En español | Aging reveals itself most obviously in a mirror, but some of your body's biggest changes happen in your digestive system. The gastrointestinal tract begins to slow, the amount of stomach acid decreases, and the enzymes along your digestive tract start to morph, changing the way your body digests food. Medications can have unwanted GI side effects, and a more sedentary lifestyle and unhealthy diet habits, which you were once able to shrug off, can start to catch up with you. The result: Stuff begins to happen along your digestive tract. Weird stuff. Embarrassing stuff. Maybe dangerous stuff.
Unfortunately, a lot of us are hesitant to ask our doctors about digestive issues, especially those that are blushworthy. So to find out what's normal and what's worth worrying about, we did the asking.
I don't poop every day. I'm constipated, right?
Not necessarily. “Our definition of ‘normal pooping habits’ is once every three days to three per day,” says Charles McMahon, a gastroenterologist at Loyola Medicine near Chicago. At your next doctor's appointment, don't just say you're constipated, because that's subjective. Instead, specify how many BMs you have per week, as well as the consistency (hard, loose).
I sometimes need laxatives, but I heard that your GI tract can get addicted to them. True?
No. “Most laxatives can be used safely as directed once or twice a day. There's no evidence this creates dependency,” McMahon says. Talk to your doc before starting them, because (as we just mentioned) you may think you're constipated when you're really not.
I get weird gurgling in my belly even when I'm not hungry. What's up with that?
All those tummy rumbles have a fun name: borborygmi. It's usually just gas moving along in your intestines. “These sounds you hear when the GI tract is moving are normal and don't suggest anything serious is going on,” McMahon says.
There's a little blood on the TP when I wipe. Is it colon cancer?
More likely it's something benign, like a hemorrhoid or an anal fissure, McMahon notes: “Colon cancers are slow growing and need to be advanced to see red blood in the stool.” Regardless, check with your doctor; blood is a red flag that he or she will want to investigate, along with making sure you're up to date on colon cancer screenings. If it's a hemorrhoid, your physician will likely recommend eating high-fiber foods and trying bath soaks for comfort. Topical pain-relieving creams can encourage a fissure to heal.
I heard that the colonoscopy prep is terrible. Can I avoid it?
No, you can't. In fact, in 2018 the American Cancer Society began recommending that all adults get a colonoscopy every 10 years as of age 45, instead of 50. “We've seen a recent uptick in colon cancer in the younger community,” says gastroenterologist Felice Schnoll-Sussman of New York-Presbyterian/Weill Cornell Medical Center. To make the process less unpleasant, Schnoll-Sussman puts patients on a low-residue diet, which means they can have yogurt and ice cream on the morning of the prep, so they don't feel as restricted as they would on only liquids. Chill the prep solution to make it more palatable, and use a straw to help it bypass your tongue.
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My stomach looks more bloated than ever. What's that about?
Think about how sedentary you've been lately, because if you slow down, your GI tract does, too. “A backup of stool and fluid in the intestines can lead to constipation, abdominal pain and bloating,” Schnoll-Sussman explains. Your gut can also go sluggish after you start calcium or iron supplements (one side effect is constipation).
I'm breaking wind a lot. Why?
Processed foods, especially packaged weight-loss or low-calorie goods, often contain sugar alcohols or artificial sweeteners, which are horrendous for the GI tract — even the sugar substitutes that are “natural,” says Joseph Fiorito, chief of gastroenterology at Danbury Hospital in Connecticut. When these sugar substitutes are metabolized, normal bacteria in the GI tract break them down into by-products that irritate the colon and trigger gas, diarrhea and bloating. Read the ingredient list, because these sweeteners can be found in drinks, sweets, condiments and sauces, and bread.
Sometimes I can't get to the toilet in time when I have to go number 2. Is this normal?
No, and there's probably a simple solution available, says gastroenterologist Daniel Sussman, an associate professor of clinical medicine at the University of Miami. Certain medications, such as blood pressure pills, can alter hydration levels and affect how fast things move through your GI tract. Though age-related changes to muscles and nerves can weaken the anal sphincter (the muscle that gives you time to get to the bathroom), there are ways to manage this issue. Try eating more fiber to bulk up BMs, and cut out foods with added sweeteners or sugar alcohols.
Should I take a probiotic to become more regular?
Nah. One metanalysis of 21 studies found that probiotics containing lactobacillus or bifidobacterium increased the number of BMs by a mere 0.8 per week. Also, probiotics aren't regulated, and there's no way to know if the brand you're taking contains many, or even any, live cultures. Your better bet is to eat more fiber (to give your natural bacteria something to munch on) and include cultured yogurt in your diet.
Is it possible I've become lactose intolerant with age?
Yes. After a certain age, the lactase enzyme, which metabolizes milk, begins to decrease in the body. This can happen anytime from puberty onward. It doesn't mean there's something wrong; it just means your body has changed, so alter your diet accordingly. If you don't want to write off dairy completely, experiment carefully to discover where your personal threshold is.
My doctor told me to eat more fiber, but now I'm just bloated and gassy. Was she wrong?
This happens a lot, especially if you try to increase fiber quickly. The recommended daily fiber intake for men and women over age 50 is 30 and 21 grams, respectively. Most Americans get just half that amount each day. If you have a sensitive stomach, Daniel Sussman suggests cutting the recommended fiber intake in half to see if that's easier on your digestion, then slowly working your way back up.
Chicago writer Jessica Migala specializes in wellness, nutrition, fitness and skin care.