DEAR DR. DONOHUE: I live in a retirement community, and constipation is the No. 1 topic of conversation. Would you kindly answer some questions we have? How is constipation defined? What can people take for it? – M.F.

Constipation is defined in a number of ways. A frequency of less than three bowel movements a week is one definition. Hard stools that are eliminated only with great straining is another way to define it. Many times, people erroneously believe they are constipated because they do not have a daily bowel movement. That’s a misconception.

The causes of constipation are as many as are its definitions. Some people – women in particular – have anatomical problems, like a rectocele. It’s a bulge of the rectum into the vagina, and it can make elimination difficult.

Both males and females can have malfunctions of their pelvic muscles or their rectal sphincter muscles.

A common cause of constipation is slow passage of undigested food through the intestinal tract with a resultant drying of the food residue.

The greatest reason for constipation is our refined diet. An insufficient supply of fiber, which retains water, causes the feces to dry and become rock-hard. The fiber problem is solved by eating fruits and vegetables, particularly those with skins. Whole grain breads and cereals are another way of getting fiber. Bran, which is available at health food stores, is a wonderful source of fiber. Metamucil, Perdiem, Fiberall, Citrucel and FiberCon provide needed fiber. They can be used daily without fear of developing a laxative habit.

Alarm signals that sound when constipation indicates serious trouble are: blood in the stool, weight loss, loss of appetite or a sudden change in elimination patterns. For those symptoms, a call to the doctor is urgent.

The new pamphlet on constipation gives a more complete rundown on this common problem. Readers can obtain a copy by writing: Dr. Donohue – No. 504, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have a dear friend diagnosed with multiple sclerosis. While at lunch, another friend sat with us and commented to my friend: “You don’t look sick, and anyway you don’t die from MS, so what’s the big deal?” Please explain what the devastating effects of MS are, even though someone doesn’t look sick. – K.

The damage multiple sclerosis does is in the brain and spinal cord, places where no one can see. MS is a series of scars spread throughout those structures. The location of those scars determines an individual’s symptoms.

Most MS patients have what is called relapsing-remitting MS. Numbness of a leg, difficulty using a hand, fatigue and urinary bladder problems might arise and then, with time, become less pronounced or disappear. However, down the road another set of symptoms appears, and with time many of those symptoms become permanent.

Optic neuritis – inflammation of the optic nerve – blurs vision and is often a symptom of MS. No one but the affected person can detect it.

People don’t die from multiple sclerosis, but they do die with it.

Eighty-five percent of MS patients are alive 25 years or more after their condition was first diagnosed.

Friend No. 2 wins an Oscar for stupid insensitivity.

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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