Diarrhoea, the antithesis of constipation, is a mysterious phenomenon in the minds of most people. When the urge to eliminate loose, watery stool becomes uncontrollable and very frequent some people fear that, like a leaking vessel, they will soon be emptied of all their contents. However, in most cases, diarrhoea should not cause anxiety, for it can actually be a useful cleansing process if it is approached with the correct frame of mind.
The increased frequency in diarrhoea is caused because of increased peristaltic movement which in turn may be due to either an increased volume of stool (perhaps because of excess water) or an increased tone in the colon wall (perhaps due to emotional excitement).
The question of what actually constitutes diarrhoea is a controversial subject. Davidson's Principles and Practice of Medicine says that"... less than 1% of the population (in Britain) have more than 3 bowel movements per day and this should be regarded as abnormal, particularly if the stool is not formed. When the stool is liquid, or semi-formed, it must be regarded as abnormal whatever the frequency of bowel movement. It should be realized that the diet in western countries is low in roughage whereas in countries where a high residue diet is usual, more than 3 bowel movements per day may be normal."*1
In investigating diarrhoea, the doctor must determine whether the cause is mental, infective, allergic, chemical poisoning, etc. To do this he will ask the following questions:
It is important to differentiate, for example, functional (psychogenic) diarrhoea which tends to occur on rising in the morning, from infection or some organic disease in which diarrhoea usually occurs both during the day and at night.
The colon normally receives 400 to 500 millilitres of chyme (the substance in the small intestine which is the end product of digestion and assimilation). From this it produces about 150 grams of faeces per day, of which approximately 70% is water. In terms of water loss from the body, the faecal component plays a minor role in the normal situation.
In diarrhoea the water and electrolytes lost come from the small intestines. The intestines are presented with more than 10 litres of liquid per day which comes from diet and from secretions of the stomach, liver, pancreas and intestines. Of this only 1/100th remains unabsorbed in the faeces. Most is absorbed in the small intestine and only 300 to 400 millilitres in the large. In the case of diarrhoea, water is either not absorbed or is secreted in excess by the organs of the body. It is then sent along to the colon whose water holding capacity is very limited. Thus the urge to defecate comes quite often. In some cases this can be excessive, for example, in cholera where 75 litres of water may be lost in 5 days. This is because the cholera exotoxin cause the intestines to secrete massive amounts of fluid.
The urge to defecate is stimulated by the delivery of faeces to the rectum which becomes distended. In diarrhoea this fullness is not essential, the massive and strong contractions of the hyper-excitable colon are enough. Although, if the contractions are strong enough, a sense of fullness of the rectum and a desire to defecate accompany each one despite emptiness of the rectum. If the contractions are very strong and repeated vigorously, the mucosa lining in the intestines may be rubbed off causing bleeding.
Diarrhoea can be categorized as follows:
"Alterations in function of the colon frequently accompany emotional disturbances. The acute reaction to extreme fright is known to everyone and is described in familiar phrases of the common speech. Medical students facing a serious examination frequently have diarrhoea."*2
No other organ system is as susceptible to psychological disturbances as the gastrointestinal tract of man. Colonic neurosis is probably the truest example of a 'civilization' disorder Most doctors will vouch for the fact that this common disorder, along with most of the other psychosomatic digestive disorderly, presents a long and often painful uphill battle that meets with little success and ultimately forces many sufferers to travel from one specialist to another in an attempt to find a cure. According to Cecil-Loeb:
This disorder is considered to account for more than 50% of all gastrointestinal illnesses and ranks with the common cold as one of the leading causes of recurrent minor disability.*3
A few lucky individuals come within the fold of yoga and find there the practical techniques necessary to eliminate the root.
Few physicians will doubt that the incidence of psychologically originated gastrointestinal disease will continue to increase under the pressures of modern living. In an effort to come to terms with this disorder and to increase understanding of it, various names have been given such as spastic colon (because the colon is in spasm and the muscles are stiff), mucus colitis (because mucus is sometimes found in the stool), nervous diarrhoea (because of its anxiety component), unstable colon, etc. Whatever its name, however, it almost always results in discomfort and eventually a visit to the doctor.
The main symptoms are described as uncoordinated muscle action, abdominal pain, flatulence, and either constipation or diarrhoea. Irregular movements of the colon and muscle spasm prevent faeces from moving properly and thus water may be reabsorbed during the time faeces is retained, causing constipation. Alter natively, it is shot out with considerable force at the most unexpected moments.
