The hot sitz bath at a temperature of 112° to 118°, duration two to three minutes, cannot be too highly praised as a measure of the highest value for use in the treatment of reflex and spastic constipation, with or without colitis. After the sitz no cold application is made. The best time for the bath is on rising in the morning.
Photophore (above) and Thermophore (below).
These are measures of great value in the treatment of spastic and reflex constipation, and are especially useful in cases in which pain is a pronounced symptom and a cause of reflex spasm. The applications should be made morning and night in place of the fomentation, and are much more effective.
There are unquestionably certain cases in which the colon has become so crippled by inflammations, stretchings, distortions, adhesions and the degeneration of its muscular structures, and consequent weakening of its contractile powers, that it can no longer be made to perform its functions, even by the use of such accessories as act as mechanical or physiological aids. In such cases and in certain emergency cases, the judicious use of the enema is not only helpful, but sometimes necessary. For example, in cases of senile constipation, where as the result of long continued colitis, the muscular walls are thin and greatly stretched, while the colon itself has become abnormally redundant and folded upon itself, the daily or frequent use of the enema may be required.
The best means of administering the enema is the fountain syringe. The tube should be long enough so that the reservoir, if necessary, may be raised to a height of five or six feet above the patient. When it is desired to stimulate the bowel to immediate contraction, the reservoir should be placed high, but when the purpose is to introduce as large quantity of water as possible into the colon, and to have it retained for a time, the reservoir should be placed at a height not exceeding two or three feet.
The position of the patient during the administration of an enema is not a matter of very great importance. In cases in which the pelvic colon is low down in the pelvis, as is shown by examination, it is well to put the patient in a knee-chest position. The water should be introduced very slowly. Ordinarily, however, the patient may lie upon the back or either side, or the enema may even be ad-ministered standing. The water quickly finds its way along the colon, no matter what the position of the patient may be.
The use of the colon tube is quite unnecessary. Indeed, as the writer learned long ago by experience, and as has been abundantly proved by examination with the X-ray, the colon tube can rarely ever be introduced beyond the rectum. It is arrested at the pelvi-rectal fold, and simply returns and coils itself up in the rectum. A tube long enough to pass the water through the anus is as useful as the longest colon tube, unless the long tube is passed into the pelvic colon past the ileosplenic flexure, a procedure which is rarely required, and, of course, should only be undertaken by a physician.
The enema may be employed in a variety of ways adapted to different occasions and purposes, and it may be repeated as many times as may be necessary. Warm water dissolves hardened fecal matters much more readily than cold water, yet in some cases it may be necessary to repeat the enema, at intervals of fifteen to twenty minutes, five or six times before the effect desired is obtained. When used for the purpose of softening hardened fecal matters, the water should be introduced slowly, and the patient should be instructed to retain as much as possible. The enema should be repeated as long as the water contains fecal matters when returned.
The temperature of the water should be 105° to 115° F. The quantity may be from one to three pints. This is preferable in cases of colitis and when abdominal pain or tenderness is present.
The addition of soap to the water somewhat increases its power to dissolve hardened feces, although the advantage of its use is not so great as might be supposed. The amount of soap should be sufficient only to make very weak suds, as otherwise, it may be irritating, especially if the soap con-tains a considerable amount of free alkali. Ordinary soap is best for the purpose.
Half an ounce of salt is added to two quarts of water at a temperature of 105° to 115° F.
The purpose of the addition of salt is to lessen the irritation of the mucous membrane. It is of special use in cases of colitis, in which the enema is administered for the purpose of removing mucous and relieving spasms of the intestine. The application should be repeated until no mucous returns with the water. Care must be taken to secure evacuation of the water so as to avoid retention of a large amount of salt, which may do serious injury.