Loose stools- Ayurvedic Treatment, Diet, Exercises, Research Papers, Yoga & Pranayama

Introduction

            Loose stools are rather a symptom than a disease. It can point out a number of diseases of gastrointestinal origin. In some rare conditions, it can be sign of serious underlying pathology like a carcinoma. Loose stools can happen to people of any age or gender irrespective of region or race. It can start as an acute problem or can be recurrent and chronic. In today’s world where people are having toxic diet habits, sedentary lifestyles and less idea about gut microbiota, loose stools are very common. It can happen even due to emotional stress like irritable bowel syndrome and can affect the person’s quality of life. Though it is very important to address the underlying disease, symptomatic management is very important as it can be fatal due to dehydration & electrolyte imbalance in some people.

Signs & symptoms

Frequent passage of watery/sticky/loose stools with or without blood mixed with it

Abdominal cramps

Tiredness

Giddiness

Emaciation

Anorexia,

Gas trouble or abdominal discomforts like belching

loss of appetite

Excessive thirst

Pain or itching in the anal region

Causes

  • Gastroenteritis (bowel infection) due t
    • Virus – like rotavirus
    • Bacteria- like E.coli,
    • Parasite – like many varieties’ worms
  • Anxiety and other emotional distress
  • Food allergy
  • Food poisoning
  • Appendicitis
  • Side effects of some medications
  • Diverticular disease
  • Crohn’s disease or ulcerative colitis
  • Coeliac disease
  • Carcinoma of stomach, intestine and other gastrointestinal organs

Pathophysiology

         Diarrhoea results from the disruption in the delicate balance between the absorptive and secretory processes within the bowel. It can be either osmotic or secretory. It is the reversal of the normal net absorptive status of water & electrolyte absorption to secretion. Such a derangement can be the result of either an osmotic force that acts in the lumen to drive water into the gut or the result of an active secretory state induced in the enterocytes. In the former case, diarrhoea is osmolar in nature, as is observed after the ingestion of nonabsorbable sugars such as lactulose or lactose in people with lactose malabsorption. Instead, in the typical active secretory state, enhanced anion secretion (mostly by the crypt cell compartment) is best exemplified by enterotoxin-­induced diarrhoea.

In osmotic diarrhoea, stool output is proportional to the intake of the unabsorbable substrate and is usually not massive; diarrheal stools promptly regress with discontinuation of the offending nutrient, and the stool ion gap is high, exceeding 100 mOsm/kg.

In secretory diarrhoea, the epithelial cells’ ion transport processes are turned into a state of active secretion. The most common cause of acute-onset secretory diarrhoea is a bacterial infection of the gut. Several mechanisms may be at work. After colonization, enteric pathogens may adhere to or invade the epithelium; they may produce enterotoxins (exotoxins that elicit secretion by increasing an intracellular second messenger) or cytotoxins. They may also trigger release of cytokines attracting inflammatory cells, which, in turn, contribute to the acti­vated secretion by inducing the release of agents such as prostaglandins or platelet-activating factor. Features of secretory diarrhoea include a high purg­ing rate, a lack of response to fasting, and a normal stool ion gap (i.e., 100 mOsm/kg or less), indicating that nutrient absorption is intact.

Diagnosis

Complete blood tests

Faecal examination

Urine culture

Fasting tests

Hydrogen breath test

Endoscopy

Ultrasound

Colonoscopy

Sigmoidoscopy

Treatments

Acute-onset diarrhoea is usually self-limited. Management is generally supportive care.

Oral Rehydration therapy (ORT)

In most cases, the best option for treatment of acute-onset diarrhoea is the early use of oral rehydration therapy (ORT).Pharmacological treatment is rarely of any use, and antidiarrheal drugs are often harmful. Vaccines (e.g., rotavirus) can help increase resistance to infection. Antimicrobial and antiparasitic agents may be used to treat diarrhoea caused by specific organisms and/or specific clinical conditions. ORT is the cornerstone of treatment, especially for small intestine infections with a large volume of watery stool output. ORT with a glucose-based oral rehydration syndrome must be viewed as the safest, most physiologic, and most effec­tive way to provide rehydration and maintain hydration in children with acute diarrhoea worldwide so far, as recommended by the WHO. Not all commercial ORT formulas promote optimal absorption of electrolytes, water, and nutrients. The ideal solution has a low osmolarity (210-250) and a sodium content of 50-60 mmol/L. Administer maintenance fluids plus replacement of losses.

Pharmacotherapy

In terms of recommended antimicrobial treatment in the immunocompetent host, enteric bacterial and protozoan pathogens can be grouped as follows:

Agents for whom antimicrobial therapy is always indicated:

The consensus includes only V cholerae, Shigella species, and G lamblia.

Agents for whom antimi­crobial therapy is indicated only in selected circumstances, include the following:

  • Infections by enteropathogenic E coli, when running a prolonged course
  • Entero-invasive E coli, based on the sero­logic, genetic, and pathogenic similarities with Shigella
  • Yersinia infections in subjects with sickle cell disease
  • Salmonella infections in very young infants, if febrile or with positive blood culture findings

Such medications include the following:

  • Cefixime
  • Ceftriaxone
  • Cefotaxime
  • Erythromycin
  • Furazolidone
  • Iodoquinol
  • Metronidazole
  • Paromomycin
  • Quinacrine
  • Sulfamethoxazole and trimethoprim
  • Vancomycin
  • Tetracycline
  • Nitazoxanide

Probiotics

Recently, some strains of probiotics (defined as live microorganisms that when ingested in adequate doses, provide a benefit to the host) have been found to be effective as an adjunct when treating children with acute diarrhoea. They consistently show a statistically significant benefit and moderate clinical benefit of a few, now well-identified probiotic strains (mostly Lactobacillus GG and Saccharomyces boulardii but also Lactobacillus reuteri) in the treatment of acute watery diarrhoea (primarily rotaviral) in infants and young children in developed countries. Probiotics can also reduce the risk of spreading rotavirus infection by shortening diarrhoea duration and volume of watery stool output and by reducing the faecal shedding of rotavirus.

