By DR. C. P. EMERSON.
(from “Essentials of Medicine”).
SOME very constipated persons are quite unconscious of the fact that their colon contains masses of very hard, dry stools, which cling to its walls. These set up an irritation there which causes a diarrhoea of liquid stools past these scybalous masses. These stools often contain a good deal of mucus, which, in these cases is not a symptom of disease, as so many think, but is secreted as a protecting coating to defend the bowel wall against these irritating, hard masses of stool.
Such patients will have alternating periods of constipation and diarrhoea, and will consider that their constipated periods are their well periods, and that the periods of diarrhoea are their sick times.
If the food remains too long in the colon, practically all of its water will be absorbed, and the masses may be almost as “hard as stone.” These large faecal masses usually crumble into smaller masses, giving the condition known as “sheep faeces.” One or two of these lumps in a diarrhoea stool will at once give us a clue as to the diagnosis.
The lower bowel may, in a severe case of constipation, become “impacted” that is, filled by masses of hard faeces which must be removed by the fingers, or first softened by large injections of oil before they can be washed out by a water enema.
The cases of chronic constipation may be divided into three groups. First, should be mentioned the cases of habit- constipation. Because of the careless habits of personal hygiene which lead some persons to delay each day the bowel movement as long as possible, the mucous membrane of the rectum becomes more and more accustomed to the presence of the mass of stool and after a while will fail to warn the person that is there.
This is by far the most common type. These are the patients who take so much medicine to move their bowels: Who try so many fads; who later resort to so many enemas; who use so many suppositories; all of which are unnecessary and even harmful.
The more we stimulate an organ of sensation, the less sensitive does this organ become, and this is as true of the rectum as of the other organs of sensation. The more we stimulate and irritate this mucous membrane the more anaesthetic it becomes.
These patients should try, by establishing the methodical habits which every normal person should have, to restore the normal sensitiveness of the rectal wall.
If as a result of their constipation these persons have developed haemorrhoids (piles) or fissures, these should first be corrected, since they tend to increase the tendency to constipation.
The patients should try to have a movement each morning at exactly the same time; not five minutes earlier or later. Their morning routine should be somewhat as follows: on rising, drink a large cup of water for breakfast, always a fruit, a cereal, and honey or marmalade; and then at exactly the same time after breakfast, they should attempt, and should try hard to have a movement.
If on two successive mornings the bowels fail to move, they should on the night of the second day take before retiring a plain water enema. Above all else, these persons should use no laxative medicines. The movement of the food along their entire gastro-intestinal canal is normal unit it reaches the last few inches of the bowel, and the trouble there is the result not of disease but of a careless habit which should be corrected.
Surely it is not reasonable to subject twenty-four feet of normal gastro-intestinal canal to a medicine which is intended to affect but one foot of it, and that the last.
In the second group of cases, the ascending colonic group, the seat of the constipation is the ascending colon and is due to appendicitis, gall-bladder disease, or other inflammatory troubles. These patients usually need surgical treatment. Certainly they should not eat a lot of coarse food, for the greater the bowels load, the less easily can the bowel handle it. These patients may, while waiting for a convenient time for operation, take laxatives which will stimulate the bowel.
The third, or atonic, group includes the weak young women with sagging intestines whose entire colon, the X-ray pictures show, is too sluggish. These patients need general muscular development, such as they can gain by outdoor exercise, riding, etc., and should receive a careful diet and medication directed far more to the nervous system than to the bowel.
Biliousness means constipation much oftener than it means liver trouble, and, as for the last promise on the label, it is certainly true, for some of the most cantankerous, melancholic, pessimistic, bad-tempered hypochondriacs, become cheerful, optimistic citizens after their constipation is relieved. Diarrhoea, as has already been mentioned, also may be a symptom of constipation.
The large, hard, faecal masses in the colon often cause “neuralgia” of the sacral nerves; while one of the commonest results of constipation is haemorrhoids, or “piles.”.
Acute constipation is a quite different matter, always indicating an acute and sometimes a serious disorder. Often in these cases one is tempted to give some purgative. It should, however, be remembered that acute constipation is an early and conspicuous symptom of appendicitis and of other surgical conditions, and that the purges so often given are very dangerous, since they may make a mild case very serious.