"Greedy Colon"

Goodhard, Schmidt, and others hold that abnormal dryness of the feces may be produced by excessive digestion and absorption, leaving so little residue that the bulk of the intestinal contents is too small to stimulate peristaltic action. It is possible that cases of this sort may exist, but it seems more probable that the fault is a too concentrated diet or deficient gastric or intestinal secretion, at least in most of the cases in which this diagnosis has been made. It is much easier to see how the intestine can fail to do its work completely than to understand a condition of excessive activity of digestion.

Excessive Dryness Of The Feces

Persons who sweat profusely, even if their habits are active, often suffer from constipation, because of dryness of the stool. This condition may also result from sweating baths and from the drinking of an insufficient amount of fluid, as we have already seen.

Excessive activity of the kidneys, as in diabetes mellitus or diabetes insipidus, may produce the same result, by depriving the feces of water.

A deficiency of fat in the food leads to constipation in like manner. The presence in the feces of a certain amount of unabsorbed fat is useful not only to prevent excessive dryness, but to prevent too great adhesiveness of the feces and thus to facilitate movement along the colon.

Contraction Of The Ileocecal Valve

Various causes, as we have already seen, may cause delay at the ileocecal valve, such as reflex spasm set up by pain in neighboring organs, and the irritation of condiments or imperfectly digested foodstuffs. Colitis may cause thickening of the valve and partial obstruction. Recent observations have shown that the valve is sometimes too small at birth, causing congenital constipation. This form of incompetency of the valve is fortunately very rare, and like others may be remedied.

Incompetency is both a consequence and a cause of constipation. The valve is often rendered incompetent by over-stretching of the bowel, usually the result of obstruction in the descending or pelvic colon. When once the valve is crippled, the constipation is made worse by the loss of the check-valve action which aids the forward movement of the bowel contents, so that the food residues oscillate back and forth between the large and the small bowel, until the water content is so much reduced that a pasty mass is formed, which is pushed forward only with great difficulty by the bowel, which at this point is adapted to dealing with thin liquids rather than semi-solid adhesive materials.

The stagnation resulting from this condition readily leads to infection of the cecum and appendicitis, and to more remote affections, through extension of the infection backward along the small intestine to the duodenum, stomach, gall-bladder, liver and pancreas, causing inflammation of the gall ducts and gall-bladder, gall-stones, pancreatitis and possibly diabetes, duodenal and gastric ulcers, and various other allied affections.

Delay At The Hepatic Flexure

The cecum is a rather thin walled pouch, intended only for holding a small amount of liquid for a comparatively short time. When the bowels are restrained from normal action, by resisting the "call" for evacuation, the cecum becomes filled by the backing up of semi-solid feces, which cause it to sag down, and in time dilate and displace it. The over-filled and heavy cecum drags heavily upon the hepatic flexure, and so narrows the passage along the colon at this point as to produce partial obstruction and delay in the movement of feces from the cecum over into the transverse colon. The observations of Virchow, Lane and others have shown that adhesions are often found at this point, which narrow the bowel and produce more or less obstruction and delay.

Delay At The Splenic Flexure

At the splenic flexure the bowel forms a very acute angle, so that the colon is narrower at this point than at any other. The overloading of the transverse colon, which results from gross neglect to attend promptly to the "call" of Nature, drags heavily upon the splenic flexure, and causes such narrowing of the bowel as to result in very considerable obstruction and delay.

As the feces are banked up in the transverse colon, this segment of the intestines sags more and more until it may be stretched to the very bottom of the pelvis. This process of prolapse is, of course, greatly favored by weakness of the abdominal muscles.

Delay At The Pelviorectal Junction

The passage from the colon to the rectum, which is closed and opened by the falling and rising of the pelvic loop of the colon, is sometimes obstructed by thickening due to inflammation or ulceration. Sometimes the pelvic colon becomes adherent to the pelvic floor so that it cannot rise, and there is more or less obstruction to the passage of feces into the rectum. In such a case, there must of necessity be an accumulation of feces in the lower bowel above the rectum, and as a consequence cumulative constipation will be found present.

The inflammatory process by which adhesions and thickenings are produced is easily set up by the colitis and other infections which are the natural consequence of retention of. feces in the bowel for an undue length of time, such as results from postponing the evacuation of the bowels, or from excessive dryness of the stool from any cause. Stasis, that is, delay of fecal matters at any point in their journey through the colon, is likely to be followed by inflammation not only within the bowel but in the whole thickness of the bowel wall and on its outer surface, thus leading to adhesions and loss of contractile power. An inflamed and thickened bowel is always crippled and incapable of contracting upon the bowel contents in a normal way.