DEAR DR. DONOHUE: I have a condition I find too embarrassing to mention to my doctor. I often lose control of my bowels. I cannot begin to tell you how this has disrupted my life. I cannot socialize out of fear that I will have an accident. Can anything be done for this? – P.G.

More than 7 million people on this continent suffer the same problem: fecal incontinence. It is a source of great embarrassment, but embarrassment should not keep you from discussing it with your doctor.

The rectum is the end section of the colon. It is an expandable pouch that can hold feces until it becomes so distended that it signals the brain it is time for elimination. The brain then alerts people to visit the bathroom.

Defecation is partly voluntary and partly involuntary. The anus is the last inch or so of the rectum. It is surrounded by two bands of muscles, the sphincters (SFINK-turs). One sphincter is not under our control. It stays closed until the brain tells it to relax. The other sphincter is under our control, and it can override the relaxation of the involuntary sphincter. At least, it can do so if its function is intact. If it is not, accidents occur. So a damaged sphincter muscle is frequently the cause of fecal incontinence.

Damaged and weakened sphincters can be strengthened through exercises. One set of exercises used for urine incontinence also helps fecal incontinence. Stop the urine stream halfway through a voiding. In contracting the muscles needed to stop the flow of urine, you are contracting the muscles that can restore both urine and fecal control. Contract those muscles 10 times in a row, three times a day.

In some instances, surgery can restore fecal control. One operation takes a slender thigh muscle and reconstructs it to form a new anal sphincter. Artificial sphincters, surgically implanted, are the answer for some patients. This is a large topic, and I have treated it too briefly. Do speak with your doctor. Doctors are confronted with this problem all the time.

DEAR DR. DONOHUE: When should one be classified as diabetic? My first urine test did not show sugar. Two weeks later, the urine did show sugar. My eight-hour fasting blood test came back normal. Here is a sample of the opinions I have gotten: (1) “Don’t worry about it, for many 70-year-old men spill sugar.” (2) “You need a glucose tolerance test.” Whom should I believe? – G.G.

Blood sugar, not urine sugar, establishes the diagnosis of diabetes.

After an overnight fast of eight hours, if the blood sugar registers 126 mg/dL (7 mmol/L) or higher on two separate occasions, that is evidence for diabetes.

A blood sugar reading greater than 200 (11.1) obtained any time during the day, without regard to when food was eaten, is another criterion for diabetes.

Glucose tolerance tests are seldom done today. However, a test given two hours after drinking a sugar solution can be used to diagnose diabetes. The drink contains 75 grams of sugar. Two hours after drinking the sugar solution, a blood sugar reading of more than 200 (11.1) establishes the diabetes diagnosis.

Urine sugars are not reliable. Nor do they always correctly reflect what the blood sugar is.

You should be aware of diabetes symptoms. People whose blood sugar is high urinate large quantities, and they are constantly thirsty. Their appetites are far greater than they normally were.

DEAR DR. DONOHUE: Please explain something that is confusing me and probably a lot of others. The nutrition facts on a package of food state calories. Does the number of calories include fat calories, or are fat calories to be added to the stated number for the total calorie count? – G.C.

Let me take the confusion away. The total number of calories is the number given at the top of the nutrition label. If you have any doubt, you can tell how many fat calories are in a food by multiplying the grams of fat (usually listed on the label) by nine. That number will be less than the total number of calories.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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