While in the normal state no disagreeable sensations are manifested during the act of intestinal digestion and defecation, in some cases of neurasthenia or hysteria we meet with exceptions to this rule. Thus, even without apparent anatomical lesions of the intestine, there may be a sensation of pressure, fulness, of pinching, of heat or cold in the lower region of the abdomen a few hours after the ingestion of food. The same sensations may also occasionally appear without the patient having eaten anything, after bodily exertion and excitements, especially after sexual intercourse.

The rectum and the anus are particularly liable to be the seat of abnormal sensations. Physiologically a feeling of fulness is experienced in the rectum when the fecal mass has accumulated in this locality. In case of neurasthenia a sensation of fulness with an inclination to go to stool may appear, even when the rectum is entirely empty. Sometimes a feeling of pressure or weakness in the anal region may be present; sometimes the patient may be tormented by a constant burning or itching in the same region. The act of defecation may be accompanied by erections, sometimes by a feeling of uneasiness; quite often a feeling of extreme fatigue after defecation is experienced.

Anaesthesia of the rectum is observed in the same class of patients. The sensation of fulness in the rectum, which causes the desire for defecation, is then absent; there is, therefore, never a desire for evacuation. In very pronouncede cases of rectal anesthesia it may occur that even the passage of fecal matter through the anus is not felt. Such a high degree of anaesthesia, however, is met with only in patients with spinal and brain troubles and in very old and decrepit individuals. Paralysis of the sphincters, which has been described above, may occasionally accompany the anaesthesia of the rectum and thus aggravate the latter. In such instances involuntary evacuations of the bowels take place without the patient's knowledge. He becomes aware of this fact only after his clothes have been soiled and by the fecal odor.

In the treatment of these abnormal sensations within the intestines attention must be directed toward the improvement of the general condition, thus raising the nervous tone of the organism. Hydrotherapeutic measures and climatic influences are of the greatest importance. While dietetic measures as such are without much influence upon the nervous disturbances which appear during the intestinal digestion, spicy food and alcoholic beverages should, notwithstanding, be forbidden and an essentially vegetarian regimen recommended. The abnormal sensations within the rectum and anus may be improved by cooling rectal douches, by sitz baths, and also by rectal galvanization.

Rectal Obturator

Fig. 37. - Rectal Obturator.

In cases of anaesthesia of the rectum a cleansing enema in the morning will remove the fecal matter and thus be beneficial during the day. Patients suffering from the severer forms of anaesthesia should wear a rectal obturator held in place by means of a T-bandage during the day (Fig. 37).