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DEAR DR. ROACH: My wife is 51 and has generally struggled with constipation for as long as I've known her (many decades). Several weeks ago, an extended period without bowel movements began. She regularly uses Miralax, fiber bars, other laxatives, and even prune juice, to no effect. She has been giving herself an enema, but again, no results. She feels miserable, and I have encouraged her to go to the emergency room. But she doesn't want to go due to embarrassment.

She occasionally feels a stomachache and had a fever the other day, but it seemed to subside. Her eating has slowed, and there is no significant weight loss or other conditions that seem out of the ordinary. I will try to encourage her to see a doctor, but until then, any advice on what is going on and why this is happening? -- W.Q.

ANSWER: I agree that she should see a doctor before attempting further home remedies. There are several medical conditions that can be causing her problem, such as very low thyroid hormone levels. But the most likely cause is irritable bowel syndrome with predominant constipation (IBS-C). Still, a gastroenterologist may want to look for a motility problem in the lower bowel. In addition, if she hasn't had a colonoscopy yet, she should.

If her doctor thinks she has IBS-C, there are additional effective treatments, such as lubiprostone (Amitiza) and linaclotide (Linzess). These would be tried after an evaluation. She should not let embarrassment get in the way of her care. Her doctor will have dealt with many patients with her problem.

DEAR DR. ROACH: As a woman of 78 years, I've managed to avoid having a urinary tract infection (UTI) until two-and-a-half years ago. I thought it might be a good idea to listen to the experts for preventative measures, rather than treating one after the fact.

Our urologist suggested I take D-mannose and a probiotic every day, and voila! No more UTIs for two-and-a-half years and counting. As I was telling a friend about D-Mannose and suggesting she take it, I went online for more info on it and discovered that it cleans your bladder. However, it is "pure glucose," and if a person is diabetic (as my friend is), then they should ask their doctor first.

I'm wondering now if this is the culprit behind my A1C level and glucose labs recently being higher (in the prediabetic category). What do you think? By the way, my primary doctor said to cut the dosage in half. -- B.L.

ANSWER: D-mannose is thought to work by blocking sites on the bladder where bacteria attach, preventing a UTI from starting. The medicine did seem to work for you. Unfortunately, the evidence that it works isn't very good. Some small studies showed a benefit, but in a large study with 600 women who got repeat UTIs, 51% continued to get them while taking D-mannose, while 55% of those taking an inactive pill got an infection.

While mannose is similar to glucose, it is not the same. Mannose is largely excreted by the kidneys into the bladder before it can be converted to glucose, so its effect on blood sugar is small in people with healthy kidneys.

The first consideration in a 78-year-old woman with recurrent UTIs is whether there is vulvar atrophy, which can lead to bacteria getting into the bladder. Topical estrogen will make the lining healthy and reduce UTIs.

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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 send mail to 628 Virginia Dr., Orlando, FL 32803.

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