3. Deficient bowel secretions.

4. Other causes. Mechanical obstruction.—Anything that will hinder the free and easy passage of the feces (bowel contents). Too tight external sphincter (rectum) muscle, stricture, tumors, etc. Bending of the womb on the bowel.

Defective Worm-like Bowel Movement.—Irregular habits of living head the list causing this defective action. Everyone should promptly attend to Nature's call. Some people wait until the desire for stool has all gone, and in that way the "habit" of the bowels is gradually lost. Everyone should go to stool at a certain regular time each day, and at any other time when Nature calls. If a person heeds this call of Nature, the call will come regularly at the proper time, say every morning after breakfast. If these sensations (Nature's calls) are ignored day after day, the mucous membrane soon loses its sensitiveness and the muscular coat its tonicity, and as a result, large quantities of fecal matter may accumulate in the sigmoid (part of the bowel) or in the rectum without exciting the least desire to empty the bowels. Again, irregular time for eating and improper diet are liable to diminish this action also. Foods that contain very little liquid and those that do not leave much residue are liable to accumulate in the bowel and at the same time press upon the rectum hard enough to produce a partial paralysis.

Deficiency of the Secretions.—Many of the causes that hinder worm-like motion are also likely to lessen the normal secretions of the bowel. Some kinds of liver diseases tend to lessen the secretions of the bowel, because the amount of bile emptied into the bowel is lessened. Sometimes the glands of the intestine are rendered less active by disease and other causes.

Sundry Causes.—Diabetes, melancholy, insanity, old age, paralysis, lead poisoning and some troubles of local origin, like fissure of the rectum, ulceration, stricture and polypus.

[DIGESTIVE ORGANS 137]

Symptoms.—Headache, inattention to business, loss of memory, melancholy, sallow complexion, indigestion, loss of appetite, nervous symptoms. Spasmodic muscular contraction of the external sphincter. The bowel contents press upon it; spasm of this sphincter muscle is frequently brought on by the presence of a crack in the mucous membrane, caused by injury inflicted during expulsion of hardened feces. Instead of aiding a bowel movement, the muscles now present an obstruction beyond control of the will and aggravate the condition. The most frequent cause of disease of the rectum is constipation and anyone of the following local diseases of the rectum and anus may be a symptom of constipation. (1) Fissure or crack of the anus. (2) Ulceration. (3) Hemorrhoids (piles). (4) Prolapse (falling). (5) Neuralgia. (6) Proctitis and periproctitis.

Fissure of the anus is a common local symptom of constipation. The feces accumulate when the bowels do not move for a few days, the watery portion is absorbed; they become dry, hard, lumpy, and very difficult to expel, frequently making a rent (tear) in the mucous membrane and resulting eventually in an irritable fissure. Ulceration of the rectum and the sigmoid (part of the bowel) is a symptom of persistent constipation, because the pressure exerted upon the nourishing blood vessels by the fecal mass causes local death of the tissues.

Hemorrhoids (Piles) may be produced by constipation in several ways; first by obstruction to the return of the venous (dark) blood. Second, by venous engorgement (filling up) of the hemorrhoidal veins during violent and prolonged straining at stool. Third, as a result of the general looseness of the tissues in those suffering from constipation.

Prolapse (Falling of the Bowel).—This falling of the rectum may be partial or complete, and may be caused by straining or by the downward pressure exerted by the fecal mass during the emptying movement of the bowel. It may also be the result of a partial paralysis of the bowel caused by pressure of the feces upon the nerves.