Milk of magnesia is quite safe and can be taken daily without problems by patients with occasional constipation, heartburn, or dyspepsia. The most common side effect is diarrhea, although this is the desired effect for patients with constipation. Allergic reactions occasionally occur, and patients with kidney disease should not take milk of magnesia without speaking to their doctor. However, milk of magnesia is a relatively safe over-the-counter remedy if used properly. Q2. I have diarrhea almost every morning that lasts until almost 11 a.m. or later. I cannot make any appointments or commitments for mornings. Sometimes I won’t have a bowel movement for a day, then it is normal until later on in the day, and then I have diarrhea again. Will a colonoscopy help to find out what the problem is? — Joan, Nevada In the United States, the most common cause of chronic loose stools alternating with constipation is irritable bowel syndrome (IBS). This very common disorder is caused by abnormal responses of the nerves that supply the colon. IBS can be constipation- or diarrhea-predominant, or vary between the two. Typically, bowel movements are worse in the morning after waking from sleep, most likely due to the accumulation of stool overnight. IBS is also usually accompanied by a sensation of abdominal bloating. Although your symptoms, including diarrhea, fit a diagnosis of IBS, the pattern is affecting your daily functioning to a level where it would be prudent to see a gastroenterologist to rule out other causes of your change in bowel habits. This work-up should include both some simple laboratory tests and stool tests, but may also include a colonoscopy. Q3. I suffer from incontinence of the bowel. This is very embarrassing for me. I have no control of it at all and no warning when this happens; it just comes out in a pumping motion. I have to wear a pad all the time. The only thing that helps sometimes if I have to leave the house is to take Lomotil and Tylenol 3. If I’m not leaving the house I just sit it out. Does anyone else out there have this problem? If so, what do you do for it? — Rose, Arizona The first thing I want to tell you is that incontinence of the bowel, also called fecal incontinence, is a much more common condition than most realize, affecting more than five million Americans. Although this condition increases with age, many young people suffer from it as well. Common causes include constipation, diarrhea, nerve or muscle damage, or a weakened anal sphincter associated with aging. The most important advice I can give you regarding this condition is to see a gastrointestinal motility expert; not all gastroenterologists are experts in this field but any of them can refer you to one. It is essential that you get to the root of your problem, since there are a variety of causes and they are treated differently. For example, your diet may be part of the problem. The ultimate goal is stool consistency, which will allow you to have greater control over your bowels. In addition, you should avoid caffeine, which acts as a laxative, and eat several smaller meals throughout the day rather than three large ones. If your doctor determines that your incontinence is due to a loss of sphincter control or a decreased sensitivity as to when you need to defecate, he or she may suggest bowel-training exercises to help you build muscle strength. There are also a number of tests that can help pinpoint the cause of fecal incontinence. These include:
Flexible sigmoidoscopy. This procedure allows the doctor to see the inside of the large intestine from the rectum through the last part of the colon.Anorectal manometry. During this procedure, a probe is inserted into the anal canal to measure the pressure exerted by the sphincter muscles.Defecography. Also known as proctography, this radiological test measures the degree of incontinence by allowing the doctor to see what actually occurs when you empty your rectum.Anal manometry. The doctor inserts a flexible tube into your anus and then inflates a small balloon located on the tip. This shows how tight the anal sphincter is and measures your rectum’s sensitivity.Anorectal ultrasonography. A transducer (a small wand that transmits sound waves) is inserted into the rectum to allow your doctor to view images of the internal structure of the rectum and sphincter.Proctosigmoidoscopy. A tiny camera is attached to the end of a long, flexible tube, which is inserted into the rectum and sigmoid to look for signs of inflammation, tumors, or scar tissue.Anal electromyography. This test involves the insertion of tiny needle electrodes into muscles around your anus that can reveal signs of nerve damage.
