Borborygmi, Stomach Growling:Ayurveda Understanding

Article by Dr Raghuram Y.S. MD (Ayu) & Dr Manasa S, B.A.M.S

Borborygmi or stomach growling are the sounds produced in the abdomen. The abdominal noises or sounds may be either normal or abnormal. It is important to differentiate the nature of these sounds from a clinical perspective.

The sounds or noises which occur during a normal process of digestion as occurs due to muscle contractions and gas movement in the digestive system as the food passes through the intestines is considered as normal and occurs in everyone. They are produced due to the normal digestion process in the gut and are usually audible after eating food. They are also produced as your intestines are contracting in an attempt to push the food and waste through the digestive passages. They are also indicative of good digestion and not a matter of concern.

On the other hand, these sounds can also be pathological or abnormal. There can be an exceptionally noisy gut pointing towards increased intestinal activity and this occurs due to gas or diarrhoea. These are called hyperactive bowel sounds. They are louder and more frequent. On the other side the sounds may be totally absent i.e. a silent gut indicating a slowdown in digestive activities due to digestive issues or constipation. These are called hypoactive bowel sounds and are quieter or less frequent.

Related Reading – ‘Borborygmi – causes, symptoms, prevention, treatment’

In this article we will try to understand Borborygmi from an Ayurveda perspective.

Borborygmi: Ayurveda Understanding

Dosha perspective

Normal sounds / noises

According to Ayurveda, the normal passage of food in the digestive tract followed by its proper digestion depends upon

–        entry of food by coordination of prana-udana vata axis
–        moistening of food by bodhaka kapha in the mouth
–        acceptance, holding, digestion of food in the stomach and pushing ahead of digested food into the colon by coordination of pachaka pitta, samana vayu, ranjaka pitta and kledaka kapha
–        expulsion of wastes generated after digestion of food by apana vata

If these mechanisms occur in an unhampered way, the digestion of food and expulsion of wastes will take place in a synchronised and un-disturbed way. The sounds produced by the movements of the gastrointestinal tract, movement of foods, liquids and gases in the gut during this normal phase of digestive activities should be considered as normal sounds or noises.

Abnormal abdominal or gastrointestinal sounds / noises

If there is disturbance in one or more of these mechanisms, then there will be disturbance in one or other level of digestive activities and this will lead to indigestion, improper expulsion of wastes, accumulation of gasses and faeces, distension of abdomen and bloating associated with abnormal gastrointestinal sounds. This will lead to borborygmi which can be considered as troublesome or pathological and might require medical attention.

Hypoactive bowel sounds – If the above mentioned doshas do not function properly or work weakly or if the mentioned events are not synchronized or are balanced, the digestive activities too will be feeble or sluggish. This may lead to what we know as hypoactive bowel sounds which indicate reduced digestive activity. This will lead to constipation, low peristalsis, indigestion, formation of ama and other disorders. The sounds here, as said earlier, are less frequent or quieter. If these sounds are accompanied by symptoms such as severe abdominal pain, bloating, or changes in bowel habits, one should immediately talk to their doctor.

Hyperactive bowel sounds – If there is hyperactivity of the above mentioned doshas or if the mentioned events are not synchronized or are balanced, the digestive activities too will be severe and exaggerated. This may lead to what we know as hyperactive bowel sounds which indicate abnormally increased digestive activity. This will lead to diseases like atisara – diarrhoea, grahani – irritable and inflammatory bowel disease, pravahika – dysentery, increased formation of gases, increased peristalsis, etc. The sounds here, as said earlier, are louder and more frequent and hence manifest as ‘noisy gut’ or noisy abdomen.

Diseases which may cause abnormal bowel sounds or borborygmi

Agnimandya – Samagni is a state of balance of digestive activities and is responsible for normal bowel sounds. Imbalance of agni takes place when agni is influenced by vata, pitta or kapha.

–        Agni influenced by vata is called vishamagni where there are erratic digestive activities. Due to this the borborygmi may also be irregular in nature, sometimes loud and sometimes feeble, sometimes not audible, sometimes frequent and sometimes occasional. If not addressed, it may cause or indicate many kinds of vata disorders developing in the backdrop, those of gastrointestinal tract or systemic. Frequently, constipation, accumulation of gases, flatulence, flatulent dyspepsia, abdominal distension, bloating and delayed evacuation of the gut is associated with borborygmi.

