DEAR DR. GOTT:
I am a 35-year-old female, am relatively healthy but have chronic constipation. I am taking Zelnorm and milk of magnesia but still only have a bowel movement once a month, usually at the time my menses start. It is very painful to pass the stool because it is like a big ball.

Recently, I started feeling tired and run down after normal activity. I consulted my medical doctor who ordered a colonoscopy and blood testing. The results of the colonoscopy were negative. Blood tests indicated my red blood count was four, so I’ve been taking iron pills for three months. It is still four. Where do I go from here?

DEAR READER:
A red blood cell count of four is hardly abnormal. I don’t believe you are suffering the symptoms of anemia.

When did the constipation and fatigue start? Do they coincide? Have you been diagnosed as having Irritable Bowel Syndrome (IBS) with constipation? (I would also like to add that having one bowel movement a month is a near physical impossibility, especially when taking Zelnorm, a drug used for the short-term treatment of IBS with constipation and milk of magnesia.)

Zelnorm shows improvement in most individuals who take it but can cause diarrhea. Milk of magnesia encourages evacuation. It seems to me that when taking both these medications, you would hardly be able to leave the house for fear of constant diarrhea. It also suggests that you may have an intestinal abnormality causing obstruction or a similar disorder.

You need to be seen by a gastroenterologist. I believe your symptoms are related to your chronic constipation. If the gastroenterologist determines there is no physical reason for the constipation and believes the fatigue is from your very slight anemia, you may wish to see a hematologist (blood specialist) for further evaluation.

To give you related information, I am sending you copies of my Health Reports “Irritable Bowel Syndrome” and “Blood — Donations and Disorders”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 (per report) to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).