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Tips for better bowel control – Harvard Health – Harvard Health



Try simple measures first, like using a fiber supplement and treating underlying conditions.

Nobody wants to talk about or even imagine it. But loss of bowel control — known as fecal incontinence — is a problem for millions of adults in the United States, especially women.

“It becomes more common with age. It’s socially isolating and takes away your dignity. You live in fear that you have stool in your pants and people can smell it. Some people won’t even tell their doctors about it,” says Dr. Kyle Staller, a gastroenterologist at Harvard-affiliated Massachusetts General Hospital.

Symptoms and causes

Feces can leak out of the rectum accidentally — in liquid form or as solid stool — for a number of reasons. One is that age tends to weaken muscles, including the anal sphincter (the muscle that holds in feces until you’re ready for a bowel movement).

Damage to nerves or muscles can also lead to fecal incontinence. You may experience damage from rectal surgery, inflammatory bowel disease, multiple sclerosis, stroke, childbirth, or diabetes, for example.

Fecal incontinence can be an effect of chronic diarrhea from conditions such as irritable bowel disease. Impacted stool due to constipation can also cause fecal incontinence.

And sometimes, fecal incontinence is the result of an attempt to thwart constipation. “Older people frequently take laxatives and stool softeners because they’re worried about constipation. That creates loose stool. If age has weakened the muscles of the anal sphincter, fecal incontinence can occur,” says explains Dr. Jennifer Irani, a gastrointestinal surgeon with Harvard-affiliated Brigham and Women’s Hospital.

Try this at home

Both experts suggest trying simple fixes for fecal incontinence before seeking treatment from a doctor.

You can cut back on stool softeners and laxatives, if those are causing the problem. Or you can bulk up your stool (so it’s easier to hold on to) with an over-the-counter fiber capsule or a powder that you can add to a drink or food. Examples include Metamucil, Citrucel, FiberCon or Benefiber.

“Fiber won’t constipate you,” Dr. Irani says. “The rectum is smart and can sense bulkiness. When you have more sensation, you have more time to get to the bathroom,” she says.

You can also try bulking your stool with dietary fiber. Legumes such as beans and lentils are a go-to source. For example, a cup of canned low-sodium black beans has about 17 grams of fiber. A cup of cooked lentils has about 16 grams of fiber.

Taking a nonprescription antidiarrheal medication such as loperamide (Imodium) can work if you have incontinence with diarrhea. “It’s okay to take it every day under supervision, but it won’t work if you have a weakened sphincter,” Dr. Staller points out.

Pelvic floor exercises (Kegel exercises) may also help reduce fecal incontinence. These involve contracting (squeezing) the anal sphincter several times per day or whenever you feel fullness in the rectum. “Pelvic floor physical therapy will help, but it won’t always solve the problem. Also, you have to do the exercises every day or it doesn’t work,” Dr. Irani notes.

Pads that you tuck into your underwear or adult diapers can offer security when you have fecal incontinence. But pads and diapers can irritate the skin, as can a bowel movement that’s been near your skin for too long. Using a barrier cream such as zinc oxide can help protect the skin.

Dietary fiber linked to a lower risk for fecal incontinence

When fecal incontinence strikes, increasing your dietary fiber with foods like legumes can help get you back to normal. And a Harvard-led study published last September in Gastroenterology suggests that eating a high-fiber diet over the long term is associated with a lower risk for developing fecal incontinence in older women.

Researchers looked at questionnaire responses from more than 58,000 women who were followed for more than 20 years. Women in the study who ate the most fiber (25 grams per day) had an 18% lower risk for fecal incontinence, compared with women who ate the least amount of fiber (13.5 grams per day). The study is observational and doesn’t prove that eating fiber prevents fecal incontinence. But it’s reasonable that it should. “There are so many reasons why fiber can be helpful. It may help ward off heart disease and diabetes. A reduced risk for fecal incontinence adds another potential benefit,” says Dr. Kyle Staller, the lead author of the study and a gastroenterologist at Harvard-affiliated Massachusetts General Hospital.

Formal diagnosis

When simple fixes aren’t making a difference, it may be time to see your primary care physician or a specialist. You can expect a specialist to take a full medical history and conduct a digital rectal exam (feeling the inside of the anus with a gloved finger to assess how tight the anal sphincter is).

