THE patients who come to me have generally tried all known methods of diet, exercise, massage, etc., so that there is nothing much left for me to do beyond finding the right remedy. But I may make a few general remarks which may prove useful.
A moderate amount of exercise is a useful measure in slight cases of constipation, but excessive exercise is just as bad as too little. For city men who have to spend the greater part of their time in offices, to and from which they travel by train, it is a very good plan to select a house just far enough from their station to ensure a tolerable walk at least twice a day. There is nothing more dismal than your “constitutional” when it is a constitutional pure and simple. But by a little ingenuity it is possible to compel oneself to take a constitutional without knowing it. Horse exercise and cycling are useful, but cyclists should resist the temptation to overdo it. A good rule to bear in mind is: never to start on a ride with the wind, or down hill, if the hill is considerable. If that is done, the rider will probably go too far without knowing it, and the return journey will have to be fought against the wind or up hill, resulting most likely in over-fatigue. Whereas if a start is made against the difficulties, the rider contends with them when he is freshest, and has the easiest part of his work for the last part of his journey.
Allied to exercise is massage and systematic movements made under the guidance of an expert. These are both of great service where ordinary exercise from any cause is inadmissible. Abdominal massage is often effective in restoring the activity of the bowels, but unless it is assisted by medicines there is apt to be a relapse when it is left off. A rather peculiar form of abdominal massage is the “cannon ball” treatment I cannot recommend it, though some claim great things for it. It consists of rolling a cannon ball (not too large, of course) round and over the abdomen whilst lying flat on the back before rising in the morning.
Hydropathy has a measure which I have seen used with success, I mean the towel pack. A towel wrung out of hot or cold (generally cold) water is laid across the body at night, covered with flannel, and fastened with another towel round the body.
Diet is a matter of great importance. Milk, eggs (especially the whites), jellies, gelatine, isinglass, are all constipating. Tea and coffee act in different ways on different subjects, producing constipation in some and looseness in others; cocoa is, so far as my experience goes, neutral, and may be safely used by all who can take it. Some of the thin varieties, as shell or nib cocoa, or Cocoa Essence, can be recommended; taken with little milk, though cream is admissible. White bread, whether it contains alum or not, is constipating to many people, and some of the excellent forms of whole-meal bread are much to be preferred, and should be used exclusively. There is no alum in them, as whiteness is not the object. Rice is also constipating, and arrowroot and milk puddings generally, and these should be avoided. On the other hand, meats and soups, fruit fresh and dried, vegetables cooked and raw, more especially green vegetables, oatmeal porridge and gruel, made with water, are relaxing. An apple or an orange before breakfast many people find of service.
Of late years it has become the fashion to drink quantities of hot water. Like other fashions this can be overdone. It should never be indulged in as a permanence, though it may be taken either night or morning for a time without much risk. The tendency is to relax and weaken the stomach.
It must not be forgotten that though the muscular coat of the bowels is composed of involuntary muscles, nevertheless the will has a good deal to say to the function. And if the call of nature is not felt at regular times, an effort should, nevertheless, be made at the time when the action should take place. Regular efforts made in this way will help considerably to restore lost or disordered function.
But after all is said and done about regimen and diet, there remain numbers of cases utterly uninfluenced by either, and if the daily pill or draught is to be dispensed with, some other medicinal action must be introduced.
On the local management of piles a few words may be said. When there is any trouble in returning prolapsing piles, or any suffering after the bowels act, it is well to encourage the bowels to act last thing at night. When there is any soreness, experience will tell that paper, even the softest, cannot be used. Water and a very soft towel are the only permissible cleansing measures. To the water, as I have said above, Hamamelis may usefully be added. Modern lavatories are so cleanly fitted up that there is no difficulty about a wash after an action. The pain can be emptied, and refilled with clean water, which may be used for bathing the parts. Hot water may be added if the cold gives pain; also the Hamamelis.