Gross Anatomy: Embarrassing Body Issues
Over half of all women don't tell their doctors the whole truth about symptoms they're experiencing—and many men go years without even seeing a physician. However, keeping quiet about things that embarrass you is unwise and unhealthy. "Major and even minor symptoms may indicate a serious condition, which you don't want your doctor to overlook," says Michael Roizen, M.D., coauthor of You: The Smart Patient (Free Press) and cofounder of RealAge.com. If you're suffering in silence from one of the following problems, it's time to start talking.
"Sometimes I can't control my urination."
Likely cause: Urinary incontinence.
What to do: A whopping one in four adult women over the age of 18 have experienced this condition that takes many forms. With stress incontinence, for example, the pelvic floor is weak or stretched out (often due to pregnancy, vaginal births or obesity) and leaking can be brought on by a chuckle, cough, sneeze or exercise. With overactive bladder, contractions of the bladder muscles cause an urgent need to urinate. To stay dry:
- Lose excess pounds, since too much abdominal weight puts extra pressure on the pelvic organs.
- Pass on the booze, soda and coffee. Caffeine and alcohol can increase bladder activity.
- Strengthen the pelvic floor muscles with Kegel exercises (simply tighten your vaginal muscles as if you were going to stop urinating midstream). Start with one set of 20 (10 slow contractions, 10 fast) daily and gradually increase to three sets per day.
- Go beyond lifestyle modifications. Depending on the type of incontinence you have, your doctor might also suggest an anticholinergic agent (a medication that quiets the bladder muscle and lessens the likelihood of leaks), injections of collagen or Botox, or surgery.
"I burp a lot."
Likely cause: Sucking in too much air when you eat or drink.
What to do: Burping is almost never cause for concern—it's simply your body's way of releasing gas from the stomach or esophagus after you eat. But if you're tired of belching so much, try to take in less air. "Train yourself to drink and eat more slowly," says Dr. Roizen. Put down your fork or food between every bite, and time your meals until you get used to eating for 30 minutes instead of 10. Skip carbonated beverages and gum. When you must have caffeine, opt for coffee. If none of this helps, make an appointment with your doctor. In rare cases frequent burping can indicate a problem in the upper digestive tract, such as an ulcer or gastroesophageal reflux disease (GERD).
"It hurts when my husband and I have intercourse."
Likely cause: Dryness.
What to do: Pain is usually due to inadequate lubrication, so first try a water-based lubricant. If that doesn't help, talk to your M.D. Since levels of estrogen—the hormone that keeps the vagina healthy and moist—drop with menopause, he may prescribe vaginal estrogen (often a topical cream). You also might have a yeast infection (telltale symptoms are itchiness and thick white discharge), which your doc can diagnose with a vaginal culture. "An over-the-counter treatment like Monistat will clear it up," says obstetrician-gynecologist Mary Jane Minkin, M.D. "One-day products are generally effective, but some women get better results with three-day varieties." Finally, ask your doctor if a medication you take may be to blame. In rare cases, painful sex can signal endometriosis, a condition in which uterine tissue grows outside the uterus and forms scar tissue or cysts.
"I adore my husband but have zero interest in sex."
Likely cause: Medications.
What to do: Depression or an underactive thyroid can hurt your libido, but most people lose their sex drive because of a medication they are taking. "Selective serotonin reuptake inhibitor [SSRI] antidepressants are probably the biggest culprit," says Dr. Minkin, a clinical professor of obstetrics and gynecology at Yale University School of Medicine. But other items in your medicine cabinet may be to blame: Drugs that lower blood pressure, for instance, can dull nerve signals, and antihistamines often dry up lubrication necessary for pleasurable intercourse. Hormonal contraceptives—such as birth control pills, the patch and the ring—can interfere with your libido. It's worth bringing up this side effect with your doctor. If it's not your meds, it could be menopause—declining estrogen levels reduce the blood supply to the vagina. "Lots of my patients ask me why there's no Viagra for women. I tell them that I already have a drug that increases pelvic blood flow—estrogen [it comes in prescription pills, patches, or topical creams]," says Dr. Minkin.
"My feet really stink."
Likely cause: Sweaty shoes.
