Synonyms

Habitual constipation, atony of the bowel, constipatio, constipatio alvi, obstipatio.

Definition

By constipation is understood a diminution in the frequency of evacuations of the bowels.

General Remarks

Healtlty persons have as a rule one evacuation of the bowels daily. Under normal conditions a movement occurs almost always at about the same time of the day. The cause of this periodicity lies most probably in nervous influences. As mentioned above in the chapter on physiology, the contents of the small intestine are propelled with comparative rapidity. In the large intestine, however, the prochoresis is very slow. The upper rectum and the sigmoid flexure form a reservoir for the storage of the fecal matter. Once in twenty-four hours through certain nervous influences the faeces are carried lower down into the ampulla of the rectum and there is then experienced the desire for defecation. This is accomplished voluntarily by relaxing the sphincter ani and by exercising a moderate pressure with the abdominal walls after more or less deep inspirations. No pain is connected with this act and a rather pleasant sensation is felt after its accomplishment.

Even physiologically there is a great variability in the number of movements. Some persons have normally two or three movements a day all their lifetime, while others have only one evacuation every other day or even every three days. In both instances there may be no abnormal sensations whatever and we are thus forced to consider them as physiological. Constipation, therefore, should signify a condition in which a person has less frequent movements than he has been accustomed to.

In rare instances, however, the number of evacuations remains the same, but their quantity diminishes. Thus a stagnation of fecal matter in the bowels occurs (copros-tasis). This condition is also usually comprised under the head of constipation. The quantity of the daily evacuation of the bowel varies greatly, depending principally upon the diet. A vegetable diet gives voluminous stools, while one consisting mainly of meats produces only a small quantity of fecal matter. The average quantity of fecal matter for twenty-four hours is about 250 c.c. While a marked divergence from the above-mentioned figure must be recognized as pathological, a small decrease of evacuated fecal matter cannot be easily discovered, the more so since, according to Woodward, a considerable quantity of the fecal matter is made up of micro-organisms whose number is apt to vary greatly, even under normal conditions.

Constipation may be due to organic lesions of the bowel (stenosis of the intestine or catarrhal conditions), or may exist without apparent anatomical changes in the intestinal tract, and thus be functional in nature. The latter class alone is dealt with here Inasmuch as in the great majority of these cases of constipation a disturbance in the nervous apparatus of the intestine may be presumed to exist, we discuss constipation in this chapter on intestinal neuroses.