Bowel Obstruction and Its Ayurvedic Management With Herbs

Abstract

Bowel obstruction or intestinal obstruction is a condition in which there is complete or partial blockage in your intestine. The affected part of the intestine can be large or small or both. The reasons for this condition are many and it also has a very strict Ayurvedic correlation too. In Ayurveda the condition is known as badodar and is explained under udar roga by Acharya charak. In this article we will discuss intestinal obstruction or bowel obstruction in detail from modern and Ayurvedic view points. Its management in Ayurveda will also be discussed later in the article. So let’s start with understanding the condition in detail.

Introduction

Rather than the large bowel obstruction, small bowel obstruction is one of the most common problems which surgeons encounter. Patients present with a variety of complications and the difficulty often lies in making the correct diagnosis. Generally the situation is considered as an emergency and immediate laparotomy is done relieving the obstruction. The bowel obstructions are generally the result of fibrous band adhesions in abdomen after a surgery or due to hernia. Even colon cancer can also be the reason for this along with strictures due to chronic inflammation caused due to certain conditions like crohn’s disease or ulcerative colitis.

Classification according to modern

A. Depending upon the nature of obstruction

• Dynamic: In which peristalsis is working against a mechanical obstruction.
• Adynamic: In which there is no mechanical obstruction and peristalsis is absent or inadequate.

B. Depending on the blood supply

• Simple Obstruction: Blood supply is not seriously impaired.
• Strangulated Obstruction: Blood supply is seriously impaired.
• Closed loop Obstruction: It means both proximal and distal ends are blocked, so there is neither progression nor regurgitation.

Etiology or causative factors

The causes of small bowel obstructions can be divided into three categories:

• Obstruction arising from extraluminal: Such as adhesions, hernias, carcinomas and abscesses.
• Obstruction intrinsic: To the bowel wall like in primary tumors.
• Intraluminal or obturator obstruction: Which are due to foreign bodies, gallstones etc.

Extrinsic and intrinsic reasons for obstruction of small intestine

Extrinsic to intestinal wall

• Adhesions which are commonly post operative.
• Hernia, like the external hernia for example umbilical, inguinal and femoral or internal hernia like diaphragmatic hernias, postoperative or mesenteric defects.
• Neoplastic like carcinomatous or extraintestinal neoplasms.

Lesions intrinsic to the intestinal wall

• Congenital factors like malrotation, midgut volvulus and duplications.
• Inflammatory factors like in chrn’s disease, infections, tuberculosis and diverticulitis.
• Neoplastic growths like primary neoplasm or metastatic neoplasms.
• Traumatic like hematoma and ischemic structure.

Pathology of bowel obstruction as explained in modern science

Changes proximal to the bowel obstruction (here proximal means the part of intestine beyond blockage) includes following:

1. Increased peristalsis
2. Peristalsis become forceful
3. Obstruction isn’t relieved
4. Peristalsis stops
5. Resulting in flaccid, paralyzed and dilated bowel
6. Fluid collects in the part of the intestine beyond the blockage. This fluid is derived from saliva, stomach, pancreases and intestinal secretions. This happens due to the decrease in absorption due to inflammation. This accumulation of fluids results in multiplication of bacterias like E.coli and toxemia occurs. Hence resulting in electrolyte imbalance and dehydration.
7. Now due to accumulation of air as well and presence of bacteria there are certain gases produced like nitrogen and hydrogen sulphide resulting in abdominal distention.
8. Defective absorption, decreased fluid intake, loss of fluid by vomiting, collection of fluid into the bowel lumen leads to severe dehydration, fluid and electrolyte imbalance.
9. Increased bacterial colonies in the bowel (due to change in bowel content) starts multiplying and produce toxins. These toxins result in mucosal as well as submucosal damage.
10. The intestine is the source of nutritional absorption but at this time instead of nutrition toxins will get absorbed along with bacteria causing bacteremia or toxemia or septicemia or multiple organ dysfunction syndrome.

In this way a bowel obstruction is potent enough to affect your whole body. Now as we have discussed what will happen beyond the blocked site in the intestine, now we will discuss what will happen at the site of blockage.

Changes at the site of the obstruction

• Initially venous return will get impaired.
• Now congestion, edema of bowel wall occurs which turns purple in color.
• Then finally the arterial supply is endangered and the intestinal mucosa now have a loss of shininess, blackish discoloration along with loss of peristaltic movements.
• If the condition is ignored for long term then gangrene may develop and this results in perforation of intestinal mucosa.
• The toxins along with bacteria and other accumulated material will escape into the peritoneal cavity causing peritonitis.

