Causes Of Constipation
( Originally Published 1938 )
It doesn't require a scientifically trained mind to see what is wrong with such a day a day, too, that is all too common in any civilized community. Yet, as evidenced by the prevalence of constipation, colds and similar conditions due to unhygienic living habits, we are apt to neglect the simple rules of health. Therefore we shall review them in the following paragraphs which deal with the causes of constipation in detail.
First of all, there is diet. We have already discussed the question of diet in preceding chapters the role of calories, vitamins, minerals, water in growth and health, as well as when to eat and how to eat. We have, moreover, followed the food mass from the time it enters the mouth until after the digested elements have been absorbed, the refuse is expelled from the body. Therefore, it will not be necessary for us to discuss them in detail here. There are, however, a few phases of the diet problem to be explained which directly concern constipation.
In the first place, errors in diet which may cause constipation are innumerable. One might almost say that there are as many as there are sufferers from constipation, for individual characteristics and idiosyncrasies or sensitivities are an important factor. In the chapter on allergy, you will recall we learned that many persons are hypersensitive or allergic to common foods which scientific analysis and common experience have proven ordinarily to be easily digested and assimilable as well as highly nourishing. Naturally a digestive upset takes place when an individual consumes food to which he is allergic. Constipation may therefore well ensue.
But an allergic tendency is not the only way in which individuals vary. Some persons are so constituted that they require the strictest regularity in their diet, or can only digest so-called simple foods. On the other hand, there are many hardy souls who apparently can digest dishes of every nation, simple or rich, and who can, within reason, vary their meal time or amount of intake without discomfort. If you are of the less hardy variety, you should, of course, do everything you can to build up your strength and resistance, but don't ever worry if you can't match your hardy brother pie for pie. It isn't necessary to be a gastronomic Atlas in order to achieve happiness, success and a ripe old age. All this may be achieved by keeping your body in the best condition possible, as far as your own particular constitution is concerned.
Age, sex, temperament and physical activity must also be taken into consideration in determining the best diet for an individual. Men, of course, require a large amount of food daily and are traditionally considered to have more robust digestive apparatus. Yet I defy any one of them to eat with continued impunity the unaesthetic conglomerations served at a women's bridge luncheon.
A person of a high-strung or nervous temperament usually requires simpler and blander food than one of a calm, even temper.
Climate, race and season are also of importance when considering the relation of diet to constipation. We are all aware, for example, that in the summer time most persons "feel better" on a lighter diet and one composed of less heating foods.
Yet, in spite of these individual variations, we all require a "balanced diet," that is, a diet which contains proteins, carbohydrates, fats, minerals and vitamins, in the proportion best suited to our particular constitutions, taking into consideration the varying factors which we have just mentioned. A poorly balanced diet or one that is deficient in any of these elements is sure to cause constipation.
An insufficient amount of vitamins, as we have already learned, is detrimental to health, growth and the proper functioning of the organism. While we have much to learn about these food factors, we know that they all are concerned with the proper functioning of the intestines, at least indirectly, and that Vitamin B is directly involved with the absorption of the digested food substances from the intestines. When there is a deficiency in this vitamin, the food absorption and the passage of the mass is delayed. The sluggishness of the peristaltic movements causes the intestines to become clogged with waste matter and constipation results.
An excess of sugar and starches in the diet may cause constipation, since they provide neither mechanical nor chemical stimulation to the intestines. The other extreme is equally harmful a deficiency of carbohydrates may be at the root of constipation, although few of us are naturally inclined to avoid this type of food. The reason is very simple. The pancreas, you will recall, secretes a digestive ferment or enzyme for each of the different food elements. However, if a particular element is not consumed, or its amount is insufficient, the pancreas will not secrete the ferment whose function it is to digest that element. Eventually then, the secretion of the pancreas as a whole will become less in quantity and efficiency. Now pancreatic juice aids in the digestion of fats, breaking them down into fatty acid and glycerin. These breakdown products help to keep the intestinal contents and to promote peristalsis. It is obvious that a deficiency of this secretion will cause the fecal matter to become hard and will render peristalsis difficult. It is also obvious that a deficiency of fats will have the same effect on the pancreatic juice as a deficiency of carbohydrates. Even if the ferment is present, if no fats are in the food mass, fatty acids and glycerin cannot be formed which aid in maintaining normal peristalsis and feces of the right amount of softness. An excess of fats, by reason of the overactivity inducedĄ usually produces at first, diarrhoea, but constipation is bound to result eventually, either from the ingestion which results (most fats are not easily digested), or from the reaction which follows the diarrhoea.
