And now, after all the nutriment has been absorbed and the flora of the intestines has done its duty, the waste matter is really ready at last to be evacuated.
The mechanism is interesting. Remember that the inner surface of the colon is peculiarly constructed. It consists of a series of half-moon or semi-lunar folds or ridges which slow up the progress of the contents. Thus the passage of the digested food is delayed and sufficient absorption of the digested parts is assured.
Evacuation is made possible by the state of the intestinal contents and by the movements of the intestinal walls. The liver, you will recall, secretes bile which is sent to the intestines through the bile duct. It mixes with the intestinal contents and softens and lubricates them so that passage will be easy and will not injure the linings of the intestines. In addition, back of the feces the longitudinal muscles contract, causing the intestines in turn to contract. The circular fibres cause them to narrow. These movements travel along towards the anus, through both the small and large intestines. While all this activity is going on above, below the contents, the intestines completely relax. Thus the feces is gradually carried onward to the rectum. At this point the presence of the feces stimulates the nerves which produce a relaxation and a consequent opening of the anal sphincters. Thus the fecal matter is expelled from the body. This act of defecation is usually aided by voluntary movements on the part of the individual. During the act, frequently without thinking about it, he draws deep breaths, holding for a few moments. This depresses the diaphragm which indirectly exerts a downward pressure on the intestines. At the same time the abdominal muscles contract and exert a pressure to-wards the front and sides.
Normal elimination is easy and without strain or pain. It should leave you with a sense of wellbeing, of lightness and buoyancy. Moreover, you should feel that the waste matter has been completely evacuated. If you have to strain, or have pain or cramps or feel that evacuation hasn’t been complete, you may be sure that your colon is not functioning as it should. And it is more than probable that the cause is constipation.
The frequency of evacuations of a normally healthy person varies considerably. Some have an evacuation every other day or every forty-eight hours, while others, apparently in good health, have as many as two or three a day. Generally speaking, the frequency depends to a large extent on the amount and kind of food and the ability of the individual to digest it. Naturally, if a diet is somewhat scanty, contains little roughage or is very thoroughly digested, evacuations will be less frequent. On the other hand, hearty eaters or those whose diet contains a large amount of indigestible or undigested matter, usually evacuate with greater frequency.
These cases represent the extremes of what is generally considered normal evacuation. The average person usually evacuates or should once every twenty four hours if he eats well balanced meals of normal quantity. But if you consider yourself a normal person and don’t evacuate this often, don’t let it worry you, provided you evacuate regularly and completely. You might be running on a thirty-six or forty-eight hour schedule and are just as well off as the twenty-four hourer. What is really important is regularity with completeness of evacuation. By being “regular” you are less likely to retain poisonous waste matter which would be absorbed into the blood again. Regularity is largely a matter of habit and can easily be acquired with a little patience. If, for example, you know from experience that you feel better if you have an evacuation when you get up in the morning, or after breakfast, make it a point to try and have a movement at that time. At first, of course, your efforts might be futile, or be rather long in producing results, but if your bowels are in a healthy condition, within a short time you generally won’t have any difficulty at all. On the other hand, although regularity should be your goal, if during any other time of the day you should have an urge to evacuate, by all means don’t neglect to do so.
A simple and very valuable way of ascertaining whether the intestines are functioning properly, in addition to the regularity of evacuation, is by an inspection of the stools themselves. To be sure, an exact interpretation of them requires the scientific experience of a physician, but a layman can often discover for himself whether his stools are normal.
The normal feces vary from a darkish yellow to a dark brown, depending upon the diet. They are usually sausage-shaped or cylindrical and definitely formed, but rather soft in consistency. Ordinarily, they are a little more than an inch in diameter, although this may vary with the structure of the individual. The daily amount eliminated varies, too, but on a normal diet, it is between three and seven ounces. About one quarter of this constitutes the solids.
The feces contains any indigestible matter swallowed with the food and the undigested residues of digestible food material. They also contain, as we pointed out before, remains of bile and other digestive juices, together with certain products of metabolism that are eliminated by way of the intestines, and bacteria, both living and dead.
When the intestines are sluggish or inactive, the stools are often large and knobby. They are dry and hard, and of a dark color. Generally, the dryer the feces, the more straining is necessary for their expulsion. This is true even when there is a normal desire present. The difficult passage of the dry, hard feces frequently causes the mucous membrane of the rectum or the anus to be torn away and blood to flow. This is very serious, for permanent soreness, piles and fissures may well result.
Many persons believe that they are not victims of constipation because they have frequent desires to eliminate or have frequent and regular stools. They are often wrong, for the eliminations, while regular, may be small or incomplete, and waste matter may be gradually accumulating in the intestinal canal. For this reason, the quantity and condition of the feces themselves and not the frequency of their elimination is a more trustworthy guide when you are trying to find out whether you have constipation.
Diarrhoea produces a stool which in many ways is the opposite from that of constipation. It is usually semi-liquid in consistency, but it may become very watery. It varies from brown to green in color, the latter being frequent in young children. The discharges vary between six and twenty a day.
A deficiency of bile due to obstruction from such causes as catarrhal jaundice or gallstones produces a pale, clay-colored, putty-like stool that is markedly greasy or fatty. A similar stool may be indicative of pancreatic disease. A milk diet or vegetable and milk diet may also produce pale-colored feces.
In persons suffering from mucus colitis or intestinal catarrh, mucus is present in the stools in grayish-white lumps. Or it may be expelled as membranous casts or strings or in masses similar to frog spawn. If it is very liquid it may make the feces semi-fluid.
“Tarry” or black stools usually result from decomposed blood from the stomach, liver or the intestines above the colon. They are frequently indicative of cancer or ulcers. If the evacuations are diarrhoeal in character, the stools may be bright red in color, as the blood from the ulcer or cancer has not had time to decompose. A tarry stool may also be the result of certain meat diets, or of blackberries, huckleberries, red wine or other foods which darken the stool.
On the other hand, if the blood comes from the colon or rectum, it can usually be seen on the surface of the stool, bright red in color. It may be the result of constipation the tearing away of the linings of the canal by hard, knotty stools or it may be caused by rectal cancer, polyps, ulcers, hemorrhoids or fistulas.
Hemorrhoids may also be indicated by flat stools, although certain uterine conditions and an enlarged prostate may produce the same kind. Stools that are pipe like in shape usually point towards a prolapsed anus, but they may be caused by starvation, spasm of the colon or the pressure of dry, hard feces.
Sometimes matter of a stone like hardness is passed. These are often called concretions and may be composed of masses of fecal matter from which every bit of moisture has been absorbed. Or they may be gall or pancreatic stones.
Offensive, foul-smelling stools may be caused by any one of several conditions. Very often the diet is the cause. A large consumption of meat, for example, produces an offensive stool when putrefaction takes place. This is likewise true when certain foods which are odorous in themselves, such as garlic or onions, are consumed. Undigested food and the various processes of fermentation also produce offensive feces. Sometimes they indicate certain diseases such as rickets or jaundice.
Nearly all these types of stools may be present when one is suffering from constipation. However, this does not necessarily mean that they are caused by it. Quite the contrary, they may be the cause of constipation. In other instances the condition which is responsible for the particular type of stool may also cause constipation, and in still others the stool may appear entirely independent of constipation.