Definition

Dropping down of the contents of the abdominal cavity, but particularly a dropping of the stomach and large intestine, transverse colon, kidneys, spleen, and pelvic organs.

Etiology

What can cause falling of the organs within the cavity of the abdomen? Weight, causing relaxation of the attachments. Anything that will distend the stomach and intestine has a tendency to cause a dropping-down or a sagging below the normal position. The stomach is distended with food. Those who eat too rapidly will always eat more than they should. After they are through eating, the food swells and distends the stomach beyond its normal capacity. In time this brings on a dilated and a relaxed state of the stomach and intestine. Indigestion will accompany this state, and more or less gas will be evolved, which pulls up or distends the organs. We not only have a dropping-down of the stomach, but we also have a puffed or an enlarged state. This interferes with the mechanism; the muscularity of the organ is put out of commission; the stomach does not empty well; digestion becomes slow, and there is more or less retention of food, This favors the development of still more indigestion and distention with gas, until the entire intestinal canal becomes more or less involved with the stomach, and from the same causes. The individual will have what is called a "high stomach;" that is, a distended, enlarged abdomen. There is always enervation accompanying such a state of the stomach and bowels. Enervation always means relaxation of muscles, and, if the cause is continued, a dropping-down of the entire contents of the abdominal cavity sooner or later follows. Some people are more inclined to take on this state of the stomach than others. Those of a relaxed, flabby habit--those whose muscles are soft and inclined to gravitate--take on the disease sooner than others.

The attachments of the kidneys partake of this same relaxation; and then, from gas distention and the ordinary affairs of life, the pressure on the loosened kidney has a tendency to pull down and elongate the normal attachments. Those who carry a great deal of fat in the abdomen--who have heavy omentums--will in time cultivate the dropping-down of the entire contents of the abdominal cavity. This intra-abdominal pressure frequently creates more or less bladder trouble, urethral trouble, and, in women, a prolapsus of the womb and ovaries--especially the left ovary, which is often pressed below the uterus into the cul-de-sac of Douglas. Then, if the intra-abdominal pressure is not overcome and constipation follows, the woman will suffer a very great deal from the pressure on the ovary; for it is crowded, so to speak, between a constipated rectum and an intra-abdominal pressure from fat and gas. Many patients will be troubled with prolapsus of the rectum. At each evacuation of the bowels the rectum will prolapse, and, unless replaced, will remain out until a night of rest allows it to resume its proper place within the body. However, when the prolapsus is very extensive it never gets back to the proper location. This same intra-abdominal pressure, and the relaxed state of the muscular system generally, favor the development of all kinds of hernias, especially inguinal and femoral. Those who are of a relaxed habit should take warning and never do any lifting without thinking of the possibility of creating a rupture. If at any time there is a sensitiveness in either flank, one hand should press upon and support it while the other does the lifting. No lifting should be done without the muscles of the abdomen being placed on guard, preventing a rupture. If people generally understood this, and would be mindful of it, they could avoid developing hernia.

Enteroptosis, then, is a dropping-down of any of the organs in the cavity of the abdomen; but, as a rule, when that word is used it is intended to convey the idea that the patient has a falling of the stomach or transverse colon. I see no reason, however, for dividing these subjects. The treatment for one is the same as for the other.

Treatment

The first and most important thing to undertake is to remove all causes that lead to intra-abdominal pressure. The cause of dilation of the stomach was given as improper eating, rapid eating, and overeating; consequently this must be controlled. All cases where there is dropping of the stomach and transverse colon must be treated in such a manner as to get rid of the fermentation. The first week the patient should be put on a fast; the second week, fruit morning and night; and the third week, two meals of fruit, and a dinner consisting of meat, two cooked, non-starchy vegetables, and a combination salad, every other day; the alternate days, potatoes, rice, or any of the decidedly starchy foods, with a cooked, non-starchy vegetable and salad. Every case must be treated according to its special needs. It is very difficult to give an exact treatment for any derangement of the body, because the individual must be treated and not the disease. All bad habits must be stopped. No tobacco, alcoholics, coffee, or tea is to be allowed.

In cases of floating kidney, the same treatment must be given for correcting the indigestion and getting rid of the gas distention, and also an excessive amount of adipose tissue in the intestine. Those who are quite stout must be fasted long enough to overcome, and cause an absorption of, unnecessary fat deposits in the abdomen. Those who are thin should be fed in such a way as to overcome gaseous distention. All cases must be exercised properly. Lying on the back and going through the movements of bicycle-riding is one of the most important exercises that can be taken for any of the diseases named under the head of enteroptosis. All hernias that have been of long duration can be cured in the same way.

This disease will require a good deal of exercise to the bowels, also manipulation of the abdomen, and the knee shoulder position should be practiced fifteen minutes twice a day if possible--in the morning and in the evening preceded by the Irish mail movement. Grasping hold of some object in front of one and squatting to almost complete bending of the knees is an excellent exercise. Directions for the different exercise and massage are explained in Toxemia.

Prolapsus of the rectum can be entirely overcome. The ligaments will shorten under the influence of the exercise recommended. The entire body should be exercised lying down. Patients should be taught to practice the tensing exercise, according to the instructions given elsewhere. Is it ever necessary to shorten the ligaments and cable the kidneys, or operate on the stomach and transverse colon? Never, unless the patient is unwilling to take upon himself the amount of work that will be necessary to restore him to his normal condition. Anyone can be restored to an absolutely normal condition without an operation; but, of course, those who are too shiftless, too indifferent to their best interests, will have to submit to questionable surgical operations. I say "questionable" advisedly; for I have never seen many people derive any great benefit from any of these operations, and, indeed, I have seen many injured by them.