Dear Dr. Roach: I am a 72-year-old female in reasonably good health. I have an embarrassing problem that no one has been able to diagnose or treat. Within 15-45 minutes of eating, I have urgent, explosive bowel movements. These bowel movements usually happen after my first meal, but often they continue throughout the day. Several years ago, I went to a gastroenterologist and had a very thorough workup, including endoscopy and colonoscopy, labs and bile analysis. The only thing that helps is taking pain meds, which of course cause constipation. I get some relief from a cholesterol powder that contains a bile acid inhibitor.
I do not have blood in my stools, I have had no significant weight loss, and diet changes have no effect on the problem. My bowel movements are rarely formed. I take levothyroxine, Zoloft, Singulair and pantoprazole daily. Help! This problem greatly affects my ability to travel, socialize, etc.
L.C.
You have an exaggerated form of a physiological response called the “gastrocolic reflex.” When food enters the stomach (“gastrum,” in Latin), an impulse travels down the nerves to the colon, causing the urge for a bowel movement. Some people with irritable bowel syndrome have a pronounced gastrocolic reflex, but people don't need to have all of the symptoms of irritable bowel to have this response. It can indeed be significantly debilitating, especially socially.
Although I don’t have a solution for this problem that works for everybody, I do have a few thoughts. The first is to really be cautious with opioid pain medications. They slow down the muscular contractions and thus help with your problem, but they have a lot of toxicity over the long term. When they wear off, the problem will be temporarily worse. Also, sertraline (Zoloft) causes diarrhea in many people, so that might not be the best choice for a depression or anxiety medicine.
Physicians often will try an antispasmodic, like hyoscyamine. Peppermint oil is an antispasmodic as well. It can be tried 20 minutes or so before eating.
Dr. Roach writes: A recent column on head lice generated many letters and suggestions for additional treatments. There are two common treatment types I cannot recommend. The first is using household products to asphyxiate the lice, such as olive oil or mayonnaise. These aren’t dangerous, but there is no good evidence that they work.
The other treatment is kerosene, which is extremely dangerous. I am loath to mention it at all, but the fact that I get letters tells me that some people still use it; they shouldn’t.
An electric comb was recommended, but I couldn’t find evidence that it worked, despite good reports from some readers. Finally, an anti-lice shampoo based on neem oil was shown to be effective. Unfortunately, I could find it commercially available only in Australia and Europe, not in the U.S. or Canada.
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.
