GASTROINTESTINAL DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 265

Persons visiting an area in which amebiasis is prevalent should consider examination
for infestation upon their return. The amoebae may lie quietly within the large intestine for
yearsandthenspreadtotheliver,wheretheyformabscessesfromwhichtheyoccasionally
even invade the lung. This form of the disease has a high mortality.
CONSTIPATION AND RECTAL PROBLEMS
Healthy adults rarely need to be concerned about constipation. The concept that normal
individuals should have a bowel movement every day is a myth perpetrated on bowel-
conscious people by remedy peddlers and overprotective mothers. Bowel rhythm can vary
widely.Forsomeindividuals,threestoolsadayisnormal;othershaveonestooleverythree
days.Achangeinbowelhabitsforwhichnocausecanbeidentifiedmaybesignificant,but
new foods, medications, travel, or alteration in daily schedule can produce such changes.
Thetypeoffoodconsumedplaysalargepartindeterminingthecharacterandfrequency
ofstools.Foodsthatarealmostcompletelyabsorbed,suchasliquidsorcarbohydrates,can-
not be expected to produce a copious stool. The converse is true for foods with a large un-
absorbedresiduesuchasbran,freshfruit,orvegetables.Reducedfoodintakeduetoillness
or dieting leads to smaller stool volume.
Constipation is more accurately defined as the passage of hard, dry stools rather than a
specified frequency of bowel movements. Reduced intake of fluids and disruption of nor-
mal schedules with infrequent rest stops (travel by air) all tend to cause constipation. An
adequate water intake of 1.5 to 2 quarts a day, fruits and other foods that loosen the stools,
and bran or high-fiber cereals that provide bulk help to maintain normal bowel function.
In general, laxatives have very little prophylactic or therapeutic value. If, in an unusual
situation,laxativesbecomenecessary,thebestandsafestisMilkofMagnesia®,oneortwo
tablespoonfuls or two to four tablets at bedtime.
Fecal Impaction
Underconditionsinwhichtheurgetodefecateisresisted,suchasweatherorillnessthat
confines individuals to their tents, the normal bowel reflexes may become insensitive and
permit stool to accumulate in the rectum. Dehydration may cause the water in the stool to
be reabsorbed with such avidity that a bulky, hard residue that cannot be evacuated in a
normal manner results.
The best way to determine whether impaction has occurred is to insert a lubricated and
(if available) gloved index finger into the rectum ( Fig. 19-1 ). If a mass of hard stool is
found, it must be extracted. The mass of stool should be broken up impacted stool with the
index finger and the fragments removed as gently as possible. Injury of the rectal and anal
tissues should be avoided. Following manual removal of the impaction the causes of the
impaction should be corrected.