Dear Doctors: I have been having some problems with voiding my bowels, and my doctor has started talking about GI motility. Can you explain what that is? She also wants me to have something called anorectal manometry testing. I would like to know more about that, too.

Dear Reader: Your symptoms have alerted your doctor to potential issues with gastrointestinal motility, which is often shortened to GI motility. The term refers to the body's ability to move liquids and solids throughout the length of the gastrointestinal tract.

GI motility entails a coordinated series of wavelike motions. Unless something goes awry with the muscles, structures and signaling it involves, it's a process we rarely notice. Yet, the journey itself, along with the tissues involved, is complex. It begins in the throat, also known as the pharynx, and moves on to the esophagus, stomach and small and large intestines. The ingested liquids and solids that remain after digestion and absorption complete the journey in the rectum and anus. That's where the final step of GI motility takes place. Working together, the nerves and muscles of the rectum and anus produce a bowel movement.

In certain cases, symptoms such as ongoing constipation or diarrhea can indicate a problem with GI motility. Additional symptoms can include heartburn, indigestion, nausea, difficulty swallowing and vomiting. Because each of these are common to a wide range of conditions, disorders and diseases, tests can be needed to narrow down and pinpoint a cause.

Among these tests is the one you have asked about, anorectal manometry. It is used when GI motility in the terminal end of the lower GI tract needs to be evaluated. The results provide information about the functioning of the anorectal sphincter muscles, which are involved in the control of bowel movements. This includes measuring pressure exerted by the anal sphincter muscles and the sensations that are present in the rectum. The test also evaluates the neural connections and reflexes that are required for the bowels to function properly.

Anorectal manometry involves the use of a flexible, pressure-sensitive tube, about the length and width of an old-fashioned thermometer. It is tipped with a tiny, inflatable balloon. The patient lies on their side on an examination table, and the instrument, which is lubricated, is guided into the rectum. It can be uncomfortable, but it is usually not painful. During the test, the doctor asks the person to squeeze, relax and bear down with their rectal muscles.

In another part of the test, the tiny balloon is inflated with air. The way in which the body responds provides important information about the reflex pathways in the rectum. In the final part of the test, the balloon is filled with water. The patient is asked to engage their rectal muscles to expel the balloon, as they would when having a bowel movement.

Taken together, the various parts of the test provide a detailed profile of rectal and anal function. The information helps to narrow down potential causes of symptoms associated with bowel control, which are common to a number of conditions.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I have been having anxiety, and now my blood pressure is getting high, too. Are they related? I understand that medications might become necessary, but I would prefer to try nonmedical treatments first. Can you recommend supplements that can help to reduce these issues?

Dear Reader: You've asked about two topics that will be of interest to a large number of people. Health data show that close to half of all adults in the United States have high blood pressure. According to the latest guidelines, this is defined as systolic blood pressure (that's the top number) readings of 130 mmHg or more, or diastolic blood pressure (that's the bottom number) greater than 80 mmHg.

When it comes to anxiety, that is a condition that is estimated to affect close to one-fifth of us, making it the most common mental health issue in the U.S. And while anxiety doesn't always lead to high blood pressure, it can be a contributory factor for some people. Surges of anxiety can cause blood pressure spikes, but these are typically temporary. Over time, however, chronic anxiety can begin to have an adverse effect on someone's baseline blood pressure.

We understand your desire to manage each of these conditions without the use of medication. At the same time, we are glad you understand that in order to safeguard your long-term health and well-being, medication may become necessary.

To that end, we think it's important that you bring up your concerns about anxiety and blood pressure with your medical care provider. If your blood pressure isn't dangerously or chronically high, they can offer guidance as you make lifestyle changes to improve it and accurately assess and track the results. These include regular exercise, improving diet and avoiding stress. They will also advise if delaying medication might become a health risk.

Regarding supplements, there are several that can be potentially helpful. For anxiety, these include magnesium, ashwagandha, lemon balm, chamomile, l-theanine and valerian root. Supplements such as garlic, green tea, magnesium and l-arginine can be useful in improving blood pressure. But don't go it alone. Always check with your doctor when adding supplements to your daily regimen. Some can interact or interfere with medications, or they can have adverse side effects. Getting guidance with dosages is important, as well.

When talking about these issues with our own patients, we emphasize that supplements, however natural, should never be the sole approach. This holds true for both anxiety and blood pressure. With anxiety, it's important to identify any specific triggers that lead to that feeling. This awareness can then help you understand the root cause. With this knowledge, you can make the appropriate changes in your life that can begin to bring relief. Additional natural approaches can include meditation, mindfulness, deep breathing, yoga, weightlifting, running or other aerobic exercise. Each of these have been shown to help.

Sleep is also extremely important. Studies have linked poor sleep to both anxiety and elevated blood pressure. And please don't discount therapy or, if needed, appropriate medication.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: Our grandfather is 84 and has prostate cancer. He has been declining and has asked to stop treatment. He and his doctors decided that he will begin hospice care. What happens in hospice care? How do you choose a provider? We hope this can be done at home.

Dear Reader: When someone lives with a serious illness, they are faced with an ongoing series of decisions regarding their medical care. For some people, this eventually includes the choice to discontinue treatment. It may be that the available interventions are no longer effective, or that they interfere with the individual's desired quality of life. When this occurs and doctors have determined that the person is nearing the end of their life, hospice care becomes an option.

The words “hospice care” may bring to mind a nursing home or other type of facility. And while some medical facilities are devoted to hospice care, the term actually refers to a specific type of end-of-life medical care.

When someone enters hospice care, it means that the treatments, medications and procedures that had been employed to stop or slow disease progress are no longer used. Instead, the focus shifts to addressing the person's physical, mental, emotional and spiritual needs as they navigate the final stages of illness.

Medications and treatments may still be part of hospice care. So may specialized equipment and supplies. However, they do not treat the disease itself. Instead, they are used to manage pain, discomfort and other symptoms or side effects that may be present due to the disease or condition. The goal is to bolster the patient's physical and emotional well-being as they near the end of life. If appropriate, spiritual support is offered, as well. While hospice care acknowledges death as an endpoint, it doesn't postpone it. And it never takes any steps to hasten it.

As we mentioned, some hospice care is carried out in a specialized facility. However, it can also take place at home. In those cases, it is offered by a specialized hospice care provider. Programs may be run by independent nonprofit organizations, or they can be affiliated with hospitals, nursing homes, religious institutions or home health care agencies. There are also some for-profit providers.

The practice of hospice care involves a team approach. It typically includes nurses, doctors, home care aides, a spiritual adviser, social workers and case managers. Offering help and support to family members is an important component of hospice care. This can include something known as respite care. This is when family members, who are the primary caregivers in home hospice care, are given time away to recharge and regroup.

Most communities have at least one hospice care provider. Your medical care provider and the person overseeing a patient's discharge from the hospital can offer information on available options. The departments of health or social services of each state also maintain a list of licensed agencies. National organizations, including the National Hospice and Palliative Care Organization or the National Association for Home Care and Hospice Care, are also excellent resources.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)