EFFECT OF INTEGRATED APPROACH OF YOGA THERAPY ON CHRONIC CONSTIPATION

Abstract

Constipation is most common GI problem which significantly affects health related quality of life, social functioning and compromises the ability
to perform daily activities. Yoga is one of the alternative and complementary therapies known to have positive role in various GI related chronic
problems. There is lack of evidences for role yoga in constipation. Thirty-seven participants suffering from chronic constipation, who attended one
week of IAYT program consisting of asana (physical posture), pranayama, meditation, devotional sessions, diet modification and interactive
sessions on philosophical concepts of yoga, atholistic health center S-VYASA, were enrolled in this study. The quality of life and the bowel habits
were assessed before and after the intervention using Patient Assessment of Constipation- Quality of Life (PAC-QoL) questionnaire.There is a
significant change in different domains of PAC-QoL such as reduction in the scores of physical discomfort (61.25%), psychological discomfort
(59.21%), worries and concern (55.92%) and satisfaction (44%) were found after one week IAYT intervention.This pilot study indicated the
potential role of IAYT role in management of chronic constipation. However further randomized control studies need to be performed in order to
confirm the findings of present study.

Full text

Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |23
Constipation as the reduction in the bowel movement to
three or fewer times per week (Jamshed et al., 2011). It is one
of the most common functional gastrointestinal disorders
(Liu, 2011) prevalent all over the world (Thomsen et al., 2010).
Chronic constipation is found more commonly in women,
elderly and patients with concurrent psychiatric illness (Liu,
2011). In the long run leads to self-medication and/or medical
consultation (Dennison et al., 2005), poor health-related quality
of life, disturbed social functioning and compromises the ability
to perform daily activities (Jamshed, Lee, & Olden, 2011). 2-
27% of world population is affected by chronic constipation
(Ines, Sanchez, &Bercik et al, 2011). It is more prevalent in
western countries which account for 30% (Longstreth et al, 2006)
and eastern countries it 11% (A, Lissner S, & MA et al, 2010).
Yog a
Recently Yoga has become popular as a complementary and
alternative medicine due to its many health implications. It well
documented that, Yoga is effective in management of various
chronic health problems such as cardiovascular diseases, diabetes,
obesity, anxiety disorder, depression menstrual problems etc.
Yoga and gastro-intestinal (GI) problems
Yoga is has been used as complimentary therapies in
gastrointestinal related problems such as irritable bowel
syndrome (IBS). In one of the randomized controlled studies
on 22 male IBS patients underwent two months of yoga
practice, at the end of the study significant decrease in anxiety
and sympathetic activity along with improvement in
parasympathetic activity was observed (Taneja et al, 2004). In
a another randomized controlled study, twenty-five adolescent
IBS subjects underwent one month of yoga intervention daily
for one hour, significant improvement in gastrointestinal
symptoms, pain, functional disability, coping, anxiety and
depression was observed in yoga group as compared to control
group (Kuttner et al, 2006). These studies indicate the role of
yoga in GI related problems.
Integrated Approach of Yoga therapy (IAYT): IAYT is a
yoga based lifestyle intervention and a form of yoga. It was
consisted of asanas (physical postures), pranayama (breathing
practices), meditation, kriyas (cleansing techniques), balanced
diet, tuning to nature, counseling session etc.
Earlier studies on IAYT proved its effects on several chronic
health conditions such as chronic low back pain (Padmini T et
al, 2008), osteoarthritis (Ebnezar et al, 2014) etc.
Materials and Methods
Thirty-seven chronic constipation subjects (age range; 35 to
55 years)visitingArogyadhama (Holistic health center),
SVYASA University, Bangalore, for IAYT treatment for
chronic constipation were enrolled in this study. The subjects
were having mean 6.4±5.46 years history of chronic
constipation. Apart from the chronic constipation most of
the subjects were having hypertension and diabetes as
associated disease.
EFFECT OF INTEGRATED APPROACH OF YOGA THERAPY
ON CHRONIC CONSTIPATION
Jayanti Rao
Yoga Therapist, S-VYASA University, Bangalore
Kashinath G Metri
Assistant Professor, S-VYASA University, Bangalore
Amit Singh
Assistant professor, S-VYASA University, Bangalore
Nagaratna R
Director, Arogyadhama (Holistic Health Center)
Abstract
Constipation is most common GI problem which significantly affects health related quality of life, social functioning and compromises the ability
to perform daily activities. Yoga is one of the alternative and complementary therapies known to have positive role in various GI related chronic
problems. There is lack of evidences for role yoga in constipation. Thirty-seven participants suffering from chronic constipation, who attended one
week of IAYT program consisting of asana (physical posture), pranayama, meditation, devotional sessions, diet modification and interactive
sessions on philosophical concepts of yoga, atholistic health center S-VYASA, were enrolled in this study. The quality of life and the bowel habits
were assessed before and after the intervention using Patient Assessment of Constipation- Quality of Life (PAC-QoL) questionnaire.There is a
significant change in different domains of PAC-QoL such as reduction in the scores of physical discomfort (61.25%), psychological discomfort
(59.21%), worries and concern (55.92%) and satisfaction (44%) were found after one week IAYT intervention.This pilot study indicated the
potential role ofIAYT role in management of chronic constipation. However further randomized control studies need to be performed in order to
confirm the findings of present study.
Keywords:Yoga, Chronic constipation, PAC-QOL, IAYT
YOGA THERAPY ON CHRONIC CONSTIPATION
Voice of Research
Volume 5, Issue 1
June 2016
ISSN 2277-7733

