Charaka Samhita (Cha. Chi.12,14) (Cha. Si. 6, 7)
Ashtanga Hridaya (Ah. Ni. 7, 8,) (Ah. Chi. 8), (Ah. Kalpa-Si. 3, 5)

A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Google Scholar to identify peer-reviewed articles related to lifestyle modifications in anorectal disorders.

The search utilized keywords and phrases including “anorectal disorders,” “lifestyle modifications,” “dietary factors,” “haemorrhoids,” “anal fissures,” and “fistula.”

Importance of Fiber For Gut Health^[6]:

Dietary fiber, defined as “the remnant of plant components that are resistant to hydrolysis by human alimentary enzymes” is a class of non-digestible carbohydrates resistant to gastric acids and hydrolysis by digestive enzymes, while “functional” fiber is defined as isolated, non-digestible carbohydrates that have beneficial physiological effects in humans.

In the colon, fiber may be fermented by the microbiota, with production of gas (CO₂, CH₄, H₂) and short chain fatty acids (SCFAs), i.e., butyrate, acetate, and propionate, which create osmotic load, accelerating intestinal transit. Moreover, butyrate, which is an important source of energy for the colonic mucosa, also acts at the level of the neurons of the myenteric plexus, increasing gut motility. Fiber can retain water, increasing the hydration of the stool. A normal stool contains 74% of water, whereas a hard stool has less than 72% and a soft stool at least 76%. Therefore, a percentage of as little as 2% in water content can make a difference to stool form. This small variation in consistency allows the stool to be more rapidly moved distally by the peristaltic waves of the colon and more easily evacuated. The peristaltic waves differ according to their amplitude and frequency.

Gut Microbiome Focus^[7]:

A healthy gut microbiome supports the integrity of the intestinal barrier and function, preventing increased permeability (often referred to as "leaky gut"). Dysbiosis, or an imbalance in gut bacteria, has been linked to several gastrointestinal disorders. When this balance is disrupted, it can lead to inflammation and increased susceptibility to anorectal disorders.

It is part of Koshtha that forms substratum for Agni. The nature of Grahani is crucial in deciding nature of Koshtha. When Grahani is unable to retain food till proper digestion or when Agni (digestive power) is Manda (weak) that it is unable to facilitate proper digestion, result is Ama (improperly formed metabolites) leading to Vyadhi (diseases). Guda is one among Koshthangas. Hence changes caused by Ahara(food), Vihara (activities) and Manasikaja (mind induced) will impair gut health, resulting in Gudagata Vyadhis (anorectal disorders).

Factors Hampering The Gut Health^[9]:

Gut is a highly dynamic system characterized by interaction with both intrinsic and extrinsic factors. Among extrinsic factors, food, regimen, region, and season, and among internal factors, physical constitution, age, and psyche are most crucial ones. All these factors directly or indirectly influence digestion and metabolism (Agni), both at gut level and at tissue level. All these effects culminate at endpoint called ‘Ojas’ or ‘Bala’ that is product of total metabolic activities happening in living body. [Su.Sa. Sutra Sthana 15/19] The Koshtha (nature of gut) is decided by Prakruti (physical constitution) of individual.

Table 2: Showing the relation of Prakruti with Koshtha and Agni^[10]

While explaining Nidana (causative factors) during pathogenesis of a Vyadhi (disease), Acharyas have categorized them into Aharaja (food specific), Viharaja (activities related) and Manasika (mental health specific). Through this we can interpret that what we consume, do and think can attribute to our overall health. Also, Ayurveda explains that avoiding Nidana (causative factors) itself is first step of treating disorders.

The three Upastanbhas outlines their role in physical as well as mental health, if taken in balanced proportions. The integration of dietary changes (Ahara), physical activity (Vihara), and adequate sleep (Nidra), can significantly enhance overall well-being and mitigate the risk of anorectal conditions.

