DEAR DR. ROACH: I am 92 and in exceptional health. I have irritable bowel syndrome, and my digestive system goes through a cycle of constipation and loose bowels. I also have episodes of incontinence with clear liquid. I would appreciate anything you can tell me about this troubling condition. — R.B.

ANSWER: While fecal incontinence is common, many people won’t talk about it with their doctors. But there is effective treatment, and it starts with an accurate diagnosis.

Irritable bowel syndrome affects more than one person in 10, and although it does not reduce life expectancy or predispose a person to cancer, it can cause a dramatic reduction in quality of life and in people’s social and work lives. It is more common in women.

Some people with IBS have only constipation; others have only loose stools or diarrhea. Some people, like you, have mixed symptoms. To be sure of the diagnosis, other conditions — some potentially serious — need to be excluded. This is especially true for celiac disease, but also other causes of malabsorption and microscopic colitis.

Initial management of irritable bowel includes dietary changes ranging from avoidance of problem foods (e.g., beans, onions, raisins and other gas-producing foods) to a low-FODMAP diet, which is much more restrictive and should be recommended in consultation with a registered dietitian nutritionist. Because incontinence is much more likely with liquid stool, managing the diarrheal aspect of your IBS is critical. This usually means increasing fiber. Fiber for constipation is effective because it carries more water in the stool, but it is effective in diarrhea for many people as well, since it absorbs excess water.

DEAR DR. ROACH: I have a crack in my thumbnail. The crack opens up as the nail grows, and I have to trim it back. It is painful if it gets caught on anything. Is there anything I can do to heal the nail and allow it to grow back normally? — E.G.

ANSWER: It depends on how the nail is cracked. Sometimes just a drop of cyanoacrylate (the ingredient in most superglue) will seal up the crack until the nail grows back. I also have seen methods using nail polish and carefully trimmed material from a tea bag.

You can try a visit to your local nail salon. They likely have seen this problem and can use one of these methods (or another) for you.

DEAR DR. ROACH: I am wondering if forskolin is really safe for weight loss. Also, when you reach your goal and stop taking it, will all the weight come back on if you haven’t changed your eating habits? — S.C.

ANSWER: Forskolin is an extract from the Indian Coleus plant. I found two studies on its use in weight loss, neither of which showed any significant weight loss, although there was some decrease in body fat as a percentage of total weight. Thus, I can’t recommend it as an effective supplement for weight loss.

To answer your larger question, if you were to take an effective medicine for weight loss, then stop the medicine and return to your previous levels of exercise and dietary intake, you would be expected to gradually return to your previous weight. In order to maintain weight loss, from any intervention, you need to continue to eat less, absorb less or expend more energy (or some combination of those). One of the only exceptions to this rule is treating low thyroid levels, as this increases basal metabolism.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.

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