Many of us are inclined to eat an overly large amount of proteins, principally in the form of meat. Putrefaction may result with its irritating effect on the delicate mucous membrane lining of the intestines.
Putrefaction means fermentation and gas which dilates the walls of the intestines, especially of the colon. The muscles lose their power to contract and the fecal matter which should be expelled, lies stagnant.
On the other hand, you will recall that we learned that proteins are muscle-building foods. If we do not eat a sufficient amount of proteins, the muscles become soft and flabby. Now this is just as true of the muscles of the internal organs as it is of the muscles we can feel and see. So often we are apt to forget this, as is entirely natural, since we don't see the muscles of the intestines, for example. The muscles of the intestines must be as firm and elastic as those of the biceps. If they are weak and flabby, fibers involved in the wave like motion and the constriction like motion cannot perform their function of elimination adequately and constipation sets in.
There are many foods which by reason of their richness in food value, should be highly nourishing. Yet they are called "indigestible" and are avoided by many persons. In reality, all our customary foods, providing they are fresh and prepared properly, are digestible. The fault lies with the individual, as we learned in the chapter on allergy, but it may also be due to the preparation, the manner in which it is eaten, nerve strain, or pre-existing constipation. However, whatever be the underlying cause, we may consider "indigestible" any food or foods which are not digested in the time or manner in which they ordinarily are, thereby causing gastro-intestinal disturbances and yielding an unusually large amount of waste matter. This undue bulk dilates the intestines, interferes with the normal secretion of its juices and injures the mucous membrane. Furthermore, putrefaction and fermentation usually take place in the undigested mass, causing further disturbance. Constipation is inevitable, even in those cases in which it is preceded by diarrhoea.
It would be ideal, of course, if we could avoid those foods which disagree with us, but the exigencies of our mode of living virtually makes that impossible. We easily can, however, see to it that when we are compelled to eat food that is not going to agree with us, that the waste matter in the intestines, which is after all poisonous to us, is flushed out completely and as soon as possible.
Equally harmful, although in a different way, are those foods which have been over-refined such as white flour and certain prepared cereals. Such foods, while they might possess high caloric values, are usually deficient in roughage, in minerals and vitamins. Such foods are naturally constipating since they in no way stimulate intestinal activity.
Overeating may both directly and indirectly be the cause of constipation. An overly large amount of food will naturally produce an amount of waste which cannot be adequately taken care of by the intestines. Digestive disturbances arise and from the undigested food and the accumulation of waste matter a toxic condition frequently results. The walls of the colon are stretched and their muscle tone is weakened. This Iack of tone increases the inactivity of the intestines and thereby causes an even greater accumulation of waste matter. In this way a vicious circle is set up.
Overeating may be harmful in another way. Usually it induces to sluggishness and laziness. We've all had the experience, or at least have witnessed it, of over eating on some special occasion on Thanksgiving Day, for example. The picture that follows the dinner that started off so merrily is familiar to all young and old draped over couches or slouched in chairs, motionless and silent, some actually sleeping. One might survive such a dinner a few times a year without any ill effects, but imagine what would happen if he made a practice of it. Not only would the mind become dull, but every muscle of the body would become soft and flabby, for most of the hours which should be spent outdoors exercising and breathing in the fresh air are spent in complete inertia. Is there any wonder that the intestines become sluggish and cannot perform their functions adequately when one consistently overeats?
Undereating, however, may be just as harmful as overeating, and in many instances it may be even more so. First, take the matter of bulk. Bulk, we have learned, is absolutely necessary, in order to stimulate peristalsis. The result in undereating is the same as in the case of overeating a loss of muscle tone and consequently an inability to expel the waste accumulations. Moreover, undereating usually implies a deficiency in vitamins and other food elements which are also needed for the proper functioning of the intestines.
Undereating has other serious effects, all of which may lead to constipation. The good nature of the fat man and the sour disposition of the thin man are proverbial. While thinness should not be taken as a measure of one's agreeableness, it so happens that a thin person is so often disagreeable that it is natural to associate the two. Undereating, of course, is one of the principal causes for thinness, but whatever be the cause, an undernourished person is weak, high-strung and extremely nervous. This, of course, is reflected in the intestines and atonic or spastic constipation may result.
