=Constipation= is an unnatural retention of feces from any cause. The
following causes are frequently met with: A deficiency of the bile or
other secretions that aid peristalsis; many acute and chronic diseases
which lessen the secretions and impair peristalsis, such as anemia,
hysteria, chronic affections of the liver, stomach and intestines
and acute fevers; certain drugs and strong purgatives; strictures;
concentrated food; sedentary habits, overfatigue and neglect of the
calls of nature. Atony of the colon may be caused by chronic disease
of the mucosa and by general disease causing debility. There may be
weakness of the abdominal muscles, due to obesity and the distention
of frequent pregnancies, or obstructions, such as displaced uterus,
pregnancy, prolapsed cecum, sigmoid or rectum, and displaced coccyx.
Constipation is really a symptom, in most cases, of some disease; many
times it is about the only symptom observed. One has to take into
consideration the many causes that would produce constipation when the
treatment of a case is undertaken. A disordered structure may be found
in almost any region of a body, which would bear directly or indirectly
in the causation of constipation.
Irregular habits often bring on the most obstinate cases of
constipation in later life. There may also be local causes, such as
disturbances of the normal secretions, impairment of intestinal walls,
due to inflammation, and mechanical obstructions caused by tumors,
intussusception, twists, etc. Constipation in infants is usually caused
by errors in diet, but may be congenital.
In all obstinate cases the X-ray should be employed in diagnosis.
In the majority of cases lesions will be found in the vertebræ of
the lower dorsal and lumbar regions, or in the lower ribs of either
side. The lesions may affect the vascular supply and innervation of
the intestines directly, or the lesion may cause the constipation
by affecting some other digestive organ first. Lesions to the vagi
affecting the peristalsis of the intestines are common.
The usual =symptoms= are frequent stools, debility, lassitude,
headache, loss of appetite, anemia, furred tongue and fetid breath.
Serious symptoms may result in long continued cases, such as piles,
ulceration of the colon, perforation, enteritis and occlusion. The
fecal mass may become channeled and diarrhea may occur from the
irritation. In long standing cases of constipation, if the patient
suddenly develops diarrhea the rectum should be well examined to see if
there are impacted feces present. Neuralgia of the sacral nerves may
also be caused by impacted feces in the sigmoid flexure.
=Treatment.=—Naturally, owing to the numerous etiological factors, each
case is a special study and the treatment is necessarily varied. Many
cases will present slight impaction of the bowels, a sluggish liver,
spinal lesions and so on, which simply require a specific treatment and
all the symptoms will be removed. On the other hand, constipation may
be due to prolonged ill health and thus require a careful, systematic
treatment, not only of the bowels, but of the entire system. Of
primary importance in these cases is regulation of the diet, plenty of
exercise, sufficient sleep, and regularity in going to stool at a fixed
hour each day. The effect of attention to the latter point, in some
instances, will be sufficient to perform a cure. Too much cannot be
said in regard to the beneficial effect of systematic habits.
Lesions may be found in the spinal column producing constipation from
about the fifth dorsal to the coccyx, although principally the lower
three dorsal and upper two lumbar vertebræ are at fault. Constipation
may be caused by defects at any point in the intestines, and
consequently the sections of the spinal column sending nerves through
the intervertebral foramina to the several sections of the bowels
should be examined. At any point from the fifth dorsal to the coccyx,
certain vasomotor, motor and secretory nerves of the intestines may be
affected by various lesions. The vasomotor nerves keep up the vascular
tone of the bowels, the motor nerves the peristaltic action and the
secretory nerves attend to the intestinal juices. In constipation,
disorders of the spinal column are generally found on the right side.
There is no good reason offered as to why this is so.[78] In those
cases where the liver is impaired, the answer might be because most of
the nerves to the liver are on the right side, but the right side is
just as often affected when the lesions are in the lumbar region and
the nerve supply to the hepatic region intact. Dr. Still considered the
fifth dorsal of importance.