This syndrome is said to be more common in women than in men and usually occurs between the ages of 20 to 40 years. The condition occurs in highly emotional individuals and is characterized by loose stools on arising, after meals, and/or as a result of some situation producing emotional strain. The sufferer may become so conscious of, and so obsessed with the condition, that a visit to the theatre, traveler any situation where there is no access to a toilet becomes impossible. The commonest complaint in this condition is lower abdominal pain which occurs in attacks and is described as cramping and diffuse. It is relieved by defecation and may be provoked by eating, presumably because the nervous system is over-reactive due to mental and emotional strain. The individual complains of recurring attacks of abdominal pain lasting for some hours, but the pain is not very severe.
There are 3 main types of irritable bowel in which:
Other symptoms common to all three conditions are abdominal distension (especially after meals), intestinal rumbling, and occasional nausea, loss of appetite and fatigue. There are no abdominal physical findings apart from fast pulse rate, brisk reflexes, and so on, generally associated with a nervous and highly emotional personality.
This syndrome is one of mental diarrhoea - a functional, not an organic disorder. Though purely psychological in origin, it can manifest because the digestive system is weakened by unhealthy' lifestyle, tension, the fast pace of modern society, ambitions and interpersonal conflicts. Physical and mental fatigue also play an important role, as do the use of purgatives. The condition tends to occur in families, because children pick up many personality characteristics from their family and others in the immediate environment.
Anything which causes fear or anger will affect this condition. Reactions to pain, fear and anxiety reduce the blood supply to the colon and therefore the secretion of mucus and motility. Anger, resentment and hostility, either overt or subconscious, increase the blood flow to the colon. This seems to be because each emotional reaction stimulates a different chemical component of the sympathetic nervous system. According to Funkenstein, fear causes the body to secrete adrenaline while anger acts via nor-adrenaline.*4 Both substances act differently. Adrenaline causes the gut to relax and the sphincters to close. Non-adrenaline is much less potent in this regard. Thus we see a difference in the effect of fear and anger.
In the irritable bowel syndrome the two main problems are:
The sympathetic system of these people is very weak. It is usually taxed and strained by real and imaginary anxiety, fears, thoughts of past and future calamities, guilt, suppression, etc. So when the sufferer meets up with a truly stressful situation, there is not enough strength and energy to cope. The sympathetic system fatigues quickly and stops working, resulting in over emphasis of the parasympathetic component and consequently speeding up of peristalsis and diarrhoea. If the sympathetic system regains strength it suppresses motility and constipation sets in. So in the irritable bowel syndrome we see the following:
The essential starting point for the whole disease is dissipation of mind, body and energy. This lack of concentration and sufficient control. Thus at its most fundamental level the irritable bowel syndrome reflects our conscious or unconscious irritation with life as a whole and perhaps even with ourselves.
The typical person with irritable bowels is a tense, conscientious individual who worries excessively about family or financial matters. There are basically good people who have taken on their own or other people's burden with excessive seriousness and lack of insight. When they use meditation , karma yoga or other yogic techniques they progress quite quickly by using the same mental attitude in a positive way. Tension is replaced by cheerfulness and the insight gained from yoga helps to solve their problems.
The combination of medical science and yoga is a practical approach to this problem. Initially, a doctor can allay many fears, especially of cancer, by excluding the possibility of organic disease. For extreme tension in certain cases, tranquillisers may be used for a short time. However, in the majority of cases drugs have no comparison with yoga in terms of safety, efficacy, and long term improvement.
Here are a few suggestions which will help you to understand and eliminate nervous diarrhoea:
This sadhana incorporates relaxation and practices designed to restabilize mooladhara and manipura chakras.
Acute diarrhoea is a medical problem and not a yogic one. However, it can be handled more effectively if yoga is used as an adjunct to medicine. Occasionally a yogi will find himself in a situation where he can use yoga to prevent a potentially serious case of diarrhoea from even starting.
Acute diarrhoea can be due to any of the following:
Gastroenteritis, the most common form of diarrhoea, can be caused by:
Poisonous foods such as certain fungi, certain tropical fish.
Chemical poisoning, for example, if a container has held poisons before food was placed in it, or if acid foods were kept in cheap enamel or zinc vessels liberating antimony or zinc. Other metals such as lead, mercury, arsenic and cadmium may also cause diarrhoea if ingested.
