Good Health and Bad Medicine:
Carsickness And Seasickness
Constipation - Part 1
Constipation - Part 2
'gas' And Bloating
Alkalizers And Acidosis
Diet - Part 1
Read More Articles About: Good Health and Bad Medicine
Constipation - Part 2
( Originally Published 1940 )
When constipation occurs only occasionally-let us say once every few weeks or so—the best thing to do is not to molest the bowel. The normal bowel rhythm will almost in-variably reestablish itself in a day or two without the aid of laxatives. If it will make you feel easier, however, a mild laxative such as one to two tablespoonfuls of milk of magnesia, one or two Seidlitz powders, or a heaping tablespoonful of effervescent sodium phosphate may be taken. An enema is the most rational and effective remedy, but which-ever is more convenient or agreeable may be tried. If neither laxative nor enema is taken, no harm will follow.
If the constipation is more frequent or if it is severe and of long standing it is advisable to consult a competent physician before treatment is started. This is especially urgent for adults who previously were never troubled by constipation. Too often a change in bowel function means a serious organic disease of the digestive tract, colon or rectum.
If a thorough examination reveals no organic disease, the constipation can be considered to be due to functional factors and treatment can be started.
In habitual constipation of the functional variety, particularly in those instances that are mild, attention to a few rules of hygiene may be all that is necessary. The first rule to follow is to discontinue the irritation and stimulation of the bowel by one's favorite laxative, so that the normal rhythm of the bowel will have an opportunity to reestablish itself. Many people will be surprised to observe that, without a laxative, they will have a very satisfactory evacuation once every two or three days, and that such a rhythm will be maintained indefinitely. The important thing is to rid one-self of the notion that a bowel movement every day is indispensable to good health.
If the laxative habit is of long duration and the bowel has been accustomed to habitual priming and stimulation, the transition to a laxativeless routine will not be easy. During this period of reestablishment of good habits it may be useful to take a very mild laxative such as liquid petrolatum or mineral oil. One or two tablespoonfuls daily may help to keep the stool soft and thus make the transition easier. After a few weeks it may be found possible to dispense with the oil.
At the same time that one is learning to abstain from irritant laxatives it is also necessary to reeducate the bowel, to restore the natural sensitivity of the rectum and colon which had been lost by continuous irritation and stimulation. In medical terms this means to restore the defecation reflex—so that when waste material arrives at the terminal part of the colon and rectum the muscles of the bowel will reflexly respond and thus produce an evacuation.
This is a most important step in the cure of functional constipation. The specific ways by which this reeducation of the bowels may be attained are numerous. First, it is essential to obey the call to stool whenever it is felt. This will not always be possible if one is working in an office or factory where the rules of management forbid interruption of work. (A little pressure by the workers' union, however, can over-come this difficulty.)
The best time to condition the bowels to proper performance is immediately after breakfast, for it is then that the bowels are on trigger-edge, so to speak, and respond most effectively. Sufficient time (about ten minutes) should be given so that the evacuation is complete. It may be necessary to arise ten minutes earlier every morning, but once the habit is established it will repay one many times in efficient bowel action.
An additional aid in obtaining good evacuations is to use a foot stool about nine inches lower than the toilet seat. When the feet rest on the stool, the thighs are close to the abdomen so that the most efficient use of the muscles of the abdomen and rectum are obtained in evacuating the terminal part of the bowel where the waste matter is collected.
Excessive straining at stool should be avoided, since it places a burden upon the heart and blood vessels, and may lead to injury in middle-aged or elderly people or in those with heart trouble. Straining also tends to aggravate hemorrhoids.
Exercises and sports have helped many people. Their chief value is in conferring the feeling of relaxation necessary to the proper performance of any natural function. Massage is generally a waste of time.
Drinking several glasses of water daily is healthful but will not as a rule relieve constipation. Most people drink all the water they need and drinking an excess will not cure constipation. Fruit juices should be taken liberally, and for some people an extra glass of orange juice, or half a glass of prune or grape juice will furnish that extra push that will insure good evacuation.
