=Definition.=—A chronic inflammation of the mucous membrane of more or
less of the large intestines. There may be ulceration.
=Osteopathic Etiology= and =Pathology=.—Chronic diarrhea may be the
result of repeated attacks of the acute form or may be caused by
cancer, tuberculosis, Bright’s disease, typhus fever, disease of
the liver, organic disease of the heart and lungs, obstructions to
portal circulation or impactions of any nature that occasion passive
congestion. Frequently cases of long standing are due to chronic
lesions of the lower ribs or lower dorsal or lumbar vertebræ. The
lesions of the lower ribs usually consist of downward displacement
of the ribs, affecting the innervation to the intestines directly,
or possibly dragging the diaphragm downward to such an extent as to
interfere with the blood and lymph vessels as they pass through it,
thus causing congestion of the intestines by obstruction to the lumen
of the vessels.
In many cases the =pathological changes= are simply those of the acute
form. In more pronounced cases the mucous membrane becomes a brownish
red, livid gray or slate color; this discoloration being due to
hyperemia and blood extravasation. The mucous coat is also swollen and
thickened. Atrophy of the mucous membrane, and in some cases of all the
coats, with destruction of the glands, may be a result of the chronic
form. Ulcerative changes occur chiefly in the lower part of the ileum
and colon; these may be follicular or there may be large ulcers and
considerable areas of ulceration.
=Symptoms.=—Constipation and diarrhea frequently alternate; the stools
are thin, mixed with a large amount of slimy mucus; the small intestine
is most frequently involved, and the patient complains of pain in the
umbilical region; there is distention of the bowels with gas; the
health gradually declines; there is great pallor, and the patient
becomes emaciated, gloomy and irritable.
=Mucous Colitis= is a chronic form of colitis, characterized by
paroxysms of severe pain and the discharge of large masses of mucus,
forming gray translucent casts, which are not fibrinous but mucoid in
character. This disease occurs usually in women of nervous type, but
is occasionally seen in men and children. When there is no underlying
organic disease, it is probably largely a secretion neurosis. Mental
emotions and worry, sometimes errors in diet, or dyspepsia bring on
the attack. Overfatigue is often an exciting factor. The nutrition is
generally well maintained, but in other cases there may be a gradual
emaciation and ultimate death. This is undoubtedly one of the most
persistent and troublesome diseases that one will meet; still the
osteopath can do much for these cases and not infrequently bring about
a cure. But the treatment must be consistent and persistent.
Mucous colitis is not hard to diagnose, although many cases are treated
for simple indigestion. It is needless to say that a correct diagnosis
is paramount. In these cases there is almost invariably some visceral
prolapse, which undoubtedly is the underlying cause, by favoring venous
congestion of the bowels. The liver is usually congested; this alone
may cause the venous stagnation, but more often it is simply due to the
common cause. Back of the visceral prolapse and congestion will almost
invariably be found a posterior dorso-lumbar curvature; still there may
be a scoliosis or single lesions only, and a downward displacement and
constriction of the floating ribs.
The =treatment= requires most persistent and careful work for at least
three months, and probably six to nine months. Correction of the spine
and floating ribs should be of first consideration; then intelligent
treatment over the abdomen, by raising and toning the bowels, not
only the bowels as a whole, but especially in the ileo-cecal, hepatic
flexure, transverse colon, splenic flexure, sigmoid flexure, and rectal
regions. The direct treatment should be cautiously given when there
are indications of ulceration.
Have the patient help himself by manipulating his bowels night and
morning, drawing the abdomen up and in, and by thoracic breathing.
Prescribe plenty of drinking water and reduce starchy and saccharine
food to a minimum. Again emphasis is placed upon the necessity of
persistent treatment, two and three times per week, for several months.
The mucus is hard to remove. It is tenacious and frequently causes
colicky pains.
To the student Von Noorden’s[76] monograph on this subject is
especially instructive. He notes that almost without exception the
patients suffer for some weeks or months prior to the development of
colica mucosa from obstinate constipation. For acute attacks, among
other things, he advises rest in bed, hot applications, and high water
injections. He believes in massage of the large intestine (particularly
of the sigmoid flexure), in cases of atonic constipation and also in
spastic constipation, provided the patient has a diet that leaves a
large residue. “A coarse, laxative diet of Graham bread, leguminous
plants, including the husks, vegetables containing much cellulose;
fruit with small seeds and thick skins, like currants, gooseberries,
grapes; besides, large quantities of fat, particularly butter and
bacon.”
=Diagnosis.=—Diagnosis is always easy. The presence of blood, pus,
or fragments of tissue in the stool point to ulceration. Ulcers in
the rectum, and as high as the sigmoid flexure, will be recognized by
examination with the speculum.
=Prognosis.=—Osteopathy has undoubtedly changed the prognosis of
other treatment. Many cases can be cured and most other cases greatly
benefited. The deep seated ulcerations may cause circumscribed
peritonitis, or even abscess, and the prognosis becomes grave as these
complications arise.
=Treatment.=—As diarrhea may be caused by lesions anywhere from the
sixth dorsal to the coccyx, a most thorough examination is necessary.
On the one hand, diarrhea may be due to a marked lateral or posterior
spinal curvature, which is plainly seen upon inspection, but on the
other hand, it may be due to a slight twist or deviation from normal
of a vertebra which would require considerable osteopathic ability
to exactly locate. Diarrhea may result from subluxation in the lower
costal region, one or more of the three lower ribs on either side
being involved. Record of one case, in particular, of chronic diarrhea
is of interest as it was due to a rib dislocation. It was the case
of a man fifty years of age, who had suffered from chronic diarrhea,
several stools a day, for over thirty years. He was completely cured
in one treatment by correcting the dislocation of the vertebral end
of the tenth rib on the left side. This case is cited to impress upon
the student the necessity of precise diagnosis and treatment. Rarely
will diseases be cured by a single treatment, but when such happens
it exemplifies the potency of the osteopathic lesion. Treatment on
the left side is usually more effective in diarrhea than treatment
on the right side. When diarrhea is a symptom of some constitutional
disturbance, correction of dorsal, lumbar and rib lesions, with
thorough inhibition, careful dieting and rest, will commonly suffice
provided the primary disease is intelligently looked after.
=Chronic lesions= of the vagi nerves may exist and produce chronic
diarrhea in the same manner as in acute diarrhea. Rest and a liquid
diet, preferably boiled milk and albumin water, will be a helpful
treatment; the diet requirement is to have a minimum amount of waste,
so that the residue will cause the least possible irritation. Beef
peptonoids with the milk will be a nutritious addition to the diet, and
change of air and surroundings may be an aid to a more speedy cure.
The skin and kidneys should be kept in a healthy condition and, if
necessary, the bowels thoroughly emptied by injections.