Further testing to look for damage to the anal canal, sphincter, or lower colon may include

  • anoscopy (insertion of a small, short scope into the anal canal)

  • sigmoidoscopy (insertion of a flexible viewing tube to examine the sigmoid or lower colon)

  • anal ultrasound (using sound waves to look at the sphincter structure)

  • anal manometry (insertion of a catheter and balloon to measure anal sphincter strength).


Often, treatment of an underlying bowel condition, such as impacted stool or chronic diarrhea, solves the problem. “It’s much easier to fix a bowel disturbance than it is to tighten up the sphincter,” Dr. Staller says.

Beyond that, there are only a few treatment options for older adults whose fecal incontinence does not respond to simple measures.

One option is called sacral nerve stimulation. “It’s like a pacemaker for your anus,” Dr. Irani explains. “We implant wires into the sacral nerve in the spine to stimulate the sphincter muscle to contract. What’s key is that it will only work if incontinence involves solid stool, not liquid stool. Also, you have to be able to operate an external device and participate in your care.”

The other option is surgery to create a colostomy, bringing the end of the large intestine through a special opening in the abdomen so that it drains into an attached bag. “People rarely choose this option. They’d rather wear an adult diaper. But people who choose surgery seem to get their freedom back. They just empty the bag when it gets full,” Dr. Irani says. “Colostomy is especially helpful for people who are in a wheelchair and can’t get to the bathroom frequently,” Dr. Staller adds.

A ray of hope

Most people don’t have to resort to drastic measures like surgery. Bulking stool through diet or with fiber powders usually solves or greatly reduces the problem. But if that’s not working for you, don’t suffer in silence. Your doctor may be able to help.

“Just talking about it with someone who knows what you’re going through is a real benefit,” Dr. Staller says. “You may not be able to get rid of fecal incontinence, but you may be able to eliminate 50% of the episodes and many of the accidents you have. And we know that even one accident feels like it’s too many.”

Image: © GregorBister/Getty Images

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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Tips for Helping Men Seek, Get Mental Health Care – Public News Service




Professional mental health experts say when people open up about their feelings of depression or other issues, don’t try to fix the problem or change the subject, but listen patiently and actively. (Publicdomainpictures)

May 20, 2019

DENVER – STRIDE Community Health Center has joined the Let’s Talk Colorado campaign, a coalition of more than 20 health organizations, and this year’s emphasis is to address some of the unique challenges men face with mental health.

STRIDE psychologist Erin Baurle says men don’t seek care at the rate women do, even though numbers show they suffer from depression, anxiety and other obstacles to their well-being the same as everyone else.

She says stigma continues to be one of the biggest barriers for people seeking treatment.

“The lack of treatment for mental health exceeds any other health condition that we have, and people are again real reticent to seek care and not getting the care that they need to address issues and concerns that are very real,” she states.

Baurle notes at STRIDE, mental health is seen as integral to overall health and well-being, and licensed mental health professionals stand side by side with medical providers during a patient’s medical visit.

Six million men across the U.S. admit to experiencing depression, and men are almost four times as likely to die from suicide as women, according to the Centers for Disease Control and Prevention.

Of the nearly 1,200 Coloradans who died from suicide in 2017, almost 900 were men.

Baurle says it’s common for men to shy away from talking about their feelings directly or in formal settings, so using a shoulder-to-shoulder approach can help bring issues out in the open.

She says it’s a good idea to let men in your lives know – as you’re driving or out on a walk – that when they are ready, you’re open to talking and are there for support.

“So it might not be in that moment that you first broach the topic, it might be at some other point,” she states. “And when he does come to you, it’s important to really focus and listen because men can more easily feel brushed off or ignored if other things are going on.”

Baurle says catching issues early in the cycle, when someone is starting to feel overly stressed, is a good time to seek professional care before the problem gets worse.

She says a good first step to getting professional help is to talk with your primary care provider.

All of Colorado’s 20 community health centers have behavioral health services onsite, or have arrangements with a community partner to whom they can refer patients.

Eric Galatas, Public News Service – CO

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Health expert Dr. Ian Smith gives tips, dispels myths on clean eating and healthy living – Qcity metro




Heart disease and stroke are leading causes of death in America, according to the American Heart Association. For African Americans, we account for nearly a quarter of the 610,000 people that die every year from heart disease.

The recent death of filmmaker John Singleton following a massive stroke sent shock waves throughout the African American community. Black men in the U.S. are at a greater risk of having a stroke and are more likely to have one at a younger age, according to the Centers for Disease Control and Prevention. Diabetes and higher rates of obesity are a few of the culprits.

