Disorders Of The Digestive Tube Associated With And Causing Constipation

The disorders of the alimentary canal, which give rise to constipation, are very numerous. Some are purely functional in character, others are organic or structural affections. All are of a nature which cannot possibly be relieved by laxative drugs, at least, more than temporarily, and most are likely to be made worse by their use, a fact which shows the folly of depending upon them for the relief of this condition, which unfortunately is rarely treated in any other way.

First let us study some of the functional disturbances of the digestive tract, which may give rise to inaction of the bowels.

Lack Of Appetite

Lack of desire for food is a common result of constipation, and may also be a cause of this condition, when it is the result of some other cause, as lack of exercise, excessive heat, etc. With loss of appetite there is absence of relish for food, and hence a failure of the meal to awaken those lively peristaltic movements which are essential to propel forward in the colon the hardening masses of fecal matter which are stored up in its lower segments waiting to be discharged. Those who eat without appetite are always constipated, and while the lack of relish for the food encourages the constipation, the latter still further lessens the appetite, and so the difficulty continually becomes more and more aggravated.

In this condition there is usually found a coated tongue and foul breath, which point unmistakably to a state of low vital resistance and malnutrition. With the removal of these conditions by the application of the proper measures, the appetite will improve and the bowels, if not organically crippled, will assume their normal rhythm.

Atony or weakness of the muscular walls of the colon itself, is no doubt sometimes a cause of very obstinate constipation. This condition sometimes appears to be hereditary. It occurs in families as a family characteristic. It is possible that in these cases the condition is only the result of improper care in infancy. No doubt a great number of cases of chronic dyspepsia and chronic constipation have their origin in the very earliest period of infancy. Prolonged indigestion in an infant may so damage its stomach and colon as to cripple these organs for life. The delicate structures of an infant's colon are easily stretched to such a degree as to be damaged permanently and to become a source of trouble during the whole after life. Cases of constipation which have existed for a life time are not infrequently encountered. Fortunately even these cases are often curable by the use of rational means.

Atony of the colon is especially likely to be encountered in persons long past middle age; but it is not at all rare to meet cases, especially women, in which the colon shows all the signs of senility at forty years, or even earlier. The age of the colon, like that of the arteries, is not to be reckoned in years, but is to be judged by the existing degree of tissue change. A colon which has been continually distended with putrefying feces or poisonous gases during twenty years or so is a senile colon, no matter what the reputed age of the possessor. An eminent French physiologist has said, "A man is as old as his arteries;" and it might be said with almost equal truth, "A man is as old as his colon."

In fever the colon as well as other parts of the intestine is in a state of semi-paralysis. The elevated temperature of the blood paralyzes the sympathetic nerves, and so interferes with rhythmical movements and causes constipation. Very hot weather and exposure to high artificial temperatures produce a like effect.

In cases of extreme obesity, in which there are abnormal fat accumulations and fatty changes in various parts of the body, the intestine suffers with other tissues, even undergoing fatty changes which render it less effective in transporting its contents and resulting in stasis and constipation.

Painful Affections Of The Abdomen

Pain in almost any part of the abdomen may cause constipation, through reflex arrest of peristaltic movement, and spasm of the ileocecal or pelvi-rectal valve. Chronic appendicitis is a common cause of this form of colon inactivity, sometimes called reflex constipation. The discovery of the fact that there is a sphincter at the ileocecal valve explains the relief from constipation, which often follows an operation for appendicitis. Painful affections of the uterus, ovaries and uterine appendages, inflammation of the prostate gland, painful hemorrhoids, rectal ulcer, and possibly ulcer of the stomach and duodenum may, through reflex disturbance of the sympathetic centers cause spasm of the ileocecal sphincter, and obstinate constipation.

The most common cause of spasm of the ileocecal valve, however, is inflammation of the appendix, an affection which is even more common than is generally supposed. The infection of the colon commonly known as colitis readily extends into the appendix, which often becomes adherent to the lower end of the small intestine and interferes with the action of the ileocecal valve, both by causing spasm of the ileocecal sphincter and by preventing proper closure of the lips of the valve, so as to prevent the reflux of fecal matters from the colon. Interference with the closure of the valve is also prevented by adhesions of the appendix to the cecum, a very common condition. Delay of the intestinal contents in the lower part of the small intestine, either by spasm of the valve or incompetency (failure to close), is one of the most pernicious forms of Constipation. The delay occurs at a point where putrefaction is most active and absorption is also greatest. Cases of this sort usually present very active symptoms of intestinal toxemia. Such persons are often victims of attacks of violent headache. They show much indican in the urine, are likely to have high blood-pressure, and sooner or later develop chronic Bright's disease of the kidneys.

A Spastic Colon. Darkest Portion Shows Dilation   Arrows indicate Spastic Condition.

A Spastic Colon. Darkest Portion Shows Dilation - Arrows indicate Spastic Condition.

Painful affections of the abdominal organs, such as chronic appendicitis, colitis, adhesions following an abdominal operation, pelvic or bladder disease, may cause constipation, not only by producing reflex spasm of the ileocecal valve, but by restraining the patient from making the necessary effort to expel the colon contents. Such efforts naturally increase the pain, and so are dreaded and avoided. In such cases the application of a hot fomentation over the seat of pain before ordering the effort to move the bowels will often render very great service. A hot sitz bath may be taken instead. A hot water bag placed against the abdomen may be found useful both by lessening pain and as a mechanical aid to defecation.