What to do: The damp, dark inside of your sneaks is a breeding ground for smelly bacteria, so wear absorbent cotton socks with shoes made from breathable materials, like canvas and leather. Wash your feet daily with antibacterial soap, and throw a tea party for your toes a few times a week (pour a pot of green tea made with several tea bags into a basin; let cool until warm, then soak for 30 minutes). "The tea contains powerful polyphenols that knock out organisms that make your feet smell," says Dr. Roizen. If this doesn't help, talk to your doc because the odor could signal a fungal infection. Athlete's foot, a fungus that makes skin itch and burn, is treatable with OTC creams, while toenail fungus, which often starts with nail discoloration, requires prescription antifungal pills or ointment.
"My breath is terrible."
Likely cause: Bacteria.
What to do: Your first line of defense is pretty obvious: Brush your teeth (and tongue) at least twice daily, and floss every night to get rid of trapped food particles that can rot and leave an unpleasant odor. But if stinky breath continues, talk to your doc. The smell could stem from an infection in your stomach caused by Helicobacter pylori (the bacteria responsible for ulcers). Your doc can do a urea breath or a stool test to check for H. pylori, which requires antibiotics. An overgrowth of other bacteria in your gut can also raise a stink. "A probiotic can help repopulate your intestines with good bacteria," says Dr. Roizen. "An over-the-counter pill often works better than yogurt or other food sources." Bad breath is also sometimes caused by sinus problems or liver or kidney problems.
"I have serious gas."
Likely cause: Your diet.
What to do: Track meals in a diary and note when you have gas, which may occur within a half hour of eating certain foods. Beans aren't the only culprit—other known triggers are veggies (broccoli, cabbage and onions), fruit, dairy products and whole grains. If dairy's the problem, try over-the-counter lactase supplements to help you digest milk and cheese. When another food is to blame and you don't want to eliminate it from your diet, try a product like Beano. Drinking through a straw, sucking on candy and sipping carbonated drinks can also introduce air into the GI tract and cause gas. If things don't improve in a couple of months, see your doctor to explore other causes, such as irritable bowel syndrome.
"Why do I get diarrhea during my period?"
Things are bad enough during that time of the month. So what's with the annoying changes in bathroom habits to boot? Here's what's happening: "During your cycle, your uterus produces chemicals called prostaglandins that cause cramping," says Suzanne Merrill-Nach, M.D, an ob-gyn in private practice in San Diego. Overproduction of prostaglandins means cramps can occur in the uterus and the intestines, causing diarrhea.
- Doctor Yourself: Take nonsteroidal anti-inflammatory drugs, such as ibuprofen (Motrin) or naproxen (Aleve), to reduce prostaglandin production a day or two before your period starts. Should you miss that window, try popping an over-the-counter (OTC) anti-diarrheal medication, such as Imodium, on the bad days.
- Call Your M.D.: If your diarrhea is not controlled by OTC meds, you may have an underlying condition (such as endometriosis) and need alternate therapy.
"Why do I feel so bloated after eating?"
There's no question about it: What you ingest can make you gassy. But there's plenty of irony in the fact that the best foods for you—beans, veggies such as broccoli and dairy products—create the worst gas. And some people are just more sensitive to the discomfort than others.
- Doctor Yourself: "Keep a food diary for two weeks," suggests Patricia Raymond, M.D., associate professor of clinical internal medicine at Eastern Virginia Medical School in Norfolk. "Watch for patterns. Gas typically occurs a few hours after eating, so you may be able to trace what's triggering yours."When dairy products seem to cause bloating, try OTC lactase supplements like Lactaid. For general gassiness, OTC medications such as simethicone (consider Gas-X), activated charcoal and Beano may provide some relief.
- Call Your M.D.: Should bloating worsen or if it's not the only symptom, ask your doctor whether a more serious issue (anything from gluten sensitivity to ovarian cancer) could be affecting you.
"Where did this mustache come from all of a sudden?"
"I jokingly call it a 'birthday gift,'" says Nia Terezakis, M.D., a dermatologist in private practice in New Orleans. "As we get older, estrogen drops, leading to higher androgen levels, and we may develop more facial hair." It runs in families, so a mom or aunts who are hairy mean you may be too.
