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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.

Dear C.H.: Irritable bowel syndrome involves 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 that 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.

Dr. Roach writes: A sharp family-practice doctor first noticed that I had miswritten the proper cholesterol ratio used to predict heart risk in a column.

The correct ratio is total cholesterol to HDL cholesterol. So if your total cholesterol is 200 and HDL is 40, you have a ratio of 5, which is average.

A desirable level of 3.5 is associated with half the risk of heart disease, and an unfavorable ratio of 9.6 doubles the risk of heart disease compared with average.

Thanks to Dr. John Patrick Stein of St. Louis and numerous other readers who read carefully and have good math skills.

Email questions to ToYourGoodHealth@med.cornell.edu.

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