Haemorrhoidal Constipation

- BERNARD H.

 Haemorrhoids play an important and sometimes even the chief role in the production of constipation. We should not forget, however, that constipation, by the very fact of its existence, sometimes develops secondary haemorrhoids. In the present division we have especially in view primary haemorrhoids, or better, the haemorrhoidal disease. The disease has been described in a masterly manner by Dr. Frédault. Often symptomatic of gout, haemorrhoids constitute one of the features of abdominal venous plethora known among the Germans under the name of abdominal congestion. Among the well-known signs necessary to diagnose this form of constipation, we will briefly cite : Alternation of constipation and diarrhoea, tenesmus, haemorrhagic, serous or mucous secretion of the rectum, more or less intense pains in the rectum, coming on even without stool, gastralgia, dyspepsia, vertigo, migraine, deafness, epistaxis, bronchial catarrh, palpitations, eczema, dysuria, dental caries, abnormal development of the veins of the extremities.
 The principal remedies here are Nux vom. and Sulphur administered alone or in alternation. Their special symptoms are known to all our readers, but we will try and give their particular indications.
 Nux vom. is of service in nearly all the forms of constipation, especially the haemorrhoidal, when there is contraction or inactivity of the intestines in consequence of the diminution of the peristaltic movements, simple haemorrhoidal diathesis or haemorrhoidal flow. Tenesmus, alternation of diarrhoea and constipation, pressure in the region of the stomach and liver, distension of the epigastrium and abdomen with gas, producing dyspnoea; weight heat, pains in the side, sharp cutting pains in the hypogastrium; dyspepsia with predominance of acidity and flatulency, especially when there is at the same time menorrhagia united with a congestion of the vena portal system, or if there exists hypochondria, anxiety with attacks of congestion of the thorax or brain, night restlessness with day somnolency, chills. Also in persons of sedentary habits, students, men of letters, drinkers of alcohol, coffee or tea, in smokers of tobacco or opium, onanists, from prolonged night vigils, and abuse of purgatives.
 As already remarked many practitioners advise that the treatment of chronic constipation should begin with Sulphur, especially in the haemorrhoidal form. If the symptoms given in connection with Nux vomica have a marked chronicity; if the frequent and ineffectual desire for stool is so painful as to lead to the postponing of the act, and is accompanied by prolapse of the rectum; if the stools when passed have a chestnut-or olive-shape; if there is a concomitant pain in the vulva; if there is a distention of the belly from incarceration of gas, numerous dyspeptic phenomena, general malaise, inability to think, Sulphur is to be employed. You will have a still greater chance of success if there exists an excessive irritability of fibre and when the lymphatic, hypochondriac or haemorrhoidal subject has psoric or herpetic antecedents, either personal or hereditary.
 Aesculus is adapted to this form when it presents the character described under the spasmodic form.
 Collinsonia can. has been studied under the paralytic form.
 Lycopodium is likewise worthy of attention in many cases of haemorrhoidal constipation, when the symptoms previously given are present.
 Carbo veg. when the stools are preceded by a great quantity of gas (inodorous or fetid), but are themselves scanty and very hard; if the haemorrhoidal constipation is accompanied with pruritus, violent tenesmus or burning in the anus and pains in the hypogastrium like labor pains; if there is a mucous discharge in connection with the haemorrhoids, and at the same time the tongue is coated in the centre and red at the edges, with acidity and cardialgia.
 If there is an alternation of constipation and diarrhoea, with undigested matter and fetid flatuosities, Calcarea carb. Is indicated. This remedy in alternation with Sulphur is adapted to many cases of chronic haemorrhoidal constipation.
 If, on the contrary, diarrhoea never alternates with the constipation, and we have a delayed menstruation, with pain in the haemorrhoidal protrusions, long-standing constipation with hardness in the region of the liver, and the stools are composed of large balls connected together by mucous filaments, or small like ascarides; also in herpetic or scrofulous subjects, Graphites will be well indicated.
 Nitric acid when there is an intestinal dyspepsia and painless constipation, or if the evacuations, preceded by a great pressure, are followed by a mucous discharge and shooting pains in the rectum; if painful haemorrhoidal tumors appear after each stool, together with a bloody discharge; if there has been an excessive use of salt, or a laryngeal cough more or less analogous to whooping cough is present.
 Belladonna will be useful for distention of the abdomen, prominent projections of knots of intestines, together with heat of the head, abundant sweats, a sensation of constriction in the breast and violent pains in the kidneys.
 Lachesis should be studied when you find, in those of the haemorrhoidal diathesis, women at the climacteric age or persons of sedentary habits, an obstinate constipation, with pressure or constant constriction and great pain in the rectum and anus without stool, or if the constipation is accompanied with a feeling of weight or pressure on the stomach, with ineffectual efforts at eructation, stools hard, scanty and insufficient; prolapse of the rectum is also a special indication for this remedy.
 Many other remedies may be indicted in this form of constipation, notably Hydrastis, Nat. mur., Sepia.