Primary constipation: Treatment

Abstract

The foregoing is an overall program which will produce satisfactory results in the most obstinate cases of Primary Constipation. In mild cases, good results are frequently obtained when the patient is instructed to take only the water and vegetables, or it may be necessary to add the salt or even the mineral oil. In extreme cases, in order to gain the confidence of his patient, the physician may outline the entire anticonstipation program in the beginning, and when he finds the patient having too many movements, he can cut down first on the oil, then on the salt, and later on fluid or diet, but one at a time, until only one defecation daily is achieved. Very frequently, in long-standing and obstinate cases, the defecation reflex has been so increased (19) that the individual is not aware that a bowel movement is imminent until great pressure is exerted. Therefore, when the regimen is first started, he should be told to be on the alert for vague symptoms of fullness in the rectum. He may wonder if he should try to have a movement. In case this occurs, and it frequently does soon after the water has been taken, he should at least go to the toilet to see what will happen. No straining is needed. If he delays, the effect of the water may be lost, and movement will not take place until later in the day, or not at all. As his habit becomes established, the threshold of the defecation reflex is lowered, and an unmistakable urge will be present. The busy family physician mav feel that this program is too involved. We do not find it so, although, it is sometimes necessary to question the patient at length in order to find in just what respect instructions arenot beine: followed. Many persons, who have taken laxatives and enemas all their lives, seem to take a fiendish delight in proving their doctor wrong, but we have found that a little persistence and patience give brilliant results in a high percentage of cases. During the past five years, prescriptions for laxatives have been almost eliminated in this clinic and in our private practice.