When the meals are not taken regularly, the rhythmic peristaltic impulse by which the feces are pushed forward from the colon into the rectum is lacking. If for example, a person's habit is to move the bowels immediately after breakfast, and the breakfast is not taken, the bowels will not move, or if a movement occurs, it will be incomplete; instead of complete emtying of the colon below the splenic flexure, which occurs in a normal movement of the bowels, only the pelvic loop will be emptied; and fecal matters remain in other sections of the colon. After the next meal, the stimulus may be sufficient to empty the colon completely; but if the irregularity is frequently repeated the normal rhythm of the bowels will be interrupted. The forward movement of food stuffs in the small intestine is continuous while digestion is going on; but the movement in the large intestine is more or less intermittent. If a meal is taken when the pelvic colon is loaded, the stimulus of the meal will cause the pelvic colon to contract and push forward a portion of its contents into the rectum. The feces in the rectum will excite the defecating center, and thus set up the automatic action by which a movement of the bowel is effected.
If a meal is taken at a time when the feces have not reached the pelvic colon, manifestly no movement of the bowels can occur, and a general contraction of the colon by which its contents are discharged does not take place. If, on the other hand, no meal is taken at a time when the pelvic colon is filled, the movement must be delayed until the next meal is taken, or perhaps until some unusual straining movement or exercise serves to crowd out some of the fecal matter from the colon into the rectum. If the fecal matters retained in the pelvic colon become too dry to be readily moved by normal stimuli, a laxative or an enema becomes necessary. In many cases, this is the beginning of chronic constipation; a few repetitions may be sufficient to create a latent constipation in which the bowel movements are always twenty-four or forty-eight hours behind time.
Since bowel movement depends so largely upon the stimulus derived from eating, it is evident that regularity of bowel movement depends upon regularity of eating.
If a full meal cannot be taken, some fresh fruit, as an apple or two, or a couple of oranges, may serve the purpose to maintain the normal rhythm. When strong stimulation of the colon is needed a bran biscuit may be added with advantage, together with a dose of paraffin.
Tea and coffee contain two substances the poisonous effects of which are well known, viz: caffein, a nerve poison practically identical with uric acid, and tannin, an astringent well known as one of the constituents of oak bark and many other vegetable substances. A cup of "good" coffee contains four grains of caffein and two of tannin. There is, in fact, nearly three times as much uric acid in a cup of coffee, in the form of caffein, as in an equal quantity of urine. The effect of tannin upon animal tissues is well shown in the process of tanning, by which animal skins are converted into leather. Tannin is an active poison to the mucous membrane of the stomach and intestines; it not only interferes with the digestive processes, but it produces changes in the mucous membrane by which its power to respond to the delicate impressions made by the food is lessened. The result is diminished intestinal movement and constipation.
Everyone is familar with the use of astringent or tannin-containing remedies in diarrhea. However beneficial tannin may be in cases in which the bowels are abnormally active, certainly its effects are nothing but pernicious when habitually used. The average civilized man requires stimulation of his food tube rather than the use of substances which produce a paralyzing effect.
Most persons who suffer from constipation habitually drink too little water. Women drink less than men. It is difficult to account for this scanty use of a necessary of life, which costs little and is of such inestimable value to the body. Water is far more immediately necessary for the support of life than is food. A man may live six weeks or two months without tasting food in any form, but a few days at the most is the limit of human life without water. The consequence of a scanty use of water is abnormal dryness of the feces, which delays their passage through the lower colon, and often causes an actual stoppage in the pelvic colon or the rectum.
Persons who sweat much, either as the result of hot weather, vigorous exercise, or hot baths, are likely to suffer from constipation, unless special care is taken to supply the body with water sufficient to make good the loss. The skin ordinarily throws off as perspiration an ounce and a half of water each hour, or more than a quart in twenty-four hours. By active exercise or sweating baths, this amount may be increased to thirty or forty ounces in an hour. The kidneys excrete two to three pints daily. It is evident, then, that care must be exercised to replace the water that is lost through the skin and kidneys.
In diabetes there is a great loss of water through the kidneys. This also must be made up by drinking. If these losses are not made good, the thirsty tissues will absorb as much water as possible from the feces, thus causing hardening and retention in the lower bowel.
Scanty and highly colored urine is an evidence that the tissues are in need of water. Dryness of the skin often testifies to the same need.
Water should be taken in proper quantity irrespective of thirst. It may be made palatable by the addition of fresh fruit juices.
For the average person a good plan is to take a couple of glasses of water on rising, and the same amount before retiring at night. A glassful should be taken half an hour before dinner and supper, and an equal amount two hours after eating. The free use of oranges or orange juice, and of other juicy fruits, serves the same purpose as water drink-ing, to the extent of the liquid which they supply.
Persons suffering from obesity or diabetes are sometimes restricted in the drinking of water, with the result that constipation is produced, if this condition does not already exist. This should never be done.
In all cases in which there is a tendency to dryness of the stools, water should be taken in increased quantity. It is important in such cases also to diminish the amount of salt eaten. The addition of salt to the food creates thirst for water to dissolve it and to aid in its elimination through the skin and the kidneys.
Children as well as adults need much more water than they are usually given. Meat eaters and those who use salt freely require a much larger amount of water than do those who adhere to a low protein dietary and who use little salt.