Common constipation, due to sluggishness of the intestinal movement and of the rectal reflex, is painless. There may be some slight sensation of discomfort, but there is no pain. Constipation produces its undoubted effect on the consciousness by the feeling that a necessary function is in abeyance or is imperfectly performed. When pain or aching is experienced, I think it is probable that a spastic condition of the colon is present. Such pain is often associated with mucous colic, and enterospasm is, in fact, the chief cause of the pain in that condition. But enterospasm, a pure motor disturbance, may occur without the conjoined secretory perversion, which is characteristic of mucous colic, and from its long duration and its profound effect on the mental state it is a matter of some importance. The pain or ache may be felt at any part in the course of the colon, but it is most common in the right or left iliac fossa, and in the former position it may arouse a suspicion of disease of the appendix.
To the patient enterospasm is constipation, and constipation is his complaint. When spasm is present, it is even more necessary than in common constipation to be chary in the use of purgatives. Without entering into details as to the best line of treatment, it may be said that dependence must be placed on general measures, such as diet, massage and regulation of the life and habits, and that little good (and sometimes even harm) will result from any attempt at energetic treatment applied to the interior of the bowel.
As in the case of mucous colic, a rather coarse cellulose diet should be aimed at, but it must be carefully adapted to the patient. Occasionally the diets that are suggested elsewhere for constipation and the less severe forms of mucous colic can be borne, and will prove of service. They should be given a full trial with the intelligent co-operation of the patient. But in consequence of flatulence and discomfort the amount of cellulose must often be diminished, and recourse should be had to the second diet recommended for mucous colic. Butter and oil are extremely useful, and every effort should be made to overcome the distaste for olive oil which is so commonly experienced.