Undereating may cause constipation for another reason one which is not easily remedied.The organs of the abdominal cavity are held in position by deposits of fat. If they do not have the support they require, prolapsus, that is, a falling or sagging of the organs, takes place. It is obvious that no organ can perform its functions adequately if it is not held in that particular position which has been given it by nature. This is as true of the colon as it is of the stomach. Since the supporting tissue is derived from the food we eat, a deficiency in food may cause prolapsus and hence chronic constipation will almost inevitably result.
We have repeatedly mentioned the fact that "bulk" is one of the factors necessary for proper elimination. That the reader may not be under a misconception, we should state that, although the bulk of the food intake is important, far more important is the bulk of the refuse after the digested elements have been absorbed by the blood. One might eat a large quantity of highly refined food such as a pudding made of white flour or cornstarch and a large quantity of sugar. After such a dessert is digested, very little residue or roughage would be left to stimulate peristalsis. What is required is a certain amount of indigestible fiber such as that found in green vegetables and in fruits, both of which contain chemical elements that stimulate peristalsis. But one must beware of over-stimulating the intestines by consuming too much "roughage," particularly of the various bran foods which are often eaten to "cure" constipation. Often-times this so-called "cure" will aggravate rather than remedy the condition.
An inadequate intake of water can lead to constipation. The cells of the body cannot perform their respective functions properly, they cannot absorb nourishment nor give off their waste products and they are less responsive to nerve stimuli if they do not receive a sufficient amount of water from the blood stream. All functioning is less efficient when the consumption of water is low, but there is, in addition, a special direct effect on intestinal activity. Water aids in the formation of normal, soft feces by its absorption by the indigestible portions of the food mass. A lack of sufficient water tends to create a dry, hard bowel content which cannot be eliminated with normal ease.
By water intake we are not simply referring to the amount of liquid taken in the form of pure water, but to the diet as a whole. There are many delectable foods that contain a large amount of water and which form a part of a well balanced diet, as for example, soups, milk, fruits, fruit ades and various creamed dishes. These serve the purpose of liquid as well as pure water. Herein lies an inconsistency on the part of many so called dieticians, who claim that drinking water with meals is harmful to the processes of digestion. In glancing over menus which they prescribe as wholesome, it will be observed the liquidy foods we have just mentioned form a liberal part of the meal. Surely there can be no difference between drinking a cup of bouillon and a glass of water with one's meal, providing it is not ice water and is not used to wash down the food. Too much bouillon would have the same effect as too much water it would take away one's appetite for other food and might retard digestion by diluting the digestive juices too much.
The diet itself is not the only factor involved in nourishment which may cause constipation. A person may eat wholesome food, and a healthful amount, but still suffer from constipation. This is because his eating habits are faulty. Irregularity in meal hours, an insufficient intake of food at one meal. too much food at another, hasty eating, eating when one is tired or under a severe nerve strain, all tend to produce constipation. As we have discussed this question at length in another chapter, it is not necessary to go into detail here.
It would be a fine thing if we could say to ourselves that we are going to adhere to rules of eating that best suit our particular constitutions. This, however, is impossible in any social community, no matter how small. All of us at some time or other have been under severe nervous strain and have had to carry on as usual; all of us have been compelled at times to hastily gulp down our food; all of us have been in unusual situations when we have had to eat irregularly. There-fore, it is quite safe to say that we all have at one time or another suffered from constipation because of unhygienic eating habits. Fortunately we have within our reach a simple and efficacious remedy.
In this enlightened era in which we live, most of us are aware of the importance of diet and at least spasmodically attempt to eat a well-balanced diet regularly and under favorable circumstances. But, strangely enough, the average person makes no attempt to keep his bowels in a healthy condition and when they fail to function as they should, he resorts to dangerous methods of "cure." This is sometimes due to carelessness, but far more often to sheer ignorance.
Postponement of evacuation after a natural urge is a bad practice. Such postponement produces a large hard mass of fecal matter in the rectum. This makes elimination extremely difficult and accomplished only by severe straining; sometimes it can only be accomplished by artificial measures. Postponing has another grave aspect. After the normal desire has been neglected, it does not return for a long time, and then it is usually weaker.
