Constipation, or irregular and insufficient action of the bowels, is one of the most common of ailments; there are few persons in fact who have not at some time or other suffered from it. It may be due either to deficient secretion of fluids in the digestive organs, or to imperfect muscular action of the bowels (see DIGESTION), or most often to both these causes combined. The retention within the organism of matters which should be regularly evacuated as they are formed, and their consequent absorption into the blood and tissues of the body, often leads to a whole train of unpleasant symptoms: headache, or pain in other regions, irritability, lassitude, and debility, and many other discomforts may be due to this cause. In prolonged and severe cases of constipation, actual obstruction of the bowels (ilæus) may result; and often the bowel becomes so distended and its muscular power so enfeebled that the restoration of a healthy condition is impossible.
Constipation is especially apt to occur in those who lead sedentary lives, or whose diet consists too exclusively of animal food and starchy substances. It may often be avoided by judicious regulation of habits and diet; and the hygienic treatment is of far more importance than the medicinal.
In perfect health, the lower bowel should be evacuated every day, or at the furthest every second day. This process, like many others in the body, tends to recur at the same period every day, and every one should do all he can to acquire a habit of regularity in this respect. Moderate regular exercise, especially in the open air, is often of great importance; where the liver is at fault, riding is specially useful. A daily cold bath, or in the case of those with whom this does not agree, brisk rubbing with a rough towel, may be helpful. A favourite remedy with some is the use of a cloth wrung out of cold or tepid water and applied to the abdomen; this, as used at hydropathic establishments, is called an 'abdominal compress,' and is worn under a bandage of macintosh cloth, to keep the moisture from escaping, during the earlier part of the day.
Attention to diet is of prime importance. In Britain very many persons live almost entirely on animal food, white bread, and potatoes, a diet extremely apt to lead to constipation. There are many easily obtainable foods the habitual use of which would in many cases correct this tendency. Oatmeal, especially in the form of porridge, brown or 'whole-meal' bread, or gingerbread; almost all vegetables (except potatoes), either cooked or uncooked; olive-oil, which may be used in salads; treacle, eaten with bread or made into puddings; fruit of all kinds, particularly prunes and figs, which can be obtained all the year round—all tend to increase the activity of the bowels. If such forms of food were more generally used, the rest of the community would gain even more than the many vendors of 'liver pills,' and other quack medicines would lose.
The amount of fluid taken in the day is also of importance. Many persons, especially those in whom much fluid taken with meals interferes with comfortable digestion, do not imbibe enough for the needs of the body. In such cases a stated amount of fluid should be taken at other times. A tumbler of water, either cold or hot, slowly sipped during the process of dressing in the morning, is sometimes efficient in relieving constipation.
Lastly, the use of medicinal remedies must be shortly considered. Compared with the measures already noticed, they must be regarded as an evil, though often a necessary one. Constipation may be seriously aggravated by their injudicious employment. Often a large dose of some purgative is taken and produces very free action of the bowels with temporary relief; but increased constipation is almost sure to follow. The condition to be remedied is a chronic and habitual one, and must be combated by patient and persevering treatment. The medicine selected should be taken every day, but the dose must be the very smallest which will produce the desired effect.
It is impossible to enumerate all the drugs which may be used, or to define the conditions in which each is most likely to be beneficial. A few of those in most general use only must be enumerated. Natural mineral-waters (Friedrichshall, &c.) are in much repute at present: a dose should be taken on rising in the morning. Epsom or Glauber's salt, if dissolved in plenty of water, is much cheaper and almost as satisfactory. Effervescing salines (seidlitz powder, magnesia, and many much-advertised patent medicines) are more pleasant to take, and have a similar action. Castor-oil in small doses at bedtime is objectionable only on account of its flavour. Compound colocynth pills, or colocynth and hyoscyamus pills; compound liquorice powder (containing senna and sulphur, one of the best preparations); Gregory's powder (containing rhubarb and magnesia); podophyllin, euonymin, and other drugs from America, are all useful aperients, and should be taken at bedtime. Nux vomica is a useful addition to other aperients, as it acts specially upon the muscles of the intestines, increasing their activity. A word of caution is necessary regarding mercurial preparations, which are most valuable in certain cases, but most dangerous if used habitually. The indiscriminate use of calomel and gray powder in the nursery, where they are very popular owing to their tastelessness, cannot too strongly be condemned. The most generally useful of all aperients at present in use is Cascara Sagrada, the bark of a North American species of buckthorn (Rhamnus Purshiana). The liquid extract is the preparation in most general use, of which from 15 to 40 drops taken daily, either in one dose at bedtime or still better in several doses after meals, is generally sufficient. It increases the secretions, but especially the muscular power of the intestine; and in very many cases can be given up altogether after being used for a few weeks (see also APERIENTS). In some cases Clysters (q.v.) are the most satisfactory means of procuring an evacuation.
Constipation in the lower animals depends, as in man, on imperfect secretion from, or motion of, the intestinal walls. In the horse it is usually accom- panied by Colic (q.v.), and when long continued leads to Enteritis (q.v.). The appropriate remedies are soap and water clysters given every two hours; smart friction and cloths wrung out of hot water applied to the abdomen, with three drachms of aloes and one of calomel given in gruel, and repeated in sixteen hours, if no effect is produced. Give, besides, walking exercise; restrict the amount of dry solid food, but allow plenty of thin gruel or other fluids, which may be rendered more laxative by admixture with treacle or a little salt. Similar treatment is called for in dogs, cats, and pigs.
In cattle and sheep, digestion principally takes place in the large and quadriseected stomach; the bowels, accordingly, are little liable to derangement; and constipation, when occurring in these animals, generally depends upon impaction of dry hard food between the leaves of the third stomach, fardel-bag, or monplies. The complaint is hence called fardel-bound. It results from the eating of tough and indigestible food, such as ripe vetches, ryegrass, or clover; it prevails in dry seasons, and on pastures where the herbage is coarse and the water scarce. It occurs amongst cattle eating freely of hedge-cuttings or shoots of trees, hence its synonym wood-evil. From continuous cramming and want of exercise, it is frequent in stall-feeding animals; whilst from the drying up of the natural secretions, it accompanies most febrile and inflammatory diseases. The milder cases constitute the ordinary form of indigestion in ruminants, are accompanied by what the cow-man terms loss of cud, and usually yield to a dose of salts given with an ounce or two of ginger. In more protracted cases, rumination is suspended, appetite gone, constipation and fever are present. There is a grunt noticeable, especially when the animal is moved, different from that accompanying chest complaints, by its occurrence at the commencement of expiration. By pressing the closed fist upwards and forwards beneath the short ribs on the right side, the round, hard, distended stomach may be felt. This state of matters may continue for ten days or a fortnight, when the animal, if unrelieved, becomes nauseated, and sinks. Stupor sometimes precedes death, whilst in some seasons and localities most of the bad cases are accompanied by excitement and frenzy. In this, as in other respects, the disease closely corresponds with stomach-staggers in the horse.
Give purgatives in large doses, combining several together, and administering them with stimulants in plenty of fluid. For a medium-sized ox or cow, use lb. each of common and Epsom salts, ten croton beans, and a drachm of calomel, with three ounces of turpentine; and administer this in half a gallon of water. If no effect is produced in twenty hours, repeat the dose. Withhold all solid food; encourage the animal to drink gruel, sloppy mash, treacle and water; and give exercise, clysters, and occasional fomentations to the belly.