CONSTIPATION

Before beginning to treat any case of constipation, its cause or causes should be known. Sometimes cancers or other tumors in the wall of the intestine, or pressing on it from the outside, or adhesions, strictures, or displacement of the bowel, bring on constipation due to partial obstruction. Detecting and correcting such conditions is beyond the skill of a person without medical training. The bowel itself may not be at fault, but improper action of the liver, gall bladder, or endocrine glands may result in sluggish intestinal action. Reflexes from a diseased rectum may affect the bowel higher up. All such conditions require study by a physician, and anyone afflicted with constipation should first make sure that they have no serious or dangerous condition beyond their own skill to remedy before attempting to solve their own problem along the lines discussed below.

A common cause of constipation is a lack of sufficient bulk in the diet. When a person consumes milk, cream, butter, eggs, meat, refined cereals, and starchy vegetables, nearly all the bulk of their food is digested and absorbed, leaving little residue. However, if they eat freely of fruit and green vegetables, a large residue of cellulose remains undigested and unabsorbed, which is useful in making the bowel act normally.

The mild acids in fruits stimulate the production of digestive juices. They also induce an antiseptic action in the digestive tract and greatly assist in reducing fermentation. They stimulate the bowels to move the food onward and downward and are nature’s wholesome laxatives.

Neglecting to answer the call of nature is perhaps the most common cause of constipation. Normally, when the fecal mass comes in contact with the mucous membrane lining the rectum, a message signaling the need for evacuation is sent over the nerves to the brain. Habitual failure to heed such messages results in obstinate constipation.

Among school children and oversensitive individuals working in offices or other public places, the call to evacuate is frequently ignored, or the teacher may unwisely refuse the children permission to go when the need is felt. Constipation due to emotional or nervous tension is also common.

In the absence of a natural call to evacuate the bowel, it is important to go to the bathroom at a regular, definite time anyway and to attempt a bowel movement. The best time for this is within an hour after breakfast. The intake of food into an empty stomach constitutes a powerful stimulant to peristaltic action, and the peristalsis which begins in the stomach tends to spread downward throughout the digestive tract. After eating, therefore, is the rational time for an effort at evacuation.

Fecal matter is collected slowly in the descending colon as it is delivered to that portion of the bowel by the upper sections. The lower part of the descending colon lies against the psoas muscle, which contracts with each step taken in walking or running. The action of the psoas muscle in walking or running is stimulating to the bowel, especially when it is full. Walking, running, or any other exercise that engages this muscle is a useful part of the treatment for constipation.

If their bowels do not move exactly when and how they think they should, many people resort to cathartics. Some take a cathartic regularly every ten days or two weeks, whether they are constipated or not. Many cathartics act by irritating the bowel. Continued or repeated irritation sets up an inflammation in the walls of the intestine and causes them to contract so firmly that the fecal mass has difficulty passing. Hence, what many people consider an effective treatment for constipation may only worsen the condition fundamentally.

The enema habit is also detrimental. Enemas tend to wash away normal intestinal secretions and may irritate the bowel. Plain water is a significant bowel irritant. Whenever an enema must be taken to clean out the large bowel, a heaping teaspoonful of common salt should be added to each quart of water used. Such a salt solution is much less irritating than water alone.

Symptoms of constipation include, besides the inability to evacuate, a feeling of fullness in the lower abdomen and a sensation of dullness, or even moderate pain in the head. Many people with chronic constipation believe these latter symptoms are caused by toxins or poisons formed in their bowels and absorbed into their blood, but such symptoms seldom result from the absorption of poisons. They are caused by irritated mucous membranes and reflexes from nerve endings in the intestinal tract.

In many cases of chronic constipation, there tends to be a spastic condition of the sigmoid part of the descending colon on the left side of the abdomen, with a dilated and inactive condition of the ascending colon on the right side. There are cases in which a considerable portion of the colon is spastic. These facts have led to the term “spastic constipation” used by many physicians, and the presence of the condition can usually be confirmed by X-ray studies. Because spasticity may be worsened by too much irritation, if the constipation is known to be of the spastic type, it may be advisable to puree fruits and vegetables to make them free from coarse fiber and harsh roughage. It may also be inadvisable to take bran, often recommended as a remedy for constipation. Later, when regular bowel action has been re-established, such precautions will become less important.

Massage may be valuable if properly given. It should be firm, deep kneading, not merely rubbing of the skin. It should begin low down on the right side, move slowly upward with a combined rolling and kneading motion to the lower margin of the ribs, then horizontally across the abdomen to the left side, and finally down the left side of the abdomen as far as possible.

WHAT TO DO

1. Try to learn the type and causes of your particular case of constipation. You may need the services of a physician in doing so, and they may need to use X-ray and other kinds of examinations to get the answer. If they find that surgery or any other special treatment is needed to correct or remove the cause, this should be arranged. The treatment program suggested below would be useless in certain cases, and it might cause dangerous delay in correcting conditions that should not be neglected. The program outlined in the following paragraphs is intended for use in ordinary cases where no tumors or organic defects complicate the situation.
2. Eat an abundance of fruits and vegetables, both fresh and cooked.
3. Drink at least eight glasses of fluid—chiefly water and fruit juices—every day.
4. Go to the toilet regularly every day—preferably soon after breakfast—whether you feel like having a bowel movement or not. Also, go at any other time when you feel the urge.
5. If unable to have a bowel movement otherwise, take a saline enema at the end of a regular toilet visit, but not more often than once every three days.
6. Three times a day, take two tablespoonfuls of powdered brewer’s yeast stirred into a glass of tomato juice or buttermilk (this usually will not have to be continued for more than a week).
7. If possible, engage in half an hour to an hour of outdoor exercise daily. The exercise should include running or walking and be vigorous enough to cause at least mild perspiration.