Clinical features of intestinal obstruction

1. Abdominal Pain:

The pain will be present in the center of small intestinal obstruction and if the pain is in the flank region or in peripheral region then its a sign of large intestinal obstruction. The nature of pain is colicky and cramp-like which usually lasts for the duration of 5-10 minutes. The type of pain is intermittent and on applying pressure it decreases.

2. Vomiting

The vomitus has stomach content at first then the bile followed by feculent matter. The feculent matter is not fecal matter but the products at the terminal ileum. The products of these ileum contents undergo bacterial degradation and fermentation results in the smell of fecal matter. If the vomit contains blood of altered color then it indicates hemorrhage and gangrene.

3. Distension in the abdomen

The distension is generally central in the ileal obstruction and at the peripheral abdominal area if the obstruction is in the large bowel or intestine.

4. Constipation

Absolute constipation means neither feces nor flatus is passed.

5. Physical Examination

This includes general signs and symptoms which are observed just by the patient like dry skin, dry tongue, sunken eyes, feeble pulse and low urinary output. In biochemistry reports low levels of potassium is a very common finding.

6. Investigation

• Complete blood count: If it indicates low Hemoglobin then suggestive of malignancy
• Serum amylase levels are raised in intestinal obstruction
• Serum potassium is low
• Multiple gas fluid levels indicates obstruction in the X-ray
• Ultrasonography suggestive of dilated bowel and fluid in the peritoneal cavity
• CT scan: It can show dilated loop, transition zone and collapsed part which are definitive features of intestinal obstruction. It can also give an idea of changes in the bowel wall, ischemia and thickening

Treatment

Treatment is done in two ways. One is conservative and the other is surgical.

Conservation management

• Resuscitation
• Nasogastric Aspiration
• Correction of fluids and electrolyte deficits
• Antibiotics

Surgical treatment

Surgical treatment includes laparotomy which is done by opening the abdominal cavity by midline incision.

Ayurvedic aspect of bowel obstruction

The Bowel obstruction as mentioned earlier is explained under the udar roga chapter in Charak Samhita. It is known by the name badhgudodar. What Is Ulcerative Colitis?. Explaining the same acharya charak has also mentioned some specific causes, pathogenesis, symptoms and treatment of badhgudodar.

Specific causes of Badhgudodar

• Intake of hairs accidentally with food
• Udavarta (Obstruction to the natural flow of vata dosha)
• Arsh ankur (Presence of hemorrhoids)
• Overlapping of intestinal parts

Pathogenesis of all udar roga

Weak digestive fire + causes

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Dosha dushti or dosha aggravation

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Blocking of microchannels (Swedavaha and Udak vaha srotas)

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Dushti of digestive fire, prana vayu and apana vayu

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Due to vata dushti, like upsneha secretion of anna rasa in udar

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The accumulation of anarsa and hence obstruction takes place. In This way the udar roga takes place.

Predominant symptoms of udar roga

• Loss of appetite
• Indigestion
• Digested food turns toxic
• Getting no specific idea about weather the previous meal is digested or not
• Oedema in feet
• Loss of strength
• Dyspnoea on exertion
• Dryness of body
• Enlargement of abdomen
• Enlargement of organs
• Faecal obstruction
• Flatulence
• Digestive food causing indigestion
• Appearance of veins over abdomen
• Absence of visible peristaltic movements over abdomen

Specific Symptoms of badhgudodar

Before mentioning the specific symptoms of this condition acharya has mentioned after the continuing practicing of causes the apana vayu gets kupit and destroys the agni or digestive fire. This results in blockage of mala, pita and kapha and hence utpatti of udar roga.

