2. Common Digestive Disorders

In this chapter some common digestive disorders are described for the benefit of readers.
Constipation
Impaction of bowels, weak peristaltic action of intestines, rectum and anus, dry and fatless foods, absence/lack of green and leafy vegetables, fruits, milk, absence of bulk forming agents may lead to constipation which is only a symptom and not a disease. Constipation is the biggest monster that triggers most of ailmentary disorders. If you have constipation, you may suffer from :

• Flatulence and wind accumulation
• Pain in abdomen (Colic)
• Dysentery
• Blind or bleeding piles
• Hernia, strangulation
• Fistula, Fissures, Cancer of rectum/anus etc.
• Acidity and heart-burn
• Sour and/or acidic eructations
• Pain in navel region
• Nausea, vomiting
• Headache
• General malaise and feeling of ‘not being well’ or ‘something is wrong’ with digestive organs and digestion.

Causes

• Use of purgatives habitually.
• Absence of stool for many days, resulting in hard knotty and dry stools which are difficult to expel.
• Lack/absence of bran, leafy and green vegetables, milk, fruits.
• Ingestion of junk food, fast food, highly spicy, fried and condimented foods.
• Lack of physical activity
• Too much rest or activity
• Habitual and excessive use of alcohol, tobacco, narcotics etc.

Prevention
Avoid the factors listed above and also change life-style, way of thinking, working and approach.
Diarrhoea
It is characterised by loose or semi solid stools, with or without abdominal pain. Real danger surfaces when too much of water and salts are lost from our body, resulting in general malaise, extreme thirst, unrest, griping pains, tenesmus, rectal pain and urgent urge to rush to the closet or, in some cases, watery stools escape in the clothes. Dehydration may cause, nausea and vomiting which are serious symptoms and might push a patient into grave condition.
Infantile diarrhoea is a serious manifestation which is a known killer of infants and children.
Types

• Diarrhoea of infants and children
• Diarrhoea of young persons
• Diarrhoea of travellers
• Diarrhoea of pregnant, post-natal ladies
• Senile diarrhoea (of old and aged people)
• Diarrhoea of drunkards, indolent, sedentary, glutt
• Diarrhoea due to dietary indiscretions
• Diarrhoea caused by anxiety, fear, apprehension, tension
• Summer Diarrhoea
• Diarrhoea of rainy/wet seasons
• Diarrhoea due to feasts, marriage dinners, club parties, social gatherings
• Beer Diarrhoea, etc.

If you look at the types of this malady, you will, at once, be able to discern and locate the cause that has triggered the malady. Once the underlying and precipitatory cause has been discerned, treatment is quite possible but the proviso remains that the patient must avoid and scruplously stay away from the causative factors. It is no using taking medicines every now then and thereafter indulge in forbidden/harmful situations/foods. Prevention and corrective approach are the watchwords.
There is a causative and underlying factor that causes loose motions. Some pre-emptive and corrective steps must be taken before starting on a journey, before onset of seasons, when ailment returns or is anticipated to stage a comeback. Once you have corrected and modified your dietary means, most of diarrhoea related problems shall get relegated to the back seat. Chronic diarrhoea is a serious disease which requires thorough clinical investigations.
Do’s

• Take rice, rice water, coconut water, lime water in plenty.
• Take ORS to ward off danger of dehydration, water-sodium imbalance, thirst.
• Moong, rice and curd should be taken as meals.
• Drink boiled water only.
• Take light tea in moderate quantity.

Don’ts

• Eliminate fats, oil, dry fruits, milk and milk products, sauces, jams, chutnies, pickles etc.
• Refrain from spices and condiments.
• Do not consume junk/fast foods, so-called ‘Office lunch’, chats, juices sold in the bazars, cane sugar or any other cold drinks etc.
• Avoid strong tea, coffee, cocoa, wine, whisky, beer, tobacco, meats, fish etc.
• Don’t be paniky and hasty and wait for the medicine to act.
• Don’t jump from medicine or system to another in a hush, and do not use medicines of divergent therapies concurrently, due to drug interaction and drug reaction.
• Do not return to your normal dietary pattern immediately after you recover—allow some cushion time between recovery period and normalcy.