Bacterial poisoning which is divided into two main groups:
NOTE: Food poisoning is usually found in more than one member of a family which helps to point out the cause of the infection.
The main symptoms of food poisoning are nausea, vomiting, diarrhoea and abdominal pain. If severe, the patient may collapse. Recovery usually takes place within 48 hours. The doctor must distinguish food poisoning from surgical conditions such as acute appendicitis, intestinal obstruction, intussusception and volvulus.
Most cases of gastroenteritis are mild and can be treated at home with bed rest, warmth, care and love. Plenty of warm fluids such as fruit drinks, water with glucose, and black tea should be taken to wash out poisons and prevent dehydration. No food should be taken until the condition improves and the appetite returns. At this stage give a semi-fluid, low roughage diet including barley water with a little sugar or salt, white bread or toast, white rice, fruit juice, boiled green banana and rice, or plain curd (yogurt) and rice. Heat applied to the abdomen is also helpful.
In the more severe cases stomach washouts are sometimes used, mainly in the hospital setting. This is rare though and is left to the doctor's discretion. Vomiting may be stopped by drugs such as stemetil; if it continues unabated, it becomes dry retching, and constitutes a threat to the organism. As a rule vomiting and diarrhoea are left to continue their natural course as they are the body's way of removing the poisons in the shortest possible time.
Antibiotics are not recommended for the typical case of food poisoning as they tend to prolong the disorder rather than cure it. The milder conditions are self-limiting, that is, they cure themselves. Typhoid, cholera, and the more severe forms are treated with antibiotics of the doctor's choice. A competent doctor is required differentiate mild poisoning from severe, and to distinguish food Poisoning from digestive upsets caused by excess sweets, fats, etc.
By eliminating excessive or upsetting foods, or those containing poisonous or infectious bacteria from the stomach before they can act on the body, we can effectively stop acute diarrhoea 'in its tracks'. The yogic technique vyaghra kriya accomplishes this. Using warm salty water, vomiting is induced as many times as is required to completely clean the stomach. In this way poisons do not travel to the intestine for absorption into the bloodstream, At the same time prana is generated in the manipura chakra area, which increases strength and vitality.
During the illness, shavasana with abdominal breath awareness, yoga nidra, antar mouna and chidakasha dharana can he used to allow the natural cleansing and defensive processes to go on unimpeded. If there is no fever, kunjal kriya can be performed to reduce nausea. As there is a chance that this may induce a mild rise in body temperature because of its action on manipura chakra (the solar plexus), a bath should not be taken until 3 hours after performing kunjal. Immediately after kunjal is finished, rest for twenty minutes then drink some warm liquids to replace fluid loss. After this try to sleep as much as possible.
This is not a disease in itself but a symptom of many diseases and disorders. Chronic diarrhoea in western countries is usually due to nervous diarrhoea, cancer of the colon, diverticulitis, ulcerative colitis, and postoperative effects. Other factors must also he considered such as bacteria, worms, protozoa, etc. If there is an infection and/or ulceration, there is usually pain. Cancer of the colon is usually painted unless it obstructs the flow of faeces. It often occurs in the elderly, so people in this age group arc advised to have a regular medical check up. Blood and mucus in the stool is usually a sign of dysentery, not diarrhoea, but this also occurs with cancers.
Anyone with chronic diarrhoea or dysentery should contact a doctor and have a thorough check up. The exact cause of the illness must be discovered and only if medical advice is completely unobtainable should self medication be undertaken.
This if inflammation of the colon and rectum which is characterized by abdominal pain and the passage of frequent stools containing blood and mucus. It is caused by bacteria and protozoa such as amoeba. There are a kinds of dysentery:
Dysentery is generally treated with bed rest (which also prevents this disease from spreading); plenty of fluids; a semi-fluid, low roughage diet; and drugs. The following suggestions are also helpful:
If you wish to attempt the removal of chronic dysentery using yogic techniques you should contact a skilled yoga therapist. In chronic amoebic dysentery, shankhaprakshalana can be used, but only with great care. It may be combined with fasting, kunjal and neti, asanas and pranayama selected for each individual case, yoga nidra and prana vidya. A skilled yoga teacher or therapist can bring the body back to sound health, especially when working in conjunction with a sympathetic physician.
