Fear, disappointment, anger, or any depressing emotion, may, through the sympathetic nerves, cause reflex constipation. Prof. Anderson, an eminent Danish physiologist who has made an exhaustive study of the influence of the emotions, found that depressing emodons powerfully excite the sympathetic. Some persons are unable to move their bowels because they are in a state of fear that they cannot. All persons are more or less at the mercy of the sympathetic nervous system, but some much more than others. A curious example of the effect of mental influence is the case of a woman mentioned by Hertz whose bowels were obstinately constipated but who had a good movement of the bowels whenever she gave one of her children a dose of castor oil, although the oil produced no effect when she took it herself.
Probably half the cases of chronic constipation are really due to some form of obstruction at some point along the food canal. It matters little, apparently, where the obstruction is; the effect is delay, and this results in constipation from absorption of water and the resulting excessive dryness of the feces.
In cases of reflex spasm of the colon, or spasm due to colitis, the intestine can often be felt under the fingers, to which it gives the sensation of a rubber tube. When the contraction is due to colitis, the intestine is not only hard and contracted but is also tender to pressure, sometimes extremely so. In such cases there are likely to be present various reflex pains such as headache, or pains in the legs, which in women suggest ovarian inflammation or some other pelvic disease.
This condition of the colon is most often found on the left side, at the site of the iliac colon, sometimes extending upward, and may occasionally be felt in the pelvic colon also. The cecum and the ascending colon are not infrequently affected, and more rarely the transverse colon, which may be felt as a hard round cord passing across the abdomen just above or below the umbilicus.
These spastic contractions are not permanent; they come and go, sometimes disappearing while under the examining finger; but they cause great delay in the progress of the feces along the bowel, and thus lead to excessive dryness and constipation.
Organic or permanent contraction of the colon is a much more serious condition than simple spastic contraction, because usually incurable, except by surgery. It may be the result of peritonitis or of colitis followed by pericolitis and adhesions.
One of the consequences of chronic constipation is incompetency of the ileocecal valve. By over-distention the intestine becomes so widely dilated that the lips of the valve no longer come in contact and so its check valve action is prevented, and the putrefying contents of the colon readily pass backward into the small intestine. The infection thus induced may travel backward the entire length of the small intestine, to the stomach, liver, gall-bladder, pancreas and duodenum, giving rise to ulcer of the stomach, duodenal ulcer, gall-stones, inflammation of the gall-bladder, infections of the liver and jaundice resulting from these conditions, and pancreatitis, a still more serious condition. It is probable also that the worst effects attributed to alimentary toxemia or intestinal intoxication are seen in cases in which through incompetency of the ileocecal valve, the putrefying materials of the colon find ready entrance to the small intestine, and are thus rapidly absorbed.
When the ileocecal valve is incompetent, it is of course incompetent to gases as well as liquids. There is evidence that the valve sometimes becomes incompetent to gases while it still may be competent to liquids. Patients whose ileocecal valves are incompetent suffer from great discomfort because of inability to expel gas from the intestine. When an expulsive effort is made gas passes in both directions, that is, out of the body and back up into the small intestine.
There is reason to believe that the failure of short-circuiting operations either with or without removal of the colon or a part of it, is often due to loss of the function of the ileocecal valve, which is of course removed with the colon. Recent, advances in the department of surgery make it possible to remedy this defect by constructing an artificial ileocecal valve.
In like manner incompetency of the ileocecal check valve interferes with the complete and proper emptying of the colon and thus becomes a cause as well as a consequence of constipation.
A. Normal Ileocecal Valve. B. Partially Incompetent Ileocecal Valve. C. Wholly Incompetent Ileocecal Valve.
The worst evils resulting from incompetency of the ileocecal valve may be corrected in the majority of cases by removing the cause, namely, relieving the constipation to which it is due. While in a majority of cases, this may be accomplished by the employment of the thoroughgoing measures suggested in this volume, a few cases remain in which an operation is required for breaking up adhesions of the pelvic colon and removing the other obstructions which have been the cause of the overloading and the distention of the cecum, which produced the incompetency of the valve. Fortunately such cases may be relieved by surgical operation, and it is even possible to repair the valve so as to enable it to resume its function.