Black Americans also suffer from some of the highest rates of high blood pressure in the world. The American Heart Association reported that more than 40% of Black men and women have high blood pressure, and we’re getting it earlier in life.

That hit home for me. John Singleton was 51. My grandfather died of a heart attack at 45. My mother was diagnosed with hypertension at the same age.

In March, at 37, I decided to make major changes in my lifestyle that will hopefully save my life. As I near the age my mother was diagnosed, transitioning to a healthier lifestyle was more than trying to look good in a bikini. I hired a trainer, ditched meat and began intermittent fasting. Although I’m not vegan, I frequent local vegan restaurants.

Dr. Ian Smith. Photo: T. Smith

New York Times best-selling author Dr. Ian Smith visited the Queen City to promote his latest book, “Clean & Lean: 30 Days, 30 Foods, A New You.” We met to chat about nutrition, fitness and fad diets.

You were appointed by President Obama to the President’s Council on Fitness, Sports, and Nutrition. During your time on the council, what was the most alarming health fact that you discovered about African Americans?

What I first found surprising is that the Council had no jurisdiction or enforcement ability. We would make policy suggestions, but we couldn’t legislate it. We were more in an advisory role. We worked with First Lady Michelle Obama on the Let’s Move campaign. I wanted to have a solidified interventional role.

I’ve been doing this for a very long time. I focus on everyone, but obviously, I have a predisposition to be overly concerned about African Americans. It just confirmed things that have plagued us for a long time such as levels of obesity, levels of inactivity and dietary lifestyles. It’s what I’ve been fighting to reverse and get people to change their lifestyles.

What are the biggest misconceptions that you hear from people who are considering making the transition to healthier lifestyles?

African Americans have to tear themselves away from the fallacy that we are genetically predisposed to be large or big boned. Our bones are no bigger than anyone else’s.

Now, we are predisposed to be more curvaceous, but that’s different, that’s soft tissue. Our bones are the same size. What we pack onto our bones is up to us, the shape of it is genetic. The way we deposit fat and soft tissue is in a curvaceous form. We are made to be more curvaceous but not to be heavier.

As you travel around the country, what have you found that people struggle with the most?

People are having a hard time being able to access and afford healthy foods and figuring out how to squeeze their workout into their day. Granted, some of that is that people just don’t like to work out. Another part of that is that people are stressed and busy. You have single parents and people with scheduling issues.

My intention with “Clean and Lean” was to think about someone with a limited income, someone who’s busy and doesn’t have two hours to spend in the kitchen cooking. I wanted to create a program that would work for them.


Dr. Ian Smith says dinner can include options like grilled chicken with brown rice and vegetables.

Let’s talk about a popular weight management trend, intermittent fasting. Critics say those who commit to the practice will gain the weight back when the fasting period is over. Is there a certain profile (age, weight, pre-existing conditions, etc.) that you’d recommend avoiding intermittent fasting?

Everyone intermittent fasts. When you are asleep, you are fasting. Intermittent fasting is periods of eating, or fueling, with periods of fasting. Some of us have longer fast periods. Some of us are more disciplined in respect to fast. I think intermittent fasting is healthy, if not done to the extreme. The three tracks that I believe in are: 16-hour feeding with an 8-hour fast; 14-hour feeding and a 10-hour fast, and a 12-hour feeding with a 12-hour fast.

To speak to the issue of gaining weight back, typically if you are losing weight via an extreme measure, then when you stop applying the extreme measure, you’re going to gain the weight back. To me, keto is extreme. Keto is effective for short-term weight loss. However, when a person stops eating in a keto fashion they will gain the weight back plus some.

Now that Dr. Ian explained why we should stop blaming weight gain on being big boned, it’s time to begin making healthier lifestyle choices. Maybe it’s increasing your physical activity or decreasing your intake of processed ingredients. Instead of focusing on summer body goals, let’s make changes this spring to improve the quality of our lives.

Nakisha Washington is a journalist who interviewed America’s first self-made female billionaire, a presidential candidate and her favorite reality TV personality all within 72 hours. Catch her talking career and lifestyle tips to curious millennials on her

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3 tips for reporting on rural health – Journalist's Resource




Mark Holmes is a professor in the department of health policy and management in the University of North Carolina Gillings School of Global Public Health and director of the North Carolina Rural Health Research and Policy Analysis Center.

At the North Carolina Rural Health Research and Policy Analysis Center, Holmes studies rural hospital closures across the country, as well as the effects of Medicare and Medicaid on rural populations and health care providers.

