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The intake of adequate amounts of liquid (8 to 12 cups daily) and the addition of fiber to the diet gen- erally alleviates constipation generic phenergan 25 mg amex. Dietary fiber is that portion of plant materials that is resistant to digestion; its addition to the diet aids in the formation of softer stool and decreases the amount of time required for stool to pass through the intestinal tract order 25 mg phenergan with visa. A high-fiber diet includes raw fruits and vegetables, nuts and seeds, and whole grain breads and cereals such as cornmeal, cracked and whole wheat, barley, graham, wild and brown rice, and bran (one of the most concentrated sources of dietary fiber). To increase the amount of fiber in your diet, your daily intake should include: • One serving of fruit (with the skin left on) or vegetable, served cooked, raw, or dried; • One half to one serving of whole wheat or rye bread, or fruit juice; and • One serving of bran (one tablespoon), bran cereal, shredded wheat, nuts or seeds; raw bran may be eaten plain; mixed 81 PART II • Managing MS Symptoms Bowel Management • Eat a high-fiber diet of balanced meals • Drink 8 to 12 cups of fluid daily • Establish a bowel program •Medications with cereal, applesauce, soups, yogurt, or casseroles; or added to flour in cooking or baking. Incorporating bran and other high-fiber foods into the diet too quickly may produce gas, distention, and occasionally diarrhea. These effects may be eliminated or lessened substantially if high- fiber foods are incorporated in small amounts and then gradually increased. ESTABLISHING A BOWEL PROGRAM Because decreased sensation in the rectal area in MS may decrease perception of the need to have a bowel movement, stool may remain in the rectum and become hard and constipating. Although this and other factors may lead to constipation becoming a significant prob- lem, it is manageable with a commitment to following an estab- lished elimination schedule, timing of meals, fluid intake, and the use of medications if necessary. The first step in establishing a bowel program is to select the time that is most convenient to have a bowel movement. Although this may vary depending on your job commit- ments, family routines, and other daily activities, the most effective time to have a bowel movement is shortly after a meal because there normally is a greater movement of contents through the bowel at that time. With this in mind, 15 to 30 minutes of uninterrupted time in which to have a bowel movement should be scheduled. After a convenient time has been selected, it is important to adhere to this routine on a daily basis, whether or not you feel an urge to defecate. Drinking a cup of warm liquid, such as coffee, tea, 82 CHAPTER 11 • Bowel Symptoms or water, frequently facilitates the process. Although this schedule initially may produce little result, it is imperative that the routine be adhered to if a successful bowel program is to be established. Medications Medications may be needed if constipation cannot be corrected by changing the diet, increasing fluid intake, and/or establishing a rou- tine. To determine the most appropriate medication, the reason for the constipation must be determined, because it may be caused by lack of bulk, hard stools, or difficulty in expelling stool. Bulk formers may be prescribed if the cause of constipation is inadequate bulk in the diet and stool.
Inattention to contextual factors may contribute to the lack of recognition of women’s and girls’ problems such as battering and other forms of victimiza- tion (Hansen & Harway generic phenergan 25mg visa, 1993; Harway & Hansen discount phenergan 25 mg on-line, 1994; Porter, 2002), the double standard about problems such as alcohol abuse (Brooks & Silverstein, 1995; Greenfield, 2002; Toneatto, Sobell, & Sobell, 1992), the overuse or inap- propriate use of labels such as premenstrual dysphoric disorder (Chrisler & Johnston-Robledo, 2002), and inattention to the ways in which culture and ethnicity influence women’s and girls’ problems such as depression and schizophrenia (C. Brown, Abe-Kim, & Barrio, 2003; Sparks, 2002) and men’s and boys’ problems such as violence, risk taking, sexual addiction, and sub- stance abuse (Brooks & Silverstein, 1995; Hoyenga & Hoyenga, 1993). Power abuses, including sexual relationships, still occur in therapy and training (Gilbert, 1999; Pope, 1994). Additional research has demonstrated therapist insensitivity to racial stereotypes, the interaction of race and gender (Davenport & Yurich, 1991; Reid, 2002; Robinson & Howard-Hamilton, 2000), and social and economic conditions that have an impact on women and girls who live in poverty and women and girls and men and boys of color (Bernal & Scharro-del-Rio, 2001; C. Lesbian relationships and partnerships have also been pathologized through the description of lesbian relationships using terms such as "merged," "fused," or "enmeshed" (Mor- ton, 1998; Pardie & Herb, 1997). Even though many psychologists believe that women’s issues in psychology were dealt with and resolved in the 1970s and 1980s, recent research indicates a continuing need for professional guidance to avoid harm in psychological practice with girls and women. Many psychologists do not recognize the harmful aspects of male gender role socialization. Hence, for couples’ counseling, a critical issue of context is the sex-role stereotype expectations of any given culture. This sex or gender role context is further complicated by issues of socioeconomic status, ethnicity, accultur- ation, sexual orientation, and ability/disability (L. Brown & Root, 1990; Clunis & Green, 1988; Comas-Diaz & Greene, 1994; Lijt- maer, 1998; Matsuyuki, 1998; Prilleltensky, 1996; Wyche, 1993). A case illustration is provided to further the understanding of feminist therapy applications. Numerous issues of interacting diversity are addressed as are future needs for theory development and research. Brown & Brodsky, 1992; Enns, 1997; Espin, 1994; Gilbert, 1980; Greenspan, 1983; Morrow & Hawxhurst, 1998; Szymanski, Baird, & Kornman, 2002; Worell & Johnson, 1997; Worell & Remer, 1992, 2003; Wyche & Rice, 1997). Feminist therapy assumes that all voices are val- ued—women’s and men’s, girls’ and boys’. The principle that "the personal is political" reflects the fact that all persons live in a political and social cli- mate and that differences in power cause differences in socialization and personality development. Therefore, client problems may be caused more by external messages and limitations than by intrapsychic factors.