–        Agni influenced by pitta is called as teekshnagni / tikshnagni. The fire is intense and all burning. The borborygmi in this condition is frequent and occurs in short spells. There may be bubbling noises due to the liquid nature of pitta. Severe hunger, improper digestion, inflammatory conditions in the body and gastrointestinal tract, like acidity, nausea, gastritis, peptic ulcers, inflammatory bowel diseases and their symptoms, diarrhoea, bloody diarrhoea, dysentery are found associated with borborygmi.

–        Agni influenced by kapha is called mandagni. The fire is very mild and there is delayed digestion, delayed absorption and delayed emptying of stomach and upper intestines. This will affect the colon too in the long run. Stagnation of food, nutritional depletion, nausea, vomiting and other systemic kaphaja disorders are found to be associated with borborygmi. The bowel sounds are mild, less frequent and at times may indicate a silent abdomen.

Ajirna – Indigestion is also of different types depending on the nature of agni and the dosha influencing the agni.

Vishtabdajirna – is the indigestion caused by vitiated vata or digestive fire influenced by vata – vishamagni. In this condition the food sometimes gets properly digested and sometimes not. The pattern of borborygmi will be the same type as explained in the context of vishamagni above.

Vidagdhajirna – is the indigestion caused by vitiated pitta or digestive fire influenced by pitta – tikshnagni. In this condition the food gets very quickly digested and sometimes burnt. This will provide very little nutrition to the body. The pattern of borborygmi will be the same as explained in the context of tikshnagni.

Amajirna – is the indigestion caused by vitiated kapha or digestive fire influenced by kapha – mandagni. In this condition, the food gets digested very slowly. As a result, there is stagnation of undigested food for a long time in the stomach and upper intestine leading to delayed emptying and lazy stomach. The pattern of borborygmi will be the same as explained in the context of mandagni.

Borborygmi: Secondary to other disease conditions

As already discussed, agnimandya and ajirna are the big basic diseases which are associated with Borborygmi. Agnimandya is said to be the foundation for many systemic diseases.

The other conditions which branch from these conditions and some more conditions which might not, will also be associated with borborygmi.

Those conditions include –

Vata Vriddhi

Vata is made up of vayu – wind and akasha – ether mahabhutas. So, when vata moves around, the features of wind and ether are also exhibited. The air moving around in the spaces of the intestines will increase, will be loud and be frequent when vata is aggravated to high proportions and cause borborygmi.

Shakrd Graha i.e. constipation is mentioned amongst the symptoms of abnormal vata increase. This would also form gases, blocks in the colon, flatulence and would influence peristalsis on the long run. All these would lead to borborygmi.

Vata Sanchaya

Stabdha Koshtata i.e. rigidity of intestines or hollow spaces of the abdomen and Purna Koshtata i.e. feeling of fullness inside the intestines or hollow spaces of the abdomen i.e. hypo-peristalsis are the symptoms of vata accumulation in its own seats. Here hypoactive bowel sounds are produced.

Vata Prakopa

Koshta Toda – pricking pain in the abdomen or viscera and Koshta Sancharana – movement of vata / air in the hollow organs of the body, mainly intestines have been mentioned among the symptoms of vata prakopa i.e. aggravation of vata. Here koshta sancharana is the explanation of ‘borborygmi like’ condition. This causes hyperactive bowel sounds.

Udavarta

Udavarta is an abnormal upward movement of vata from colon upwards. This is caused by many causes but mainly due to forcible withholding of body’s normal urges. There are 13 such urges which Ayurveda stresses upon not to withhold. Among these, the natural urge for – bowel evacuation (defecation reflex), urination, passing of fart, belching, eating food (hunger), sleep and vomiting, when forcibly held, may cause borborygmia in the long run.

Adhmana

Adhmana means tympanitis or distension of the abdomen. It is caused due to obstruction of vata and presents with atopa – sounds in the abdomen (borborygmi), adhmana – distension of abdomen and ugra ruja – severe pain in the abdomen.

Atopa

Atopa is defined as disturbances or irritation in the abdomen along with sounds in the abdomen / intestines – borborygmi. This is a part and parcel of adhmana.

Anaha

It is a condition caused either by excessive accumulation of ama in the stomach or faeces in the colon, further vitiated by vata and not expelled out at the right time. This condition too causes borborygmi.

