By the systematic use of the cold enema the dilated colon may gradually be restored to its normal size; its relaxed walls will recover their tone, and its function will be more properly performed. When sensibility of the rectum has been lost it may also gradually be recovered. It is necessary, however, that the greatest care should be taken to see that the colon and rectum are never once distended by fecal accumulation. Many persons suffering from cumulative constipation take an enema every other day, or once or twice a week, waiting for symptoms of accumulation before the enema is taken. This practice is altogether wrong, and results only in a perpetuation of the disease. Of course, when an accumulation occurs, it must be removed, but if a cure is expected, accumulations must not be permitted to occur.

In obstinate cases the application of a sinusoidal electric surrent to the colon and the rectum aids greatly in the restoration of these parts to a normal condition. By the use of special electrodes electricity may be applied to the interior of the colon, as well as to the rectum, thus securing vigorous contractions of the bowel, which are not always produced by external applications, especially in chronic cases in which the intestine has to a large degree lost its normal sensibility. While strong electrical applications made to the spine and abdomen sometimes stimulate the muscles of the intestine as well as those of the abdominal wall, when the intestinal muscles have long been over-stretched and are perhaps to some degree degenerated, direct applications are necessary. These must be made by a physician by the aid of the proctoscope, which can be readily passed into the pelvic colon.

Vibration and massage of the interior of the rectum are measures of doubtful value. They are likely to give rise to abrasion and irritation of the mucous membrane, and are not to be recommended.

In cases of cumulative constipation, in which painful ulcer or irritable hemorrhoids exist, effort to restore normal action of the bowels may be made ineffective by spasm of the sphincter muscles. This may be relieved temporarily by external applications of heat by means of a fomentation. A very effective plan is to move the bowels while sitting over hot water. Boiling hot water may be poured into a chamber or other suitable vessel. The steam relaxes the anal sphincters, and not only facilitates the bowel movement, but relieves or prevents the pain.

Dryness of the lower bowel due to deficient secretion, the result of chronic proctitis and associated with loss of rectal sensibility, is not infrequently a cause of obstinate cumulative constipation. The stools are exceedingly hard and dry, and are discharged with great difficulty. When the rectum of such a patient is examined, the mucous membrane is found to be exceedingly dry, and often irritated. The normal lubricating mucus is not present. The result is the delay of the feces in the rectum until a dry hard mass is formed, which is not easily gotten rid of. In such cases, lubrication of the rectum is needed. The remedy for this is paraffin, of a special sort which melts at 102° F. For details respecting the use of this highly valuable remedy see pages 260-270.