University of Virginia Library

HABITUAL CONSTIPATION

Massage and movements are now freely used for constipation. The treatment must always be local in the beginning, and afterward constitutional.

• 1. Local massage (ten to twenty minutes).
• 2. St. bending of knees (hands on hips).
• 3. L. raising body.
• 4. S. turning of body.
  

  FIG. 113.

  [Description: Drawing of a man lying on a bed. Dotted lines indicate movement to a sitting position. ]
• 5. St. beating of sacrum.
• 6. See 3.
• 7. See 4,
• 8. Flexion and extension of legs.
• 9. St. percussion of back.

Schreiber says: "Chronic constipation offers the most signal success to mechanotherapy, for it is possible to make direct mechanical pressure upon

the celiac and hypogastric plexuses, and through these to reflexly excite peristalsis; furthermore, the vasomotor nerves and the intestinal muscular fibers are directly stimulated by the squeezing to which they can be subjected.'' The treatment is indeed very effective, and it is not rare to obtain an evacuation of the bowels immediately after the manipulations.

FIG. 114.

[Description: Drawing of a man lying on a bed. Dotted lines indicate movement of the legs. ]

After the patient has taken a course of treatment he should be instructed to take every morning a few exercises to keep the bowels working properly. The patient will, as a rule, offer the common excuse he has no time for such a procedure, but the operator should rigidly insist upon it, telling him that he, by neglecting to take the exercises, may gradually lose the benefit of the course of treatment he has undergone, and incidentally, he may suggest to his patient

simply to rise ten minutes earlier and he will have ample time to perform the movements. We have selected five of the most effective exercises easily performed in the bedroom.

As in Fig. 113, the patient should lie flat on his back, without head-rest, with hands clasped back of the head; he should slowly rise to a sitting position,

and, if able, even bend forward as much as possible. When first taking the movement he will have some difficulty in keeping his feet down; tell him to put a pillow or quilt on top of his feet. By this exercise we strongly compress the abdomen, aiding in fecal movement mechanically, increasing the general peristaltic action, and accelerating the secretions from the various glands. The following four exercises (see Figs. 114—117) are very similar in their effect, and they are so clearly illustrated that we do not deem it necessary to separately describe them. (The standing bending of the body should be carefully done by patients suffering from hemorrhoids.)

Constipation is of most frequent occurrence in infancy. Less than three evacuations a day indicate a constipated condition. Place the child flat on its back in the bed, or, if convenient, on the

FIG. 117.

[Description: Drawing of a seated man with his arms extended. Dotted lines indicate movement. ]

mother's lap; smear the abdominal wall with pure olive oil, and proceed with the massage of the abdomen as previously described, paying special attention to the various parts of the colon. Colic, so frequently caused by improper action of the bowels, is often quickly relieved by massage. If the abdomen is much distended, care and judgment must be used so that too much pressure is not applied. Pass lightly over the region of the transverse colon, and never use so much pressure on any part as to cause pain. Any intelligent mother can be properly instructed to treat her child for constipation, and such knowledge will often be very useful not only directly at the time, but also indirectly afterward, as it will often save the child from irritating and weakening laxatives carelessly administered without the physician's orders. Even in cases of infants, we must not lose sight of the wonderfully strong tonic effect of the massage.