Dysentery
It is also a form of diarrhoea but, here, the stools are accompanied by mucus or blood or both which condition points to infection in the intestines. There is much pain, tenesmus, passage of mucus and blood tinged loose or semi solid stools. There is indigestion, bleeding, loss of weight, anaemia. The infection is brought on by food impurities resulting in ulceration of intestines and the occasional formation of abscess in the liver. Amoebic dysentery is controlled by drugs like emetine and tetracycline, but treatment has to be continued for a fairly long period—depending on severity and depth of infection.
Amoebic dysentery is generally confined to tropical and subtropical regions/countries.
Dysentery is a recurring phenomenon and auxilliary measures like intake of boiled water, cleaned and washed vegetables and fruits, high standard of personal hygiene. Amoebic dysentery is caused by a parasite or protozoa called Eantamaeba hystolytica.
Another type of dysentery is ‘Bacillary Dysentery’ which is caused and spread by bacteria of the genus ‘Shigellia’ and is spread by contact with a patient/carrier or through food, contaminated water or by faeces. This condition may spread in the form of epidemic. Infections include diarrhoea, fever, cramps, and they persist for a week or so. There could also be present dehydration and bleeding from the gut. Use of antibiotics efficiently controls the malady but may reappear if causes surface again.
Fluid and sodium losses should be controlled by ORS which should be taken in place of ordinary water. But, in any case, boil the water very thoroughly, in addition to taking safeguards, diet and hygienic measures suggested under this heading and diarrhoea. If vomiting and nausea also accompany dysentery, position becomes more serious and may assume form of cholera. In any case, accord topmost priority to control of bleeding and vomiting.
Nausea And Vomiting
Feeling that one is about to vomit is called ‘Nausea’ and is most common during travelling, sea-sickness, pregnancy (in early stages). The substance of food, bile, phlegm/mucus, water/liquids purged out, subsequent to nauseating feeling, is no vomiting which can also occur due to acidity, water brash, cholera, disagreeable food, odour of gases and chemicals, seeing some unpalatable event/scene or even seeing another person vomiting, nauseating filth and foul smell; high blood pressure and headache ( in some cases it is relieved by vomiting). Vomiting during 1st trimester of pregnancy is quite common and not unnatural but if it occurs on/after 7th month and the bouts are shattering and convulsing, an abortion may take place.
Vomiting and nausea can also be triggered by ingestion of drug, during/after operation, food poisoning (Ptomaine Poisoning), cold, cough etc. Certain causatives are beyond control but some can be offset by taking proper precaution and safeguards. Profuse and persistent vomiting is a serious and life threatening situation, when the patient should be put on saline-glucose drip into which some anti-emetic and anti nausea agents should be injected so as to restore saline-glucose and water level in the body and also for treating nausea and vomiting with requisite medicines.
Instead of going into the unnecessary details about causes, try to control vomiting and/or tone down frequency, restore sodium-water-sugar balance in the body, maintaining general resistance and strength of the patient. If situation is too grave to be controlled at home, rush the patient to doctor or call in the doctor. Remember, even a slight delay can prove fatal or, at least, complicate the case.
Flatulence/Colic/Gas/Wind
When too much of wind producing eatables are ingested but the food remains stuck up in intestines, it gives rise to accumulation of gas/wind in the stomach, due to which the abdomen bloats and there is a gurgling sound. In majority of cases, there is also pain, restivity, sweating, uneasiness, unfructuous desire to visit the toilet to pass stools—when neither stool nor wind gets expelled. I have taken up all the factors together because there is hardly any difference in symptoms, causes and complaints. The fact of the matter is that winds gets locked up, abdomen bloats, wind/gas does not pass and if such a situation lasts longer, there may be pain (colic) in the abdomen.
The root cause of all such disorders is overeating but, in other cases, when food is not taken for a longer period, even then there is accumulation of wind which, if not expelled, causes pain. The later variety of colic yields when food is eaten in moderate quantity. The next cause of such complaints is constipation but all the symptoms subside as soon stools are passed and wind gets discharged. If the pain lasts even after passage of wind and stools, it must not be taken lightly and got treated by a doctor. All said and done, all pains in the abdomen must not always be attributed to constipation and locking up of wind.
Colic is rather a confusing term which is also called for Renal colic, Intestinal colic, Billiary colic, Gallstone colic, Flatulent colic, etc. Here the name of the disorder points to the involvement of a particular organ being at fault. Hence, when treating case of a colic, always try to find out which of the organs in ailmentary tract is at fault—once the organic cause has been properly discerned, there is not likely to be any difficulty in treating the agonizing disease and its symptoms.
If wind fails to pass through downwards, it may travel upwards and, thus, exert pressure on the heart region which conditon is misconstrued as an Angina Pectoris (pain in the heart region) but symptoms are so variable in both the conditions that there is hardly any occasion not to distinguish between the symptoms.
Acidity & Heartburn
These conditions point to depraved digestive system for which so many factors are accountable. Even a small deviation from late lunch or dinner, overeating, consumption of liquor, tobacco, spices, fats, too much meats and fish, high protein but low carbohydrate diet, recent or chronic constipation, sedentary habits can protect you.
Symptoms
Too frequent heartburn and acidity can adversely affect liver, stomach and its lining, enzyme production and, above all, entire digestive system is thrown out of gear. There is a constant burning sensation, acidic/sour eructations, restivity, pain or discomfort. Usually character of pain is of burning which is felt behind the breastbone and often appears to rise from the upper mid abdomen, either towards or into the throat. The patient feels as if the ingested food would come upto the mouth and that he may have to vomit but vomiting doesn’t occur. Heartburn might be accompanied by appearance of bitter or acidic fluid in the mouth, and is generally and quite often caused by regurgitation of the stomach contents into the gullet or by esophagus.
If there is nausea and much restivity, at once precipitate vomiting which will relieve and mollify most of the symptoms but bitter and acidic taste will be left in the throat and mouth.
Peptic Ulcer
Excess of acids is the major factor that causes sour eructations, stomach upset and indigestion or heartburn and we try to mollify such symptoms by taking antacids which are considered to rectify and prevent sour eructations. Infact, hydrochloric acid is a natural constituent of stomach secretions, and helps the digestive enzymes to activate. Recurrent bouts of excessive acidity permeate in the form of peptic ulcer which is a condition of localised destruction of mucosa of stomach or inner wall of the stomach.
When upper part of small intestine gets infected, it gives rise to duodenal ulcer, or we can say that it is a wound inside the stomach or duodenum. Persons, who have 6 to 8 times more acid than is normally required, do suffer from peptic ulcers but there are many exceptions also, hence this is not a standard criterion. There are cases which have low grade acidity but, even then, they have peptic ulcers.
Excessive use of spices, condiments, alcohol, tobacco, coffee, tea etc. is held to be the basic cause of peptic ulcer. In addition, there are drug-induced peptic ulcers which are caused by indiscreet/overuse of resperine, caffeine, corticosteroids, indomethacin, brufen, aspirin etc.
Symptom

