It is now accepted that adequate preparation for most barium enema examinations is essential, particularly if the double contrast technique is to be used (Fisher 1923; 1925; Case, 1937; Welin, 1958). Several studies have shown that preparation with laxatives may be as good as, or better than, colon washout (Sowerbutts, 1960; Prat, Peynon and Prie, 1965; Mitchell, 1967), and may cause the patient far less discomfort. Controlled trials have demonstrated the superiority of a standardised senna preparation (Senokot) over cascara (Duncan, 1957), and of bisacodyl (Dulcolax) over glycerine suppositories (Church, 1959) and over castor oil (Keogh and Fraser, 1958; Popell and Bangappa, 1959; Ritan, 1962). Recently laxative preparations including the faecal softener and detergent dioctyl sodium sulphosuccinate (Wilson and Dickinson, 1955; Hyland and Foran, 1968) have been introduced and it seemed of value to compare in a double blind trial three of the most widely used laxatives, Senokot DX (sennosides A and B 14 mg), Dulcolax (bisacodyl 5 mg) and a preparation consisting of bisacodyl 5 mg, and dioctyl sodium Read more [...]

The British Medical Journal, Feb. 22, 1936 Before beginning the treatment of a case of alleged constipation one should ascertain whether the patient really is constipated or only believes himself to be so. He should therefore be instructed to stop all aperients for three days, taking only a teaspoonful or two of paraffin at night to keep the contents of the bowel soft. If at the end of that time there has been no proper relief, constipation may be diagnosed. If the rectum is full of faeces it is a case of dyschezia; if not, of Colon constipation, of which there are two varieties: (1) atonic; (2) spastic. Atonic Constipation General Management Insist on the patient's making a regular daily attempt at evacuation and giving enough time to the act. See also that the seat is not too low nor the closet too cold. It may be necessary to advise more exercise, especially such as is calculated to strengthen the abdominal muscles. Massage is often useful if the abdomen is flabby and distended. It may be done by the patient himself lying on his back in bed night and morning and following the course of the Read more [...]

It is the purpose of this communication to present the symptoms and the findings associated with chronic fecal impaction in children, and to outline a method of treatment. This distressing condition is not rare, and it may easily go unrecognized. It causes disturbing psychologic problems for both the child and the parents — problems that can quickly abate when the cause is known and the treatment started. The series here reported upon included 17 patients, nine females and eight males varying in age from three months to ten years. The average age was 7.25 years. Nine of the patients were between seven and ten years of age. The duration of the symptoms varied from two months to five years, with an average of 19 months. Clinical data is summarized in Table 1. TABLE 1. — Clinical Data on 17 Cases of Fecal Impaction in Children Case Age Sex Duration Degree of Pain* Degree of Soiling* Degree of Bleeding* Anal Injuries* Degree of Patulous Sphincter* 1 7 years M 3 months 0 3 0 0 1 2 8 years M 5 years 0 4 0 0 3 3 9 years F 3 years 3 0 % 2 0 4 8 Read more [...]

There is perhaps no drug which has attained such a wide and universal currency for this purpose in the civilized world of today. Its acceptance is based on the belief that mineral oil is a bland and innocuous intestinal lubricant, while the numerous and considerable deleterious effects which may follow its continued administration have failed to be recognized. In this paper attention will be drawn to the effects of mineral oil in disturbing normal physiologic processes, as well as to the pathologic changes which may attend its use. The texts on pharmacology suggest no rational therapeutic basis for the use of liquid paraffin, the chemistry of which is, to say the least, uncertain. The rectum is not a reservoir. Functionally it is but a short passage to the exterior. The use of mineral oil as a laxative is open to severe criticism on the ground that it destroys the normal physiologic processes. When mineral oil is present in the rectum complete evacuation is impossible. The use of mineral oil was shown to be the cause of weight loss in children by Till and Dutcher. Mineral oil, Read more [...]

Introduction The more cases of constipation I see the greater is the number in which the cause seems to me to be of a nervous or mental nature. In scores of cases I have seen it come and go according as the patient's mind was agitated or at rest. This is not so surprising when, as usually happens, the X-ray shows no sign of abnormality in the tract; the remarkable thing is that the same observation can be made in people with definite lesions interfering with colonic action. I know people whose bowels are all matted together after pelvic peritonitis, and yet they have no constipation. Others with similar adhesions, operatively demonstrated, suffer most of the time from an obstinate form of constipation; yet they have had periods of relief lasting weeks together, when the bowel movements were perfectly normal. This occurred generally when they were on a vacation or otherwise mentally at peace. I have seen a man with obstruction so severe that he came near being operated upon, yet his bowels moved perfectly a few days after a tremendous strain let up. Any thinking physician must wonder also at Read more [...]