Beware of constipation
Dr Pankaj Garg

Constipation is a very common problem, especially in India. Today’s lifestyle and eating habits are mostly to blame. It must be prevented as constipation can lead to many diseases.

The causes: Low fibre (roughage); not drinking enough water

l Medicines: Pain-killers (particularly those with codeine), some antacids, some antidepressants, iron tablets, morphine, etc.
l Medical conditions: An under-active thyroid, irritable bowel syndrome(IBS), and conditions that cause poor mobility, particularly in the elderly.
l Pregnancy: About one in five pregnant women become constipated. It is due to the hormone changes during pregnancy that slow down the gut movements.
l Emotion: There is some evidence to suggest that "emotional problems and stress" can lead to constipation.
l Unknown cause (idiopathic): Some people have a good diet, drink a lot of fluid, do not have a disease which can cause constipation, yet they become constipated. Their bowels are said to be "underactive". This is quite common. Most cases occur in women. This condition tends to start in childhood or in early adulthood, and persist throughout life.

Prevention: Constipation is best avoided. It can be done in the following manner:

l Eat plenty of fibre: By eating plenty of fruit, vegetables, cereals, fruit juice, wholemeal bread, etc.
l Have plenty to drink: At least two litres (about 8-10 cups) of fluid per day. Most sorts of drink will do, but alcoholic drinks can be dehydrating and may not be so good.
l Exercise regularly if possible. Keeping your body active helps to keep your gut active.
l Toileting: Do not ignore the feeling of needing the toilet. Some people suppress this feeling if they are busy. It may result in hardening and backlog of faeces that may become difficult to pass later.

Treatment: Treatment with a laxative is needed only if the measures above (fibre, fluid, etc) do not work well. There are four main groups of laxatives that work in different ways:

l Bulk-forming laxatives (fibre supplements).
l Stimulant laxatives.
l Osmotic laxatives.
l Faecal (stool) softener laxatives.

As a rule, a laxative should be used only for a short time, when necessary, to get over a bout of constipation. Once the constipation eases, you should normally stop the laxative. Some people get into the habit of taking a laxative each day "to keep the bowels regular" or to "prevent constipation". This is not advised, except for bulk forming (fibre ) laxatives.

Bulk-forming laxatives (fibre supplements): These increase the "bulk" of your faeces similar to fibre. They can have some effect within 12-24 hours. However, their full effect may take some days to develop. Unprocessed bran is the cheapest. Alternatives are ispaghula husk (Isabgol), methylcellulose and sterculia.

Stimulant laxatives: These stimulate the nerves in the large bowel which causes the muscle in its wall to squeeze harder than usual. This pushes the faeces along and out. Stimulant laxatives include senna (Softovac), bisacodyl, phenolphthalein, castor oil, sodium picosulphate (cremalax) and dantron. Their effect is within 8-12 hours. Therefore, a bedtime dose is recommended so that you have the urge to go to the toilet the following morning.

Stimulant laxative suppositories act more quickly (within 20-60 minutes). Possible side-effects from stimulant laxatives include abdominal cramps, and a "weakened" bowel (lazy bowel) with long-term use.

Osmotic laxatives: These work by retaining fluid in the large bowel by osmosis (so less fluid is absorbed into the bloodstream from the large bowel). A commonly used one is called lactulose (Loose). However, this can take up to two days to have any effect, so it is not suitable for rapid relief in constipation. Possible side-effects of lactulose include abdominal pain, bloating and an unpleasant taste. Another osmotic laxative is called polyethylene glycol (Peglec). This usually has a rapid action.

l If regular constipation is a new symptom, especially in people above the age of 40 years and there is no apparent cause such as a change in diet, lifestyle or medication. (This is to rule out cancer)

Flossing makes teeth healthy
Dr HS Chawla

Many of us think that we have good and healthy teeth, whereas 95 per cent individuals above the age of 35 years have gum (periodontal) disease. Dental caries is present in 65-70 per cent of children, even at 12 years. People think they have no dental disease even though they are harbouring it is because both dental caries and gum disease begin painlessly.

Dental caries and gum disease are preventable by simple means. An important measure is thorough cleaning of the teeth using toothbrush, dental floss and an inter-dental brush. Normally when we brush we take care of the front, back and top surfaces of the teeth, and stress more on the visible parts. These surfaces of the teeth, where we usually concentrate, in fact also get partially cleaned by the rub of fibrous food.

The sides of the teeth, adjacent to the adjoining teeth — mesial and distal surfaces (proximal surfaces) — are not cleaned by routine brushing nor by the friction of the food. These surfaces, which are often missed and ignored, gather more dirt - bacteria. Bacteria multiply in this protected environment inflicting by both dental caries and gum disease on these surfaces, even in the most diligent toothbrush users.

To clean the sides of the teeth, dental floss and inter-dental brush are required. Dental floss manufactured by various firms is available most chemist shops.

