Etiology. — Habitual constipation is more frequent in adults than in children, and more frequent in females than in males. Probably the most efficient causes of constipation are sedentary in-door habits with deficient out-door muscular exercise. The first necessarily lessens the efficiency of respiration and internal dis tribution of oxygen, thereby lessening the tone and activity of the nervous and muscular structures generally; and the omission of the latter still further lessens tissue-metabolism and excretory proc esses. If we add to the foregoing the depression of the transverse colon and the crowding of the abdominal and pelvic viscera down upon the rectum by well known female habits of dress, we will have the chief causes why females suffer much more from constipation than the male sex.
Tbe hxmorrhoidal arteries and veins are closely connected with the portal cir culation by the anastomosis between the hfflmorrhoidal branch of the inferior mes enteric, which supplies the upper part of the rectum, and the Inemorrhoidal branches of the internal iliac, which sup ply the lower part; congestion of one circulation means congestion and slug gishness of the other. The rectum, in its descent into the pelvis, goes from the left sacro-iliac synchondrosis to the mid dle of the sacrum, the ovary and tube on that side being almost in contact with it; a distension of the rectum by faecal accumulation implies a fixity of the uterus, and a congestion of the pampini form plexus and congestion of the ovary. To relieve this condition we must not rely on hot douches, iodine, or glycerin applications, but relieve the engorg,ement of the ovarian veins by the emptying of the rectum. Murray (Archives of Gyne cology, June, '91).
There is, beyond doubt, a form of habitual constipation in which there is either diminished irritability of the in testinal nerves or defective development in the muscular coat of the intestine; an hereditary factor is often present. It may be acquired through habit of sup pressing the desire, insufficient diet, or abundant diet difficult to digest, deficient in water, or too easily absorbed. Seden tary habits are also a cause, but obsti nate habitual constipation may occur even in those who lead an active life. -Disturbances in the circulation—as in heart disease, mechanical pressure, and particularly pregnancy—may produce it; but displacement of the bowel, such as occurs in Gl6nard's disease, is of doubt ful influence. Adhesion of coils of in
testine together, or to sozne other organ, is an occasional cause. The relation of constipation to mental disturbance is well known, and the theory of intestinal intoxication, also, cannot be set aside. Prognosis, as a nfle, is unfavorable. Ewald (Berl. kiln. Woch., Mar., '97).
Another very common cause of con stipation is the failure to adopt and per sistently maintain a regular time for daily defecation.
Instead, many persons frequently re sist a desire to evacuate at the regular time from pressure of other engagements, and thus the nerves of the rectum be come habituated to the contact of fmces and cease to renew the desire to evacuate except at long intervals.
Constipation generally results from di minished secretion, atonic condition, and relaxation of abdominal muscles depend ent on sedentary habits and irregularity in defecation, irrational diet, or excessive use of drugs. Kress ( Virg. Med. Semi Mo., Nov. 26, '97).
Constipation is met with in two forms: (I) general or peristaltic constipation and (2) rectal constipation; both forms may be present. In the second form most cases begin from the neglect of the habit of periodic relief, and the impairment of the evacnant function of the rectum is the primary feature, the rectum becoming no longer merely a passage and an evacu ant, but a mere receptacle like the bowel above. The habitual use of aperients is unscientific; the difficulty is in the low est portion of the canal and is not prop erly met by stimulants directed to the bowel generally, or to a large part of it. Hingston Fox (Gaillard's Med. Jour., May, '9S) So-called "dilatation of the colon" has been enumerated among the important causes of constipation both in young children and in adults.
Introduction of a large quantity of water into the intestine recommended in order to diagnose a condition of atony or dilatation. One to 11/4 pints are neces sary in order to produce the splashing sound in the normal intestine, perceptible in the neighborhood of the transverse and descending colon ; while only VG or 'A pint will prodlice the sound if there is atony or dilatation ; and in such a case it is perceptible first in the sigmoid flex ure, then in the transverse colon, and finally in the entire large intestine.