Dear Dr. Roach: I hope you can help elderly folks (like myself, age 83) who have a very embarrassing situation wherein their stool seeps out of them. The problem is only noted when I sit down and find that my underwear sticks to me. The problem appears to happen anytime, and sometimes after a bowel movement.
R.C.
Fecal incontinence is a far more common problem than often realized, partially because many people are too embarrassed to even mention it to their doctors. As people get older, it becomes more prevalent, as there are additional risk factors, especially people with diarrhea (people are much more likely to have incontinence with liquid stool than with solid), diabetes and women who have taken hormone replacement.
There are many possible causes for fecal incontinence, and successful treatment depends on finding the underlying cause. However, I can recommend some general advice that will help many cases.
The first is that if stools are very hard, taking fibre or a stool softener may solve the problem. Constipation is a frequent, unrecognized and counterintuitive reason for this problem. Conversely, liquid stools are much more likely to pass involuntarily, so fibre or an antidiarrheal medicine are helpful in people with frequent loose or liquid bowel movements. Often, the problem is a decrease in nerve function in the area, both the sensory part (alerting you to the need to defecate) and the motor part (properly holding the sphincter closed when it needs to be). The fact that you are often unaware of this happening suggests a problem with sensation.
Caffeine and sugars, which are hard for some people to digest (such as lactose and fructose), should be avoided to see if that helps. A gastroenterologist is the right person to see for this if initial treatment fails. This may include an endoscopic evaluation of the rectum and measurements of the pressures in the anus and rectum. Many people don鈥檛 get help because they are embarrassed to ask for it 鈥� don't let that be the case for you.
Dear Dr. Roach: I was diagnosed with hyperparathyroidism. Is this hereditary?
C.B.
Hyperparathyroidism is a condition of excess parathyroid hormone caused by a benign tumour in the neck, and most cases are not hereditary. However, a very few cases are caused by abnormalities in the MEN gene (for 鈥渕ultiple endocrine neoplasia鈥�) or other genes.
High levels of parathyroid hormone elevate the blood calcium level. The diagnosis is most often found on routine blood testing now. Symptoms of high calcium include kidney stones, bone pain, nausea and vomiting, and decreased concentration or confusion (memorized by generations of medical students as 鈥渟tones, bones, abdominal groans and psychiatric overtones鈥�). Surgery is the preferred treatment for people with symptoms, when the calcium is very high, and in younger people (younger than 50).
Dear Dr. Roach: Is quinine effective for muscle cramps or restless leg syndrome?
R.F.
There is no evidence that quinine is effective for restless leg syndrome. For nocturnal leg cramps, quinine is modestly effective, but has significant risks, including abnormal heart rhythms, bleeding problems and allergic reactions, which happen in about two to four per cent of people who take the medication, so it is not recommended as a first-line treatment. Stretching, fluids and light exercise are first-line treatments.
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 [email protected].