Depending on the cause, different treatments or even minor procedures may be very helpful, or if necessary, a more intensive surgical solution could be indicated. In general, over-the-counter Imodium works better than Lomotil specifically for incontinence, so you may want to try this medication, particularly before leaving the house. Q4. Why do I always seem to have diarrhea during my period? Hormonal changes that occur during the menstrual cycle can alter bowel movements. For some patients, constipation appears during mid-cycle or during the menstrual period itself, while for others, loose stools predominate. However, we don’t know exactly why these female hormones change bowel habits distinctly in different individuals. You may want to try over-the-counter anti-diarrheal medications, which may improve your symptoms. If the diarrhea gets worse, then you should see a physician to rule out inflammatory bowel disease or another chronic condition. Q5. I am a cancer survivor, with many symptoms left over from radiation and chemo. I have constant (and immediate) diarrhea from short bowel syndrome. I’ve lost a lot of weight. A nutritionist suggested I eat soft protein and lots of meat but cut out all fresh veggies, fruit, and dairy. I don’t think I should take this as a final answer to my problem. Drugs that contain Vicodin help the stools become more solid. But one can’t live on narcotics! Do you have any suggestions? Short bowel syndrome can occur when 50 percent or more of the small intestine is diseased or surgically removed (resectioned). Conditions that can impair the small intestine to this degree include Crohn’s disease, ischemic insult to the small bowel (the interruption or slowing of blood flow to the intestine, which causes severe inflammation), and swelling brought on by radiation therapy. Fortunately, for many patients, the small intestine often adapts or increases its ability to absorb nutrients following injury or resection, a process that can take up to three years. For patients whose small bowel is not functioning well, a growth hormone or other hormones can be prescribed to improve the intestine’s adjustment. It is important to see a physician who can measure how well your small intestine is absorbing essential nutrients with tests such as beta-carotene and D-xylose absorption and stool fat concentration. The results can help guide your diet and your need for nutritional supplements. For example, if fat is poorly absorbed, then a low-fat diet and supplements of more easily absorbed fatty acids, like coconut oil or palm kernel oil, may help. While I would agree that protein is important for patients with a low-functioning small bowel, the fiber found in fresh fruits and vegetables can be well tolerated and actually “bulk up” the stools. Regarding medications, Vicodin and other codeinelike substances can help reduce diarrhea by slowing the small intestine’s transit time. Other drugs, such as loperamide (Imodium), work well in many patients. Finally, some patients develop bacterial overgrowth after radiation treatments — this can aggravate absorption problems and diarrhea. It would be helpful for you to meet with a physician who specializes in short bowel syndrome and discuss all of your options, from antibiotics to dietary changes. Q6. I have had diarrhea for nine months now. Is there anything I can take to remedy this? — Alice, Canada The most effective way to treat the symptoms of diarrhea is to determine what’s causing it. As a general rule of thumb, people between the ages of 15 and 30 suffering from chronic diarrhea have irritable bowel syndrome, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), or celiac disease. After age 30, other conditions become more common, including nondigestive disorders that can result in diarrhea, such as diabetes, pancreatitis, rheumatologic disorders, and the side effects of medications. In all age groups, infectious causes of diarrhea should be ruled out — risk factors for infectious diarrhea include travel and recent antibiotic use that can result in Clostridium difficile colitis. Two of the most common causes of chronic infectious diarrhea are the parasites giardia and amoeba; both organisms can be found throughout the United States and should be ruled out in your case. The main point here is that symptoms of chronic diarrhea should not be treated without a visit to your physician — he or she can help you to determine the cause of the problem and prescribe the appropriate treatment. Q7. I am a 50-year-old male, and I have been taking a senna-based laxative for about 20 years and now find myself dependent on the laxative for a bowel movement. Is there any way to kick this habit and get back to a natural bowel movement on my own? Unfortunately, senna compounds and some other over-the-counter laxatives deplete the gut of neurotransmitters over the long term and lead to the type of dependency you describe. These supplements should be used only on a very short-term basis and can be quite effective. Once senna or another stimulant depletes these neurotransmitters, long-term constipation may become permanent. Fortunately, there is another approach that works well, even for those who have become dependent on products such as senna. This approach includes drinking enough fluids daily (at least eight glasses of water or the equivalent per day), eating a high-fiber diet, and using medications known as osmotic agents. These agents include lactulose, sorbitol, and Miralax, all of which are available by prescription (Miralax has recently become available over the counter as well). Q8. I try to eat a healthy diet that includes oats, grains, fruit, and plenty of vegetables. I drink lots of water and exercise daily. Can you give me an idea why I still periodically suffer from constipation? — Jaunita, Illinois The most common cause of constipation in Western countries, including the United States, is constipation-predominant irritable bowel syndrome (IBS), an intestinal disorder that is often associated with bloating. Occasional constipation can be treated with fiber supplements such as Metamucil and Citrucel, in addition to the measures you are already taking. There is also a new over-the-counter laxative, Miralax, that has been shown to be safe and effective in patients with occasional constipation. If your symptoms become severe or more frequent, you should see a gastroenterologist to rule out other causes of constipation. Learn more in the Everyday Health Digestive Health Center.