Other common causes of chronic diarrhoea, especially in the west, are ulcerative colitis and Crohn's disease. These conditions occur most commonly between the ages of 20 to 40 years of age and the main symptoms are loose bloody stool with mucus, pain and tenderness in the abdomen, fever, tachycardia and exhaustion.
Medically speaking the organic cause is unknown, through certain theories are given:
From the yogic point of view, colitis has deep mental roots. People with colitis usually have an indefinite aim in life and are prone to frequent feelings of hopelessness and helplessness. This is basically due to imbalance in the mooladhara chakra, a disturbance in the self-preservation instinct. Yoga has the means to approach the root of this problem and to eradicate it.
Medical therapy consists of such measures as hospital admission in severe cases and drug therapy. Tranquillisers may also be used for anxiety and agitation which are both causative and aggravating factors. The course of the illness is one of exacerbation and remission, becoming particularly bad when the unconsciousness material from mooladhara chakra is surfacing most actively, and disappearing when the mind becomes happy and peaceful.
It is with this in mind that yoga deals with the problems of colitis. Meditation techniques are particularly useful in helping to handle the surfacing material. They also offer more insight into life and thus help us to chose a suitable purpose and direction, thereby overcoming the helpless, hopeless factor.
The following practices, when learned under expert guidance, are useful in relieving the distressing symptoms and if practiced regularly they help to prevent relapse.
During a bout of chronic diarrhoea or dysentery, certain techniques can be used to relax the source of tension and relieve pain. Remembrance of God, guru or mantra is very powerful. It also can take the form of visualization, perhaps a special symbol, a peaceful scene, a healing colour. The practice of pure awareness, watching the body, breath and mind, and the various responses to the illness, are also recommended. Antar mouna allows the thoughts, visions and feelings of the subconscious, many of which cause inner tension, weakening the body and mind, to surface and be eliminated. Yoga nidra completely relaxes the body-mind, relieves pain and conserves energy.
During the period of convalescence, pawanmuktasana and mild nadi shodhana help to rebalance the energies of the body. Meditation practices such as yoga nidra, antar mouna, chidakasha dharana, and japa relax the mind and quell any turbulence in the body. Later, as convalescence progresses, hatha yoga shatkarmas act directly on the digestive system to strengthen it.
In terms of diarrhoea and dysentery, the following measures win help to maintain good health wherever sanitation and hygiene are a problem.
A dichotomy in terms of world health has arisen. The western countries emphasize outer cleanliness and prevention of bacterial spread, but they have not yet stressed the importance of the mind in preventing disease - the 'constitution factor'. In the east the opposite situation exists - the mind is given first priority, ignoring the infectious agent. As a result, infectious diseases are rampant in the east while psychosomatic diseases are rampant in the west. Obviously some meeting point must be reached. People in the west need to improve their constitutional and mental health as much as people in the east need to improve sanitation and hygiene. In this way diseases such as peptic ulcer on the one hand, and amoebic dysentery on the other, will cease to pose such a threat to such large numbers of people.
Yoga is the obvious solution to both these problems. It makes us more aware and sensitive to our inner needs and the needs of our environment, which are ultimately one and the same. Regular practice is the means to improve our physical, emotional and mental health. Yoga channels our energies, making them useful, creative, purposeful and practical rather than disease-producing and destructive. Our energies can be channeled both internally and externally. Along with daily practices, karma yoga, bhakti yoga and gyana yoga help us to improve ourselves and the world around us.
Our state of being has a powerful effect on the environment. As our own lifestyle becomes more simple, clean and ordered, we tend to make our immediate surroundings the same also. Family and friends are quick to notice the positive change and may also be inspired to improve themselves. The yogic process of increasing health and- mental peace is infectious and leads to prevention of disease on a long term and worldwide basis.
*1. Davidson's Principles and Practice of Medicine, 11th ed., ed. by J. Macleod, Churchill Livingstone, London & New York, 1975.
*2. H.W. Davenport, Physiology of the Digestive Tract, 2nd ed., p.76, Year Book Med. Pub. Inc., Chicago, 1968.
*3. Cecil-Loeb, Textbook of Medicine, nth ed., p.822. ed. By P.B. Baeson and W.M. Dermott, Saunders Co., Philadelphia and London, 1963.
*4. D.H. Funkenstein, "The Physiology of Fear and Anger", Scientific American, May 1955.