DEAR READER: A No. 10 envelope is the most common size. It is about 9-1/2 inches wide by 4-1/4 inches high. Read the envelope box, and it will provide the information.

DEAR READER: I do not have one ongoing newsletter as such, but I have a few suggestions. Health Reports on 50 topics can be ordered through the clearinghouse mentioned at the end of many of my Q&As. Beyond that, my column now appears on the Internet. From my website, you can download an order form and forward your request. Visit www.AskDrGottMD.com.

I am a 74-year-old female in good health. Over the last few months my bowel movements have become consistently hard, small lumps. I mentioned this to my doctor during a routine check up and told him that I had been using stool softeners and Metamucil with little effect. I was told to take large doses of Metamucil (which I had been doing since the onset). I also tried your colon cocktail. I have not seen any improvement and know I shouldn’t have to strain as I do. Should I be concerned? This has never happened to me before and came on quite suddenly. I don’t drink a lot of water but no less than I have always done.

DEAR READER:
I urge you to see a gastroenterologist. Sudden changes to bowel movements (such as consistency, frequency, or color) that are not related to changes in diet or lifestyle need to be addressed. The specialist will examine you and likely order blood work, occult blood fecal tests (to determine if there is blood in your stools) and a sigmoidoscopy or colonoscopy to visualize the colon itself. It is important that this is done quickly to determine if the cause is something benign such as polyps or more sinister.

He or she will likely ask you if you have made any dietary modifications, started new medications or are currently taking anything that may now be causing side effects. If the cause is benign such as irritable bowel syndrome, or no cause is determined, your doctor may recommend increasing your fiber intake, occasional laxative use and increasing your fluid intake.

I also urge you not to strain because you may be causing damage to your colon. Straining can lead to hemorrhoids, anal fissures and other uncomfortable conditions.

To give you related information, I am sending you a copy of my Health Report “Constipation and Diarrhea”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.