What Is A Cure Of Constipation?

When a child has measles or scarlatina or when a person suffers an attack of typhoid fever, the usual result under modern management is such a recovery that no traces of the disease or its effects are discoverable. The individual is apparently as well in every respect as before the illness. Modern medical research has taught us, however, that this completeness in recovery is more apparent than real. Besides the permanent injuries to eyes and ears, which are often left after measles and scarlet fever, there are not infrequently far more serious injuries to heart, lungs, or kidneys. And statistics show that whenever typhoid fever and small-pox are prevalent, pulmonary tuberculosis increases. Thus we know that recovery does not really mean, even in acute disease, absolutely complete restoration to former soundness.

In chronic disease this is still more evident. An attack of acute disease is like a sudden outburst of flame in a dwelling from the upsetting of a lamp or from some similar accident. The fire is usually quickly extinguished and the house itself is little injured. A chronic malady is often like a fire which has begun in the basement of the house and has gradually worked its way up in the inner walls until it has reached the top and burst out in flame through the roof. Acute disease we may say is analagous to a fire in a house while chronic disease is a fire of a house. In lung tuberculosis a cure means an arrest of the disease process and a healing of ulcerated surfaces in the lung; but lung tissue which has been destroyed is not restored; and the consumptive who has been cured by the out-of-door life and other means must continue to employ the essentials of the curative treatment in order to keep well. No consumptive can expect to remain well if he returns to the old conditions of life under which he became ill. He must make a radical change in his habits of life and the change must be permanent. In case of an injury to a leg, the patient may recover, but with the loss of a leg.

By the aid of an artificial leg he will be able to walk very well, but not so well as with a natural limb.

The situation is exactly the same in constipation. In very- chronic cases, much irreparable damage has been done. The colon has been permanently crippled. The art of treatment is to find out the exact nature of the injury and to find means for supplying the needed aid, much as an artificial leg in a large measure supplies the place of a missing limb. These measures must be such as render aid in a physiologic way, and must be harmless in character. When once the necessary means have been found and adapted to the individual case they must be perseveringly employed not for a few days or weeks or months; their use must become a life habit. In general it is possible to secure a considerable degree of improvement so that a few and simple means will afford all the aid required though at first the concerted use of many measures was required.

If, for example, it is found that the addition to the food of a liberal quantity of sterilized wheat bran will secure three normal bowel movements daily, this simple means must be faithfully used, not only daily, but at every meal. If it is found that the bowels are ready for evacuation at a certain hour, a natural "call" being experienced at that time, this hour must be religiously set aside for this duty. Nothing may be allowed to interfere with this duty. Whatever plan or program is found to secure efficient bowel action, this program must be carried out every day with greatest circumspection. Nature must not be discouraged or thwarted in her efforts. Every pains must be taken to foster every symptom of returning normality in bowel functions. When a "call" occurs, it must be answered at once. The delay of a few minutes only may extinguish the effort Nature is making to reestablish the normal rhythm. It takes considerable will and character to conquer constipation as well as knowledge and perseverance. But the gain in clearness of mind, zest for work, endurance of mind and body, and general efficiency, to say nothing of such gains as keenness of appetite, sweetness of breath, clearness of skin, sound sleep and sense of joy in being alive,'are ample compensation for the effort-required. If it is a life-long battle to conquer constipation, it may be a winning battle and one which lengthens one's days and wonderfully increases capacity for useful activity and enjoyment of life.

When Is Surgery Needed?

It will not be possible to review in a brief paragraph the various opinions which have been expressed by eminent medical authorities respecting the indications for surgical relief in cases of obstinate constipation, nor to offer the reasons for or against the various surgical procedures which have been proposed. It must suffice simply to enumerate the principal conditions concerning which the concensus of authoritative surgical opinion is settled and clearly defined.

Constipation due to organic obstruction resulting from tuberculosis, cancer, or other morbid growths, necessarily requires surgical interference, and an abdominal surgeon should be consulted at once, one experienced in intestinal surgery. This is important, for in surgery of this character results depend almost wholly upon exactness and perfection of technic, such as can be gained only by long and extensive practice.

Chronic as well as acute appendicitis is an indication which may open the way for relief of constipation by removal of an active cause. This is especially true in cases in which an X-ray examination shows many adhesions about the inflamed appendix, which fix the cecum so that it cannot empty itself or perhaps cause obstruction of the lower end of the small intestine. The necessity for operation may exist in cases of this sort, even when little pain is felt in the region of the appendix. Not every case in which such adhesions exist, however, requires operation. By far the great majority may be substantially relieved by non-surgical measures.

Adhesions of the ascending or descending colon, and especially adhesions which compress the pelvic colon and limit its movements, may be relieved by appropriate surgical procedures when other means fail. These cases seldom require removal of the colon or any portion of it, or even the so-called short-circuiting operation which often affords only temporary relief unless care is taken to restore the ileocecal check valve. When adhesions of the pelvic colon are broken up the pelvic loop must be suspended in such a way as to prevent the reproduction of the restricting adhesions which will almost certainly occur unless some efficient means of prevention is adopted.

A very definite indication for operation in certain cases in which other means fail is incompetency of the ileocecal valve accompanied by very pronounced stasis or stagnation in the small intestine. This condition is sometimes accompanied by the most incorrigible constipation and by most pronounced intestinal toxemia as shown by enormous quantities of indican and other putrefactive products in the urine and by intractable headaches. An operation has within a few years been devised by which the incompetent valve may be repaired so as to effect a radical cure of the incompetency of the valve and, fortunately without any considerable degree of risk. This operation has been now performed in a sufficient number of cases to demonstrate its value in cases which do not yield to other measures.

Diverticulitis (see page 348) sometimes requires operation but probably much less often than has been thought if thorough-going non-surgical measures of treatment are instituted. Anal hemorrhoids, fissures, fistula, spasm due to local irritation, recto-cele in women and prolapse of the rectum are other measures which may be readily cured by surgical procedures which are not attended by risk nor even, when skillfully done, by much pain or inconvenience.