(GLENARD’S DISEASE)
=Definition.=—A displacement of the stomach and intestines.
=Osteopathic Etiology= and =Pathology=.—A weakened, debilitated spine
is the common cause. A slight posterior curvature is a frequent
occurrence. A debilitated spine impairs the innervation to the
abdominal viscera and to the muscles of the abdomen. Many cases are
of congenital origin due to lack of complete development and weakness
of the supporting tissues. Other causes are muscular strain, repeated
pregnancies, tight lacing and malnutrition. A downward displacement
of the floating ribs, and a consequent prolapse of, and atony of the
diaphragm, is an important cause.
=Prolapses= of the stomach and intestines are of frequent occurrence
in both sexes, and very common in women. It is a condition oftentimes
overlooked, and when recognized, little has been done in the way of
a cure. It is the cause of much disturbance, not only to the stomach
and intestines, but to the various abdominal viscera and to the pelvic
organs, and it is the cause of a large percentage of prolapses of the
uterus, (excluding lacerations from childbirth) for not only is the
great suspensory ligament of the uterus (the peritoneum) prolapsed as a
consequence, but all of the abdominal viscera and the parietes of the
abdomen are also prolapsed and crowded down into the pelvis. The small
or large intestine or the stomach may be prolapsed singly. This is
frequently the case with the transverse portion of the colon, which may
be elongated and tortuous and prolapsed nearly to the symphysis pubis.
Prolapse of the liver, spleen and kidneys may occur singly or with a
general displacement of all the organs.
=Symptoms.=—The abdominal walls are weak, oftentimes flabby. The
viscera of the abdomen do not have normal resistance upon manipulation.
The spinal column presents lesions. There is dyspepsia, flatulency,
constipation, abdominal pains and various neurasthenic symptoms.
=Diagnosis.=—Is readily made by the lack of tone to the abdominal walls
and viscera and the general debility of the patient. Inflation of the
stomach with air will determine between gastroptosis and dilatation.
The X-ray is of special value in determining position, function,
spasms, kinks, etc. of the digestive tube. There are innumerable
gradations and phases of this condition.
=Treatment.=—To remove the cause is of primary importance. This is to
be followed by treatment of the spinal column, correcting its various
derangements and improving the innervation to the atonied viscera and
abdominal parietes. Direct treatment over the abdomen helps to give
tone to both the viscera and abdominal muscles. In many cases the
treatment will have to be a prolonged one in order that the tissues
may regain their normal condition. Usually a treatment from two months
to a year, or possibly more, is required. Exercises and manipulations
that tone the tissues, correct the posture, and raise the chest,
diaphragm, abdominal and pelvic viscera, and release spasms, kinks, and
adhesions, are indicated. The diet of the patient should be nutritious,
and sufficient in emaciated cases to increase his weight if possible.
A supporting bandage will often give some relief. A few cases will
require surgery.
Particular attention should be given to the colon, duodenum and
diaphragm.
Relative to the treatment of gastroptosis and enteroptosis, W. E.
Harris writes as follows: “I first set to work trying to correct the
spinal irregularities; coupled with this I give deep and careful
manipulation of the gastric and intestinal walls—treating my patient
two or more times per week for a period of one to three years. A lesser
period is not long enough to bring the desired result in such cases. I
also instruct the patient to knead his own bowels, which I prescribe
as a necessary proceeding, and to be performed twice daily on retiring
and before rising. Of equal importance with the osteopathic treatment,
come local, specific abdominal exercises. These are to be of the
resistive type, and must also be taken for the general musculature.
I have my patient retract the abdominal walls and voluntarily draw
the abdominal contents towards the diaphragm, in regular series.
These exercises must be faithfully performed and continued after the
treatment has ceased in order to be of real value. I do not find our
treatment, without the hearty cooperation of the patient in doing his
exercises conscientiously, to be sufficient in itself. Have the patient
avoid overloading the digestive tract. Use concentrated foods, in small
quantities, i. e., only sufficient to sustain strength, twice daily
and without taking fluids at meal times. Of course water, in small
quantities and at frequent intervals, may be taken between meals. To
summarize—First, corrective treatment. Second, resistive exercises.
Third, attention to diet.” (See Dilatation of the Stomach.)