The important relation of sleep to constipation is shown by the fact that loss of sleep, or a change of sleeping hours from night to day, very quickly upsets the bowel rhythm when it is nicely balanced in a person of sedentary habits. Cannon showed that the bowel contents advance very slowly during sleep, but very rapidly during and directly after eating. Evidently sleeping after eating must tend to constipation by interfering with the normal advance of the colon contents toward the exit.

Loss of sleep does not, however, increase bowel activity, but rather has an opposite effect, doubtless because of its general depressing effects. This is shown in the lack of appetite and in the coating of the tongue which result from loss of sleep. Relish for food is one of the normal stimuli of the intestines.

Posture During Sleep

This is by no means a matter of no importance. Gravity exerts a decided influence upon the contents of the stomach and intestines in states of disease, although the influence of this force is of little moment in conditions of health. In health the food is grasped by the digestive tube as soon as it reaches the back of the throat, and this vital grip is maintained until the residue of the food is cast out at the anus.

In disease, the situation may be greatly changed. The walls of the stomach, instead of contracting upon the food and kneading it, are relaxed and hang loosely separated like the sides of a bag. The stomach no longer grips the food, and so gravitation controls it to a large degree. Under these circumstances it is best for the patient to lie upon the right side in case a meal has been eaten within two or three hours before going to bed, or if there is evidence of the presence of food or liquid in the stomach on retiring.

When the cecum is known to be dilated and the seat of stagnation, it is well to sleep upon the left side, so as to facilitate the movement of food along the relaxed colon.

In cases in which the abdominal muscles are much relaxed and the whole colon dilated, so that intra-abdominal pressure is much reduced, it is well to lie upon the face, so that the weight of the body may by constant pressure upon the abdominal contents aid the progress of the feces along the crippled colon. Thin persons may often adopt with advantage the practice of sleeping on the face with a pillow beneath the abdomen. Backache, and various discomforts in the abdomen, especially in cases of colitis, may be relieved by this simple procedure. Persons whose stomach and intestines are much relaxed and sluggish in consequence are much benefited by lying upon the face for half an hour or an hour after each meal. This not only aids the passage of liquids from the stomach, but helps the colon, and prevents the excessive congestion of the viscera, which naturally results from the excitement of digestion when the intra-abdominal pressure is very low. The nervousness from which many dyspeptic and constipated persons suffer after eating may be relieved and prevented by half an hour's rest lying upon the face after meals. It should be observed that it is not well to sleep at this time.

Diet In Constipation

The writer once asked a celebrated Vienna professor, "What do you do for constipation?" The reply was, simply, "Diet." "But, professor, what do you do for cases in which diet and all other means have failed?" The reply was still, "Diet, only diet"

Proper regulation of diet is certainly the most important of all measures to be adopted in the treatment of constipation although there are other measures which are too valuable to be neglected. A practical cure may in many cases be effected by this means alone, provided, of course, that proper attention is given to ordinary bowel hygiene. No attempt should ever be made to treat a case of constipation without proper regulation of diet. Such a course, no matter how gratifying may be the results for the time being, must end in disaster; for a physiologic diet is of all things most essential as the means of securing normal activity of the intestines.

First of all, the fact should be recognized that food is Nature's laxative. Natural food taken in the proper manner and at proper intervals gives to the alimentary canal just the kind and amount of stimulation that is required to maintain the normal procession of nutrient material along the digestive tract, and to effect the prompt discharge of unusable residues and poisonous wastes from the body. As has been pointed out in preceding chapters, one of the effects of eating is to set up in the stomach a series of vigorous peristaltic movements, which pass from the stomach along the whole length of the digestive tube. Under normal conditions these movements are sufficient to cause the fecal remains of a preceding meal to move down into the lower and discharging part of the colon, thus setting up the reflex actions which result in their discharge from the body. This statement is not based upon theory alone, but is founded upon careful observations by expert roentgenologists, made upon the stomach and intestines with the X-ray after the administration of the bismuth meal. It also agrees with the every-day experience of normal persons. The natural time for the bowels to move is soon after eating, and under fully natural conditions a bowel movement occurs after each meal, at least, after each principal meal. The writer has met a number of persons whose intestines were so sensitive to the stimulation of food that the taking of food at any time, even in a small quantity, had the effect to produce within a few moments a desire for evacuation of the bowels. Cases are occasionally met in which the taking of food produced such strong stimulation that the patient found it difficult to finish a meal without interruption by the demand of the bowels for evacuation.

In the dietetic treatment of constipation, it is necessary to understand the particular properties of food stuffs to which stimulation of the intestinal movements is due, and to make use of these several qualities as they may be required in individual cases.