Visuchika

Visuchika is often correlated with cholera but it can be more than just being that. It is said to develop in people not having ‘eating discipline’ and are attracted towards all kinds of foods. This will expose the person’s gut to all kinds of wrong food combinations which will eventually lead to variations in agni, indigestion, formation of ama and conditions like visuchika. This disease is marked by both diarrhoea and vomiting occurring at a time along with other symptoms and also abnormal movements in the intestines and colon, leading to borborygmi – basically hyperactive bowel movements.

Alasaka

This is a condition wherein there is severe anaha – distension of abdomen by accumulation of faeces (constipation) or ama. The word ‘PARIKUJATI’ used in the context of symptoms of anaha points out abnormal abdominal sounds – borborygmi. The obstructed winds move upwards producing reverse peristalsis and abnormal sounds. There is absolute constipation i.e. non elimination of faeces and fart. In milder conditions it may be hypoactive bowel movements. Later as the disease progresses, in spite of having constipation, excessive movement of gases, flatulence and retrograde peristalsis presents as hyperactive bowel movements.

Vilambika

This is rather a serious condition built on the base of alasaka, but is said to be an incurable condition. It is caused due to excessive and regular consumption of contaminated and incompatible foods. The undigested food neither moves upwards or downwards. It can be considered as clinical emergency of the sorts of intestinal obstruction. We can expect minimum bowel sounds of low intensity or a completely silent abdomen herein.

Atisara

In the premonitory symptoms of atisara – diarrhoea, anila sannirodha – excessive accumulation of gases in the intestines and vit bhanga – constipation is mentioned which basically cause borborygmi. Presence of these symptoms with other premonitory symptoms of atisara, along with borborygmi indicate that atisara might manifest in a day or two.

Sa-Shabda has been mentioned in the Vata type of atisara which means ‘with sounds’. Sounds in abdomen and while passing loose stools may occur in any type of atisara, but will be predominant in vataja atisara.

Grahani

This is a condition wherein grahani – small intestine / duodenum is contaminated by the doshas and loses its capacity to digest the food properly. Sometimes there is constipation and sometimes diarrhoea. In both conditions there will be borborygmi.

Vata type of grahani presents with difficulty in digestion of food and fermentation of food in the stomach. Dysentery, distension of abdomen after or during digestion of food, delayed evacuation of dry, less watery, thin, ama mixed stools along with froth and sounds are mentioned amongst the symptoms. Presence of ‘sounds’ points towards borborygmi.

Pittaja Grahani, presenting with diarrhoea and symptoms resembling gastritis will obviously be associated with borborygmi. Even in Kaphaja Grahani there is delayed digestion and excretion of faeces which is mixed with ama and kapha and is heavy. Borborygmi may be associated with this condition.

In special conditions of Grahani called Sangrahani and Ghatiyantra Grahani manifestation of antrakujana i.e. gurgling sounds in the intestines (as felt and experienced on the abdomen) and sa Shabda mala pravritti – defecation along with sounds clearly point out towards the explanation of borborygmi.

Pravahika

Pravahika is a condition which is marked by pravahana i.e. straining during defecation. This condition is correlated with dysentery which is definitely associated with borborygmi.

Udara Roga

Udara means abdominal disorders or enlargement of abdomen caused due to various causes.

Adhmana – distension of abdomen, durbala agnita – weakness of digestive fire and vata purisha sanga i.e. obstruction of fart / gases and faeces are mentioned amongst the symptoms of udara roga. All these may cause borborygmi.

In Vataja type of udara roga, Vayuscha atra saruk shabdo i.e. painful movement of gases all through the abdomen – borborygmi has been mentioned amongst the symptoms along with constipation, distension of abdomen and other symptoms.

In baddha gudodara – a type of udara in which there is obstruction of intestines by impacted food, foreign body or faeces, there occurs enlargement of abdomen. This condition can be associated with borborygmi. Modern medicine too tells that borborygmi can be caused by intestinal / bowel obstruction.

Gulma

Gulma is a condition in which circular masses which either increase in size or not, movable or immovable are caused in the abdomen, often considered as tumours. Gulma can be things beyond tumours or cysts also, since there is no clear mass in vataja type of gulma.

Antrakujana – abnormal sounds in the abdomen, purisha bandha – constipation, atopa – sounds with pain and distension in the abdomen, adhmana – distension of abdomen and apakti – indigestion of food are mentioned amongst the premonitory symptoms of gulma. So, long standing and unaddressed borborygmi along with the mentioned premonitory symptoms will indicate that gulma will be manifested in near future.

