Predisposing Factors of Constipation

By Charles Drueck

            In prehistoric man the lower bowel was probably as sensitive to irritation as any other part of the digestive tract. The customs of polite society, in short, the demands of civilization, practiced through the centuries, has more and more tended to make of the lower bowel as a distended reservoir. In our modern times various predisposing causes lead to irregular evacuations, some of which will be discussed.

Improper Food and Drink

One of the simplest causes is starvation. Many specialists believe and teach that just about as many people undereat as overeat. All such people inevitably may expect to suffer from constipation. If little food is eaten, there will of course , be little residue, and if the food is too readily assimilated, it will almost all be absorbed, and there will be little or nothing to pass down into the rectum.

Food that is concentrated, that has little residual matter, and which forms all or nearly all of an individual’s food requirements for too long a time is likely to result in constipation. This kind of constipation in itself is not harmful; but it means that such a person is neglecting to consume very vital elements, as some of the vitamins are contained only in certain rough foods. Such a procedure is likely to result in a serious “deficiency” disease in addition to the simple constipation.

It follows, therefore, that a mixed diet, composed of a variety of easily assimilated foods, as well as other kinds which contain sufficient fibrous, inert, and indigestible materials to form a residue, is that best adapted to the regulation of the normal bowels, as well as to most needs of the body. People who change their diet materially, or take, for a time, less amounts than they are accustomed to, as in travelling, visiting, or taking a sea voyage, are apt to suffer from irregular action of the bowels until they have adjusted themselves to the new conditions. A feeble or capricious appetite is another cause and also a result of constipation. Many people suffer from constipation for the simple reason that they fail to drink enough water.

The need of roughage is very important. Carnivorous animals are constipated, while the herbivorous animals have full and frequent bowel movements. Realizing this, it therefore behooves us to see that there is incorporated in to our daily regimen a sufficient quantity of roughage or vegetable material, which will leave undigested fibre in sufficient quantities to produce stimulation of the bowel, such as corn, cabbage, celery, carrots, beet tops, lettuce, spinach, watercress, kale and other green vegetables as well as seed vegetables and fruits. The dietary should also include a sufficient quantity of mineral salts, particularly sodium chloride, because of the gas development which they cause, bearing in mind that carbon  dioxide gas is one of our best laxatives. Above all, the food must not be concentrated; it must give sufficient bulk to the stool so that it will properly fill and distend the bowel, give it work to do, and thereby produce the proper stimulation to contraction, which is distention. The value of oatmeal, whole wheat bread, and bran lies in the quantity of cellulose in the husk, which is a very important element in the stimulation of the mucous lining of the bowel. People who frequent quick-lunch counters and cafeterias and who devour a full mean in 10 minutes do not properly masticate their food, thereby causing incomplete stimulation to peristalsis and consequently improper stools.

It takes the contents of the small bowel four to six hours to travel from the pylorus to the cecum, a distance of 20 feet in the average case. From the ileocecal valve to the rectosigmoid juncture the rate of progress is much slower, the average time being form 14 to 20 hours. It will be noted, therefore, that the waste products of ingested food should normally be expelled approximately 24 hours after the meal. Retention longer than that period would make the patient either a constipated or an obstipated patient, depending on the cause of this retention.

Course of Food

After the food has entered the stomach and the albuminoids are converted into peptones, it passes through the pylorus into the small intestine. As the stomach contents pass through the pyloric valve, they are acid. The secretions in the small bowel – the bile and the pancreatic juice –being alkaline when the acid contents are poured into the small intestine, coming in contact with the alkaline intestinal secretions, a stimulation, or irritation, is caused, which produces a wave of muscular contraction or peristalsis.

At the same time that the chemical reaction of the stomach content on those of the intestine is going on, certain gases are created. These gases serve to distend and increase the caliber of the bowel, and by this distention still further stimulate muscular contractions. These gases are not abnormal but serve a most useful purpose. It is when they are in too great quantities and produce too great distention of the intestinal canal that they are harmful . They then cause atony or paralysis of the circular muscle fibres and loss of muscular tone. These gases are largely reabsorbed by the blood vessels or discharged from the anus.

 

Important Bainel Stimulation

Another important source of stimulation to the coats of the bowel is the harsh, indigestible particles of food, familiarly called roughage, which are not acted upon by the digestive secretions. These also irritate the mucous lining of the bowel, and stimulate the contraction of the circular muscular fibres of the small intestine. Of no small importance is the stimulus caused by the to-and-fro movement imparted to the bowel by the movements of respiration. The upward and downward excursions of the diaphragm impart to the small bowel in particular, but also to the transverse colon. a movement which stirs up and churns, as it were, the intestinal contents. The respiratory movements change the position of the bowel, and help to keep the intestinal contents on the move. It can be easily seen, therefore, how any article of clothing, or posture assumed, or certain occupations which restrict the full expansion of the chest, will interfere with the intestinal functions and assist in causing constipation.

