digestive powers and is less likely to stimulate bowel movements.

• It is important to replace the fluid lost with diarrhea. Drink six to twelve cups of fluid per day. If you are not thirsty, you must still drink. Try taking it in smaller amounts, about 1/2 cup of clear fluid every two hours. For serious cases, use the electrolyte replacement soup below.

• Avoid coffee, which can stimulate bowel movements and urination. Sodas also stimulate urination due to their high sugar content. Surprisingly, these fluids can actually lower your total fluid balance by prompting you to excrete more than you take in.

• A temporary low-fiber diet may decrease cramping and gas in severe cases. Choose softer white breads, white rice and pasta at first. Although you want to limit high-fiber food sources for a period of time, water-soluble fiber supplements such as Metamucil and pectins will help you produce a firmer stool. They can also help absorb irritating excess bile salts.

• Eat foods high in potassium and salt, such as crackers, bananas, baked potatoes, bullion, potassium broth, chicken soup and tomato juice. If the diarrhea is severe, use commercial electrolyte replacement solutions, or make your own with the recipe provided earlier.

• Pro-biotic supplementation is helpful for easing diarrhea.  The usual dosage is two capsules per day (10 billion organisms) for up to two weeks, then one capsule per day. The organisms are quickly excreted, so usage should be constant in severe cases.

• Eat fewer fruits, and limit portion sizes. It is probably best to primarily use fruit juices because they provide the nutrients and are easier to assimilate than whole fruits. Unpeeled fruits can be irritating. If you have been told to avoid sugar, you can make blueberry or raspberry juice in your blender by combining berries, water, and a non-caloric sweetener such as stevia leaf.

• For vegetable sources, use well-cooked soups at first, gradually reintroducing cooked and raw vegetables.

• Many people with chronic diarrhea have celiac disease or difficulty digesting milk. Signs of lactose intolerance include gas and cramping after consumption of dairy products in addition to the diarrhea. Some people have to avoid all milk products, while others can use lactase supplements or may only be able to tolerate yogurt or cheese.  There are several commercially available products that can be used in place of dairy if necessary.

Recipe for Homemade Electrolyte Replacement Soup

Simmer several of the following chopped vegetables for 2 hours in about 2 quarts of water: green beans, kale, broccoli,  cabbage, onion, garlic, parsley, cilantro, celery, baby bok choy, brussel sprouts, asparagus, chard, collard greens, etc.

Strain and add:
1 tsp. salt  (mineral salt is best)
1 cup fresh carrot or tomato juice
1 tsp. baking soda
2 tablespoons molasses
1 teaspoon Miso

Mix all ingredients together and refrigerate. Drink 1/2 cup three or four times per day.

 

Posted on Sunday, April 3, 2005 at 10:43AM by Registered Commenterposted by Dr. Tillotson in | Comments Off

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