How often should I have a bowel movement?
Normal bowel movements range from 3 times per day to three times per week.

I have a lot of problems with gas. Should I avoid certain foods?

Foods that cause a normal amount of gas (allowed)

1. meat, fowl, fish
2. vegetables: lettuce, cucumber, broccoli, peppers, avocado, cauliflower, tomato, asparagus, zucchini, okra, olives
3. fruits: cantaloupe, grapes, berries
4. carbohydrates: rice, chips, popcorn, graham crackers
5. all nuts
6. eggs, jello, fruit ice

Foods that cause a moderate amount of gas (may need to avoid)

1. potatoes
2. eggplant
3. citrus fruits, apples
4. carbohydrates: pastries, bread

Major gas producers (avoid)

1. vegetable: onions, celery, carrots, brussel sprouts
2. beans
3. fruit: raisins, bananas, apricots, prunes
4. carbohydrates: bagels, wheat germ, pretzels

Sometimes at night or after bowel movements I have an irresistible urge to scratch. What can I do about the itching?
A careful examination by a colon and rectal surgeon or other physician may identify this or another cause for the itching. The most common cause is a condition called pruritus ani. If you have pruritus ani treatment may include the following five points.

1. Avoid further trauma to the affected area.

• Do not use soap of any kind on the anal area.
• Do not scrub the anal area with anything-even toilet paper.
• For hygiene use wet toilet paper, baby wipes, or a wet washcloth to blot the area clean. Never rub.
• Try not to scratch the itchy area. Scratching produces more damage, which in turn makes the itching worse.

2. Avoid moisture in the anal area.

• Apply either a few wisps of cotton, a 4 x 4 piece of gauze, or some cornstarch powder to keep the area dry.
• Avoid all medicated, perfumed, and deodorant powders.

3. Your physician may prescribe a topical medication to apply to the affected skin. Apply prescription medications as directed to the skin around the anal area and avoid rubbing.

4. Avoid excess fluids. In most instances, a daily maximum of 8 glasses of fluid is reasonable. There is not usually any health benefit to drinking more than this in the course of a day. Certain beverages including some alcoholic beverages (especially beer), milk, citrus fruit juices, and drinks containing caffeine, such as coffee, tea, and cola may aggravate the condition.

5. Avoid certain foods. Similar to the fluids listed above, there are also some foods that may cause a problem including chocolate, fruits, tomatoes, nuts, and popcorn.
You should experience some relief within 1 week. Total relief may take 4-6 weeks. You may need an appointment with a colorectal surgeon.

I have had some problems with bowel accidents, especially when I have had loose stool. What can I do to help avoid this?
The more active your bowel is and the more it pushes stool against the sphincter, the harder it is to avoid having accidents. The bowel is most active 30-60 minutes after a meal and even more active when this has been a large meal that may contain greasy foods. Therefore, when you are in a situation where a bathroom will not be available, having smaller meals and ones that do not contain greasy foods will minimize the increase in bowel activity that might cause accidents.

Although in general having a high fiber diet is good for your bowel, it may pose more challenges for those people who have problems with bowel control. Keeping somewhat on the constipated side may actually help to decrease the number of accidents that you have. A simple way to help with this is to take a once-a-day multiple vitamin that contains iron because iron tends to be mildly constipating. Avoiding foods that tend to cause increase bowel activity may be another way to minimize accidents.

Immodium is an over the counter medication which helps to cut down on the activity of the bowel and help to minimize bowel accidents. This medication can be used when you are in situations where a bathroom will not be readily available. Having dinner with friends, being on long car rides, being away from bathroom facilities on trips are examples when it may be a good idea to take Immodium. Also if you are having problems with diarrhea because of a short-term illness Immodium may be helpful. You can purchase this medication without a prescription and you may want to take some for a few days to see how it affects your bowels. If you have problems with chronic constipation this is probably not a good medication to take.

I am having problems with staining my underwear.
Sometimes staining of underwear occurs because small amounts of stool adhere to the lining in the anal canal. This stool can leak out over time and cause staining. This is usually not a cause for concern. Most of the time the soiling is minimal and you need not worry about it. If you wish to try something, a simple way to reduce staining is to clean up a short way inside the anus after a bowel movement with premoistened hygiene wipes (Wet Wipes) over one of your fingers.