Aharasayanabrahmacharyamyuktya Prayojitaihi |
Shariram Dharyate Nityamagarmiva Dharanaihi: || Ah.Su.7/52

Ahara (Food) and Mental Health:

Ayurveda emphasized that root of living is Ahara, which is “Mahabhaisajyam” (best medicine). Acharya Susrutha has stated Ahara as one of potent ways of controlling disease. Ayurveda insists that Ahara should be consumed in accordance with Prakriti (constitution) of individuals. Pathya Ahara (Wholesome food) as per Ayurveda is conducive for maintenance of good health, longevity, strength, intellect, good voice and complexion. For a disease-free life, Ayurveda emphasizes on importance of proper nutrition through intake of food by appropriate food choices, food combination, and cooking methods, in right quantity which gets digested as well as metabolised in time. The food ingested is transformed to three categories after digestion, namely Sthoola (gross), Sookshma (subtle) and Mala (waste product).^[12] The Sthoola (gross) part nourishes body tissue (Dhatu) and Sookshma (subtle part) nourishes mind while Malas (waste products) are excreted. Thus, mind is influenced by food taken. While describing nutritional properties of various foods, Ayurveda texts use several terms pertaining to impact at mental level. Some of these terms are described below with examples.^[13]

Disturbed sleep is linked to the following clinical conditions:^[14]

A. Gastroesophageal reflux disease (GERD) - Sleep deprivation can worsen reflux symptoms by impairing the body's ability to clear acid from the esophagus during sleep.

B. Altered gastrointestinal motility - it slows down gastrointestinal transit time, leading to constipation or irregular bowel movements. Conversely, it may also trigger episodes of diarrhoea due to increased stress responses.

Effects on Gut Health^[15]:

A) Increased Intestinal Permeability: Lack of sleep can lead to higher levels of cortisol, a stress hormone that disrupts the gut lining's integrity. This disruption can result in intestinal permeability, often referred to as "leaky gut," where toxins and undigested food particles pass into the bloodstream. Symptoms include bloating, abdominal pain, and food sensitivities.

B) Gut Microbiome Imbalance: Sleep disturbances can alter the composition of gut bacteria, leading to dysbiosis - an imbalance between beneficial and harmful bacteria. Research shows that sleep deprivation can decrease beneficial bacteria like Bacteroidetes while increasing Firmicutes, which may contribute to obesity and metabolic disorders. A diverse- microbiome is linked to better sleep quality, indicating that poor sleep can create a vicious cycle affecting both gut health and sleep patterns

C) Inflammation of the Gut Lining: Studies indicate that inadequate sleep can increase pro-inflammatory markers in the body, exacerbating inflammation in the gut lining. This inflammation is associated with conditions such as inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), leading to symptoms like chronic diarrhoea, constipation, and abdominal discomfort.

D) Dietary Choices and Eating Patterns: Lack of sleep influences hormones that regulate hunger, such as ghrelin and leptin. Sleep-deprived individuals often experience increased appetite and cravings for unhealthy foods high in sugar and fat. These dietary choices can negatively impact gut health by promoting the growth of harmful bacteria and worsening digestive symptoms.

Bhagandara (Anal Fistula)^[17]:

Parikartika (Anal Fissure)^[18]:

Prebiotics and Probiotics^[20],[21]:

Prebiotics are non-digestible food components that selectively stimulate growth and activity of beneficial microorganisms in gut, conferring various health benefits. Concept was introduced in 1995 by researchers Glenn Gibson and Marcel Roberfroid, who defined prebiotics as substances that improve host health by promoting specific beneficial bacteria, particularly in colon. A prebiotic is defined as “a substrate that is selectively utilized by host microorganisms conferring a health benefit”.

Probiotic, any of various live microorganisms, typically bacteria or yeast, that are ingested or otherwise administ. as means of potentially aiding prevention & treatment of gastrointestinal disorders.

Takra Prayoga^[22]:

Takra (buttermilk) is recognized as a potent probiotic food that offers numerous health benefits, particularly for digestive health.
Takra - curd prepared by churning with water- 1/4th of the quantity of curds.