Even in the general symptoms of gulma are mentioned krichra vin mutra vatata i.e. difficulty in expulsion of faeces, urine and fart, antra vikujanam – abnormal sounds in the abdomen – borborygmi, anaha – severe accumulation and obstruction caused by ama and faeces and upward movement of vata – retrograde peristalsis.

Koshtagata Vata

When aggravated vata gets accumulated in koshta – hollow visceral organs there is obstruction of urine and faeces with other symptoms specific to the disease. Borborygmi might occur due to these obstructions.

Gudagata Vata

When aggravated vata gets accumulated in the rectum / anal region, there occurs obstruction of faeces, fart and urine along with other symptoms like distension of abdomen, colic, pain in the legs, thighs, hips, foot and back. The obstructions occurring in the colon by faeces and fart would produce borborygmi.

Pakvashayagata Vata

When aggravated Vata gets accumulated in the colon, it causes antrakujana – abnormal / gurgling sounds in the abdomen – borborygmi, pain in the abdomen, noises with pain in the abdomen, obstruction of ama and faeces, difficulty in elimination of faeces and urine and pain in the low back and sacral region.

Vidavruta Vata

It is a condition wherein vata is obstructed by faeces. Herein the faeces do not move down easily and pain occurs in the rectum. The vata always moves upwards in its abnormal course – reverse peristalsis – this may cause borborygmi.

Krimi

It is a topic which explains microorganisms of various types and sizes. Atisara – diarrhoea is one of the symptoms of the manifestation of krimi. Avipaka – indigestion, arochaka – anorexia and anaha – constipation and blocks caused due to accumulation of ama in the stomach and faeces in the colon – are some of the symptoms of krimis of kapha type. In Madhava Nidana, Krimi chapter has been explained immediately after chapter dealing with ‘Ajirna – indigestion’ and the commentator tells that krimis are formed due to indigestion. All these events may lead to borborygmi.

Modern medicine says – Gastroenteritis, an inflammation of the stomach and intestines, caused by viruses, bacteria, parasites or food poisoning often leads to hyperactive bowel sounds. It is characterized by symptoms such as diarrhoea, abdominal pain, nausea, vomiting, and fever.

Causes of Borborygmi

Below mentioned may be considered as the important causes for borborygmi –

Viruddha Ahara – Mutually incompatible or antagonistic foods may cause complex reactions in the stomach and intestines leading to agnimandya, ajirna, formation of ama, abnormal peristalsis and many abdominal disorders leading to borborygmi.

Asatmya Ahara – Foods which are incompatible or new kinds of foods (food experimentation) to which the body is not used to when used in excess and repeatedly might cause disturbance in digestive activities leading to borborygmi. This can be considered as intolerant foods, unaccustomed foods or food intolerances.

Abnormal and wrong eating habits – Adhyashana – eating foods when the previously eaten food has not been digested and ati ashana – excessive eating can cause borborygmi. Anashana – not taking foods and liquids for long durations and repeatedly – can also cause borborygmi.

Ahara-Vihara – foods and activities which increase or decrease bowel movements or cause indigestion of food and formation of gases, foods which cause constipation. Vata aggravating foods and activities are also causal, can cause irritable bowel syndrome – vataja grahani and cause borborygmi. Those which cause pitta aggravation might cause inflammation in different parts of the gastrointestinal tract leading to inflammatory bowel disease / celiac disease – grahani and cause borborygmi. Kapha aggravating foods and activities can slow down the gastrointestinal activities, cause indigestion and ama and lead to borborygmi.

Baddha Gudodara – obstruction of bowel / intestine by impacted or undigested food, faeces or foreign bodies for a long time. Modern medicine too has counted this as causal for borborygmi.

Primary diseases which can cause borborygmi – like agnimandya, ajirna, and all other conditions discussed above can be causes for borborygmi.

Manasika Nidana – Stress factor has also been mentioned amongst the triggers of digestive imbalances and irregularities which can lead to borborygmi. Irshya – jealousy, bhaya – fear, krodha – anger, lobha – greed, dainya – helplessness, pradvesha – aversion or hatred for foods, chinta – overthinking / stress or worries, shoka – grief, duhkha shayya – uncomfortable bedding and prajagara – excessive awakening during night (which is a cause for stress and vata aggravation) have been mentioned amongst the causes for ajirna.

