Recommendations from Indian Experts on the 'Piku' Syndrome or Chronic Constipation

Constipation refers to bowel movements that are infrequent or hard to pass. It is a common condition that affects people of all ages, and is one of those topics few like to talk about. Although there are several Ayurvedic medicines and home remedies that claim to ease bowel movements, constipation is a painful reality one has to live with, sometimes for many years. If you ask about the one thing that Amitabh Bachchan-starrer ’Piku’ has done to the Indian masses, apart from entertaining them, is bringing into the public domain a topic that is taboo in social conversations but that almost everyone experiences or has been a chronic sufferer- constipation. The ’Motion Se Hi Emotion’ tagline of the unpretentious, low-budget film has become such a talking point and has touched an empathetic chord in people. It has brought out the ’bowel problem’ of people out in the open.

Dr. Deepak Lahoti, senior consultant (gastroenterology) at Max Super Speciality Hospital in New Delhi said, "The Indian squat position is the best to beat the morning blues (which, in fact, actor Irrfan Khan suggests to Big B in ’Piku’ too). It is more effective than the western chair position to maintain a healthier bowel movement, especially if you raise your knees towards your chest."

Dr. Yogesh Batra, director and senior consultant (gastroenterology) at BLK Super Specialty Hospital in the capital, also said, "The squat position is definitely more physiological for passing stools. It has been used by Indians for ages. The reason behind this is simple. The acute angle present between the rectum and the anal canal gets straightened and there is external pressure applied over the anterior abdominal wall for the smooth release of the stool. One disadvantage is that it is difficult for old people with knee problems to sit for long. An option is to convert the western commode to semi-squat position by keeping a stool under the feet." 

In fact, a new book titled ’Charming Bowels’ by Giulia Enders, who is studying in Germany for her medical doctorate in microbiology, has but stressed the claim that humans should be squatting, not sitting, on a toilet pot. This is because the closure mechanism of the gut is not designed to open the hatch completely when we are sitting down or standing up- it is like a kinked hose. Squatting is more natural and puts less pressure on our bottoms. Enders said, "Nearly 1.2 billion people around the world who squat have almost no incidence of diverticulosis and fewer problems with piles. We in the west, on the other hand, we squeeze our gut tissue until it comes out of our bottoms."

Another way to tackle constipation is to change your diet. Dr. Manish Kak, consultant gastroenterology at Ghaziabad’s Columbia Asia Hospital said, "Oats and high-fiber diet helps in tackling mild-to-moderate constipation. However, in case of severe constipation, you need to seek expert advice."

Dr. Batra added, "A fiber-rich diet is important. The reason for this is that fiber increases the bulk of the stool and thus facilitates its passage through the intestinal passage. Fiber does not get absorbed and travels easily triggering reflexes which make it easier for a person to pass motion."

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Besides this, drinking two to three liters of water every day, maintaining an exercise regime with yoga or jogging or a walk in the morning helps to relive constipation. Alcohol, stress and fried foods need to be avoided. Dr. Batra said, "Try home remedies like Isabgol husk, black currants, mint, bael (wood apple) powder or juice. These are free of side effects of using laxatives."

Dr. Lahoti said, "The key to defeat constipation is to maintain a healthy lifestyle.”

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Source-Medindia