DEAR DR. GOTT: I have had a problem with severe constipation for many years. I have taken different laxatives and have been on milk of magnesia for a long time. I took a large dose of it last night and the night before, to no avail. I use Fleet enemas and suppositories, and strain with all my might to get any kind of action.

I have approached my primary-care physician and others and get no answers at all. I will say I am desperate with the terrible problem and am hoping you can give me help. I'm physically active and seem to be in good health otherwise.

DEAR READER: Constipation is a persistent decrease in the frequency and ease of bowel movements. On a temporary basis, this is nothing to worry about. Long term, it should be investigated.

You do not indicate how often you actually have a bowel movement. Every person has a slightly different pattern. For some, it's once a day, three times a day or even once every three days. Do you include adequate fiber and sufficient fluids in your diet? Or is your diet high in animal fats and refined sugars? Have you had your thyroid gland checked? A sluggish thyroid can cause chronic constipation.

The habitual use of laxatives can be dangerous. As with addictive drugs, doses of laxatives over time must be increased in order to produce the effect needed. Eventually, the intestines can become unresponsive to the drugs altogether, and cease to become effective.

Constipation can be a symptom of a more serious problem, such as medication interactions, hormonal disturbances, thyroid disorders and more. It can also lead to hemorrhoids from straining and fissures caused by hard stool stretching the sphincter muscle. With that in mind, I recommend you make an appointment with your primary-care physician, who hasn't listened to you thus far, to demand help, or request a referral to a gastroenterologist. Ask to be checked for the obvious possibilities mentioned. If nothing is found, your concerns should be put to rest at least.

While waiting for the appointment, bypass all the over-the-counter drugs you have. Instead, add fiber and plenty of fruits and vegetables to your diet, and increase the amount of fluids you consume daily. Consider warm prune or apple juice with breakfast or try my colon cocktail (equal portions of bran, applesauce and prune juice, 1 to 2 tablespoons taken daily). Exercise regularly to the capability you feel comfortable with. Perhaps this translates to a walk around the block after work. Allow your body to get back on track without the aid of outside forces. You might be amazed at the results.

To provide related information, I am sending you a copy of my Health Report "Constipation and Diarrhea." Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a check or money order for $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR DR. GOTT: I am a 78-year-old female. Eight months ago, I was diagnosed with atrial fibrillation and congestive heart failure. I was put on Coumadin, but take generic warfarin. Since the regimen began, I have itched all over, especially in body crevices. I have a number of lesions and, even as I write this, I have bandages on three areas of my torso trying to protect spots where the skin is raw from scratching because of the itch.

I went to a dermatologist, who gave me a sample of a white ointment and recommended I buy a small bar of soap for $10. This has helped little, if at all.

Before being put on the warfarin I never had any problems like this. The Coumadin clinic I go to for lab work and my doctors seem unconcerned. In fact, I asked my doctor about another treatment, and all I got was that Coumadin is what I need, period!

For information, I take medication to lower my blood pressure and Prilosec for heartburn from a hiatal hernia. None of my medications have been changed.

DEAR READER: Coumadin and its generic form of warfarin act as an anticoagulant to help reduce the formation of blood clots. The medication was prescribed because of your atrial fibrillation, a rapid and irregular heartbeat. This is important because most people with this condition are at higher risk of blood clots, which may lead to stroke.

Hives, rash and itch are side effects. You are likely experiencing an allergic reaction to the drug or a possible cross reaction from the hypertensive medication you are on. I believe your dermatologist is off base. Lotion will not make your problem go away. If your physician is unwilling to work with you, request a referral to another physician or cardiologist. Also, consider seeing an allergy specialist.

To provide related information, I am sending you copies of my Health Reports "Consumer Tips on Medicines" and "Allergies." Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a check or money order for $2 for each report to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

Peter Gott is a retired physician and the author of the book "Dr. Gott's No Flour, No Sugar Diet," available at most chain and independent bookstores, and the recently published "Dr. Gott's No Flour, No Sugar Cookbook."