Treatment Of Latent Constipation

In this form of constipation the stools are regular, the bowels move every day, and there is no accumulation of feces in the rectum. The patient is generally unaware of the fact that he is suffering from constipation, although not infrequently an observing patient becomes satisfied that there is something wrong, often because of too frequent bowel movements, which are not uncommon, together with pain, the passage of mucus, perhaps, and other symptoms.

In a London clinic the writer once heard a Scotch laborer complain of very frequent bowel movement. The examining doctor said to him, "Then you are suffering from diarrhoea". "No, Doctor," replied the patient, "I think I am suffering from constipation in diarrhoea form,"- - a good practical description of certain forms of latent constipation. This patient was found to have a very extensive accumulation of feces due to cancer of the rectum.

In addition to the most thoroughgoing application of all the measures recommended for simple constipation, a thorough examination including an X-ray inspection of the whole intestinal tract, after a bismuth meal must be made. The rectum and lower bowel must be carefully examined to exclude cancer or other organic disease. Careful examination must be made in the region of the appendix, and in women a thorough pelvic examination is necessary, since in many cases the delay may occur above the ileocecal valve, in consequence of spasm of the sphincter at this point. Or the delay may be due to incompetency of the ileocecal valve.

"Lane's kink" may be an occasional cause of latent constipation. It is more likely to be a result of this condition.

When the difficulty is due to spasm of the ileocecal valve, the result of reflex irritation from the inflamed appendix or from inflammation of the ovaries, uterus, bladder, or prostate, or painful disease of the rectum, it is of course necessary that these conditions should be removed by proper treat' ment. Temporary relief is generally most readily obtained by hot fomentations over the abdomen, with special attention to the seat of pain. The hot sitz bath, the hot enema and the wet girdle covered with mackintosh, worn day and night, are measures of great importance, and often secure very complete and speedy relief.

When the intestinal inactivity is the result of general feebleness, short cold baths should be employed daily. A cold bath may consist of a general cold shower of from fifteen to twenty seconds9 duration, a cold douche to the spine, a cold towel rub, or cold sheet rub, according to the strength of the patient. The cold bath should be preceded by a short electric light bath. It aids in the elimination of accumulated toxins, and prepares the skin to react to cold application.

In latent constipation, the enema is sometimes useful chiefly as a means of introducing water by which the accumulated toxins may be washed out through the kidneys. In such cases the difficulty lies too high to be reached by the enema. The large cool or cold enema may, however, render service in cases in which the delay is due to atony, by improving the tone of the bowel muscles and so aiding peristaltic movement, by which the accumulated putrefying material in the lower part of the intestine may be moved on to the colon, and so be gotten rid of. The cold enema should not be used, however, in cases where there is reason to suspect spasm of the ileocecal valve, which is likely to be the case when latent constipation is associated with painful disease in any part of the pelvic region. In these cases a hot enema should be employed.

The rapid absorption of water from the colon is shown by the copious discharge of urine which usually appears within a few minutes after an enema is taken. The increase in the quantity of urine occurs so quickly after a large enema, that some medical writers in the early part of the last century were led to advance the theory that a direct connection existed between the colon and the kidneys. This fanciful theory has, of course, no anatomical foundation.

Mechanical kneading, the application of the sinusoidal current, and intelligently administered massage and other means by which success may be attained in combatting latent constipation.

The Treatment Of Spastic And Reflex Constipation

These conditions, most commonly associated with colitis or appendicitis, require the use of special measures. In spastic constipation the cause of stagnation of the intestinal contents may rest anywhere between the ileocecal valve and the anus.

In many cases of so-called spastic constipation, this condition is only a complication of colitis or chronic infection of the colon, due to delay of fecal matters in the colon.

The best means of securing immediate relief in cases of this sort are the hot sitz bath, the hot enema, and hot fomentations or diathermy applied over the abdomen.

In cases of painful disease of the ovaries or uterus, the hot vaginal irrigation must be used in addition to the hot enema.

The constipation which occurs at the monthly period in women suffering from menorrhagia, may often be removed by a hot hip and leg pack applied by means of a woolen blanket wrung out of water as hot as possible. The application of cold water after the pack should be avoided. The patient should be wrapped in dry blankets, and gradually cooled by tepid spraying.

Sometimes the warm oil enema proves more serviceable than the hot water enema, because less irritating. The addition of salt to the water is sometimes useful in cases in which the mucous membrane of the intestine is eroded, as a weak solution of salt is less irritating to raw surfaces than pure water.

The application of the arc light and the photo-phore are extremely useful means of relieving the internal spasm. These applications should be made daily for ten to fifteen minutes' duration. In severe cases the light applications may be intensified by a special device through which the excessive rise of temperature is prevented by a stream of cool ait or water playing upon the abdomen.

When making general cold applications, the abdomen should be protected by a warm flannel or a hot fomentation. A patient suffering from constipation must take special care to avoid chilling, and must keep the feet and hands warm. The chilling of the hands and feet always aggravates the spasm. The drinking of ice-cold water must also be prohibited.

The cold towel rub is especially suited to these cases, as a general tonic measure.

A person skilled in massage may make good use of this measure in the general application of heat, in cases in which massage is indicated, as when the cecum is loaded as the result of contraction of the transverse colon, or at the splenic flexure. The tendency of massage to aggravate the contraction is counteracted by a general application of heat.

The moist abdominal bandage without the mackintosh cover should be done at night and if possible also during the day time.

The abdominal supporter is also highly important in these cases, to prevent drag upon the mesentary by prolapse of the bowels. The writer has observed several cases in which the wearing of an efficient abdominal supporter has given prompt relief from very obstinate constipation.