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    Mayo Clinic Health Letter: Highlights from the January 2014 Issue

ROCHESTER, Minn. — Jan. 30, 2014 — Here are highlights from the January issue of Mayo Clinic Health Letter. You may cite this publication as often as you wish. Reprinting is allowed for a fee. Mayo Clinic Health Letter attribution is required. Include the following subscription information as your editorial policies permit: Visit http://healthletter.mayoclinic.com/ or call toll-free for subscription information, 1-800-333-9037, extension 9771. Full newsletter text: Mayo Clinic Health Letter January 2014 (for journalists only).

Pacemakers ― Getting Better for 50 Years

Pacemaker Illustration

For more than 50 years, pacemakers have been used to maintain a steady heart rhythm in hearts that beat too slowly. The January issue of Mayo Clinic Health Letter provides an overview of these implanted high-technology devices that have become a routine part of medical care, both prolonging life and improving quality of life.

Over the years, pacemakers have gotten smaller, more durable and have been loaded with more helpful features. When a heart is beating too slowly or in an uncoordinated way, the pacemaker starts sending electrical impulses to get the heartbeats back on track. Pacemakers have sensors to detect physical activity and exertion and will raise or lower the heart rate to meet the body’s needs. They also can monitor heart rhythms ― which can help diagnose other heart rhythm problems over time ― as well as battery life, pacemaker function and other factors. This information is stored and can be retrieved wirelessly at a doctor’s office, or it can be sent to a doctor automatically over the phone.

The pacemaker consists of a pulse generator and one or more insulated wires (leads). The pulse generator is a thin metal container that may be as small as a silver dollar, although most are somewhat larger. It is usually implanted under the skin beneath the collarbone.

Surgery to implant a pacemaker usually requires only sedatives and numbing of the skin at the site of the placement, not general anesthesia. During surgery, the leads are inserted into a major vein under or near the collarbone and guided to the heart with the help of X-ray images. One end of each wire is secured to the appropriate position in the heart and the other end is attached to the pulse generator. Typically, just one night in the hospital is needed. It takes about a month for the scar tissue to form and anchor the tip of the lead within the heart. During that time, vigorous exercise and heavy lifting must be avoided.

After healing, most people can return to normal activity levels that can include golf, walking, cycling, tennis or travel. Battery life of a pacemaker is about eight to 10 years, and then the pulse generator is replaced.

Tips to Reduce Belching and Passing Gas

Belching and passing gas are natural, normal ways to relieve built-up air or gas pressure. But some people ― or their partners ― might wish this release didn’t occur quite so often. The January issue of Mayo Clinic Health Letter explains why this pressure builds and offers tips to minimize belches and passing gas.

Swallowing air: Air often gets swallowed along with food. Belching is a way to expel that excess air. An occasional belch is normal, but frequent belches indicate excess air is being swallowed. These suggestions may help:

Eat and drink slowly ― Typically, less air is swallowed when eating and drinking more slowly. It may also help to avoid talking while eating.

Drink fewer carbonated beverages ― Soft drinks and beer release carbon dioxide gas, increasing the volume of air in the digestive system.

Avoid gum and hard candy ― Swallowing air increases when chewing gum or sucking on hard candy.

Skip the straw ― Sipping from a glass reduces air swallowed compared to using a straw.

Don’t smoke ― Air is swallowed when inhaling tobacco products.

Check dentures ― When dentures are loose, excess air is swallowed when eating and drinking.

Get past gas: Passing gas occurs about 10 to 20 times a day in normal adults; the expectation of avoiding it altogether isn’t realistic. Gas can be due to swallowed air that makes it way down to the colon. More often, it results from fermentation of undigested food, such as plant fiber, after it reaches the colon. Tips to minimize passing gas include:

Limit foods that produce gas ― Common culprits include beans, lentils and legumes; dairy products; whole grains; some vegetables; excessive amounts of fruit or fruit juices; and artificial sweeteners, sorbitol and mannitol, found in sugar-free candies and gums. A wholesale elimination of nutritious foods that might cause gas isn’t advised, but rather a step-by-step process of elimination. Even then, smaller amounts of a gas-causing food or a different food preparation might be well tolerated.

