QUESTION # 1

"Do men pass more gas than women?"

My usual answer to this question is, "No woman in North America has ever passed gas - until you marry her!" In general I do think that men pass more gas than women primarily because they eat more which leads to more undigested residue in the colon. Any residue that passes into the colon is then acted upon by the bacteria in the colon leading to the production of methane and hydrogen gas, which of course are flammable gases - so watch out! Many years ago I saw this demonstrated by bored college students who were supposed to be studying for final exams. Occasionally a contest would break out where they would each pass gas while holding a flame near their anus - a practice I do not recommend!

The only other source for intestinal gas is excess swallowed air. We all swallow some air as we eat and drink, however, there are some people who swallow an inordinately large amount of air. In most cases this is a nervous disorder.

QUESTION # 2

"How many women like me are so concerned about their bowels?"

When women were asked, "Have you ever consulted a physician for problems with your bowel pattern?" 26% of women said they had and another 4% said that they had thought about it. This figure of approximately 30% of women recurs throughout the study. In contrast only 5% of men who also took the survey said they either had consulted a physician regarding their bowels or had thought about it.

When asked, "Have you ever used OTC medication?" 8% said frequently and 36% said occasionally.

When asked, "Has your bowel pattern interfered with your lifestyle?" 26.5% answered affirmatively compared to only 8% of men.

QUESTION # 3

"What is a normal bowel pattern anyway?"

"How frequently do you pass a bowel movement?" 67.6% of women said they pass a bowel movement anywhere from once every other day to one or two per day. But notice, 32.4% pass a bowel movement less than once every other day and some women pass three of more times per day. There's that figure of approximately 30% again.

QUESTION # 4

"Do you consider your bowel pattern normal?"

32.4% said, "No" - that figure of approximately 30% again. Another 10% said that they didn't know. How is it that something we all do everyday can be unknown as to what is normal by 10% of women?!

QUESTION # 5

"Why do I pass so many BM's in the morning? I know where every bathroom and bush is on the way to work!!!"

When I looked at the Frequency of BMs In Women With "Normal" & "Abnormal" Bowel Patterns, I found that those women who considered their bowel pattern normal passed stools at least every other day to as often as one or two stools per day. In contrast, those women who felt that their bowel pattern was abnormal 10.9% passed three or more stools per day, 5.5% passed less than one stool per week and 30.9% passed only one or two stools per week.

When I asked survey participants, "Do you need to make a BM soon after eating out?" 7.5% women said that every time they ate a meal at a restaurant they had the need to immediately pass a bowel movement. Additionally, 43.7% of women said that they often or occasionally had to pass a bowel movement when eating out.

QUESTION # 6

"Do all women feel the same as I do about those gas station bathrooms?"

"On the Interstate would you use that gasoline station bathroom to make a BM?" 58.5% of women said, "Never!" or "Only if I am desperate."

"On the Interstate would you use that gasoline station bathroom to urinate?" The responses were rather evenly divided: 25.3% said, "Only if I am desperate!" 21.8% "Occasionally." 23% "Often." And 28.2% "Frequently."

"How do you feel about using a hotel toilet to make a BM?" Again the responses were somewhat evenly divided: 21.5% said, "Only if I have to." 22% "Only if I am alone." 21.5% "Only with a family member in the room." 35% "With anyone in the room."

Many women have what is called the "Bashful Bowel Syndrome," viz. they like the "Home Field Advantage."

"In a hotel, what precautions do you use before making a BM?" 34.8% of women said that they just sit and use the toilet. 21.6% wipe the seat first, 1.1% disinfect the seat, 35.3% place a protective covering on the seat and 7.2% do something else. Something else! What else is there to do? Here were the answers:

• "Squat." (How does that work? It sounds difficult to do.)
  
• "Sit on my hands."
  
• "Look to be sure it's clean."
  
• "I just don't sit down." (Is this the same as the "Squat?")
  
• "I try to hold myself up." (Sounds like it requires some gymnastic skills!)
  
• "Put down TP and sit on my hands."
  

QUESTION # 7

"Why do my bowels lock up when I go on vacation?"

When asked, "What happens to your bowel pattern on vacation?" 55.6% of women said that they often of occasionally become constipated and 4% said they developed diarrhea.

QUESTION # 8

"If I change my diet, will that help my bowels?"

"Have you ever changed your diet due to your bowel pattern?" 34.1% of women said they did.

QUESTION # 9

"I am so bloated all the time! Where does all the gas come from?"

I mentioned above how gas is produced in the colon. However, there are many women who complain of "gas" and "bloating" yet on physical examination, the abdomen is not distended and extensive radiographic studies have shown that these women have no more gas than normal. So why do they complain of gas and bloating? The explanation is a problem called visceral hypersensitivity. This is where a normal amount of fluid and food in the intestine produces normal distention of the bowel that is perceived as abnormal. This is common in patients with irritable bowel syndrome. Fortunately, we now have medicines to change this perception.

QUESTION # 10

"What is all this hype about IBS?"

The classic presentation for irritable bowel syndrome (IBS) always involves abdominal pain or discomfort. This pain or discomfort is accompanied by a change in bowel function, with the stools becoming too frequent and loose or too infrequent and hard. As many as 20% of American women will experience IBS symptoms in their lifetime. The onset is usually between the late teen years up to age 45.

Zelnorm (tegaserod) is new medication produced by Novartis Pharmaceuticals. It has a structure similar to serotonin. All of us have a CNS (central nervous system), a PNS (peripheral nervous system) and an ANS (autonomic nervous system). The CNS consists of the brain and spinal cord; the PNS consists of the nerves that come off the spinal cord going to our legs and arms; and the ANS has two divisions, the sympathetic and parasympathetic divisions which control involuntary functions such as sweating, internal anal sphincter function, and many other functions that we do not have to think about but that happen automatically.

Recently, scientists have discovered that we also have an ENS (enteric nervous system). The word "enteric" means intestinal. The ENS is located in the intestine and controls secretion, intestinal movement and registers feeling within the gut (i.e. pain). When Eli Lilly Pharmaceuticals first released Prozac, suddenly everyone was talking about serotonin. Prozac blocks the reuptake of serotonin by brain cells. In some people who have depression, blocking this reuptake of serotonin improves their mood alleviating depression. Only 5% of the body's serotonin exists in the brain. The other 95% is located in the gut where it functions as the main neurotransmitter. A neurotransmitter is a messenger molecule. In the intestine, serotonin binds to different type of receptors to stimulate secretion and intestinal movement. Zelnorm, with its structure similar to serotonin, binds to the same receptors producing the same effects. Therefore, in women with constipation predominant irritable bowel syndrome, Zelnorm relieves constipation by increasing secretion and contraction of the colon. But, equally as important, it also reduces bloating, pain and discomfort. Another product called Lotronex, manufactured by GlaxoSmithCline, blocks serotonin receptors in the bowel. Hence, it is useful in those patients with diarrhea predominant IBS to eliminate the diarrhea, urgency, bloating and abdominal pain and discomfort. Both of these new products have literally given some patients their lives back.