Medical Question Corner
By P. S. Bourdieu-Sisco
Answers by Dr. P. S. Bourdieu-Sisco, head lady physician of the Washington (D. C.) Sanitarium "I AM greatly troubled with constipation. I had an operation for piles, but am more or less troubled with them yet. I use cereals, whole-wheat bread, and have tried eating prunes and apples for supper; but this does not help me much. Have been taking injections of tepid water for six years, using about two quarts, and holding it for half an hour. I also massage the abdomen, but without much effect. What can I do more than I am doing? Mrs. C. R." TREATMENT.—For constipation one should observe a very regular program for work, repose, and eating. Any exercise that strengthens the abdominal muscles or serves to jar the abdominal contents will be helpful, such as boating, walking, bicycle riding, jumping, horseback riding, or any outdoor work. The skin must be kept active. It is a good plan to rest one hour after meals. Of course, all causes of constipation should be removed. Piles may be one cause. There are two types of constipation, the spastic and the atonic kind. The treatment in these cases is very largely dietetic. For spastic constipation avoid foods leaving too much residue in the intestine, as, for instance, coarse vegetables or fruits with their skins; also avoid stringent foods, like raspberries, blackberries, and all fruits that are unripe. One should not eat greasy foods or foods cooked in grease. Avoid highly seasoned foods, pastries, spices, all foods leaving too much indigestible residue, and all irritating foods. Drink abundantly, but not to excess, preferably hot drinks—no tea nor coffee. For atonic constipation the diet régime is, in general, the opposite of that for the spastic form. A certain amount of fat and fatty foods should be insisted on. Quite large quantities of fat, such as butter or olive-oil, may be taken with the meal, or, better, in a free form. The bulk of the diet should be vegetarian in nature, food that has much residue for the purpose of stimulating the bowel activity by its bulk, though all coarse and green vegetables should be chopped fine before using. Milk and milk products are of benefit. Acid fruits are excellent, except those containing tannic acid, like blackberries and raspberries. Large quantities of grapes produce excellent results in some cases. A large dish of prunes eaten just before retiring is very effective, and figs are also laxative. Any acid fruit before breakfast is recommended. Bread should be made of the whole kernel of the grain; that is, it should contain the bran, whether it is wheat, rye, or barley. Water should be taken in sufficient quantities, but it should be cold water, and in some cases it may be very cold, a glass before breakfast being found very helpful. Cold stimulates intestinal activity. The enema is helpful when the bowel does not move freely, but it may easily become a bad habit. If warm water is used, a few ounces of cold water should be used after the movement, in order to tone up the bowel walls. A small cold enema is often better than a larger warm one. An ounce or two of olive-oil may be taken as an enema at night and retained, insuring a movement the next morning. Medicine is, of course, the last resort, and a doubtful one, for constipation, and should be used only in cases of absolute necessity. One of the best, perhaps, is cascara in some form; but when the bowels move freely, the doses should be gradually diminished. Massage, mechanical vibration, electricity, and hydrotherapy are very useful when they can be properly applied.