Spasmodic or constrictive Constipation

- BERNARD H,
The spasmodic action of the sphincters which opposes itself to the evacuation of the effete materials and perhaps also the spasm of the expulsive muscles, says Villemin, promotes the retention of stercoraceous matters and causes constipation from muscular spasm. It is besides impossible to call in question the existence of this form of constipation when we have read, in Boyer, for example, the history of fissures of the anus. This variety of constipation occurs especially in hysteria, hypochondria, chorea and as a general thing in all neuropathic subjects.
 In the great majority of cases it will be well to begin the treatment with Nux vom. and Sulphur, either in succession or alternately.
 If there are involuntary and at times periodic contractions of the anus with shooting pains deep in the anus, tenesmus either before or after an evacuation, and also prolapse of the rectum or fissure of the anus (Sedum acre), Ignatia is to be preferred. A sensation of crawling and itching in the rectum, as of worms, a dull pain in the rectum as if distended by gas, the etiological influences of a cold or carriage riding, and the complication of neuroses with or without spasms, characterize the indications for Ignatia.
 If there exists every evening before going to bed a formicant tenesmus, and a violent pressure in the rectum without any evacuation, Platina is of service.
 For pain and a paralytic sensation in the lumbar region spreading to the hips with aggravation on motion; if after the stool there arise marked sensations of constriction, prolapsus, fullness, dryness, itching and tenesmus, Aesculus. Hale compares Aesculus and Nux vom.; they have in common, hard, knotty and dry stools, and differentially, a white color for Aesculus, and a blackish-brown for Nux vom.
 For urging desire and fruitless efforts at stool accompanied with erections, or when there is severe pain in the anus during an evacuation, Thuja.
 The tenesmus ad also prolapse of the rectum are within the sphere of action of Mercurius and Podophyllum.
 Calcarea carb., Carbo veg., Magnesia mur. and Zincum, may at times be consulted with benefit. 

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