• Pain in upper part of the abdominal region, usually aggravated by food.
• Pain is sharp, penetrating and of burning type.
• In gastric ulcers pain increases soon after or immediately after taking meals but, in case of duodenal ulcers, pain may occur 2-3 hours after taking meals. These are variable timings of occurrence which clearly distinguish pain, in one ulcer from another.

Type of ulcer can be finally determined after few tests, examination of stomach and its contents.
The problem gets complicated when there is bleeding/ perforation at the site of ulcer, in which case surgery becomes necessary but, in all other situations, specified drugs and general measures will resolve the problem.
Generally cold and toned milk mollifies the problem but a bland diet also solves the problem. Milk may be served to the patient even after 15 minutes or even 2 hours, depending on severity/intensity of the case. Milk counteracts acidity and also delays emptying time of stomach, thus allowing the drug to act for much longer period.
Jaundice
In healthy state, bile is expelled into the duodenum during the process of digestion and is again absorbed. But, when excess of bile circulates in the blood, it gives rise to yellow colour (tint) in the eyes, nales, skin, renders urine deep yellow in colour, with passage of white stools. Prominent symptoms of jaundice can be listed as bitter taste in the mouth, slow pulse, extreme debility and exhaustion, either diarrhoea or constipation, pain in liver region. When you see any person having the said symptoms, you can immediately make out that he is suffering from jaundice.
Cirrhosis of Liver
It is also called intestinial hepatitis, nutmeg liver or sclerosis of liver. This is generally a chronic condition of the liver when there is an increase in the connective tissue but decrease in its size, alongwith degeneration of the parenchyma.
Alcohol is the chief factor. Next cause is carrying away of irritants to the liver by the blood vessels or by way of the capsule. Drugs like Arsenic, Quinine, Phosphorus, unproperly prepared food, food poisoning, infectious diseases, syphilis, and obstruction of the bile ducts can cause the disease.
Symptoms

• Anorexia (loss of appetite)
• Nausea, with/without vomiting
• Bad taste and belching
• Pressure in epigastriurn
• Tenderness in region of liver
• Hepatic colic
• Breathlessness
• Occasional full red tongue
• Jaundice of skin
• Occasional constipation
• Enlargement of liver
• Skin looks dirty, of mudy colour
• Bleeding from gastro-intestinal passage
• Swelling beneath the eyes, near genitals, legs and feet.
• Urine is high-coloured, heavily loaded with urea, some amount of bile but albumin and casts may also appear in the urine when kidneys are also involved.

Temperature is usually normal or below normal but in some cases may elevate to 1010F or slightly higher (though quite rarely).
Alcoholism/Syphilis are considered to be the precipitatory factors. As a rule cirrhosis of liver is almost incurable but further damage might halted if diagnosed and treated at the initial stage. With proper dietary regimen, safeguards, and by giving up alcohol totally may prove productive, or at least arrest further progress of the malady.
Hepatitis-a
This must not be confused with jaundice or any other depraved liver function or disorder. Here, some virus infection causes inflammation of the liver or amaebic dysentery and lupus. Infectious hepatitis is generally caused by contaminated food or drink, either by a patient or a carrier and generally occurs where there is poor sanitation.
Symptoms
After an incubation of 15-30 days the patient develops fever and nausea, yellow discolouration of the skin (as in jaundice) appears after a week or so thereafter, and persists for about 3 weeks. There are not much complications as the disease generally yields to treatment and doesn’t recur, except when the patient gets again infected. In any case, proper treatment can provide immunity.
Hepatitis-b