Earlier this month, Holmes participated in a panel on rural health at Health Journalism 2019, the annual conference of the Association of Health Care Journalists (AHCJ). Beforehand, we took the opportunity to sit down with him and ask about his tips for reporting on rural health. Below are three of the key takeaways from our conversation.

Tip #1: Be specific about what you mean when you say “rural.” Different regions face different issues.

The term “rural” can be used as a monolithic catchall for vast and diverse areas of the country: for example, the U.S. Census defines rural as “territory, population, and housing units not classified as urban.”

“I think there’s an under appreciation of the nuance of ‘rural,’ in that rural North Carolina is very different from rural Wyoming, and we tend to lump them all together,” Holmes said. “I think certainly people have been talking about the difference in the demographics –the rural South versus rural Midwest — but also I think the notion of isolation, geographic isolation, can be quite varied.” In other words, be specific about what you mean when you’re talking about rural: Is the area isolated? Far from a hospital? Sparsely populated?

The upshot: It’s important to know the issues facing the various rural regions in the United States.

With that in mind, we asked Holmes to provide, to the extent that he was comfortable, a categorization of many of the rural regions across the U.S. and the key health issues for local journalists to keep an eye on. Here are his suggestions:

Northeast New England (categorized by Holmes as consisting primarily of Maine, northern Vermont and New Hamsphire, and western Massachusetts):  Holmes said the key concerns in the rural Northeast are the opioid epidemic and an aging population.

“A lot of New England is not terribly far from other large health care systems,” Holmes qualified.

South (including the Mississippi Delta, Appalachia and the ‘Stroke Belt’): Key health-related issues include racial disparities, poverty, homicide, rural hospital closures and rural hospital financial distress – i.e., hospitals struggling to cover their costs.

Upper Midwest (Minnesota, Wisconsin, Michigan, North and South Dakota, Iowa): “From a mortality standpoint, the Midwest tends to be some of our healthiest regions — not just rural, but urban as well,” Holmes said.  However, the upper Midwest is “generally more isolated than we see in the South. You can get into a frontier area in the Midwest pretty quickly.” Holmes explained that the isolation in some parts of the Midwest means rural residents might not have ready access to hospitals.

Mountains West: Suicide – particularly suicide involving firearms– is a major issue in the rural, mountainous West, he said.

Rural California (particularly the Central Valley and the southern border region): Holmes said this region faces “its own acute or more specific challenges particularly associated with migrant farm workers.”

Alaska: Geographic isolation creates health-related challenges here.

Hawaii: The state is unique, Holmes said, in that it is geographically isolated, but each island has its own hospital, so access to health care is not impeded by its isolation. The issue then becomes the economic and operational challenges of maintaining hospitals that are underused. “Those are some of the most underused hospitals,” Holmes said. “You’ll have a hospital on an island that might have, like, one patient a week. But when you need it, they’re there.”

Tip #2: Don’t just focus on problems; also cover successful community-based solutions in rural America.

“I think the biggest [issue with coverage of rural health] is every story about rural is despondent, despair,” Holmes said. “I think some really groundbreaking approaches have been developed in these kinds of communities.”

Holmes described his own experience growing up in rural Michigan. After a spate of teen deaths in car accidents, Holmes said the community came to a realization: “Now we have a crisis. And so the whole community rallies around each other and sort of figures out what we’re going to do about it.

“You can see faster action, I think, in rural communities, because at the coffee shop you can get the three people that matter together on a Thursday afternoon without a lot of the hassles you might see in larger communities.

“Those are harder stories to find, but I think they’re really interesting, because as researchers we pound the table and say you need to use evidence-based programs, and draw from what we know works,” he says. “But innovation often happens in rural communities where they say, you know what, we got this thing over here and this thing over here and in using our assets in an innovative area, or in an innovative manner, we can try something new. Sometimes it works, sometimes it doesn’t.”

Tip #3: Understand that health care touches other newsroom beats, and other beats touch health care. Consider, for example, its connections with economic development.

“Rural areas face a wide variety of decisions about what their economic development strategy will be — keeping people and recruiting people,” he said. “Having a viable, strong health care system, it is really important, and of course it goes the other way as well — the economy improves the health care system.

“My bread and butter is rural hospital closures,” Holmes said. But he and his team also research rural hospital openings. “We found two in one year and looked at the stories, and both of the justifications were highly dependent on: we want to create a place where people want to live, because having the hospital here makes it worth it,” he said.

Additional resources

Holmes recommended the following resources for journalists looking to learn more about rural health:

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