Prognosis

The prognosis of diarrhoea is generally good. The discomforts will be subsided within days.

Complications

Dehydration

Electrolyte imbalance

Kidney failure

Organ damage

Malabsorption

Disease & Ayurveda

Atisaara

Nidana

Excess water intake

Intake of dry meat & meat of emaciated animal

Food which is not habitual or suitable to body

Sesame (dry, grinded and oil removed)

Sprouts

Alcohol

Dry food intake

Excess food intake

Haemorrhoids

Faulty routine during ghee intake (as a treatment)

Intestinal parasites

Suppression of natural urges

Purvaaroopa

         Pricking pain in chest, rectum and abdomen

              Weakness of body

              Constipation

              Distended abdomen

              Indigestion

Samprapti

         Due to the causative factors, Vaata dosha vitiates and brings the water content in the body into the koshtha and expels through anus. With this excess water in koshtha, reduces the Agni (digestive fire), damages the gastrointestinal tract along with faecal matter and causes loose stools. It makes the stool watery and the disease diarrhoea gets manifested especially in people who eat unwholesome diet.

Lakshana

         Vaathika

                             Watery, more frequent stools with obstruction

                             Defaecation with pain & abnormal sounds

                             Dry, frothy/clear or hardened stools

                             Resembles over-cooked jaggery

                             Sticky stools passed with severe tearing pain

                             Dryness of mouth

                             Rectal prolapse

                             Horripilation

                             Groaning

              Paittika

                             Yellow, black, green like grass,

                             With blood

                             Foul smelling,

                             Excess thirst

                             Fainting/giddiness

                             Excess sweating

                             Burning sensation

                             Abdominal pain

                             Heat and inflammation of rectum & anus

Kaphaja

Heavy, sticky, with thread-like structures, white in colour, oily & sticky, faeces with particles of undigested food

Irregular & interrupted flow containing only a little faecal matter in one vega with mucous &foul smell,

With flatulence

Pain

Excess sleep

Lazy

Aversion to food

Horripilation

Feeling that not completely voided faeces after defaecation

Sannipatajam

                             All three doshalakshanas are present

Bhayajam and Shokajam

(Resembles Vaata-Pitta akshanas)

                             Very hot and liquified stools

                             Very light & floating  

Divisions

         6 types

  • Vaatika
  • Paittika
  • Kaphaja
  • Thridoshaja or sannipaatika
  • Bhayajam (due to fear/anxiety)
  • Sokajam (due to grief)

2 types

Saamam            – with indigestion

Niraamam        – without indigestion

2 types

Saraktam          – with bleeding

Araktam            – without bleeding

Prognosis

Kricchrasadhya in healthy individuals without any complications & dhatudushti.

Asaadhya in children, old persons and with complications. 

Chikithsa

         Ayurveda treatment for atisaara includes fasting as an important method.

Samana

Langhana          – fasting

Upekshaa         – Leaving the body to expel out the excess doshas by atisaara

Aamapachana

Agnideepana

Sodhana

Vamana – In atisaara with severe abdominal pain & distension

Snehavasti

Kashayavasti-Picchavasti

Commonly used medicines

                  Vilwadi gulika

                             Kutajarishtam

                             Pippallyasavam

                             Dadimashtakachoornam                       

Brands available

AVS Kottakal

AVP Coimbatore

SNA Oushadhasala

Home remedies

Taking Oral Rehydration Therapy: Mix one glass of boiled water with one teaspoon of sugar & one pinch of salt. Take it sip by sip for 3-4 hours. This is the simplest method of rehydration which can be done at home.

Moderate fasting on solid foods  till feeling better & hungry.

Fenugreek seeds boiled in water for drinking

Carminatives like cumin seeds help correct the indigestion

Buttermilk boiled with turmeric, curry leaves, ginger, etc.

Diet

  • To be avoided

Heavy meals and difficult to digest foods – cause indigestion.

 junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine

 carbonated drinks – makes the stomach more acidic and disturbed digestion

refrigerated and frozen foods – causes weak and sluggish digestion by weakening agni (digestive fire)

 curd – causes vidaaha and thereby many other diseases

  • To be added

Drink only boiled water

Light meals and easily digestible foods

Green gram, soups, buttermilk boiled with turmeric, ginger and curry leaves

 freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc

Behaviour:

Better to avoid exposure to excessive sunlight wind rain or dust.

Avoid lifting heavy weights and other vigorous physical activities.

Maintain a regular food and sleep schedule.

Avoid sitting continuously for a long time and avoid squatting.

Yoga

Complete bedrest is advised for a patient with loose stools But after regaining normal health, following a daily exercise routine will help the person to improve digestion & health.

Stretching exercises and specific yoga asanas like pavanamuktasana, vajrasana, bhujangasana etc are recommended.

Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.

 Yoga can maintain harmony within and with surroundings.

Pavanamuktasana

Vajrasana

Bhujangasana

Exercises for Low backache

All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.

Research articles

https://pubmed.ncbi.nlm.nih.gov/22268237/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2761799/

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