This generally occurs in drug addicts. The infection is transmitted by blood or blood products that contaminate injection needles. That is the reason why disposable syringes and needles are recommended to be used when an injection is intended to be given. There is hardly any chance of infection when disposal syringes are destroyed after being used once only. In some places, those used syringes are not destroyed and, thus, used for other patients. This is unethical and condemnable practice. So, whenever you are to be injected always carry your own syringe and needle and destroy the same after taking the injection. Treatment depends on the type of infection.
Symptoms
Headache, fever, chills, jaundice and general weakness. The disease can be identified by detection of ‘Australian Antigen’ in the blood.
Worms
There is hardly any person (of any age or sex) who had never had worm infestations, rather it would be more correct to say that alomost every person carries worms in the intestines. This a major public health problem and the number of such infected persons is on the rise. Worm infection is present to the extent of 90% in the residents of tropical countries, like India where standard of personal and general hygiene is apallingly low and the underlying cause is an impure and contaminated water supply, unhealthy environments, and socio-economic status. The position is still worse in other Asian and African countries where hygienic standards are still poorer.
Generally an infected person doesn’t know presence of worms unless there are serious complications and problems. Once eradicated, through medication, the worms hatch and cause agonizing distresses again, so a total immunity from worms cannot be had due to recurrence factors. Lack of knowledge, as to hygiene, water and vegetables contamination and impurities, prohibitive and high cost of medicines which not many people can afford, lack/absence of proper medical facilities (more so in remote corners and villages, small towns) and high rate of infection are some of the contributory factors that lead to various worms and worm-related disorders—some of which are quite serious and may threaten even life.
Types of Worms
Roundworms Threadworms
Hookworms Giardia
Pinworms Whipworms
Tapeworms
It may be remembered that worms hatch only where there is filth and filth is created by chronic constipation when stools remain lodged in the intestines and cannot be compelled due to weak/absent peristaltic action of intestines and rectum. In fact faeces remain lodged in the intestines for days together and putrify there, giving birth to various types of worms, constipation, foul smell, gas formation, flatulence, gastralgia etc.
As long as worms remain lodged in the intestines there are symptoms like gnashing of teeth, pillow wetting, irritation in the anus, occasional pain, general distress in abdomen, incarcerated and foul smelling wind, constipation, occasional piles (blind or bleeding) etc. Problem gets complicated and serious when worm infection travels to liver (as in the case of amaebic dysentery). Worms may even travel to brain or, for that matter, any other part of the body. But, once the body has been freed from worm infestations, most of the symptoms disappear and normal health is restored. If ever anyone or more of the said symptoms are felt or observed, get the stools tested which, in all probability, will disclose the type and presence of worms in the system. Once it has been confirmed as ‘Positive’, there should be no delay in treating the patient.
Cancer of Stomach
This is a fatal disease but can be contained to some extent if detected at the initial stage. Sometimes even the patient also neglects this disease because symptoms are not that glaring or even disturbing but, when the actual malady is detected at later stage it is too difficult to cure.
Children rarely suffer from stomach cancer and so do ladies, but exceptions are still there.
Causes
Hot drinks, foods, hard fibre and injuries—too much use of alcohol, tobacco, drug addiction, irregular food habits, tension are some of the predisposing factors. Chronic state of peptic ulcers may also lead to cancer.
Symptoms
These are insidious in their development. It was previously thought that absence of Hydrochloric acid (Hcl) results in cancer, whereas excess of Hcl surfaces in the form of ulcer. It is a fact that in the majority of cancerous cases there is no Hcl. Prominent symptoms are listed below. It is not all the symptoms can be found together in one patient, but may be majority of the cases.