Use gas-reducing food additives ― Nonprescription products such as alpha-galactosidase (Beano) might help with bean digestion but won’t stop all gas. Lactase supplements help digest dairy products if they appear to cause gas.

Adding fiber gradually ― High-fiber foods are excellent for digestion, but adding too much, too quickly can cause gas.

Preventing constipation ― Regular exercise reduces intestinal gas by helping prevent constipation, as can eating fewer fatty foods such as fried meats, cream sauces and gravies.

When steps to reduce belching and passing gas don’t help, a visit to the doctor may be in order. Belching may sometimes be related to gastroesophageal reflux disease (GERD) or stomach inflammation (gastritis). Excess gas, particularly when coupled with weight loss, diarrhea or abdominal pain, can be caused by a variety of bowel conditions.

Stool Leakage often Treatable

Fecal incontinence ― unexpected leakage of stool from the rectum ― affects an estimated 8 percent of the general population and 15 percent of people age 70 and over in the United States, according to the January issue of Mayo Clinic Health Letter.

Determining the exact number is difficult since many people are reluctant to discuss this condition, even with their doctor. Symptoms may range from an occasional leakage of stool while passing gas to a complete loss of bowel control. There are many possible underlying causes and many effective and conservative treatment approaches.

  • Causes of fecal incontinence can include:
  • Damage to muscles that ring the rectum, due to childbirth, hemorrhoid or cancer surgery.
  • Nerve damage related to childbirth, a habit of straining to pass stool, a spinal cord injury, stroke or diseases including diabetes and multiple sclerosis.
  • Chronic constipation that can lead to a mass of hard, dry stool in the rectum that’s too hard to pass. Surrounding muscles eventually weaken, allowing watery stool to leak out around the mass.
  • Diarrhea, which can make fecal incontinence worse.
  • Loss of storage capacity in the rectum because of a stiffening rectum. Changes from radiation treatment, rectal surgery or inflammatory bowel disease can reduce the capacity to hold stool.

After diagnosing the cause of fecal incontinence, a physician will likely recommend multiple treatment approaches such as:

Diet changes: If constipation is a concern, more fluids and fiber-rich foods can help. Adequate fiber can help with diarrhea, too, as it bulks up the stool.

Medications: Anti-diarrheal drugs or laxatives may be recommended, depending on the underlying cause. Sometimes, medications taken for other conditions can contribute to fecal incontinence, and medication changes may be appropriate.

Biofeedback and pelvic floor exercises: Restoring pelvic floor muscle strength can improve anal sphincter muscle control and awareness of the need to have a bowel movement. Biofeedback is used to train patients how to properly squeeze and relax the pelvic floor.

Bowel training: Establishing a specific time of the day for a bowel movement ― and allowing adequate time not to rush ― may help.

Electrical stimulation: This relatively new treatment is an option when more conservative therapies haven’t helped. A device is implanted in the upper buttocks under the skin and delivers continuous small electrical impulses to the sacral nerve to help strengthen muscles in the bowel.

Surgery: Surgery may improve symptoms when the underlying cause is related to pelvic floor damage or muscle injuries that affect the anal sphincter.

Although fecal incontinence is more common in middle-aged and older adults, it’s not an inevitable part of aging. Better understanding of the disorder, awareness, and improvements in diagnosis and treatment make it possible for many people to be helped.


Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today’s health and medical news. To subscribe, please call 1-800-333-9037 (toll-free), extension 9771, or visit http://www.healthletter.mayoclinic.com/.

About Mayo Clinic
Recognizing 150 years of serving humanity in 2014, Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit 150years.mayoclinic.org, http://www.mayoclinic.org/ and newsnetwork.mayoclinic.org.
Ginger Plumbo, Mayo Clinic Public Affairs, 507-284-5005, Email: newsbureau@mayo.edu