Medicines

Discussion of the medicinal treatment of constipation is not within the scope of this work, but the practice of continually taking laxatives and strong cathartics cannot be too strongly condemned. The constant daily overexcitation of the bowels by such remedies as aloes produces a deplorable condition in which the bowels refuse to act at all without constantly increasing dosage.

The majority of such cases can be cured by diet, but the rules must be very distinctly laid down, and the patient must exercise patience and care in adhering to them. I have sometimes been able to relieve patients who for several years had depended wholly upon strong cathartic pills or enemata, by stopping all medicine, and enforcing simple dietetic rules, especially in regard to drinking abundant fluid and eating laxative and bulky food. They often think that a daily movement is absolutely necessary, and the worry and nervousness which its absence occasions increases the difficulty. They should be reassured, and told not to be concerned if the bowels do not move at first for two or three or even four days, and that if they do not have an unaided passage in that interval they can certainly be relieved, and diet and regimen will succeed in time if persistently followed.

In very obstinate cases when diet does not succeed alone, attention to its regulation will enable the patient to obtain the desired result with mild and decreasing doses of simple saline laxatives such as Congress, Crab Orchard, Mt. Clemens, Apenta, or Rubinat water, in lieu of strong cathartic pills, or patent medicines.

Tobacco

Tobacco smoking increases peristalsis. Some men become constipated when deprived of their after-breakfast cigar. The effect of tobacco is not constant, however, and by disordering digestion too much smoking may be an indirect cause of constipation. In those in whom it acts favourably upon the bowels, a good cigar is usually more active than any other form of the weed.

Bathing

A daily morning cold bath followed by vigorous friction of the skin is of great service.

Electricity

Faradisation of the abdominal walls is frequently useful, but, owing to the fact that the electric current when applied superficially radiates over the skin without penetrating to any extent beneath the surface, it cannot be expected to reach the intestinal wall. Any benefit derived from such application must be purely of a reflex character from excitation of the cutaneous nerves transmitted through the cord to the sympathetic nerves. A much better method of applying a faradic current consists of introducing one electrode for several inches into the rectum, while the other is moved about over the surface of the abdominal muscles. In this manner these muscles may be made to contract and move the intestines to some extent, and it is possible for a portion of the current to pass through the sigmoid flexure. If carefully adjusted, the application of the current gives rise to no pain or discomfort.

Bandaging

In very obese persons, who are liable to suffer from constipation, the pendulous and relaxed abdominal wall should be supported with an abdominal bandage. The same treatment may give comfort when the wall is much distended in childbearing or by the presence of large abdominal tumours or accumulations of ascitic or ovarian fluid.