Injured Levator Ani Muscles

When these muscles are crippled so that they cannot contract properly, the rectum is not emptied but remains relaxed and filled with feces, which give rise to much annoyance, and may become a cause of rectal ulceration and hemorrhoids. The levator ani muscles are often damaged by lacerations at childbirth, or by the prolonged contact with hardened feces, which gives rise to atrophic changes. Laceration of the perineum permits the pelvic floor and anus to bulge forward, stretching the rectum and thus creating a wide reservoir for feces.

Anal Disease

Pain arising from ulcer, fissure, fistula or inflamed hemorrhoids may cause so strong a contraction of the anal sphincters that they fail to relax at the command of the defecation center, so that the bowel must force the feces down through the rectum in opposition to these muscles. This condition exists more frequently than was formerly supposed. Many cases of obstinate constipation have been cured by an operation for removal of painful hemorrhoids or relief of a painful ulcer or fistula.

Pregnancy, extreme retroversion of the uterus, an enlarged and painful prostate, malignant or other growths in or about the rectum, and in women, rectocele, from laceration of the perineum, are causes of interference with the proper action of the defecating mechanism.

The usual result of this defective action is to leave a quantity of feces in the rectum or the pelvic colon or in both cavities. The retained feces become dry and hard, sometimes to a surprising degree, and form a mechanical obstruction which results in a damming back of the feces which are left to accumulate in sections of the colon higher up.

Loss Of Rectal Reflex

The key to the automatic or involuntary act of defecation is the rectal reflex, which is discharged by contact of the feces with the walls of the rectum. The long retention of feces in contact with the rectal nerves destroys their sensibility and so the reflex is lost. This is one of the worst results of the disturbances in the defecating mechanism, which have been above enumerated. Patients suffering with this form of constipation often report that they have felt no desire for evacuation of the bowels for years. The loss of hearing, or even of the sense of sight, would really be less of a calamity in many cases than the permanent loss of this useful reflex, which is one of the most important protective mechanisms with which the body is provided. Fortunately, however, the reflex generally may be restored.

Disease of the spinal cord may permanently destroy the defecatory center. Constipation is sometimes a most troublesome symptom in locomotor ataxia.

Alimentary Toxemia Or Intestinal Autointoxication

Bouchard; an eminent French physician, was first to coin the word autointoxication, and to point out the various ways in which the disease may be produced by poisons generated in the body. He called special attention to the fact that the intestine, and especially the colon, is a prolific source of poisons. Some of these poisons are excreted by the liver. The bile, as shown by Bouchard, is six times as poisonous as the urine, producing poison enough within ten hours to cause death. The mucous membrane of the intestine has been shown to be another source of highly active poisons, which are separated from the blood by the mucous membrane and thrown into the cavity of the intestine to be removed from the body.

Still another source of intestinal poisons is the putrefaction of that portion of the protein of the food which fails to undergo absorption.

The bile, mucous, and other secretions of the intestine and the adjacent glands also undergo putrefaction when conditions are favorable.

This putrefactive process is, as shown by Pasteur, the result of the growth of certain forms of bacteria. These putrefactive bacteria are found everywhere. They are present in great numbers wherever putrefaction is taking place. The flesh of every dead animal is filled with teeming millions of these poison-forming microbes within a few hours after death. A piece of flesh taken from an animal just killed, and placed in a tightly sealed glass jar, will be found in a few days in an advanced state of putrefaction. Experiments of this kind were made by Professor Tissier of the famous Pasteur Institute of Paris. He found it impossible to obtain meat so fresh that it did not contain bacteria of different species sufficient to produce complete putrefaction. As ordinarily eaten, the flesh of animals is always in a state of more or less advanced putrefaction, and hundreds of millions of living bacteria are found in every morsel. This is true even when the flesh has been cooked; ordinary cooking does not destroy the putrefactive bacteria.

Commercial cow's milk also abounds with bacteria, some of which are of putrefactive sort. Street dust consists very largely of putrefactive bacteria derived from animal feces which have been dropped in the street and ground into dust by passing vehicles. It is evident then, that the human intestine is very greatly exposed to infection by putrefactive bacteria; and it needs no argument to show that any delay of food residues capable of putrefaction, together with the bile, mucus, and other constituents of the feces, must result in the production of a large amount of intestinal poison.

In view of these facts, it is safe to say that the worst effects of constipation are those which arise from intestinal autointoxication. Not only Bouchard, but Tissier, Combe, Bourget, Lane of London, and a great number of able medical experts in all parts of the world have within the last few years recognized the great and far-reaching destructive effects of the absorption of bacterial poisons from the intestinal tract.

It is entirely possible for a person to suffer from intestinal toxemia without constipation, as in cholera morbus, cholera infantum and summer diarrhoeas of infancy; but it is impossible to have constipation without intestinal autointoxication. The fact that the symptoms of toxemia do not occur in every case is no evidence that they are not present. The body must be unduly exposed to toxic influences, even though it may possess to such an extraordinary degree the power to defend itself against these intestinal poisons that immediate visible effects do not appear.

When the intestinal mucous membrane is intact, it is able to exclude most of the intestinal poisons, acting like a filter, which permits only the useful substances to enter the blood. The liver, the largest gland in the body, possesses the power to destroy poison to a considerable degree. There are various other organs of the body, such as the glands of internal secretion, of which the thyroid gland is a conspicuous example, which aid in the destruction of poisons. The kidneys both destroy and eliminate poisons, and the skin and the lungs also share in this protective work.

So long as the defensive powers of the body remain intact, enormous quantities of poisons may be produced in the intestine without apparently evil results. This is the reason why many constipated persons seem to suffer no ill effects from intestinal inactivity.

In every case, however, the time comes sooner or later when the intestinal filter no longer acts sufficiently in excluding poisonous matters - when the liver is no longer able to destroy all the poisons brought to the blood; when the thyroid and other glands have become worn out with over-activity; when the kidneys have ceased to be able to maintain the normal degree of blood purity by the excretion of poisons.

When the symptoms of toxemia appear, the fact shows that the poison-destroying mechanism of the body is broken down; the great margin of safety which Nature provides against emergencies, has been used up; the defenses against autotoxins have been swept away, and the tissues are flooded with these subtle and mysterious disease-producing elements.

The simple and latent forms of constipation are those in which the symptoms of toxemia are specially prominent, for the reason that in these forms of constipation the delay occurs in those portions of the digestive canal in which the intestinal contents are still fluid, a condition in the highest degree favorable to the growth of putrefactive bacteria. Besides being fluid, the contents of the small intestine and first part of the colon contain a varying amount of protein, the food element on which putrefactive bacteria thrive, and from which alone they are able to produce their deadly toxins.

In cumulative constipation, the protein is almost wholly absorbed before the lower colon is reached, and the amount of water is reduced to such an extent that putrefaction is necessarily limited, and the resulting autointoxication is proportionately less.

In latent constipation, especially, the conditions are in a high degree favorable for the development of intestinal autointoxication. The stasis or stagnation above the ileocecal valve affords conditions the most favorable for putrefaction and absorption of putrefactive products. It is evident, then, that the study of constipation cannot be complete without a thorough study of intestinal toxemia. This is especially true as regards the treatment of this condition both with reference to the causes of the constipation and its consequences.