Method to use floss: Take about six inches of floss, hold it between two hands and roll it on one or both fingers so that about two inches remain between the two hands. This portion is passed between the teeth. Use short see-saw strokes so that the floss does not enter the proximal area with a thud, but softly. The floss is rubbed vertically on the mesial and distal surfaces individually.

Move it from the gum downwards for the upper teeth and gum upwards for the teeth in the lower jaw. This movement of rubbing is performed at least six to seven times on each surface like the repeated brushing of the front surfaces of teeth. It should be remembered that flossing of teeth is not just passing the floss between the teeth and taking out, but is meant to clean the mesial and distal surfaces of the teeth by rubbing the action described above.

Initially, it feels difficult and should be practised in front of a looking glass. Each time floss is taken out of the mouth after cleaning the mesial or distal surface, some material sticks to it. This material is a part of dental plaque and should be wiped or washed off each time. The rubbing action of floss on the teeth is repeated till the time the floss comes out clean. Gradually, with practice, the use floss becomes easier and easier and can be performed without the help of a mirror.

The trick to learn flossing is to start from the space where we got stuck last time. Another important point is to start from the front teeth and sequentially go to the back teeth. The reverse movement is not desirable because the bacteria in back teeth are anaerobic (harmful) and when we floss from the back to the front teeth there is a likelihood of infecting the front teeth with harmful anaerobic bacteria.

Another important point to remember is that if the gums bleed during flossing, do not stop flossing. Rather increase the frequency.and the bleeding will stop. In case it does not even after flossing twice a day for three-four days, this means there is gum disease and a dentist should be consulted.

Interdental brushes look like mini-bottle brushes. These are also meant to clean the mesial and distal surfaces (proximal surfaces). The method consists of entering the inter-dental area and brushing against the mesial and distal surfaces by the to-and-fro movement of the interdental brush with at least six to seven stokes each side. Floss is meant to be used during the early ages of life when the inter-dental spaces are narrow. In the later ages, when the gum recedes with advancing age or due to gum disease, the inter-dental brushing can be started. The use of dental floss should also be continued at this age as it helps clean the contact areas of the teeth.

Comprehensive tooth cleaning involves the use of toothbrush, dental floss and inter-dental brush. Remember, inter-dental cleaning with dental floss and inter-dental brush is more important than the routine brushing of the teeth.

The writer is Professor, Oral Health Sciences Centre, PGI, Chandigarh

Tips to prevent neck pain
Dr Ravinder Chadha

Posture is defined as the attitude of the body. The first step in the management of almost all chronic head and neck pain cases is the restoration of normal posture. The following tips help achieve this goal.

Desk job: While reading/working for long hours at a desk with a forward head posture or with the neck in sustained flexion activates and perpetuates strain on neck muscles. It is advisable to do the following:

l Adjust the computer so that the monitor is at the eye level. Peering down continuously exerts a negative effect on soft tissues around the neck and the shoulder region. Take frequent breaks to stretch the neck and shoulder region. Shrug your shoulders up and down. Pull shoulder blades together and relax.
l Sit well back in the seat, supporting low back. Your head and neck should be tucked in with the shoulders relaxed and the upper back extended.
l Never slouch in the chair as it puts strain on the back of the neck.
l Use a sloping desk while working.
l While talking to a visitor when working at the desk, turn the chair (not just the head) to face the visitor squarely.
l Lie down as often as is feasible while experiencing neck pain. This relieves the weight off the spine, preventing irritation of the soft tissue and facilitating relaxation.

EYE GLASSES: Adequate focal length eye glasses should be used to achieve clear vision while holding your head in a balanced upright position.

l Bifocal insets, which are half the height of the entire lens, should be used when undertaking tasks such as reading and sewing.
l The lower portion of the rim of the frame should not occlude the line of sight when looking down. The lower rim should rest against the cheek so that one can read by turning the eyes downwards.

l Sleeping on the back is the ideal choice. If sleeping on the side, shift sides frequently to evenly distribution the weight pressure on the neck. Also try putting a pillow between the knees for added support.
l While sleeping on the back, tuck the corners of the pillow between the shoulder and the chin on each side to avoid shortening of neck muscles.
l Sleeping on the stomach puts strain on the soft tissues of the neck as the head is turned to one side.
l While sleeping, the nape of the neck should be fully supported by a pillow to avoid sagging lower than the neck. Also the neck should not be bent too forward by too many pillows. Pillows structurally supporting the natural curve of the neck are ideal.
l Avoid excessive rotation of the neck. Head rolling exercises or other movements which hold the head in extreme positions while changing the direction of stretch should be avoided. It is better to laterally flex the neck by slowly bringing the ear towards the shoulders and holding for a few seconds.
l Never strain or stretch the neck to a point where discomfort or pain is experienced.
l Reading light should shine directly on the book from overhead and not from the side as it causes the head to turn in one side, causing strain.
l Sitting directly near an airconditioner for prolonged periods — such as in an aeroplane — causes pain in the neck and the shoulder. It is good to use a scarf or neck sweater.