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To Your Good Health: Help for Fecal Incontinence

Dear Dr. Roach: My husband, age 67, has had an increase in bowel movements in the past year or so. These are more watery or mucus-filled than ever before. They also are urgent.

He had a colonoscopy that showed little, but the doctor recommended adding more fiber to my husband’s diet, which we have done. He has had episodes of not making it to the toilet before the movement, thereby soiling himself. He is very frustrated and embarrassed. Are there any other dietary changes we can make? — C.B.

Answer: Fecal incontinence is a common and potentially devastating problem that many people are reluctant to talk about. Only one-third of people with this condition tell their doctor about it.

There are many causes of fecal incontinence, including neuropathy and fecal impaction, but often the cause is never found. In addition to the evaluation you have had done, I agree with the addition of fiber to try to make the stools less watery. Watery bowel movements are much more difficult to control than solid. Unfortunately, it doesn’t sound like fiber has done the trick. I would consider a trial of methylcellulose, such as Citrucel, and even loperamide, such as Imodium.

Biofeedback and surgery have been tried for this condition but haven’t been so helpful.

Dear Dr Roach: I have had a very enlarged testicle for the past 60 years. As a young boy, I had mumps, and that was when this condition occurred. Since then it has posed no problem in any way — no pain, little discomfort. I’m a very active senior and am used to playing sports such as soccer, swimming and working out.

However, during the past few years, I am more aware of its presence insofar as it seems to have dropped. There has never been any associated pain.

Could it be that the scrotum becomes flaccid with age and would allow the testicle to drop? — G.S.

Answer: Orchitis is the name doctors use for inflammation of the testicle, and it’s a complication of mumps. Fortunately, there are almost no cases of mumps anymore (fewer than 500 cases in the U.S. per year) due to vaccination.

Following orchitis, there often is atrophy, shrinkage, of the testicle. A persistently enlarged testicle seems to be unusual. Some reports suggest that the incidence of testicular cancer increases after mumps orchitis.

The scrotum does tend to sag as men get older, so your explanation probably is correct. However, because you have persistent enlargement and have noticed a clear change, there may be an increased incidence of testicular cancer. You are at an age when testicular cancer is common, so I would recommend a visit with a urologist, who will do an exam and perhaps a sonogram to make sure of the cause of the apparent change.

Please let me know the result.

Dear Dr. Roach: I have been diagnosed with FHH. I am told it is very rare. What can you tell me about it? They tell me that there is no treatment now but my calcium level in the blood will continue to be checked. I am not to take calcium supplements, but I can continue to eat foods containing calcium. I have never had any parathyroid problems before, and I am now a senior citizen. — P.L.

Answer: Familial hypocalciuric hypercalcemia is indeed a rare diagnosis, but one that is important to look for when evaluating causes of high blood calcium, because it looks very similar to hyperparathyroidism. However, there are usually no symptoms, and surgery doesn’t help. It’s important to know about the diagnosis in order to avoid surgery. No treatment is usually necessary.

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 or write to P.O. Box 536475, Orlando, FL 32853-6475.