DEAR DR. DONOHUE: Please explain rectocele and the procedure to correct it.

Also, when you have your gallbladder removed, where does the bile go? Does gallbladder trouble cause rectoceles? – Anon.

ANSWER: A thin sheet of supporting tissue and muscles separates the rectum from the vagina. If that sheet weakens, the rectum bulges into the vagina and can even protrude through the vagina to the outside. That is a rectocele. Childbirth and straining to pass stool are some of the causes that stretch and weaken the partitioning tissues.

Rectoceles can make defecation troublesome. Sometimes they hurt. The only solution to the problem is surgical. A doctor has to tighten the supporting tissue and muscles and tack the rectum back in place. All operations are unpleasant, but this operation ought not to instill great fear. It is on a par with a hernia repair. A rectocele is, in fact, a hernia – a special kind.

Without a gallbladder, bile drips from the liver into the small intestine. The gallbladder is only a storage bin for bile, and it empties its contents into the small intestine when the brain signals it to do so. The signal comes when people eat fried or fatty foods. Without a gallbladder, people can still digest fried and fatty foods. They do so by the drip method rather than the jet method.

Rectoceles have nothing to do with gallbladder trouble.

DEAR DR. DONOHUE: I am an elderly lady who experiences constipation. Is it harmful to take a stool softener daily? What type do you suggest? – J.M.

ANSWER: Stool softeners facilitate the mixing of water with fat. The mixture keeps undigested food moist and soft and easy to propel through the digestive tract. Colace is a popular brand.

However, ask your pharmacist for the kinds of stool softeners stocked in his store, and experiment. Start with the cheapest. Whichever gives you the best results for the lowest price is the one made for you.

It is not good to commit to long-term use of any laxative except bulk formers such as Metamucil, FiberCon and Fiberall. Psyllium is a generic name for a bulk former, and it is relatively inexpensive.

Why not take advantage of nature’s laxatives? They go by the name of fiber. We are supposed to get around 30 grams of fiber every day, but in Canada and the United States, most get only about half that amount. Bran, which is sometimes available in the supermarket and always available in health food stores, is a rich source of fiber. So are most fruits, especially when you eat them with their skins. Vegetables provide fiber.

I have a recipe for a natural and not-bad-tasting laxative. Mix together 2 cups of bran, 2 cups of applesauce and 1 cup of prune juice. Refrigerate the mixture and take 2 or 3 tablespoons twice a day. I don’t know who devised this concoction. I will give that person full credit when I find out who it is.

The report on constipation and laxatives has an abundance of information on these topics. Readers can order 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 read your column daily and have wanted to ask a question, but I am in my 70s and on a fixed income and am afraid I would be charged a large amount. If the charge isn’t more than $25, please answer this question. What are some preventions for osteoporosis other than calcium? – H.R.

ANSWER: There’s no charge. This is a free clinic.

Vitamin D is necessary for calcium absorption. For ages 50 through 69, 400 IU is the daily recommendation. For those 70 and over, it is 600 IU.

Exercise strengthens bones. Walking does the trick. Lifting light weights does the trick even better.

Fosamax and Actonel can restore calcium to bones. So can Fortéo, a parathyroid hormone medicine. The hormone incorporates calcium into bones. A nasal spray, Miacalcin, is another popular medicine.

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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