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constipation,infrequent or difficult passage of feces. Constipation may be caused by the lack of adequate roughage or fluid in the diet, prolonged physical inactivity, certain drugs, or emotional disturbance. Sudden unexplained changes in bowel habits can be a symptom of a serious disorder (such as lower intestinal obstruction by a growth) and should receive medical attention. Most cases of constipation can be relieved by following a diet that includes adequate roughage and fluid and by establishing regular habits of evacuation. The continued use of laxatives is inadvisable. Daily bowel movements are not essential; many persons suffer from the harm caused by constant use of laxatives and enemas in an effort to establish the desired regularity.
prolonged (more than 48 hours) retention of stools or, when there is a daily stool, difficulty in evacuating the intestinal tract, accompanied by a feeling of incomplete discharge.
Constipation is classified according to its causes as alimentary, or dietary, connected with the habitual intake of minced food that is poor in cellulose, insufficient intake of liquids, and so on; neurogenic, caused by disturbances of the conditioned reflexes (systematic suppression of the urge to defecate) and diseases of the viscera, genital organs, spinal cord, and brain; inflammatory, in diseases of the intestinal tract itself (colitis, hemorrhoids, anal fissures and fistulas); mechanical, caused by the development of an obstruction in the lumen of the intestine (tumors, fecal stones, pressure from adhesions); toxic, from poisoning by certain substances (lead, morphine, atropine); and endocrine, caused by functional disturbances of the ovaries? thyroid, or pituitary.
A sedentary life, and the obesity and pulmonary emphysema associated with it, predispose to constipation. In neglected cases of constipation there may be heart palpitations, pains in the region of the heart, headaches, dizziness, weakness, and depression. Patients often feel considerably worse because of an erroneous notion of the great danger of ordinary constipation. They are troubled by eructation, poor appetite, distortions of taste perception, rapid satiation, a feeling of fullness in the stomach, incomplete evacuation of the intestine, coliclike pains in the abdomen, and unpleasant sensations and itching in the anus. The pains are especially intense in the presence of hemorrhoids and inflammation of the rectum. Sometimes changes in the liver and biliary tract are observed. With chronic constipation, the acidity of the gastric juice may be elevated. The skin loses its elasticity and becomes flabby; sometimes hair loss and brittleness of the nails are observed. The feces may resemble those of sheep. In constipation it is important to examine the rectum (rectoromanoscopy, X ray).
Treatment, depending on the individual characteristics of the patient and the form of constipation, includes evacuant enemas, a diet with a large amount of roughage (sour black Borodino bread, cabbage, carrots, sugar beets, tomatoes, and fruits—apricots, grapes, muskmelon, watermelon); acidophilous milk, one- or two-day kefir, koumiss, lemonade, Russian kvass, and sour cabbage soup. If the patient is not obese, products with a large amount of fats are also recommended (dairy butter, vegetable oils, cod liver oil, sprats, sardines). If there are no disturbances of blood circulation, intake of an adequate amount of fluids (cold water, water with sugar or preserves) is recommended. Cocoa, wine, rice, white bread, chocolate, black coffee, strong tea, red whortleberry, bilberry, and strained foods are not permitted. Treatment for neurogenic constipation consists in removal of the primary causes and the use of tranquilizers. Used in all forms of constipation are therapeutic exercises, abdominal massage, physiotherapy, pelotherapy, and mineral waters (Essentuki No. 17, Batalinskaia, Borzhomi, Karlovy Vary). Laxatives are not recommended for alimentary, endocrine, or neurogenic constipation. Camomile infusion, a solution of table salt, or vegetable oil is used in enemas. Constipation caused by local affection of the intestinal tract and gallbladder is eliminated by treatment of those diseases. Preventive measures include avoiding cold, dry foods and long intervals between meals; learning to eat, from childhood, an adequate amount of vegetables; and developing the habit from early childhood of evacuating the bowel at a definite time. A generally hygienic way of life and occupation with physical labor and sports are of great importance in preventing constipation.
A. G. GUKASIAN