- Doctor Yourself: Plucking, waxing, bleaching and depilatory creams are inexpensive solutions. Even shaving is fine—it's a myth that the hair grows back thicker. The diameter of the hair that comes through the skin surface just appears thicker because it's not tapered.
- Call Your M.D.: Laser hair removal and electrolysis are long-term fixes, lasting for years. But they're expensive and require multiple visits, says Dr. Terezakis. A less pricey option is Vaniqa, a prescription cream that slows hair growth. But tell your doctor about any other symptoms (hair on your chest, acne, irregular periods), which may be signs of a hormonal imbalance called polycystic ovary syndrome (PCOS).
"Help! I'm sweaty all the time."
It could be hyperhidrosis, a condition in which perspiration exceeds what's needed to maintain ideal body temperature. "Nobody knows what causes it," says Patricia Farris, M.D., clinical associate professor of dermatology at Tulane University. It tends to run in families and often shows up first in your teens or twenties, so keep an eye on your kids as they enter adolescence.
- Doctor Yourself: Wear dark-colored cotton clothing, which dries quickly and can help conceal sweat marks. Also, apply antiperspirants in the morning and before bed to all your sweatiest areas: Soft solids go on easy under arms and bra straps as well as along the hairline; try aerosols on feet and between toes. Look for products labeled "clinical strength." They contain more of a sweat-duct-blocking ingredient than regular formulas.
- Call Your M.D.: When these remedies still leave you self-conscious, ask about prescription antiperspirants (such as Drysol) or prescription oral medications (such as Robinul, which prevents the stimulation of sweat glands). Periodic Botox injections and miraDry (a new procedure using microwave technology) also provide long-term results, but only for armpits.
"There's a bad smell down there."
It's completely normal to have vaginal secretions, which are usually clear or whitish with almost no scent. "But a change in consistency or odor means you may have bacterial vaginosis (BV), an infection due to the overgrowth of naturally occurring bacteria," says Dr. Merrill-Nach. Sometimes it also causes a fishy smell that worsens after sex. While BV is the most common vaginal infection in premenopausal women, its cause is unknown.
- Call Your M.D.: Unfortunately, there aren't any OTC treatments for BV, so you have to dial your ob-gyn. You'll need a prescription antibiotic, such as metronidazole, that's taken orally or as a vaginal cream. If symptoms return, a second round of antibiotics should do the trick, says Dr. Merrill-Nach.
We've all been there. Constipation is one of the most common GI complaints in the U.S. But how often you go isn't the issue. "It's about how you feel," says gastroenterologist Felice Schnoll-Sussman, M.D., acting director of the Jay Monahan Center for Gastrointestinal Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York City. "You're constipated when you're straining, you have hard stools or sense your bowels are not emptied. "If you don't get adequate fluids or fiber—or are on pain medications or supplements such as calcium and iron—you may be more likely to get backed up.
- Doctor Yourself: Drink the recommended nine cups of water per day, and aim for 25 grams of daily fiber from whole grains, fruits and veggies. Or try stool softeners, an OTC supplement containing psyllium (such as Metamucil or Konsyl) or osmotic laxatives (such as Miralax). Regular exercise also helps bowels move, says Dr. Schnoll-Sussman.
- Call Your M.D.: Report any change in bathroom habits that lasts a few weeks as well as unexplained weight loss, rectal bleeding or fatigue, which can be signs of colon cancer.
How to Tell Your Doctor Anything
Trust us, your M.D. has heard it all. But if you're still considering suffering in silence instead of speaking up, try these approaches:
Admit you're nervous. It's a good icebreaker. "Say something like, 'I'm a little uncomfortable with this next problem. Can you help me with it?'" suggests Dr. Raymond.
Use your pen. At home, jot down some notes about when your problem started and what makes it better or worse. Read off the list or hand it to your doctor so you don't have to say a word.
Look over there! Cast your glance at the wall or out a window (eye contact can be disconcerting) and just blurt it out. "Really, there's nothing that shocks me or my nurses at this point," says Robin Ashinoff, M.D., chief of dermatologic, Mohs and laser surgery at Hackensack University Medical Center in New Jersey
Let regret inspire you. "You don't want to go home wishing that you had asked me something," says Dr. Merrill-Nach. Bypass disappointment later by convincing yourself to pipe up now.
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