Undue straining, whether caused by postponement or by habit, is very dangerous and can easily lead to constipation. Many persons, sometimes for no reason other than haste, strain the muscles of the diaphragm and the outer abdominal muscles in an effort to expel the feces. This may not only eventually cause hemorrhoids or a prolapse of the anus or rectum, but at the time of the desired bowel movement, it may increase the contraction of the sphincters which control the outlet for the waste, and therefore entirely defeat the object in view. A very light tension of the diaphragm and abdominal muscles is often helpful and may be used with safety, for it does not hinder the relaxation of the sphincters which is necessary for evacuation. But under no circumstances should straining be resorted to. If it is merely a habit, it should be stopped at once, and if it is due to costiveness and hard, dry feces, the condition should be remedied.
Closely related to postponement is irregularity in evacuation. The intestines are peculiarly susceptible to habit, and when the habit of regular evacuation is not established, they may retain the waste products for a longer period of time than when one has acquired the "habit time." Elsewhere we have discussed the question of habit fully, so that here we have but to point out a further advantage of securing an evacuation at a convenient time.
While we are on the subject of habits, we should point out there is no habit so conducive to chronic constipation as the so called drug habit the habit of taking laxatives and cathartics to relieve acute constipation. More will be said on this subject in the sections dealing with the treatment of constipation. Here we shall only say that the after effects of laxatives are conducive to chronic constipation. The so called mild remedies for dyspepsia and other gastrointestinal disorders may also bring about constipation for they frequently irritate the mucous membrane and the secretory cells.
Another common cause of constipation is lack of sufficient exercise. If you stop to think what a large portion of the human body is composed of muscles, it is obvious at once that unless a proper muscle tone is maintained, the organs whose functions are largely dependent on muscular action cannot perform their functions properly. This is as true of the internal muscles as it is of the external muscles the heart, the stomach, the intestines and all the other organs composed largely of muscle carry on their work with an efficiency which is in direct ratio to the tone of their muscle fibers.
Lack of sufficient exercise and sedentary habits are all too common amongst city dwellers. in a large city, transportation is easy, much of the work requires little or no exercise, most easily accessible amusements are indoors, living quarters are small and often without adequate sunshine and fresh air. It is easy to acquire sedentary habits, which lead to laziness and sluggishness. Small wonder that the muscle tone of the intestines becomes weaker and weaker and constipation becomes chronic.
Sedentary habits not only have this direct effect on bowel functioning, but many indirect ones as well. For example, an inactive person usually overeats this does not necessarily imply that he is eating more than he should if he were living a normal life, but that he is eating too much with reference to the amount of energy he is expending. Remember, overeating almost always tends to produce constipation. Moreover, it has been observed that those who do not get sufficient exercise are frequently the ones who postpone their response to natural desire, and who are irregular in their habits. This may be due to laziness at first, but it stands to reason that as the bowels become weaker in muscle tone and become clogged with waste, the stimulus to evacuate will become fainter. Since we have discussed exercise in detail in another chapter it is not necessary to speak of the subject further.
Closely associated with sedentary habits is the problem of clothing. It is clear to everyone that any clothing which restricts and therefore does not allow proper play of muscles in their position as ordained by nature,is bound to interfere with the functioning of the organs which they support or compose. Yet fashion is so all-prevailing that if she rules that a particular silhouette be in vogue, no matter how unnatural it may be, it will be adopted. In this respect women are the chief offenders, but men are not entirely innocent.
While the old-fashioned corset with laces and stays has been abandoned to a large extent, the modern girdle of elastic is equally, if not more harmful. All the organs the stomach, the diaphragm, the liver and the intestines are pushed out of their natural position, and worse still, the pressure exerted in every direction by the garment does not allow the natural movement of the muscles. The peristaltic movements of the intestines are restricted to a large extent and as a result, the waste matter which should be expelled is held back and constipation results. But this is not all. If we exercised sufficiently and walked and sat properly, as well as observed all the other rules of right living, it would not be necessary to wear tight foundations unless the wasp waist or some other unnatural figure becomes the fashion, although, even at that, much can be achieved by the cut of an unrestricting outer garment.
However, the average person, particularly the woman, is careless and soon after she passes her teens finds that she bulges where she should gracefully curve. The quickest and easiest way to get rid of the bulge is to push it to some other region of her anatomy where she fondly believes it will not be noticeable, with the aid of a tightfitting garment that defies all the laws of anatomy. Consequently muscles lose their tone and soon cease to function normally. Chronic constipation is the penalty she must pay for her stupidity and vanity.
