Food is a factor of some importance in the treatment of constipation. Food may promote peristalsis through a mechanical action, as in the case of foods rich in cellulose, .which leave a large residue in the intestine; or it may influence the bowel by a chemical action, through the agency of the organic acids produced by bacterial decomposition of the carbohydrates and cellulose of the food, as in the case of vegetables and fruits. Among foods rich in cellulose, green vegetables, oatmeal, and wholemeal bread occupy a prominent place, and these should enter largely into the diet of constipated subjects. Fruits are also of great value, more especially figs, prunes, dates, apples, pears, oranges, and peaches. Fruit should be taken once or twice a day; it may be taken fresh or stewed, and it is best taken on an empty stomach the first thing in the morning. Fat is useful as a lubricant, and the patient should be encouraged to take plenty butter and cream. A little marmalade, honey, or treacle taken at breakfast has a useful aperient action. A common fault in the dietary of constipated subjects is a deficiency in fluid, and patients should therefore be encouraged to drink 2 to 3 pints of fluid in the day, one tumblerful of hot or cold water being taken the first thing in the morning. Excess of meat and excess of tea are factors in the development of constipation, and the amount of these must be restricted. The main points in the dietary for constipation may be represented as follows: -
Foods rich in cellulose should bulk largely in the dietary e.g., porridge, especially that made from Scotch oatmeal and Quaker oats, wholemeal bread.
Vegetables, especially green vegetables, should be taken freely.
Fruits have a useful aperient action.
The taking of fat should be encouraged, as in the form of butter or cream.
Milk is constipating to the majority of individuals, but in exceptional cases it has a laxative action. Buttermilk has a laxative effect.
There are many factors at work in the development of constipation, and these require attention as well as the diet. Lack of exercise, too sedentary habits, matetudinal hurry, are important contributory causes. Defective education of children as to the acquirement of the regular habit of going to stool is often the primary cause; this can to some extent be corrected by cultivating regularity in habit in later life. In looking for recovery from constipation in long-standing cases it is essential to point out to the patient the necessity of patience, and the long-continued use of a diet adapted to the condition. Massage and suitable exercises are important aids in treatment.
The following is a suitable dietary for a case of constipation. Importance should be directed to the necessity of taking the food slowly, and of thorough mastication.
7 a.m. - Tumblerful of cold or hot water.
8 A.M. - A little fruit taken before breakfast.
Bowl of porridge made from Scotch oatmeal, with liberal supply of milk and cream. Cup of tea; toast or rolls, butter and marmalade.
I P.M - Broth.
Bread and cheese; wholemeal bread, with liberal supply of butter.
4.30 p.m. - Cup of tea, and thin slice of bread and butter.