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Frequent bowel movements without pain
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DEAR DR. ROACH: I am a 77-year-old female in good health. I am 5 feet, 2 inches tall and weigh 125 pounds. I exercise regularly and eat a varied, healthy diet. For some years now, I have had what I consider too many bowel movements every day. I have complained to my doctor at my yearly checkups, but nothing ever gets resolved except for the diagnosis of IBS. My last doctor recommended I take Metamucil, and that helps in the passage, but not the frequency. Upon arising in the mornings, I have two to four good-size bowel movements without fail, with more throughout the day. I do experience gas, too, although it is not as bad as it was before the Metamucil. It seems that every time I eat, I experience some gas or have to eliminate. Isn’t there some way to quiet my system and eliminate just once a day? -- C.H.

ANSWER: Irritable bowel syndrome involves both a change in bowel habits (too many or too few; occasionally these alternate) and chronic abdominal discomfort or pain. IBS is very common, especially among women, and can be frustratingly difficult to treat, on occasion. It sounds like you don’t have any chronic discomfort, just increased numbers of daily bowel movements. 

I agree with your previous doctor’s recommendation of fiber (such as Metamucil), as it is the mainstay of initial pharmacologic therapy and is used when changes in diet have failed to relieve symptoms.

In general, I recommend minimizing the amount of medication taken. Although I suppose it could be possible to use medication to reduce the number of bowel movements a day, I wouldn’t recommend it in absence of chronic pain or discomfort. In my opinion, the treatment might make things worse than the symptoms you have now. I would recommend that you avoid foods that tend to promote excess bowel movements, especially including those with nonabsorbable sugar alcohols, like sorbitol, mannitol and xylitol. 

DEAR DR. ROACH: My mom is required to take warfarin for atrial fibrillation. She tells me and her doctors that it makes her feel ill, similar to heartburn. She also notes joint pain, muscle “pulls” and a bad taste in her mouth. Her doctors tell her and our family that they are not familiar with anyone having such side effects. Are you? What are the worst side effects you’ve heard of? -- D.M.

  ANSWER: Warfarin (Coumadin) is a powerful anticoagulant medication. Its major side effect is increased propensity to bleed, especially at high levels (the effect of warfarin is measured by a blood test called the INR, which for most people should be between 2 and 3). However, other side effects are possible, and I have heard of a bad taste in the mouth and both nausea and abdominal pain. I am concerned about the joint and muscle pains, since these might represent bleeding into the affected joints and muscles, but hopefully her doctors are monitoring her level carefully and are doing exams to look for bleeding.

  The most dangerous side effect, in addition to bleeding (which in itself can be fatal), is a rare complication that happens when people first start on warfarin, called skin necrosis. This is thought to be related to low levels of protein C and usually happens when very large doses of warfarin are used initially. I have seen two cases in my career, which is two too many.

  Many people are on newer alternatives to warfarin, which do not require monitoring and have similar or lower rates of serious bleeding. The effects of warfarin can be reversed in the case of severe bleeding. This is not true of the newer drugs.