In its turn, constipation produces sluggishness and aggravates the already weakened condition of the intestines. The wellknown vicious circle is set up and it is almost impossible to discover which is cause and which is effect. The circle must be broken somewhere in order to restore a condition of normality. All the factors contributing to the condition must eventually be remedied, of course, but it is not possible to remedy them all at the same time or with equal quickness. It takes a long time to restore muscle tone and for organs to regain their proper positions the latter, indeed, is not always possible. The logical place to break the circle, then, is to break up constipation. To endeavor to restore health by wearing proper clothing and enjoying sufficient exercise while the intestines are clogged with toxic waste substances is absolute folly. Let us take a simple analogy. Suppose your little fiveyear old child had a decayed tooth which was causing her pain and making her ill and you took her to the dentist. What would you do if the dentist told you that her diet was deficient in the vitamins and minerals which promote the growth of strong teeth and prescribed a diet without filling or removing the bad tooth? There would be only one thing you would do take her to another dentist who would not only prescribe hygienic measures to be carried out at home, but who would treat the sore tooth. Common sense tells you that no diet or other hygienic method is going to rebuild the decayed tooth and prevent its infecting the rest of the teeth and finally impairing her whole delicate little organism. To attempt to remedy chronic constipation by exercise without regularly flushing the intestines and getting rid of the toxic wastes is just as absurd.
Before leaving the subject of tight clothing, we want to make it clear that we are not advocating the discarding of all supporting garments. Young persons may be able to do so without discomfort or harm, and with considerable benefit, but older persons who have worn supports for many years are likely to feel marked discomfort physically, and the embarrassment and other emotions experienced because of their consciousness that they don't look their best, may indeed do more harm than good.
We have now reviewed all those factors tending to produce constipation which belong to the hygiene of our daily lives. Most of them are the result of indifference and laziness or of ignorance, and the damage caused by them, provided it hasn't reached a too advanced state, may be repaired if patience and common sense are exercised. Unfortunately, however, as we have previously intimated, there are many other internal and external conditions which may produce constipation and over which we have little or no control.
Chief among these forces we may rank our emotions. Grief, fear, worry, fright, anger, exhaustion of mind and body, all may reduce the secretions of the intestines to such an extent that bowel action may be seriously delayed or reduced. How this can be, can be readily understood, if you but recall what we have written previously about the secretion of the "appetite juices" as an aid to good digestion. It has been proved, we noted, that these juices are secreted when you are in pleasant surroundings and in a happy mood. There is another, more tangible proof of the effect emotions have on internal secretions. We all have experienced a dry mouth when we have been frightened or grief-stricken.
The emotions may also tend to produce constipation in a less direct way. Most of the cases of so called nervousness can be traced to undue mental and emotional strain. Since all our organs function through the nerves, it is obvious that any disorder which involves the functioning of the nerves, will affect the action of the intestines. Frequently diarrhoea results, but it is always followed by constipation. In the section on spastic constipation we have discussed the question of constipation in neurasthenic or neurotic persons, hence there is no need to go into more detail here.
But there is one thing we want to say before we leave the subject. It is difficult for us to avoid real worries and fears, but with a little will power most of our pet imaginery worries can be dispelled. There is one worry, however, whether the object be real or imaginary which can and should be got rid of at once. This is the constant worry of hypochondriacs over intestinal inactivity and the innumerable consequences that may result. Such worry alone is sufficient to bring about constipation or to aggravate a preexistent mild case. Since constipation may increase the nervous condition, the familiar vicious circle is set up and both the nervous disorder and the constipation are aggravated to the serious detriment of the whole constitution.
As we have said, the perfect functioning of any organ depends not only on a healthy condition of the nerves which supply it, but on the muscles as well. You will recall that we have repeatedly stressed the need for a good muscle tone, but this alone is not the essential. Normal structure and position are just as necessary. If for any reason and poor muscle tone is frequently the underlying cause an organ is prolapsed or sags, its retarded or feeble functioning will eventually result in serious damage, although in the earlier stages the victim will be unaware of the abnormal condition.
The stomach is very prone to prolapsus or sagging, but the small intestines, because of their convoluted, irregular structure and position in the abdominal cavity, are less subject. The large intestine, on the other hand, is equally, if not more subject to sagging than the stomach. Some of the serious cases of constipation can be traced to the sagging of the large intestine.
There are many other structural and mechanical abnormalities which cause constipation. Among them we find strictures which may be the result of inflammations or operations. When they occur in the intestines, they contract the walls and therefore narrow the opening.
Adhesions produce a similar result. They may be due to appendicitis, peritonitis, intestinal or pelvic inflammations or the other effects of major abdominal operations. They may join the wall of a part of the intestines to the wall of another part, or they may join the intestines to another abdominal organ. This interferes with peristaltic action.
The same inflammations which we have just mentioned as a cause of adhesions may produce kinks or twists in the intestines. This results in the complete blocking of the intestinal contents. Similarly a hernia may produce persistent constipation and even a complete blocking of the intestinal tract and vomiting. Naturally such a condition requires immediate action, not only to bring about normal evacuation, but to prevent the circulation of the part of the intestine protruding through the hernial opening from being blocked and to prevent gangrene.
If the liver or the gall bladder or the bile duct is congested because of any organic or functional disturbance, the duodenum does not receive the proper amount of bile. Not only is intestinal digestion impaired, but the food mass and fecal matter do not receive the lubricating or the other beneficial effects of the bile which promote good bowel movement. Constipation is invariably the result.
Tumors in the abdominal cavity are frequently causes of constipation. Sometimes they exert a direct pressure on the walls of the intestines, thereby narrowing the passageway through the canal. Again, by exerting pressure on another organ which in turn pushes against the intestines, the same result is produced. In other cases they may interfere with secretory glands.
Pregnancy is a frequent cause of constipation be-cause the foetus, by exerting pressure on the large intestine may interfere with the peristaltic movements. An obstinate case of constipation may well result.
Likewise an enlarged prostate or a prolapsed uterus, or where either organ is otherwise out of its normal position may result in constipation.
In addition to these conditions which are located in the abdominal cavity itself, there are many systemic or organic diseases which are accompanied by constipation. Any disease, whether it is a "cold" or one that seems to be of graver import, when accompanied by fever, usually has for one of its symptoms, constipation. This is because the functioning of the glands of internal secretions is considerably weakened, as well as the normal peristaltic action of the intestines. Very often, too, the absorption of fluid from the intestinal tract is more rapid than when the body is functioning normally. And just as in the case when you don't drink enough water, dry hard feces are produced which are extremely difficult to eliminate.
The underfunctioning of the glands of internal secretion such as the pituitary and thyroid glands, is usually accompanied by obstinate, chronic constipation. Anemia is often associated with constipation. Sometimes it is the cause of it and sometimes they both arise from the same general causes. While anemia is sometimes the result of factors beyond our control, it is frequently due to improper hygienic and dietetic habits, just as constipation is. Diabetes is frequently a cause of constipation. Rheumatism, gout, arteriosclerosis and diseases of the lungs, heart, liver, kidney and pancreas in short any disease which results in muscular atony or sluggishness of the intestine may result in constipation temporary or chronic.
To sum up the causes of constipation, we may say that they may be drawn together under three broad classifications. First and foremost are all those causes which may be classified as wrong living habits. Under this heading we may put improper diet and eating habits; insufficient exercise, sleep and fresh air; restricting clothing; poor posture; careless habits of elimination, such as irregular and incomplete evacuation and undue straining; the use of drugs and other harsh remedies purported to "cure" constipation; overwork and worry.
In the second division we may put malformation and other conditions which are present at birth, although they might not be recognized at the time; and conditions which are similar in nature, such as the mal-position of the stomach or uterus, which develop later in life. The cause or causes of the latter is frequently found in the first group.
In the third division we may put organic diseases and "infections" which weaken the motor and secretory functioning of the intestines. When fever accompanies such diseases a general weakening of the intestinal canal takes place, Moreover, because of the greater absorption of fluid from the intestine, the feces become dry and hard and evacuation is difficult.
The first group is by far the most important, as far as we are concerned, for several reasons. In the first place, practically all of us at some time or other have suffered from constipation that was caused by one of the factors mentioned in the group. In the second place, with a little common sense and patience, most of these causes can be practically eliminated. Furthermore, many of the disorders listed in the other two groups can be eliminated if the errors and careless habits acquired in the course of our daily lives are corrected. In this connection, do not forget that when constipation, particularly chronic constipation, is present, a vicious circle is set up and it is difficult to distinguish between cause and effect. The constipation which might have started as a result, becomes a cause.