The intestinal contents are fluid until they reach the ileocecal valve. The mucous membrane of the colon is thicker and not so sensitive more stimulation; consequently, the stools are more solid in this portion of the bowel. If, however, an excessive amount of vegetable fibre and indigestible material is present, the colon tends to become overstimulated, over-extended, and atonic; the fecal mass moves very slowly, and chronic constipation, and sometimes fecal impaction result. The fecal material, when it reaches the sigmoid, rests until ready to be passed out through the rectum and anus.

Habitual neglect of the natural stimulus to bowel movement is brought about by lack of opportunity for regular evacuation among working people, by false modesty among others who are afraid of meeting someone on the way, and by sheer carelessness among others who simply find it inconvenient. It is interesting to learn how many adults, both men and women, who have been untrained in childhood, continue to suffer in maturity. In this same group may be included those who lack proper exercise or have sedentary occupations. Such factors are present in many individuals having normal evacuations, and in the absence of additional exciting factors constipation will always disappear following hygienic and dietetic care and cannot therefore be classed as chronic.

The Enema Habit

As the lower bowel becomes more and more distended, its expelling power is more and more reduced, and the sphincter of the anus is stronger and its natural spasmodic power harder to overcome. At the same time, as the lower bowel becomes more distended it absorbs more moisture from the contents resulting in a larger, dryer fecal mass remaining. In attempting to overcome this condition a great deal of damage is generally done which results in increased dilatation and further loss of sensibility. We refer to the habit of colonic irrigations or enemas so frequently practiced. This habit simply means the conscious taking over of the functions of the lower bowel, interrupting the orderly natural processes. The relief experienced is only temporary. The enema habit itself, becomes a cause of the very condition it is sought to overcome. It also results in washing out of the colon much food in the process of fermentation and digestion in that important organ, and in the case of malnourished people aggravates that serious condition. continued and repeated irrigations after a time become very harmful. On account of the fact that nature has given man at least partial control over the lower bowel, there is a difference in the peristaltic action of the colon from that of the small intestines.

Habit Time

The normal peristalsis or wave action of the colon occurs only at intervals and the movement is long and sweeping. These waves are much more active during the day than at night. Thus one of the most common causes of constipation is the failure to observe a regularly appointed time each day for attention to the bowels. Irregularity which means neglect or postponement of attention at the exact and proper time each day is sure to bring on constipation. It is perhaps the most common cause, certainly the chief cause for the beginning of the trouble. Lack of accommodation facilities is a cause in many industrial plants such as railroad offices, factories, large stores and so on, which employ many people without sufficient toilet facilities.

Frequently such facilities in private or corporation plants are not kept clean and so neglect of this function is encouraged. In some there is lack of privacy. However, all such defects are rapidly being remedied through more modern construction and better inspection service. A multitude of farm women, rural teachers and others who live in rural sections without benefit of sewage and toilet facilities easily establish the constipation habit because of a lack of comfortable sanitary privies. This is especially true in cold and inclement weather.

Occupation

A sedentary occupation, while not in itself cause becomes so often through the contraction lax habits about physical exercise or exertion.

 

 

Emotion

Depressing emotions such as worry, anxiety, fear, anger, may cause temporary constipation, and if not immediately overcome and adjustment made chronic trouble may ensue.

Another is hurry. Many people get up in a hurry. Bathing and dressing are done on the run. Children are hustled around in order to get them ready for school. Instead of a good breakfast for all the family, consisting of plenty of fruit and other properly prepared food leisurely eaten by all, they dash for the dining room and hurriedly bal their breakfast. And what food. Generally insipid, “quick,” patent breakfast foods, with very little food value, bulk considered. Such a breakfast is over within form three to five minutes. More hurry in a race for school, or to work in factory, store on office. The whole nervous system wound up like an eight-day clock first thing in the morning. constipation is only one of the many troubles which such living may cause.

Medicine Habit

Sometimes obstinate constipation is caused by abuse of the “medicine habit.” Prolonged use of laxatives and cathartic drugs unless carefully watched by a good physician not only often causes intractable constipation, but brings on many serious complications, such as haemorrhoids, fissures, mucous colitis, and ulcers, etc. –Med. Record.

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