=Prolapse= of the =bowels=, as a whole, or, more frequent still,
of a part, is undoubtedly the most common form of organ prolapse.
The intestines are so situated that they readily feel the effect of
gravitative influences, of atonic and anemic states, and of weaknesses
and disorders of other abdominal organs.
Spinal irregularities come first as potent =causes= of bowel prolapse.
The spinal nerves to the supports of the intestines, to the muscular
coats of the intestines, and to the abdominal walls, are obstructed in
their normal activity, and consequently those tissues to which these
nerves are distributed are affected. Wasting diseases, as anemia,
consumption, cancer and the like predispose to intestinal atony.
The severe mechanical wrenches, strains, frequent pregnancies, tight
lacing, heavy skirts, large abdominal tumors, obesity, cause more or
less general or local weakness.
The pendulous abdomen, from wrong or careless posture, and exclusive
of other causes, is a common source of general bowel displacement.
This form of disorder, besides being unsightly, favors abdominal
stoutness. There are a number of instances where simply voluntarily
holding or “sucking” the abdomen into place, until it becomes strong
enough to support itself, has reduced one’s weight by five, ten or
fifteen pounds. These were cases where most of the adipose tissue was
about the abdomen. Thus exercising and toning the abdominal organs
by keeping them in normal position rectified a dormant blood and
lymph circulation, which was followed by absorption of the abdominal
stoutness.
Congenital weaknesses are to be considered in many cases. The muscular
ligaments may not be developed, the mesenteric attachments may be
too long, and various other abnormalities may result from congenital
disturbances.
Of particular local interest to the osteopath, outside of the bowels
dislocating as a whole, are: first, the hepatic flexure; second, the
ileo-cecal region; third, the sigmoid flexure; fourth, the rectum; and
fifth, hernias. Each of these sections are of separate interest and
will be considered presently.
The =symptoms= are extremely variable. Constipation, a feeling of
discomfort in the bowels, nervousness, depression, lassitude and anemia
are frequent. Colicky pains in the intestines, indigestion, hysteria
at times, are also among the symptoms. In reality a great variety of
symptoms may be present. The patient is likely to be emaciated. In some
cases exhaustion is marked.
=Diagnosis=, as a rule, is not a difficult matter. The various
neurasthenic symptoms in a lean patient with constipation, indigestion,
and stomach and intestinal distress would lead one to suspect
intestinal displacement. The outline or contour of the abdomen will
often reveal the character of the trouble. The atonic, thin and relaxed
walls of the abdomen may readily give view of the displaced organs.
Then careful examination by palpation and percussion will help very
materially in the diagnosis. Radiographic examination is a decidedly
helpful diagnostic method.
The =hepatic flexure= is frequently prolapsed. The bowel (colon)
ascends from below upward to beneath the costal arch and then angles
sharply into the transverse colon, which extends directly across the
abdomen to the left side. The ligaments that support this flexure
are apt to become weakened or stretched and allow a descent of this
section of the bowel, which is followed by constipation, indigestion,
etc. The ligament especially involved is the colo-hepatic ligament.
The =duodenum= may require attention. This can be raised by getting
beneath it where the organ descends alongside of the ascending colon.
The effect of treatment is to release tension of the duodeno-hepatic
ligament which is closely associated with the portal vein, hepatic
artery and bile-duct.
The =ileo-cecal region= is an area that readily becomes congested
and catarrhally inflamed, especially from constipation or impaction
at this point. The section often becomes atonic and prolapsed with
resultant clogging of fecal matter. Owing to the close proximity of
the vermiform appendix, appendicitis frequently results from the above
condition. The osteopath can do much in these cases of appendicitis.
Lesions are invariably found in the lumbar vertebræ or the floating
ribs are depressed.
The =sigmoid flexure= is also frequently prolapsed. The fecal mass
often becomes impacted here, owing to a settling or prolapse of this
part. In some cases the prolapse is so marked that it extends to the
rectum below and drags on the splenic flexure above.
Lumbar and innominate lesions are the usual causes, although, it seems
in a number of instances, that relaxed walls of the abdomen cause a
“contraction of the diaphragm resulting in kidney displacement and
followed by intestinal prolapse.” The vertebral lesions, probably,
first weaken the muscular coat of the bowel, then, second, the bowel
supports (other than its own inherent tonicity) and the abdominal walls.
