The act of defecation normally occupies but a few seconds. The colon acts with so much celerity that when watched under the penetrating X-rays its movements can scarcely be followed by the eye. There is a vigorous surging which passes in waves from one end of the colon within a few seconds, and then the colon is at rest; but it is easily seen that the contents have either disappeared or have been moved forward. After a normal movement, the colon is empty from the splenic flexure down, and there is seen to have been a forward movement of feces in other parts of the colon.
There are, however, so many persons who are not quite normal, even though apparently healthy, that perfectly natural bowel movements are probably the exception rather than the rule among civilized adults. It often happens, at least after the first portion of feces has been expelled, that a second or even a third installment is brought down, and a second or third action of the colon occurs. The pelvic loop of the colon has in most people been so much abused by resisting the "call" and so compelling an accumulation here, that it is often so much dilated or so much folded upon itself that two or even three efforts are necessary for its complete evacuation. To accomplish this requires a little patience, and sometimes a great deal of persevering effort. The first partial movement empties the rectum and the lower part of the distended pelvic colon. By straining, that is, by strong contractions of the diaphragm, aided perhaps by pressure with the hands upon the lower abdomen on the left side, an additional portion of feces may be forced down into the rectum. This excites the center of defecation just as touching the, back of the throat excites the vomiting center, causes the colon to contract, the anus to open, and reinforcement of the contraction of the abdominal muscles with a second bowel movement results. In like manner, a third or even a fourth movement may be secured.
But this requires time, perhaps five, ten or even fifteen or twenty minutes. The bustling or worried business man, the hurried clerk, the student who has barely time to reach his school before roll call, the housekeeper who is perhaps superintending some important culinary operation, these and a thousand other busy individuals believe that they have not time to devote to a function looked upon as grossly animal and repulsive, and so it is cut short at the earliest moment possible.
Ignorance of the consequences does not, however, prevent the evil effects which certainly follow such neglect. The feces left behind in the half-emptied pelvic colon become so dry and hard before another opportunity for evacuation occurs that the difficulty is greater than before, and so a considerable quantity, often an increasing amount, of feces is held back, and cumulative constipation is established.
Undue haste in bowel movement is also encouraged by unsuitable toilet arrangements. In many places, especially in country districts, the insufferable "privy" still exists, and is a most prolific source of misery. The use of such a place for evacuation of the bowels is at all times more or less inconvenient and offensive, and on this account is avoided as much as possible, leading to neglect of the "call", and when necessity compels the use of the offensive place, the visit is made as brief as possible.
In cold weather, the danger of injury from exposure of the unprotected body to a low temperature, sometimes even zero weather, is very great, especially in the case of feeble or delicate persons. Extreme cold also tends to prevent effective defecation, by contracting the anal muscles so strongly as to negative the effect of the automatic reflex by which the outlet is normally opened.
The toilet should be conveniently placed, and should be made as warm and comfortable as a bathroom. It should be kept in so neat and sanitary a condition as to be in no way offensive.
The time devoted to defecation should be sufficient for complete emptying of the descending and pelvic colon. All fullness and weight in this region, as well as the sense of fullness in the rectum, which commonly prompts to bowel movement, should disappear after defecation. If necessary to occupy the mind by glancing over a morning paper, this will do no harm provided that it is not allowed to interfere with the muscular efforts which may be necessary to force down into the rectum from the pelvic colon a sufficient amount of feces to induce an expulsive action of the bowels.
The natural position in defecation is squatting or crouching. All savages assume this attitude in moving the bowels. The reason for this, as has been fully explained in a preceding chapter, is that in the natural position the abdomen is compressed by the thighs, and thus the feces are forced into the rectum, and so the automatic process of bowel movement is set going.
The ordinary water closet is so constructed that natural bowel movement is impossible in its use. By bending strongly forward, some compression of the thighs may be effected, but it is only in the squatting position that the pressure can be as great as is possible and often necessary. By placing a low platform in front of the closet so as to raise the feet eight or ten indies, this objection may be very largely overcome. Some closets are now made with this idea in view, and are a great improvement over the old style. The same thing may be accomplished by the use of a chamber.
Many surgeons have learned the importance of the squatting position to secure complete evacuation of the bowels and bladder, and forbid the use of the bed pan in any except the feeblest cases, requiring the patient to be supported as may be necessary while using the chamber.
Although this matter is one of very great importance, it is more than likely that half a century will pass before manufacturers and plumbers, upon whom we are dependent for these necessary conveniences, recognize to any appreciable extent the need of a change in closet construction.