• Marked acidity and indigestion.
• Fetid breath, flatulency.
• Sensations could be either sharp or dull, burning, gnawing, lancinating, sticking.
• Tenderness when touch or pressure applied over the painful region.
• Vomiting—if cancer is at the cardiac end of stomach, vomiting comes soon after, but if at the pylorus (opening of stomach mouth into the intestines), vomiting comes several hours after taking food.
• Marked anaemia and general emaciation.
• Slow action of the heart, feeble pulse and rapid respiration.
• Earthy or waxy colour of the skin.
• Swelling of ankles.
• Pain radiates from stomach towards back or behind the shoulders.

Piles (Haemorrhoids)
Piles is found in two forms—when there is no bleeding but pain is severe and unbearable and whole rectum smarts, aches due to painful passage of hard, dry and knotty stools. Another form is of bleeding piles when there is much oozing of blood from the rectum and there are grape-like boils in and around the anus. The eruptions look like bunch of small grapes.
Causes

• Chronic constipation or diarrhoea.
• Elimination of fats, milk and milk products from diet and too much consumption of dry food items.
• Irregular eating and working hours or else sedentary life-style and lack of physical activity.
• Excessive use of alcohol, spicy food, tea, coffee, cocoa, tobacco, drugs etc.
• Habitual use of purgatives.

Symtpoms
Herunder given the combined symptoms of both types of piles:

• Pain before, during or after stools—and sometimes pain persists in all the three conditions.
• Enlarged and tangled, hard and swollen veins.
• Great tenesmus and constriction
• Bleeding at the end of defecation.
• Inability to sit, move or even lie down

Corrective measures

• Regulate food timings, rest and proper physical activity.
• Avoid using cushioned seats, synthetic canes, but use airy chairs where air can easily let in.
• Take plenty of milk, green and leafy vegetables, pulpy fruits, coconut water, radish, cane sugar juice.
• Eliminate spices, condiments, liquor, tobacco, purgatives.
• Take 1-2 tsp of Isabgul husk with lukewarm milk. A little pure desi ghee may also be added but do not use any strong purgative.