24 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733
Inclusion criteria
Who fulfill the Roam criteria for constipation; Subjects with
minimum 3 years history chronic constipation; Subjects within
age range 35 to 55 years; Willing to participate in the study
Exclusion criteria
Subjects having neurological disorders; Subjects with any
mental disorders or on any antipsychotics; History of any
abdominal surgery
Assessment
All the subjects were administered with PAC-QOL before and
after intervention. PAC-QOL is a self-reported questionnaire,
was used to measure the quality of life of patients (McShane
RE et al, 1985). The validated PAC-QoL is composed of 28
items grouped into four subscales: physical discomfort,
psychosocial discomfort, worries and concerns, and satisfaction.
The first three subscales are used to assess the patient
dissatisfaction index, with an overall score ranging from 0 to
96 (where lower scores correspond to better quality of life).
The satisfaction subscale includes four items with a global
score ranging from 0 to 16, so that each patient’s self-reported
definitive outcome is defined as either poor (0-4), fairly good
(5-8), good (9-12), or excellent (13-16)
Results
Suffering since (months) (Mean ± SD): 81.24±71.46, Age
(Mean ± SD): Male (48.61±12.74), Female (44.14±9.55)
Prominent ailments: hypertension, diabetes
The patient assessment of constipation- Quality of life
questionnaire consists of 4 domains which are physical
discomfort, psychological discomfort, worries and concern and
satisfaction.
Physical discomfort
The PAC-QOL scores showed a significant reduction in the
physical discomfort after the intervention and is significant
(p<0.01). There was significant reduction in the scores from
1.91 ± 0.85 to 0.74 ± 0.73 with 61.25% of change.
Psychological discomfort
The PAC-QOL scores showed a significant reduction in the
psychological discomfort after the intervention (p<0.01). There
was significant reduction in the scores from 1.52 ± 0.81 to
0.62 ± 0.55 with 59.21% of change.
Worries and concern
The PAC-QOL scores showed a significant reduction in the
worries and concern after the intervention (p<0.01). There was
significant reduction in the scores from 1.52 ± 0.85 to 0.67 ±
0.55. The worries and concern reduction percentage was 55.92%.
Satisfaction
The PAC-QOL scores showed a significant improvement in
the satisfaction after the intervention (p<0.01). There was
significant reduction in the scores from 2.50 ± 0.84 to 1.40 ±
1.02 with percentage of 44%.There was a significant reduction
in the total score from 1.86 ± 0.46 to 0.86 ± 0.36 (p< 0.001).
Discussion
Summary
This pilot study was aimed to see the impact of IAYT in
chronic constiaption. There was significant reduction in the
scores of physical discomfort (p<0.01), psychological
discomfort (p<0.01), worries and concern (p<0.01) and
satisfaction (p<0.01) of the PAC-QoL questionnaire. And
the total score also reduced indicating a better quality of life.
Earlier studies have observed overall improvement after yoga
intervention in GID patients. There was significant decrease
in the bowel symptoms, state anxiety and there was enhanced
parasympathetic reactivity measured by heart rate parameters
in diarrhea-predominant Irritable Bowel Syndrome (Taneja et
al., 2004). Another study showed significant improvement in
the physical functioning of adolescents while young adults
recorded significant improvement in IBS symptoms, global
improvement, disability, sleep quality, fatigue and psychological
distress. A minimal clinical significant reduction in pain in
44% of adolescents and 46% of YA having IBS symptom
was recorded (Evans et al., 2014). Previous study on IBS
reported lower levels of functional disability, less use of
emotion-focused avoidance and lower anxiety in adolescents
in the yoga group and also adolescents had lower scores of
gastrointestinal symptoms (Kuttner et al., 2006).
The exact mechanism behind these findings is not known.
One of the possible mechanism can be; as constipation is
psychosomatic problem (Nehra et al., 2000), various
psychological components such as stress, anxiety, depression
etc. leads to sympathetic overdrive (Tougas, 2000), which is
related to reduced intestinal motility. Earlier studies have shown
that yoga reduces anxiety (Gupta, Khera, Vempati, Sharma, &
Bijlani, 2006), stress, depression (Streeter, Gerbarg, Ciraulo,
Brown, & Saper, 2012) and it also improves the
parasympathetic tone (Bharshankar, Bharshankar, Deshpande,
Kaore, & Gosavi, 2003), improved parasympathetic activity
might have lead to improvement in intestinal motility.
Strength of the study& limitations
To the best of our knowledge this is the first study which has
looked into impact of yoga in chronic constipation; There was
significant reduction in all the scores in such a short term; This
YOGA THERAPY ON CHRONIC CONSTIPATION

Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |25
is also having several limitations a) Lack of control group, b)
Small sample size, c) Lack of objective variables; Suggestions
for future studies; Future studies conducted with randomized
controlled design in larger sample size; Future studies should
also include objective autonomic variables; Follow studies
should be done in order to assess the consistency of the results.
Conclusion
This pilot study suggests the potential role of yoga in chronic
constipation. However further randomized control trial need
to be confirm the findings of current study.
Table 1 - Results of Physical Discomfort (paired t test)
Abbreviation: PHY_DIS - Physical Discomfort, CI – Confidence
Interval, % Change – Percentage Change
Table 2 - Results of psychological discomfort (paired t test)
Abbreviation: PSY_DIS - Psychological Discomfort, CI – Confidence
Interval, % Change – Percentage Change
Table 3 - Results of worries and concern (wilcoxon signed rank test)
Abbreviation: W_C – Worries and Concern, % Change – Percentage Change
Table 4 - Results of Satisfaction (wilcoxon signed rank test)
Abbreviation: SAT – Satisfaction, % Change – Percentage Change
Table 5 - Pre-post changes in total score of PAC-QOL
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YOGA THERAPY ON CHRONIC CONSTIPATION
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