Prolapse of the =rectum= is of such separate importance that it will
be but partly outlined here. As stated above, a source of rectal
displacement arises from the section of the bowel above settling
downward and ultimately causing invagination of one or more coats of
the rectum. Dislocation of the coccyx is a potent cause of rectal
disorders. Lumbar lesions, especially twists between the fourth and
fifth, and fifth and sacrum are common causes of rectal weaknesses.
Slips of the innominata are other causes of prolapse.
Osteopathy has had marked success in these cases. Cures may result
from a single treatment to readjust the coccygeal displacement or
temporarily relieve excessive physiological activity by dilating the
rectal sphincter, or the treatment may demand a number of months’
work in correcting general abdominal prolapse. Raising the sigmoid is
effectual.
A =hernia= is “the protrusion of a loop or knuckle of an organ or
tissue through an abdominal opening.” Two of the common hernias of
the intestines are inguinal and femoral. These conditions are most
often acquired from severe straining, so that a loop of the bowel
protrudes through a weakened and stretched area of the abdominal walls,
though there is reason to suspect that congenital defects are often
predisposing factors.
Mention of the hernia is here made because, in a way, it is a form
of bowel prolapse; that is, a limited form, and osteopathy contains
certain possibilities for a successful treatment. Hernia has always
been looked upon as purely a surgical disorder; i. e., remediable by
surgical measures only. Where a truss has failed to give relief surgery
has been resorted to. This is true in most instances, but where the
hernia is in the incipiency careful abdominal exercises (this should be
carried out with great care, for severe exercise may produce a hernia
or increase one already existing), massage to the tissues about the
hernia, attention to the bowels, and spinal stimulation corresponding
to the weakened tissue, and avoidance of strains may strengthen the
tissues materially about the hernia.
Occasionally a loop of the intestine will prolapse into the cul-de-sac
back of the uterus. A heavy dragging pain low down in the center of the
abdomen and constipation or complete obstruction are the pronounced
symptoms. Careful lifting of the loop of bowel by pressure within the
vagina and traction from above with a hand outside, with the patient,
on her back, with buttocks elevated, gives speedy relief.
The =treatment= of the prolapsed bowels represents those measures that
will replace and keep in position the displaced organs. Naturally, the
spinal and abdominal treatment comes first; this strengthens intestinal
ligaments, tones intestinal muscles, and contracts the abdominal
parietes, and at the same time the bowels are regulated, digestion
and nutrition improved, and the general health built up. In some
cases abdominal supporters will be of value. In a number of instances
attention to chest mobility and diaphragm tonicity will be of value.
Right living, which is represented by proper diet, sufficient outdoor
exercise and regular habits, is invaluable.
The really specific treatment is to correct spinal, rib and innominate
deviations and abnormalities. But direct local work will be, in many
instances, necessary. General abdominal manipulation is good, but this
should be supplemented by careful local treatment. The hepatic flexure
requires a direct stimulating and replacing treatment. The ileo-cecal
section should be raised, stimulated and emptied of the fecal mass.
Direct upward manipulation of the sigmoid flexure in the left iliac
fossa and of the splenic flexure beneath the left costal arch is
extremely efficacious. Care must be taken not to bruise the parts.
Getting beneath the prolapsed area and gently and intelligently raising
the bowel so that it is emptied, toned up, and vascular congestion
relieved, are the indications. This requires careful work and the
necessity of gentleness can not be emphasized too much. Still in all of
this treatment we should never forget the absolutely essential spinal
readjustment.
Rectal prolapse requires lacol internal treatment, external tissue
correction, especially of the coccyx, an innominatum or the lumbar
spine, and, of much importance, deep, careful and thorough work over
the sigmoid section.
Cases of bowel prolapse are every day experiences with the osteopath.
The osteopathic treatment is of great value in these and a successful
issue is very often the result. Cases of pendulous abdomen, of
obstinate constipation, of chronic indigestion, of many nutritional
disorders, of feeling pain, weight or dragging, locally or generally,
in the abdomen, are very apt to be in persons suffering from prolapsed
intestines.
A number of cases of bowel prolapse are associated with general
prolapse of abdominal organs; that is, displacement of the stomach,
kidneys, liver, spleen, etc. This general condition is termed
enteroptosis or Glenard’s disease. It usually requires several
months to treat it successfully. These patients are neurasthenic,
malnourished, and often hysteriacs. The symptoms from which they
suffer are innumerable. Mechanical weaknesses, lowered vitality, poor
innervation and blood supply, and auto-intoxication are causative
factors.