This unpleasant symptom is a very common result of constipation. Vertigo is a common symptom in cases of arteriosclerosis caused by constipation, and sometimes results from irritation produced by the presence of feces in the rectum. In certain nervous persons, vertigo, faintness or exhaustion are sometimes experienced when the bowels are evacuated by a saline laxative or by an enema. The cause of this is doubtless the absorption of poisons brought into solution by the large amount of fluid present in the intestine. So long as the feces are hard, little absorption can take place. But when they become semifluid, the poisons present are brought into solution and are also made to come in contact with the mucous membrane, so that rapid absorption occurs. In some instances, the prostration is such that recovery does not take place for several hours. These are probably cases in which the liver and kidneys are crippled as the result of long-standing disease.
Dr. Case has observed that unpleasant symptoms immediately following an enema are connected with the entrance of the injected liquid into the small intestine through an incompetent ileocecal valve. This is an interesting observation. It suggests that vertigo at other times may be due to refluxed material from the colon, due to antiperistaltic action of the colon. The wretched feeling which many neurasthenics experience in the morning may be due to the same cause. Case has observed that although the small intestine may be entirely empty at night, in the morning several feet of the intestine may be filled with fecal matters which have returned from the colon through an incompetent ileocecal valve.
Urinary troubles in both men and women, as well as in children, are often traceable to constipation. Very foul-smelling urine often owes its unnatural odor to the presence of putrefaction poisons absorbed from the intestine.
Both inability to urinate and a frequent desire to urinate may result from the accumulation of feces in the rectum. In children the escape of urine during sleep is often due to constipation.
Prolapse and retroversion of the uterus is a common result of the straining necessitated by constipation in women and girls.
Dysmenorrhoea, leucorrhoea, and a varicose condition of the broad ligaments, which is accompanied by much pain and discomfort, may result from the pressure of feces in the rectum and lower colon. Nocturnal seminal losses and an abnormal irritability of the parts, causing erection and also neuralgic pains in the testicles, and varicose veins, may result from the congestion caused by the pressure of feces in the rectum and lower colon.
Accumulation of feces in the colon is a frequent cause of attacks of fever which so much resemble malarial paroxysms that they are usually treated by the administration of quinine. There is often a distinct chill, followed by fever and sweating. The tongue is coated, the breath bad, and there is much headache, and sometimes vomiting. The fever may last several days, but disappears quickly when the bowels have been thoroughly evacuated.
These attacks are very common in persons who are subject to colitis, and much mucus is often discharged when the bowels are cleared out.
Abdominal surgeons have constant occasion to note the effect of fecal accumulations in raising the temperature. A rise of temperature after operation is more often due to this cause than to any other. This fact led to the practice of thoroughly evacuating the bowels before operation, and early moving them afterwards, an innovation introduced by the late Dr. Lawson Tait, and which has been the means of saving more lives than any other modern improvement in surgery, except aseptic technic in operation.
Neglect to secure complete and regular evacuation of the bowels is a frequent cause of rise of temperature after confinement and in convalescence from acute illness. Accumulation of feces not infrequently occurs when the bowels move daily, and even when the bowels are quite loose, as shown by the immense quantities of loathsome material which may be washed out by means of a thorough enema. The writer recalls a case in Which a woman who had very loose movements for two or three weeks was found to have an enormous mass of hardened fecal matter in the rectum, and a very great accumulation of feces in the lower colon.
Bed patients should always be made to sit up when moving the bowels or urinating, when this is at all possible, so as to secure complete evacuation of the urine and feces. In most cases this may be done without injury after the second day. The same remark applies with special interest to cases of confinement. There is so often an accumulation of feces in the colon in pregnancy, especially within the last two or three weeks before confinement, that it is highly important to give the matter prompt attention at once after the child is born, as well as before confinement. Very often a great quantity of putrefying material will be removed, the retention of which may give rise to autointoxication with fever and even worse symptoms.