The role of diet in the development of constipation has been exaggerated. Too much stress has been placed upon the need for bulk or roughage in the diet. Addition of more fruits and vegetables to the daily diet is healthful and should be encouraged, and has relieved many instances of constipation, but those who are troubled by "spastic constipation" cannot tolerate the roughage that fruits and vegetables supply and suffer from colic, gas and even increased constipation from the use of them. The most important requisite for a suitable diet in the treatment of all types of constipation is that it should be well balanced. In spastic constipation roughage must be excluded (see page 99).
The constipated person who is thin will profit by including more fats in the diet. The obese constipated person will profit by a reducing regime supervised by a physician. If the bowels are sensitive and prone to attacks of colic and gas, as they are in spastic constipation, roughage foods should be scrupulously avoided. The most common roughage foods are apples, nuts, cabbage, cole slaw, cucumbers, celery, pickles, radishes, broccoli, eggplant, kale, onions, rhubarb, sauerkraut, squash, spinach, beans, corn, whole wheat and graham bread.
If roughage foods can be tolerated, their addition to the diet may completely relieve the mild case of constipation. Half a dozen or more stewed prunes every morning may do the trick. Bran and other "sawdust" foods should be avoided by everyone, since they are an irritant to the stomach, colon and rectum. Bran may have a place in the diet of cattle, but many doctors are agreed that it is not fit for human consumption. Instances of obstruction of the intestine by bran accumulations have been reported, as well as cases of "gastritis" and rectal disorders.
Sour milk and buttermilk help some people. One or two glasses a day can be recommended to those who like them and who do not get indigestion from their use. Cultured milks such as acidophilus milk are being extensively advertised at present. Undoubtedly they help a few people, but they are expensive and they may cause indigestion. They certainly do not prolong life, act as a tonic or perform any of the miracles proclaimed for them by some of their exuberant devotees.
Laxative drugs for the relief of habitual constipation should be used only as a crutch until good bowel habits replace bad ones, that is, until reeducation of the bowels has occurred and an efficient defecation reflex has been restored. For some people, an effective and harmless laxative consists of salt water prepared by dissolving 1/2 teaspoonful of table salt to a glass of water. Two or three glasses of this may be sipped every morning immediately after rising and during the completion of one's toilet. The slow sipping will prevent distention of the stomach and a tendency to nausea. A glass of plain hot or cold water is sufficient for some people.
When the stools are hard and small and straining is necessary, a "lubricating" mineral oil, such as Heavy Liquid Petrolatum, may be helpful. Differences between Russian oil and American brands are too slight to be of importance. In most instances oil labeled as Russian Mineral Oil is not genuine imported oil, despite the label. The official U.S.P. Heavy Liquid Petrolatum is satisfactory in all respects, including economy. If there is a tendency to leakage, the Emulsion of Liquid Petrolatum U.S.P. may be tried.
Leakage is not the only disadvantage in the use of mineral oil. The oil may also cause gas, indigestion and rectal trouble. There is also evidence that the habitual taking of oil may interfere with the digestion and absorption of food, and particularly with the absorption of pro-vitamin A. However, these disadvantages can be overcome to a great extent by the use of a single dose of one or two tablespoonfuls taken every night or every other night before retiring. The comfort that moderate doses of mineral oil can give to some people justifies the slight or negligible risk involved.
Agar or agar-agar is the least harmful of all the bulk-producing laxatives. Emulsions of mineral oil and agar owe their efficacy, if any, solely to the mineral oil content, since none contains more than about 1% of agar. Psyllium seed and proprietary compounds such as Saraka and Serutan should be avoided, because of tendency to obstruction and irritation of the digestive tract. "Psyllium jelly" and "karaya gum" preparations should be used only under a doctor's supervision.
Cascara sagrada may be used to advantage. One to three teaspoonfuls of aromatic fluid extract of cascara may be taken daily. After a few weeks, the dose should be reduced to the smallest amount necessary for a satisfactory evacuation. Gradually the interval between doses is lengthened (once every two, then every three days). Cascara sagrada is particularly useful for elderly people who cannot be expected to submit to a discipline of bowel reeducation. What they need is a drug that will act smoothly and without much inconvenience, and cascara may meet these requirements.