Following are the symptoms of Badhguodar:

• Trishna (Excessive thirst)
• Daha (burning)
• Jwar (fever)
• Mukha talu shosha (Dryness of mouth and palate)
• Uru vedana (pain in thighs)
• Kasa and shwas (cough and dyspnoea)
• Aruchi evum Avipaka (Anorexia and indigestion)
• Adhmaan (Tympanitis)
• Mala and mutra avrodh (Retention of urine and faeces)
• Swathu (Sneezing)
• Sir, hridya, nabhi aur gudda shoola (Headache, chest pain, pain in anus and around umbilicus)
• Retention of gases inside the udar
• Venous engorgement over abdomen
• Cow’s tail like prominence above the umbilicus

Treatment according to Ayurveda for badhgudodar or intestinal or bowel obstruction

• Firstly the sweden is done (sudation) and then administration of snuhiksheer etc. teekshana herbs are mixed in gumutra along with til oil and saindhav salt. Enema is prepared and administration of firstly niruha and then anuvasana basti is done.
• At the time of eating after basti vata pacification food must be administered.
• If the purgative procedure is important then sharp purgation (tikshan virechana) must be given.

Herbal remedies by Planet Ayurveda

Planet Ayurveda is a leading Ayurvedic firm which deals with the manufacturing of herbal formulations. These formulations are prepared using potent herbs which are really effective in managing many conditions related to digestive system disturbances along with it’s hampered working. The formulations prepared by Planet Ayurveda do not contain any kind of adulterants, dyes, additives, fillers etc. These medications are really potent to manage various conditions or symptoms arising due to Bowel obstruction and are very fruitful hence giving positive noticeable results. The medication or formulations offered by Planet Ayurveda for the management of bowel obstruction are as following:

1. Avipattikar Churna
2. Abhayarisht
3. Kumari Saar
4. Panchsakar Churna

Product description

1. Avipattikar Churna

Avipattikar churna is a classical formulation which has ingredients like Amla (Emblica officinalis), Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica) Pippali (Piper longum), Sonth (Zingiber officinale), Marich (Piper nigrum), Amla (Emblica officinalis), Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica) and many more. All of the ingredients of this formulation works really well in pacification and balancing of pitta in the body along with the vata dosha as well. This churna is generally known to have a healing effect on the lining of the stomach and is very much best to avoid or prevent or manage conditions like constipation, heartburn, indigestion, gastritis and others too. This is having really good results in bowel obstruction too.

Dosage: Half tsp before meals twice a day with lukewarm water.

2. Abhayarisht

Abhayarisht is an Ayurvedic liquid preparation which is prepared using fermentation method using herbs like Haritaki (Terminelia chebula), mahua flower (Madhuca longifolia), Munnaka (Vitis vinifera), vayavidanga (Embelia ribes) and many others. Abyarishta is very effective in opening the blockage in the intestines and also is really helpful in reducing inflammation. It acts as a vata anulomana or vata pacification agent and also has an impact on digestion. It enhances the digestion fire and stables back the digestion process. Abhayarisht is really good and has a very great effect on almost the digestion related ailments including intestinal obstruction.

Dosage: Two tsp twice daily after meals with lukewarm water.

3. Kumari Saar

Kumari saar is exclusively having kumari or aloe vera. The formulation is prepared in such a way that it remains pulpy and adds fibre in the digestive tract when its intake is done. This helps in opening the obstruction present in the intestine. The herb also has certain anti-inflammatory and antioxidant properties which makes it more potent to be used as a choice of formulation in bowel obstruction. It enhances the all over metabolism of the digestive tract and has its importance as a nutritional supplement. It’s the best nature’s formula to detox your body.

Dosage: Two tsp in equal amounts of water at the morning time.

4. Panchsakar Churna

The panchsakar churna is very effect blend of many herbs like Sonth (Zingiber officinale), saunf (Foeniculum vulgare), Senai (Cassia angustifolia), choti harad (Terminalia chebula) along with saindhav lavan or rock salt. The formulation is effective in relieving the obstruction in the intestinal tract and also balances the potassium in the body which is towards the lower side and needs to be balanced. Along with all of this it relieves the recurrent cramps in the abdomen along with feelings of nausea and vomiting. The formulation is very potent in subsiding other symptoms and correcting the metabolism.

Dosage: Half tsp twice daily after meals with lukewarm water .

Conclusion

The bowel obstruction is something which can not be ruled out easily. It’s like having one thing constantly in your mind and that is something is hanging in your digestive tract. In situations like this keeping a straight mind set is difficult. Usually the condition is the result of old strictures, colon cancer or rectal cancer etc. The above mentioned formulations can be used and effectively manage the situation. All of the above mentioned medications are totally herbal and do not have any kind of side effects. These can be used in any age group but the dosage may vary. To confirm the dosage one must take these medications under the guidance of a professional Ayurvedic physician. In case of any query kindly visit www.planetayurveda.com