There are, of course, a great many other causes for constipation but these are the important ones. When we find the cause of any particular case it will suggest the remedy and we must employ it faithfully if we hope to effect a cure. If it is negligence, we must correct that fault and compel our daily routine to accommodate itself to a regular observance of this function. If it is lack of exercise, we must get more exercise, or if it is lack of bulk in our food, we must change our method of living and select with more care the foods we eat. If it is lack of water, we can correct the constipation by adding the proper amount of water at the proper time.

A patient who has been a victim of chronic constipation for some time must live a life somewhat after the following general plan:

She should increase the vegetables, fruits, and fats in her diet and she should drink enough water. It is a good plan to sip slowly one-half pint of hot or cold water morning and evening. Daily exercise in the open air is advisable; exercise of some kind, even if taken indoors, is imperative. Walking, riding, bicycling, tennis, golf, swimming, are the best forms of exercise for women. Indoor gymnastics can be made a satisfactory subst.i.tute. After the exercise a hot shower bath and a cold sponge bath or cold plunge or a swim should follow.

Women in very moderate circ.u.mstances may walk briskly a distance of three or four miles, and on returning can take a warm bath followed by a brisk rub-off with a coa.r.s.e towel wrung out of cold water, or they can use a hose with a spray nozzle and allow the cold water to run over them for a few seconds after the warm dip in the bath tub. After the adoption of these measures the bowels may tend to regulate themselves. If so, this is the proper time to cultivate the habit of regularity, by selecting a certain time each morning or before retiring for this function. The patient should go to the toilet at the regular time even if the desire is not present. By straining slightly, and by encouraging the voluntary desire, the bowel may receive the necessary stimulation and an evacuation may result. If there should seem to be no disposition on the part of the bowel to become accustomed to this procedure, we must aid it for the time being. A glycerine or soap suppository, a gla.s.s of aperient water, Pluto, Hunyadi, Apenta, or the imported Carlsbad salt in warm water, or the effervescent Citrate of Magnesium, will result in a prompt emptying of the bowel. There are a great many other cathartic drugs and many well-known laxative pills, etc., but these are not necessary if a systematic effort is being made to cure the constipation, because success will come within a reasonable time if the patient will not become unduly discouraged. Many victims are deficient in fat; the bowel needs lubrication; we therefore recommend a good quality of olive oil, one tablespoonful after each meal. Frequently it is of advantage to inject, high up in the bowel, two or three ounces of sweet oil at night, as is done in children, and which is fully described in the previous chapter.

If the constipation is due to deranged nerves, in which the reflexes of the intestinal wall seem to share, we advise ma.s.sage of the abdomen, and an occasional hot or cold rectal injection. The proper quant.i.ty to use for this purpose is from two to three quarts. The solution to use is the normal salt solution. See page 627.

In that form of incomplete constipation in which we stated that there was a layer of hard, impacted feces covering the bowel wall, a special method of treatment is necessary. In these cases nothing will succeed as satisfactorily as very hot, high rectal injections. The object of course is to rid the bowel of the old, hard, dry ma.s.s, which has collected there, before we can hope to get the bowel into condition to perform its own work. It is almost incredible that the human bowel can hold so much old dried-out, nasty stuff as is stored up in these constipated bowels.

Hot salt water, as hot as can be tolerated, two or three quarts at a time, is the correct way to dislodge this ma.s.s. It will not be done at once; it frequently takes two or three weeks before the bowel is fairly clean. The irrigations should be given every second night until the bowel is clean. The method of giving these washings is fully described on page 312. While these irrigations are being given the patient should take olive oil by the mouth, one tablespoonful after each meal. The proper food, open-air exercise, sanitary living, plenty of water, and regular attention to the bowel movements will in the end cure the affliction.