The so-called saline laxatives include milk of magnesia, sodium phosphate, sodium sulphate (Glauber's salt), magnesium sulphate (Epsom salts), and Seidlitz powder. Milk of magnesia and Seidlitz powder are the mildest of these drugs and may be used for occasional constipation. One or two tablespoonfuls of the former or one or two powders of the latter will produce an easy evacuation. It should be kept in mind, however, that after the bowel has been emptied by a laxative, it requires about two to three clays for it to be filled again and ready for another evacuation. The laxative habit frequently has its beginning because people are ignorant of this fact and persist in taking a laxative every day in order to obtain a daily movement.
The other saline laxatives—sodium sulphate, magnesium sulphate, and sodium phosphate—usually have a violent effect on the bowel. They should not be taken for either temporary or habitual constipation. Despite their potential harm they are the main ingredients in the most widely advertised laxatives such as Sal Hepatica, Pluto Water and many so-called mineral waters. The latter are almost invariably made up in a factory and not from a spring.
Aloe or aloin is present in many laxative pills. It is often too irritating for occasional or habitual use. Senna, another popular laxative drug, also is somewhat irritating to the intestine. It is an ingredient of most of the herb teas on the market.
Phenolphthalein is the drug most widely used by manufacturers in the preparation of laxatives. It is the active agent of at least 150 patent medicines on the market, concealed in chocolate, candy, chewing gum and other confections and in many mineral oil emulsions.
Phenolphthalein produces a bowel movement by irritating both the small and the large bowel. The drug has acquired a notorious reputation with physicians because of the many instances of colic, gas and other evidence of intestinal irritation that have followed its use. In children it has caused more serious symptoms, such as collapse. And in both children and adults it has caused mild and severe eruptions of the skin and ulcers of the mouth. Because of the drug's many serious drawbacks, all products containing it should be avoided.
Enemas, like laxatives, are useful as aids in the reestablishment of good bowel function. As a matter of fact, they may be more useful than laxatives, since in most instances of constipation the waste matter stagnates in the last foot or so of the large bowel. It is much more reasonable to clean out this last foot with an enema than to upset the whole digestive tract from the stomach down by a laxative or cathartic. The most satisfactory solution to use is warm or tepid salt water—one teaspoonful of salt to a pint of water. Usually one pint of water is sufficient, but some people have roomy colons and require a quart. As with laxatives, the amount of water is gradually reduced over a period of weeks, and the intervals between enemas lengthened until finally their use is no longer necessary.
Some will find it preferable to use a water or oil enema instead of a mild laxative. A glycerine suppository may also be tried. Whichever method is least irritating and most convenient and agreeable should be attempted. It may take some experimentation to determine the best method. Frequently one method will work for several weeks or months and then it will fail, so that another will have to be tried. It should be kept in mind, however, that whichever remedy is used should be considered only as a crutch until good bowel habits replace bad ones.
Colonic irrigations should never be taken except under the supervision of a physician. Their value has been tremendously exaggerated. They have a limited place in the treatment of a few specific disorders. The need for them should be determined by a physician and not by the director of a "colon laundry."
Children rarely require laxatives or cathartics. Temporary constipation in an infant or child is no signal for running to the medicine chest or to the drug store for Castoria. The constipation may be due to a mild infection or a dietary inadequacy or disturbance. The normal rhythm of bowel action will return in a day or so. It is not necessary to give a laxative or an enema. In fact, they are distinctly harmful to children. If the constipation does not clear up in a few days, a doctor's advice should be sought. Habitual constipation in a child is usually part of a personality problem and frequently re-quires the services of a competent physician or child psychiatrist.
When there is abdominal pain in child or adult, laxatives and enemas must not be used, since the pain may be a symptom of acute appendicitis. Thousands of lives are lost every year because of rupture of an acutely inflamed appendix brought about by the taking of a laxative. Abdominal pain is not a signal for cleaning out the bowels. If the pain lasts more than two to three hours or is accompanied or followed by nausea, vomiting, chills, fever or weakness, it is imperative to see a physician. Taking a laxative under such circumstances may be the first step toward the morgue.
In adults occasional constipation will cause no harm, but if a mild laxative is desired, it may be chosen from the following list.
For temporary constipation:
Milk of Magnesia, U.S.P. 1 to 2-tablespoonfuls.
Bulk-producing, other than agar: