Diagnosis

The recognition of constipation is not difficult, except in those cases in which there is a daily evacuation of the bowels but not a complete one, so that fecal matter is more and more accumulated in the intestine. Frequently hard fecal masses of rosary shape will be discovered on palpation of the abdomen in the region of the colon. Most often the sigmoid flexure and the caput coli are the favored sites of this phenomenon. The detection of these fecal masses shows the existence of an insufficient evacuation of stools, in other words, constipation.

1 Senator: "Hydrothionsemie und Selbstinfectiou durch abnorme Verdauungsvorgange. " Berl. klin. Wochenschr., 1868, No. 24.

The diagnosis of pure constipation (habitual constipation) can be made, if organic lesions of the bowels (stricture, tumor, and also intestinal catarrh) can be excluded. This diagnosis having been made, it is of importance to find out to which group the constipation belongs, whether it be due to an abnormal gastric condition, or disease of some other organ, or to a neurotic affection of the bowel itself (atonic and spastic constipation).

Constipation due to anomalies of the function of the stomach can be ascertained only after a thorough analysis of the gastric contents and after resort to treatment directed toward the improvement of the gastric condition. Constipation due to disease of other organs (heart, lungs, kidneys, liver, etc.) may be assumed to exist when an examination discloses their presence. Constipation due to atony of the bowels is often revealed by a slightly bloated condition of the abdomen with evacuations of hard fecal matter, often balls, sometimes covered with a thin layer of mucus. While there may be a feeling of despondency, dizziness, and somnolence, real severe pains are rare. Constipation due to a spasmodic contraction of the bowel is attended with a general feeling of uneasiness and pains in the abdomen, occasionally accompanied by fainting fits. The fecal matter is not so hard, although it is evacuated only after severe straining of the abdominal walls, and is voided in narrow tapelike pieces. The abdomen is often rather sunken and contracted.

Intestinal coils can frequently be palpated.

Prognosis

The prognosis of constipation is favorable in the large majority of cases, especially with regard to life. It must, however, be admitted that after having lasted a long time constipation may give rise to severe, sometimes irreparable anatomical lesions of the intestine, as for instance atrophy, peritonitic adhesions, malpositions of the bowel, even perforation with consequent peritonitis and death. The latter instances, however, are very rare, if we take into consideration the large number of persons suffering with constipation who reach an advanced age, and they will most probably become still less frequent if the patients do not neglect this condition and consult a physician at an early period.