Constipation may be defined simply as the slow movement of the digestive residue, or the fecal mass through either the small or large intestines or a relatively insufficient daily evacuation. There is seldom any interference with its progress in any portion of the small intestine because of its liquid condition. As the chyme travels from the duodenum towards the large bowel it gradually becomes more solid until it reaches the cecum, where it is fairly firm and moves slowly.

Experimentation with the X-ray demonstrate that in the average adult the fecal mass reaches the transverse colon within about ten to twelve hours after the ingestion of food, and then takes from sixteen to twenty-four hours longer to reach the sigmoid flexible The natural receptacle in which the fecal mass rests prior to expulsion is the sigmoid flexible, as is further demonstrated by these experiments. The expulsion act begins, as a rule, with the descent of the mass from the sigmoid to the rectum and it is this movement which is followed later by the desire to defecate soon after the ingestion of food and is probably due to some reflex stimulation from above in the intestine. In normal children, constipation is mostly dependent upon their inability to interpret this physiological sensation when it occurs.

Constipation may be the cause directly of a fissure in anew, hemorrhoids, ulcer, hypertrophy catarrh proctorial, or erosion, any of which may in turn be the starting point for other disease.

Constipation is so closely associated with rectal and stomach diseases that it almost always forms an integral part of the complex symptomatic and is rather to be expected in the consideration of all these cases. Its relation to rectal diseases bears so strongly upon the ultimate cure or the amelioration of symptoms, that a knowledge of its causes and treatment.

The position when distended based upon the effects of drugs in the sigmoid and rectum, is absolutely necessary. This affection is in most instances only a symptom of disease of the colon. the nervous apparatus, or the result of habit. It represents a discharge of the digestive residue dependent upon the quantity and character of the food eaten, the time taken to traverse the intestinal canal, and to the power of digestion and assimilation in each individual. Therefore, it should not be applied indiscriminately to every person whose bowels do not move each day. To find the cause of constipation involves frequently the solution of a very complex etiological question, as the systematic and motor nerves undoubtedly often play a large part in its causation. Hypertrophy catarrh colitis is a disease in which the over-secretion of mucus is sometimes associated with a very obstinate constipation and alternating diarrhea. It is hard to understand why constipation exists during the course of this disease unless due in some way to a nervous disturbance. It can be easily understood why strophic catarrh colitis has, as a constant symptom, a protracted constipation owing to the weakness of the atrophied muscular coats. Fecal discharges which are hard and in the form of little balls would indicate the presence of an strophic catarrh colitis, or a slight rectal tenements The condition is sometimes induced by the hypertrophy of the sphincter an muscles or the overgrowth of Houston's valves.

The character of the stools should in all instances form part of the knowledge procured from the patient.Constipation is due to many causes commonly associated with diet faults and habits.

The Motor Activity of the intestine may be lowered as would occur with constitutional disorders and protracted fevers which would for a period be the cause of a disordered nervous system.

Fig. 58. Diagram of normal large intestine.

Over-distention of the bowel with gas, the result of fermentation, will in some instances stretch and weaken the muscles of the intestine. This condition is undoubtedly a very common beginning of constipation in children.

Deficient Amount of Food. When insufficient food is taken there is not sufficient residue to be evacuated within the ordinary limits of time and an apparent constipation exists.

In others the natural stimulants contained in the food residue are not in sufficient quantity. For example, the proteins in excess will almost invariably bring about constipation. A vegetable diet contains a generous amount of sugar, organic salts, cellulose, acids, fats and other indigestible residue.

Lack of Water. The skin and kidneys during exercise excrete so actively and profusely, particularly during hot weather, that a deficiency in the bodily supply of water may exist. Under these conditions, the deficiency should be compensated by a generous quantity of water. It should be remembered, the contents of the intestinal canal lose a proportionate amount of fluids under such circumstances, which results in a hardness and dryness of the fecal mass.

Over-activity of the Motor Centers is apt to produce constipation alternating with diarrhea, and the condition known as mucous colitis results. These cases resemble in their origin the asthmatic as being the result of a prolonged irritation succeeded by over-activity of the motor nerves.

A Disorder of the Inhibitory Nerves, which are from the sympathetic system, may produce constipation, or it may result from a disease of the motor nerves. The motor nerves are the magi to the small intestine and the sacral to the colon; hence, constipation may be produced all through the intestine by irritation of the sympathetic nerves alone and produced in the small or large intestine singly, if either the magi or sacral are diseased.

Enter-spasm (Spastic Constipation) may result from over activity of the motor nerves supplying either the small or large intestine, producing the well-known symptom of colic.

Congenital Kinking of the Sigmoid, due to its excessive length compared to the other portions of the colon, before the age of five or seven years, may cause a relatively slow movement of the bowel contents, owing to its length, and in addition offer an obstruction at the point of kinking. This congenital condition of the sigmoid is considered by Jacobi as one of the most common causes of constipation in children during this period of life.