SEMI-CONSTIPATION AND ITS DANGERS.
"At least six times in every fleeting day
Some tribute to the renal functions pay,
And twice or thrice all alvine calls obey."
What has been said thus far has been based on chronic constipation
mainly, and the accompanying intestinal foulness, which condition was
shown to be so annoying that it compelled the sufferer to resort
frequently to some more or less direct and artificial means for the
relief of the bowels and the incidental indigestion. It has been
further shown that many of the chronic cases fail to take on the normal
amount of flesh or lose what flesh they have because of self-poisoning
(auto-infection), which in turn is the outcome of mal-assimilation and
mal-nutrition, and that this consequence must occur wherever there is
an absorption of waste through a checking or disturbance of systemic
functions. Emaciation and anemia are inevitable in such cases. On the
other hand, there are cases that have such great powers of assimilation
and elimination that they are able to stand the invasion of destructive
material, may maintain the normal amount of flesh, or even take on an
abnormal amount, but with the invariable accompaniment of more or less
impoverishment of blood, disturbed circulation, indigestion, and the
usual nervous derangements. The harmful practice of the lean and the
fleshy sufferers of resorting to daily medicines--cathartics,
digestives and tonics--has been commented upon. Willingly do they
squander their money to get relief from an ever-present ailment. Cases
are these of hope deferred that maketh the heart sick.
The primary cause of chronic constipation, namely, proctitis, has been
explained, and its many symptoms, as indicated by the functional
disturbances of many or all of the organs of the body, enumerated.
But beside the cases of chronic constipation--both lean and fat--there
are many sufferers from auto-infection who have only semi-constipation,
or partial evacuation of the feces daily. Though they suffer from the
effects of self-poisoning, yet they have no such well-defined symptoms
of local disease and functional disturbance as are always found in
those who have chronic constipation. Nevertheless, they have
disturbances of practically all the functions of the system. Believing
as they do that the evacuation of their bowels is complete, they are at
a loss to find a cause for the toxemia (blood-poisoning),
mal-nutrition, debility and general atony. The symptoms of
auto-infection with the semi-constipated are as complex as with the
severer cases, but not so well defined. The most prominent symptoms are
those connected with the process of katabolism, that is, of
degeneration of the tissues, as indicated by their color and texture.
The liver, however, is usually held responsible for the bad complexion,
impaired nutrition, constipation and diminished vitality, when really
the liver is only indirectly concerned, as made manifest in the
previous articles. The seat and source are found to be the diseased
colon and rectum.
Dr. Treves says: "The colon being the part of the bowel involved in
obstruction due to fecal accumulation, it may be further assumed
that the blocking of the gut will most usually concern its lower or
terminal parts. Accumulation of feces is most common in the rectum
and sigmoid flexure, and then in the cecum. Masses of feces may
block the colon at any point, and more particularly at the flexures
of the bowel. Still, the three common sites of the accumulation are
those just named. The accumulation in the colon may assume the form
of a more or less isolated nodule or mass. Thus a considerable lump
may be found in the cecum or sigmoid flexure and the rest of the
colon be comparatively clear of any gross accumulation. An isolated
lump may even persist after free purgation. On the other hand, the
accumulation may assume the form of several isolated fecal masses.
One of them may occupy the cecum, another the transverse colon, and
possibly a third the sigmoid flexure. The bowel between these
masses may appear to be fairly clear."
A number of the exciting causes of inflammation of the lower or
terminal portion of the large intestine have been mentioned. It cannot,
however, be too strongly emphasized that chronic inflammation of the
colon and rectum results in hyperkinesis (excessive muscular
irritability) and contraction of the diseased portion invaded, thereby
retarding or preventing the passage of feces and gases. A portion of
the daily accumulation of feces in the sigmoid may pass through the
diseased rectum every day, but not without increasing the inflammation
and the spasmodic contraction; this in time inhibits the elimination of
the accumulating feces, which by undue retention become condensed and
hardened. Each day will then be a repetition of the abnormal and
partial effort of the organ to accomplish the act of defecation, and
there will be no thought of the cumulative and chronic intoxication
(poisoning) of the system from the imprisoned feces and gases.
It may be stated without reservation that the rectal canal cannot be
involved in chronic inflammation without involving the anal canal, and
_vice versa_. One half of civilized people are suffering from chronic
constipation, and very nearly the remainder from semi-constipation. The
semi-constipated are now under consideration. The chronic cases are
those that have a _complete_ impaction of feces in the terminal portion
of the sigmoid and rectum; the semi-constipated have the usual daily
_partial_ impaction, that is, an incomplete or partially successful
evacuation of the contents of the bowels: the incompleteness is due to
disease of the anal and rectal canals.
The anal and rectal canals are made up of circular and longitudinal
muscular bands, which, when invaded by disease, lose their proper or
normal sensibility and coöperative voluntary action. The excessive
contraction of the circular muscles closes the calibre or bore of the
gut, and the excessive contraction of the longitudinal muscles shortens
the length of the gut, thus throwing the mucous membrane into abnormal
folds which increase the depth of the sacculi, or cavities, between the
fibrous folds. In the normal gut the sacculi and bands act as valves to
control the descent of the feces. This valvular arrangement and the
curvatures of the lower bowels conserve the energy of the involuntary
and voluntary nerve force until there is a sufficient accumulation of
feces to excite a normal desire for stool; otherwise the feces would
rush upon the anus at once and occasion much inconvenience.
Catarrhal inflammation of the mucous membrane of the anal canal will
sooner or later penetrate the muscular structure of that canal, causing
an abnormal irritability and contraction of the sphincter ani and the
other tissues composing its structure. The contraction of the anal
tissues becomes more permanent as the muscular tissues of the structure
become cohered or bound together by the process of inflammation.
The normal stimulus and sensation that should precede the act of
defecation are perverted or destroyed by the excessively irritable
contraction of the sphincter ani, which contraction is occasioned by
the presence of feces and gases just above the seat of inflammation,
that is, above the anal canal or at the lower end of the rectum. As the
bulk of feces and gases lodged at this point increases, the anal
contraction becomes firmer in grip, and as a consequence permits no
hint of the imprisoned contents until the accumulating bulk is beyond
the power of toleration by the organ. Daily a portion of the lodged
feces, or some new addition to the mass, passes the anal canal, but the
attending irritation or contraction of the muscles prevents any further
exit of the imprisoned rectal contents.