DEAR DR. DONOHUE: Is irritable bowel syndrome something that happens in the digestive tract, or is it something that happens only in the mind? I have terrible bloating with pain, and I have terrible constipation. My husband says it’s in my head. My doctor says it’s irritable bowel syndrome. Does diet have anything to do with it? – G.N.

Irritable bowel syndrome is in the intestines, the digestive tract. It’s a common disorder affecting about one in every 10 adults. It often begins in young adulthood, but rarely begins after age 50. People 50 and older can have the syndrome; it’s just that it more frequently starts in younger people.

The symptoms are bloating, abdominal pain and either diarrhea or constipation or alternating diarrhea and constipation.

Although neither a scope exam nor an X-ray of the digestive tract shows any abnormality, the digestive tract’s muscular walls are out of sync, and the digestive tract has become extremely sensitive to pain signals.

Your question about diet is not easy to answer. There is no special diet for irritable bowel patients, but they should note if a particular food sets off painful spasms. That food, of course, should be eliminated. Foods that give some irritable bowel patients trouble include caffeine, fatty foods, beans, cabbage, broccoli and cauliflower.

If diarrhea is a major problem, avoid fruits and dairy products. If constipation is the predominant symptom, then fiber foods are recommended. Introduce the fiber foods slowly, because they can instigate stomach pain.

Medicines have a place in treatment. Loperamide often controls diarrhea. So-called antispasmodic medicines can relax the intestinal muscles and lessen pain. Levsin, Robinul and Bentyl are examples.

Irritable bowel syndrome is not in the head, but the head can affect the intestinal tract. Mental stress worsens symptoms.

DEAR DR. DONOHUE: When I delivered my last child 10 years ago, my uterus was removed because of uncontrollable bleeding. The ovaries were left in place.

I am now 48 and wonder how I will tell when menopause starts, since I do not have a uterus. – P.M.

Women have a reliable sign of menopause when menstrual periods stop. You don’t have menstrual periods, because you don’t have a uterus. However, since menopause results from the slowdown of estrogen production, your intact ovaries will slow down their manufacturing of estrogen. You will know. The dip in estrogen gives most women hot flashes. In addition, vaginal membranes dry, and every woman can detect that. You are unlikely to need a blood test to prove you have entered menopause. Symptoms will tell you.

DEAR DR. DONOHUE: What is rheumatic fever, and why don’t we hear of it anymore? In my day, everyone feared getting, since it attacked the heart. Where has it gone? – K.R.

Rheumatic fever is the dreaded complication of a strep throat. Prompt treatment of strep throats eliminates the rheumatic fever complication.

Some strep germs jolt the immune system into production of antibodies that can attack the heart, its valves and joints. The longer the germ stays in the throat, the greater is antibody production, and the more likely it is to harm the heart and joints.

Anywhere from 10 to 30 days after an untreated strep throat, rheumatic fever can appear. Joints can suddenly swell and hurt. The swelling and pain leave one or more joints only to appear in other joints. It is a “migratory” arthritis.

Heart involvement is often silent. For a few, shortness of breath gives it away. For many without symptoms, heart murmurs can be detected. The damage to heart valves shows itself much later in life.

Some children with rheumatic fever have jerky movements of the arms and legs that look like the movements of puppets on a string. This sign, which is not frequently seen, is called St. Vitus’ dance.

The advent of penicillin contributed to rheumatic fever’s decline in North America. It has not declined in other places on the globe. There has also been a drop in the number of strep germs that cause rheumatic fever. The reason for that is not known.

DEAR DR. DONOHUE: I am a 76-year-old woman in excellent health. My doctor tells me that I have uterine prolapse. Please discuss this condition, its progress and remedies. I believe that many women would be interested in this subject. – M.F.

The pelvis is the bony container where the uterus, urinary bladder and rectum sit. They are held in place by fascia (a tough support tissue), ligaments and muscles.

Childbirth and the passage of time take their toll on these supports. As they lose strength, organs begin to sag. Uterine prolapse is a sagging uterus.

What to do about it depends on what symptoms it produces. A little drop requires no treatment. A greater drop can lead to discomfort that worsens on standing. Backache is another possible consequence.

When the uterus drops so far that it protrudes through the vagina, that is a matter that calls for action.

Kegel exercises can sometimes restore strength to the pelvic supports. If a woman stops the flow of urine in midstream, she can learn what muscles need to be contracted for these exercises. The exercises are done throughout the day regardless of place or time. Ten contractions in a row followed by a short rest period and then repeated two more times can sometimes help the pelvic supports to shore up the uterus. If a woman performs the exercises three or four times a day, she should know within six weeks if they are working.

Pessaries – hollow rings frequently fashioned from plasticlike material – can be inserted into the vagina and placed around the cervix of the uterus. The cervix is the uterus’s necklike extension into the vagina. Pessaries are sometimes difficult for some women to use, and they have to be removed from time to time to prevent irritation of pelvic tissues.

Surgery is the final solution.

You are in the driver’s seat. You make the decision when you want something done for your prolapsed uterus.

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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