Bowel Movement

Introduction
F

or close to twenty years, my mother went out every Tuesday afternoon to meet three of her friends. I often wondered what they talked about-probably their husbands, their children, and later their grandchildren, politics, or good sales. So one evening I asked her what the conversation had been about on that afternoon. She looked at me a little oddly, clearly embarrassed, and said, "Well, I must admit today's conversation focused upon our various approaches to having a good bowel movement. I'm afraid that this has become a constant topic of our conversations and we try to get hints from one another. We're all having trouble."

Failure to regulate bowel activity is one of the most common complaints of older persons and this problem applies even to individuals who are otherwise quite active, consider themselves well, and suffer from very few illnesses. So, why does it happen? And what can we do about it?

Medications and illnesses that affect bowel function
A variety of illnesses and medications affect the normal passage of food down the intestine, and the passage of fecal material through the colon to the rectum. There are a number of metabolic and endocrine disorders that can frustrate your bowel schedule. The most common is diabetes mellitus, but it can also result from conditions in which thyroid hormone activity is low, there is excess calcium, or too little potassium in the blood. Common diseases of the nervous system that can cause problems in evacuation in the elderly include Parkinson's disease, and stroke. Neurological illnesses such as multiple sclerosis rarely cause changes in the intestine themselves, but they can damage the nerves of the autonomic nervous system (which controls heart rate, blood pressure, and breathing) that may alter bowel movement.

Medications are a serious culprit of bowel problems as well. Antihypertensive drugs, calcium channel-blockers, and anticonvulsants may present problems. Iron and calcium supplements, both of which may be very important as supplemental nutrients in the elderly, and aluminum containing antacid compounds, including sucralfate, may cause constipation. Also, drugs that are used for the treatment of Parkinson's disease, antidepressants, and antipsychotic medications are all common causes of bowel roadblocks.

Diagnosing the problem
In order for your doctor to make an accurate diagnosis, tell him or her how frequently you have bowel movements. Keep a record for a week to ten days before your appointment, and record the following:

What does the stool look like?

Are you straining when you defecate?

Do you lose stools either with a little soilage on your underclothes, or is there severe fecal incontinence?

Do you have any pain in the rectum, or any stomach pain? Is this pain related to defecation?

Do you have a history of hemorrhoids or any diseases of the rectum?

Is there ever any blood or mucus in your stool?

How frequently do you take laxatives? Daily? Weekly? And be prepared to give a diet history. All these historical points are important in determining how best to manage the problems you are having, and to decide whether you need any tests to eliminate the possibility of serious bowel disease.

Treatment
The first easy treatment for your discomfort is to drink eight glasses of water a day, and add fiber to your diet. High-fiber foods include many fruits and vegetables, bran cereals, and whole-grain bread. Management without drugs should be the foundation of long-term treatment. But when you need to take a drug to treat your constipation, how should you proceed?

Laxatives
First a warning...habitual laxative use can result in distention of the colon and the rectum and can stop the urge to defecate, which can result in-you got it-taking even more laxatives. Everyone must be very careful about this problem.

So with this caution, you could start by taking an over-the-counter bulk laxative, which contains psyllium and ispaghula. These laxatives can absorb a lot of water, which makes it easier to pass stool. However, taking such laxatives makes the colon work harder, and can cause pain, discomfort, or excess gas, so you have to proceed slowly.

Other bulk laxatives include Milk of Magnesia (magnesium hydroxide) and saline laxatives. Magnesium salts draw fluid into the small bowel and cause movement of feces to the rectum. Products that contain sodium phosphate can also be used to draw fluids into the small bowel. There also are so-called hyperosmolar laxatives that include lactulose, which is a sugar that is not absorbed in the small intestine. Lactulose is broken down by bacteria in the colon and increases the water content, thereby making stool passage easier.

If these types of products don't work, you may need to use stimulant laxatives, which include senna and phenolphthalein-containing compounds such as Ex-Lax or Correctol, or bisacodyl (Dulcolax). These laxatives whip the colon into action, but often result in your needing more and more of the compound to have an effect. It is not a good idea to use senna or Dulcolax for more than seven to ten days.

Suppositories and enemas
Occasionally, if you need quick action, it is much better to use suppositories, either a glycerine suppository or a Dulcolax suppository, or you could even use an enema. However, overuse of enemas can create problems as well. The colon can get used to the enemas and depend on them for any bowel action at all. Occasionally the lower bowel can be damaged by excessive use of enemas.

Conclusion
These are a few ideas that might help ease your bowels and ease your mind. If simple measures don't work, see your doctor so that you can rule out more serious causes of your discomfort.