Proctitis

In cases in which cumulative constipation involves the rectum, infection, here known as proctitis, develops in this part also. Infection may extend from the pelvic colon into the rectum. When the rectum is involved, the patient often suffers from more or less constant pain and uneasiness in this region; there may be frequent desire to move the bowels, but however frequently the bowels may be moved, there will always be some feces remaining in the rectum, together with mucus and, occasionally, blood. An examination of the rectum sometimes shows ulceration. In advanced cases, the mucous membrane is smooth and dry, with patches of mucus adhering here and there, and frequently raw surfaces which bleed when touched. The conditions are identical with those which are found in the bowel higher up. The point of junction of the colon and the rectum is a favorite seat for ulcerations and thickenings of the mucous membrane.

When the disease extends deeper into the wall of the bowel, as it does sooner or later, thickening and rigidity result. By extension of the disease through the membranous wall, the outer surface becomes inflamed, and adhesions may occur between the lower bowel and the bladder, which sometimes result in fistulas between the two viscera. Adhesions may also occur between the colon and small intestines and other parts; the ulcerations may heal and form cicatrices, which contract and produce obstruction. The lower part of the rectum and the juncture of the colon and rectum, the pelvirectal valve, usually show the worst effects of catarrhal colitis, and these points are the favorite seat of cancerous growths. The long continued irritation to which these parts are subjected also leads to the development of other growths, which, together with ulcerations, as has been shown by Mummery, a very eminent London specialist, are very prone to develop into cancer, and on this account, every person who suffers from catarrhal colitis, as shown by the presence of mucus in the stools, should submit himself to a physician for examination in order that any existing tendency towards maligancy may be recognized sufficiently early to permit of its radical treatment.

The treatment of proctitis is essentially the same as that already outlined for colitis. Change of the intestinal flora, frequent bowel movements, daily cleansing of the colon, an anti-toxic diet, and the introduction into the colon of cultures of lactic acid forming organisms are the most important measures. Faithful employment of these measures will usually effect a cure.

Muco-Membranous Colitis

This disease is probably only a variety of the preceding. Of this the writer has been convinced for many years, although most authorities still describe this malady as a nervous disorder. The only particulars in which it differs from catarrhal colitis are:

1. The fact that mucus is not constantly present in the stools as in catarrhal colitis.

2. The presence of membranes which are sometimes complete casts of the bowel, and may be a foot or more in length.

3. Colic pains.

4. Intermittent occurrence of the symptoms.

These differences are not sufficient to characterize this condition as a distinct disease. Constipation is the predisposing condition which lies back of this disease, as well as of catarrhal colitis. If the infection is not sufficiently intense to produce continuous symptoms, it is only necessary that it should be increased by some indiscretion in diet, exhaustion, a severe cold, or some other factor, to precipitate an attack. The casts consist of coagulated mucus, and not mucous membrane as patients often imagine.

The colic pains are due to violent contraction of the colon, which are excited by the accumulation of gas and irritating fecal matter. This disease is often associated with chronic affections of the pelvic organs, and is much more frequent in women than in men.

Colitis in any form is a serious condition which cannot be safely neglected. Sooner or later it creates conditions which are beyond remedy except by surgical means.

Treatment

The treatment of this condition does not differ from that already outlined for the treatment of colitis. Medicinal laxatives of all sorts must be avoided, because these only serve to aggravate and perpetuate the disease.

Enlargement Of The Liver And Spleen

Marked enlargement of the liver and spleen are frequently the result of chronic constipation with intestinal autointoxication. The constant flooding of the liver with toxins must result in damage to its tissues. Boix showed this in his experiments upon rabbits. Some years ago the writer encountered a case of enormous enlargement of the liver, in which mere had never been any use of alcohol, and there could be found no more tangible cause for the disease than a chronic constipation which had existed for many years. The writer has seen many cases of decided enlargement, of the liver and spleen, in which constipation and autointoxication existed to a marked degree.