Paralytic Constipation

- BERNARD H,

If the motility of the muscles of the intestine and the walls of the abdomen is weakened or exhausted in its excito-motory source, the stasis of the faecal matters is the necessary consequence of the powerlessness of the expulsive force, and we have then constipation from muscular paralysis. This is undoubtedly one of the most frequent forms met with in practice. It appears especially in subjects of an advanced age, women, infants, persons who lead sedentary life, or who live on an insufficient or innutritious diet, in the period of convalescence of those diseases accompanied by great debility, in chlorotic women and large eaters; it also forms a complication in the greater number of the affections of the nerve centers, and is present in paraplegia and many cases of metallic poisoning. Opium and lead, of which we have already spoken in connection with idiopathic constipation occupy here an important place. They will have to be employed often, either separately or alternately and according to the indications already given.
 Nux vom. and Sulphur will be often useful on indications already given, and which will be found more fully given under haemorrhoidal constipation.
 Lycopodium should be thought of when the stools are semi-solid, semi-liquid, when there is a large collection of flatulency, acidity or irresistible somnolency after eating, red ??? in the urine with severe dorsal pains preceding its emission, or accompanied with cutting, burning pains in the urethra; also if there is paleness of the tissues, moroseness, depression of spirits, syncope; ringing of the ears during stool; in onanists; if fatty degeneration of the liver is present.
 Natrum mur. will be indicated if there are fissures, throbbings, tearing and burning pains in the rectum; if there is a pressing down pain from the umbilicus to the pelvis, or a sensation of weight across the pelvis and bladder, aggravated when walking, and compelling the patient to sit bent forward; if there coexists gastralgia, pyrosis, acrid risings, a feeling of painful dryness in the mouth, and superficial ulcerations of the tongue; irritability and chronic dryness of the mucous membranes or a tendency to catarrhal affections; a disposition to cutaneous eruptions from a chill 'eczema, acne, etc.); when there are diurnal sweatings; if the mental despondency is in ratio with the degree of severity of the constipation; sensitiveness to cold and emaciation; engorgements of the liver and spleen, as well as fatty degeneration and valvular lesions of the heart, will be additional reasons for calling attention to this remedy.
 Kali carb. when, beside the special inactivity of the rectum, there is inertia of the abdominal muscles, as for example, in females who have had several abortions or numerous and painful labors; contrary to that which happens under Natrum mur. the sweats are nocturnal. The coexistence of cardiac palpitations or a predisposition to pulmonary tuberculosis will strengthen the indications.
 If contrary to Nux vom., the stools are pale and large; if the evacuation is effected only after violent efforts; if there is heavy pain, heat and itching at the anus, sensation of sand and gravel in the rectum; frequent venous engorgements and cardiac or cerebral congestions, alternating with haemorrhoidal symptoms, Collinsonia can. will be indicated.
 We use Veratrum alb. if there is dryness of the intestines, gastralgia, dyspepsia, bulimia with prompt satiety, hypochondria or mania, increased urinary secretion, abdominal engorgements, hepatic antecedents.
 When the constipation is accompanied with atony of the sexual organs, Phosphorus or Phosphoric acid are to be studied.
 Silicea when the stools are composed of large, hard, masses which are partially expelled by violent efforts but then return into the rectum.
 Causticum in gouty, rheumatic and haemorrhoidal subjects; when there is obstinate constipation from nerve and nutritive atony, with pallor of the face, pains and anxiety; and especially if the evacuations are pale, greasy, accompanied with vertigo or followed by palpitation, heat of face and sweats.
 Hepar sulph. in smokers or when there has been the abuse of Mercury.
 Alumina when there is inertia and at the same time dryness of the rectum, itching at the anus, pain in the stomach after stool.
 Among the medicines which may be consulted in addition to the above mentioned, we would name Cocculus, Staphysagria, Cinchonine, China, Aurum mur., and Prunus pad. We will have occasion also to mention some others especially Sepia.