Gunas of Takra:

It is Kashaya-Amla Rasa Yukta (sour & astringent in taste), Madhuravipaka (attains sweet taste at the end of digestion), Ushnaveerya (hot in potency), Deepana (increases appetite), Laghu (light for digestion), Preenanam (replenishing), Vrushya (aphrodisiac) & Vatanashaka (destroys Vata).^[23]

Probiotic Properties:

1. Rich Source of Probiotics: Buttermilk is fermented with beneficial bacteria such as Lactobacillus acidophilus and Lactobacillus bulgaricus, which help maintain a healthy gut microbiome. These probiotics promote digestion, enhance nutrient absorption, and prevent the growth of harmful microorganisms in the digestive tract, thereby protects the gut health.
2. Digestive Aid: Regular consumption of buttermilk can alleviate symptoms like indigestion, bloating, and constipation. Its probiotics support smoother digestion and help restore balance in the gut, making it particularly effective after meals.

Importance of Takrapana:

Doshagnibalatrividham Tat Prayojayet | Hatani Na Virohanti Takrena Gudajani Tu ||
Bhumavapi Nisiktam Taddeha Takram Trnolupam | Kim Punardiptakayagnehe Sushkanyarshamsi Dehinaha || Cha. Chi.14/75-76
Acharya Charaka says that Arshas (Haemorrhoids) once destroyed by buttermilk do not recur.

• Amlatakra (buttermilk) with Shunti (dry ginger) and Saindhava - mitigates Vata Dosha.
• Amlatakra (buttermilk) with Sita (sugar) - mitigates Pitta Dosha.
• Amlatakra (buttermilk) with Vyosha (dry ginger) and Kshara (alkali) - mitigates Kapha Dosha.

The use of probiotics (live beneficial bacteria) and prebiotics (substances that promote the growth of beneficial bacteria) can help restore microbial balance. Probiotics have been shown to enhance gut barrier function, reduce inflammation,

Figure 2: Pavanamuktasana

Figure 3: Paschimotasana

Figure 4: Dhanurasana

Figure 5: Shalabhasana

The gut-brain axis plays a crucial role in how stress affects gastrointestinal health. Stress can alter gut motility and microbiome composition, potentially leading to conditions like irritable bowel syndrome (IBS).^[26] Stress can enhance the perception of pain through mechanisms involving central nervous system sensitization. Patients with functional anorectal pain often report heightened sensitivity to pain stimuli, which may be aggravated by psychological factors such as stress and anxiety This heightened sensitivity complicates treatment outcomes and may necessitate a multidisciplinary approach that includes psychological support.

Toilet Habits and Ergonomics:

Regular toilet habits help train the body to recognize when it is time to have a bowel movement. Responding promptly to the urge to defecate is crucial (Vegaan Na Dharayet). Ignoring the urges can lead to harder stools and increased difficulty in passing them, ultimately contributing to conditions like haemorrhoids and anal fissures.

Straining during bowel movements can lead to various anorectal disorders. Good toilet habits involve taking the time needed for a comfortable bowel movement without rushing, which helps prevent excessive pressure on the anal region.

Optimal Sitting Position:

Squatting helps straighten the anorectal angle, which facilitates easier passage of stool. This position relaxes the puborectalis muscle, allowing for a more direct route for waste elimination. Studies have shown that individuals using a squatting position can experience quicker and more complete bowel movements compared to sitting toilets.^[27]

The traditional sitting position on toilets may not be the most effective for everyone especially the older adults. If in a western commode, elevating the feet using a footstool can create a more natural squatting position, which helps align the rectum more favourably for easier stool passage. This position reduces strain and promotes relaxation of the pelvic floor muscles.

Body Mechanics:

Leaning slightly forward while resting forearms on thighs can facilitate relaxation of pelvic floor muscles during bowel movements.

Future studies are vital for establishing best practices that could help identify which interventions yield the most significant benefits over time, empowering patients and improve their overall well-being.

References