The =vagi nerves= have important bearing upon the motor apparatus of
the intestines. Lesions in the upper cervical, involving intestinal
fibers of the vagi, occur occasionally. Stimulation of these fibers
increases the peristalsis of the intestines. Mechanical stimulation of
the mid and lower dorsal region, as shown by osteopathic experiments,
increases peristaltic action and vaso-constriction in the stomach and
intestines.
The value of =direct treatment= over the intestines from the duodenum
to the rectum in most cases of constipation cannot be overestimated.
It aids peristaltic action, removes impactions, stretches adhesions,
strengthens weakened muscles of the intestines and abdomen, and in
general gives tone to all of the abdominal organs. The treatment should
not be given in a hap-hazard manner, but each effort should be for a
definite purpose. Care should be taken not to bruise the intestines or
other organs, as by gouging or severe punching; the flat surface and
the palms of the hands should be used. This means that the part of the
bowel involved should be treated intelligently, the osteopath reaching
underneath the section and the patient drawing the bowels up and in.
Obstructions and impactions of the gut, especially at the ileo-cecal
and sigmoid regions, should be carefully corrected. At all angles of
the gut, impactions and prolapses may occur.
J. H. Sullivan[79] makes the following observation concerning severe,
deep abdominal treatment: “I have noted that this often resulted in
the reverse of good effects. In constipation, naturally then, I am
chary about treating abdominally, confining my work principally to
the biliary regions, the ileo-cecal and left iliac regions and have
attained good results when a promiscuous working of the abdomen had not
so resulted.” This emphasizes the point that specific treatment is as
much indicated for the abdomen as it is for the spine.
Frequently there will be found a spastic condition of the pelvic colon,
often associated with congestion and adhesions. This probably sets
up a reversed peristalsis. Treatment by inhibitory relaxation, with
patient in knee-chest position, and adjustment of lumbar and innominate
lesions, is indicated.
Direct treatment to the liver and biliary ducts is necessary in many
cases, as the bile secretion is often defective; thus a slowness or
inactivity of the liver and bile ducts might cause costiveness.
Some cases result from anesthesia of the rectum, due to pressure of
the fecal matter collecting in the rectum. Simple dilatation of the
rectal sphincters and a stimulating treatment through the sacral nerves
will bring about a healthy activity of these parts. Occasionally the
coccyx becomes displaced and produces paresis of the rectal nerves; or
a displaced uterus or a tumor may produce the same result.
The use of =proper food= is essential. Coarse food leaves a great
amount of residue, and on the other hand, dainty food leaves but little
residue, both causing costiveness. As a rule increase the amount of
fruit and vegetables. The patient should drink considerable water, and
the time is of importance. Have a glass of cool, not iced, water taken
on arising and if breakfast is delayed sufficiently, another in half
an hour. Most people do not drink enough water. Unless contraindicated
eight or ten glasses daily should be insisted upon. An enema[80]
occasionally is indicated and is a great aid when used, particularly
in cases of paralysis of the intestines and in impactions. Correct
breathing and out door life are beneficial.
=Treatment of the Constipation of Infants.=—Repeated small enemata
at a fixed hour each day will often be satisfactory but be certain
that the tissue is not irritated. Two ounces of tepid water at a
time should be injected. Careful spinal treatment and massage to the
abdomen will be useful, as will slight dilation of the anus, which is
usually done with the little finger, but in obstinate cases a soap
stick may be used. When there has been continued straining at the
stool, the sigmoid and rectum will often be found prolapsed, causing
a mechanical obstruction. With the finger well lubricated this can be
corrected and often is all that is needed. These directions, with care
in the foods, are usually sufficient in any case not congenital. In
chronic constipation Ruhrah outlines dietetic treatment as follows: “In
infants see that they get sufficient fat and protein; well cooked and
sweetened oatmeal gruel is useful. Orange juice, baked apple, or prune
juice taken on an empty stomach is of service. Olive oil, the malted
foods, or malt extracts are useful. In older children fresh fruits,
vegetables, and oatmeal porridge are of value. Graham bread, dates,
figs, and prunes may be used.”