Avyayama – Regular exercise keeps the digestive fire activated and its normal functions regulated. It also contributes to proper digestion and balanced gut health, including proper peristalsis. One who is sedentary and is not indulged in exercises will suffer from digestive irregularities and gastrointestinal problems arising from the same, leading to many symptoms including borborygmi.

Not following the Ahara Vidhi Vishesha Ayatanani – Not following and bringing into practice the food etiquettes, rules and regulations laid down for consumption of food.

Ayurveda Management of Borborygmi

Nidana Parivarjana

Following the golden principle in comprehensive treatment of any condition, avoiding the causative factors which might cause borborygmi forms the key intervention. This itself becomes preventive measures.

Treatment of causal doshas

The dosha predominance in causation of borborygmi or in diseases causing borborygmi should be identified and addressed promptly.

Treatment of causal diseases

It is important to address the main / primary disease which is responsible for borborygmi and treat that condition. When the cause is addressed, the effect too will go away.

Trividha kukshi

Ayurveda classifies the stomach into three compartments in relation to the quantity of consumption of food. One portion should be reserved for solid foods. The second compartment is for liquids / liquid foods. The third part should be left empty for the action of doshas i.e. vata, pitta and kapha. This means to say that one should not eat beyond one’s capacity to keep the gut health intact. He or she should properly customize the quality and quantity of food ideal for their health and should practice it regularly. If this rule is broken, the stomach gets overloaded and eventually leads to indigestion and related problems which may eventually cause borborygmi.

Sattvavajaya Chikitsa

Stressed gut can have digestive issues as already mentioned. It is important to manage mind related issues like anxiety, stress etc and control extremes of rajas and tamas qualities of mind and bring them to a state of balance. This is very essential in conditions like ajirna and grahani disorders. Guidelines of treatment are based on principles of dealing with manasika rogas – mental disorders or manovaha sroto dushti – contamination of channels related to mind. This includes psychotherapy and external treatments like shirodhara, shirobasti etc.

Panchakarma procedures

Virechana and Vasti are ideal therapies for many conditions (mentioned above) causing borborygmi. Vamana may be skilfully chosen as and when required to get rid of morbid kapha. These therapies not only cleanse and detox the gastrointestinal tract but would also address the issues / conditions causing borborygmi and also would prevent their recurrence.

Nabhi Lepa

This is a treatment done with paste of herbs applied in the navel pit and around the navel. The paste is made up of herbs which stimulate agni and balance vata and other doshas.

Related Reading – Nabhi Lepa

Vatanulomana

In most cases of borborygmi, vata is involved. In many cases, vitiated vata has an abnormal course and has moved upwards in contrast to its normal downward course. It is important to give medicines which can push vata downwards, in its normal direction.

Beneficial formulations

Below mentioned formulations are helpful in combating with borborygmi –

–        Gandharvahastadi Kashayam / Eranda Tailam
–        Rasonadi Kashayam
–        Indukantam Kashayam
–        Sukumaram Kashayam / Ghrtam
–        Tiktakam Kashayam / Tiktakam Ghrtam
–        Jeerakarishtam
–        Jiraka Rasayanam / Leham
–        Hingvashtaka Churna
–        Hinguvachadi Churnam / Gulika
–        Chitrakadi Vati
–        Dhanwantaram Gulika
–        Vayu Gulika
–        Kankayana Vati (Gulma)
–        Shanka Vati
–        Shanka Bhasma / Kapardika Bhasma
–        Drakshadi Leham
–        Trivrit Leham

Beneficial Yoga poses

Below mentioned Yoga postures are beneficial for those suffering from borborygmi and also for gas and bloating –

–        Apanasana – Knees to chest pose
–        Pavanamuktasana – wind relieving pose
–        Utkatasana – chair pose / fierce pose
–        Paschimottanasana – seated forward bend pose
–        Supta Matsyendrasana – Spinal Twist
–        Trikonasana – Triangle Pose
–        Marjaryasana – Cat pose
–        Bitilasana – Cow pose
–        Adhomukha Shvanasana – Downward facing dog pose
–        Sethu Bandha Sarvangasana – Bridge Pose
–        Balasana – child’s pose
–        Ananda Balasana – Happy Baby Pose
–        Marichyasana – One legged seated spinal twist-        Pranayama – breathing exercises