|Each chapter in this book touches on the physical, emotional and social
consequences of women’s most common bowel conditions, from endometriosis
to irritable bowel syndrome. In many cases, I highlight patients whose diagnoses
are illuminating or particularly interesting (though for space’s sake,
they are abridged here, and out of concern for privacy their names, occupations
and other possible identifiers have been changed). These women wanted
to tell their stories so that other women might know that, yes, we’re all in this
together. Indeed, while digestive dysfunction can point to serious problems,
often it’s a common ailment with a clear-cut solution. How reassuring for the
millions of women scouring the Internet in secrecy, running to the bathroom
between appointments and avoiding social situations for fear of an eruption to
know that there’s help. Each chapter also includes Q&As, designed to answer
the most common questions I hear in my practice. You’ll also find advice on
what to ask your doctor and which medications are worthwhile (and which
ones aren’t), as well as nutrition tips.
So find a quiet corner-maybe your bathroom, even?-and start reading!
How Uncouth: Stomach Shame
"For marriage to be a success,
every woman and every man should have
her and his own bathroom.
- Catherine Zeta-Jones
| Why are stomach ailments shrouded in shame and embarrassment
for women? We all have to cope with them at some point in our
lives - a volcanic explosion after a Mexican dinner, a knot in the
stomach before a big job interview or after fighting with a spouse. This is normal,
and speaks to how acutely stress and discomfort resonate in our stomachs.
But, for some of us, our stomachs are the center of our very being.
Many of us live with constant constipation, diarrhea, indigestion, cramping -
without relief and without answers. Often, we suffer quietly - scouring the internet
to self-diagnose or bouncing from doctor to doctor, trying to figure out
what’s going on. Even worse, many women simply figure that this is the way life
has to be, and we don’t get the help we need. It doesn’t have to be this way!
Chances are, if you’re reading this book, you have stomach issues or
care about someone who does. This chapter offers basic information about the
digestive system and the way it affects our lives when it goes haywire. I’ll focus
on an overview of common issues that I see in my practice every day and the
typical effects these problems have on my patients’ lifestyles. In the discussion
below, when I use the word stomach, it’s as a general term to describe any problem
First things first: Bowel function is a fact of life, and it shouldn’t be humiliating.
Everyone goes to the bathroom! And when we go normally, we don’t
spend too much time thinking about it, right? However, when something goes
wrong, it affects us deeply. For most of us, stomach function is a complete mystery,
and we take it for granted when our digestive system works as it should.
The flip side of this is that when it doesn’t, we tend to panic.
Part of the reason for this panic is that it’s socially unacceptable to talk
about bowel problems. We have no problem moaning about a horrible headache
or even PMS cramps, but if we’re going to the bathroom constantly- or
not at all- there’s really no one to tell. This is ironic since children are often
obsessed with excrement, both as a curiosity and as something that’s a little
naughty and taboo. However, as we become "socialized," we lose that obsession,
or we just joke about it and brush it under the rug.
This isn’t a new phenomenon. In the eighteenth and nineteenth centuries,
the health of the bowels was often equated with the health of the soul.
Bad odors indicated that rot lurked inside. Better to cover up the odors with
perfume and sprays! This stigma hasn’t evaporated with time. Bad breath,
gas, belching - if we can produce such horrible smells and sounds, there
must be something awry, possibly deep within our bodies.
There’s a reason
people load up on mouthwash, chewing gum, perfume and floral-scented
Yes, our odors are best kept hidden. Society has deemed it unladylike
to smell bad. It has not always been that way, of course. Here, it’s instructive to
examine the life cycle: Shortly after birth, a baby has its first bowel movement,
beginning a lifetime "practice." The mother (or father), who usually changes
the diapers, is aware of the baby’s poops, gas and colic. She knows whether the
baby’s elimination is effortless or distressing, and there’s no taboo in discussing
this with the pediatrician. The toddler eventually becomes toilet trained. At this
point, Mom and/or Dad have to be actively engaged in the elimination practices
of their child, often spending hours in the bathroom, cajoling and pleading
and teaching, plus many hours changing and washing sheets or clothes. We
sit around with other parents and commiserate about our kids’ bathroom woes.
We have no problem sharing gory details about their bathroom habits - but
would you really tell your fellow playgroup moms about your own constipation,
gas or diarrhea? Not exactly something you gossip about over lunch. I
think that kids must sense our discomfort with our own guts and exploit that
unease. When children don’t want to do something, they will often develop a gut ailment - abdominal pain, nausea or vomiting. It often takes an astute parent to recognize this action for what it is.
When then does "poop," gas or abdominal pain become a taboo subject
of conversation? Why are they considered dirty, disgusting and embarrassing?
As we get older, the bathroom becomes an intensely private place for
women. In high school, guys shower and use the bathroom en masse in the
locker room. Women, of course, require privacy and closed doors. As we get
older and enter romantic relationships, a double standard begins to emerge: It’s
okay for your boyfriend or husband to joke or brag about his odors and noises,
but it’s just not something women do. Remember on Sex and the City, when
Carrie Bradshaw hid from Big after accidentally farting at his apartment? Or
when Charlotte York exploded with diarrhea on the girls’ trip to Mexico and
was mortified? Not pretty! These are lighthearted examples, but the core issue
is troubling: Women do not like to discuss their stomach problems. And, as a
result, they often suffer in silence for long periods of time.
In the United States, Canada and Northern Europe, women are more
than twice as likely as men to ultimately seek the advice of physicians for changes
in bowel function. Yet most women won’t talk about their fears until pushed.
They don’t discuss them with their family members, significant others, friends
or, in many cases, with their physicians; many women who come to see me
skirt the reason for the visit until I pry it out, and once I do, I’m the first person
they’ve told. Moreover, some stomach issues are woman-only problems, like
endometriosis, ovarian cancer and that good ol’ standby, PMS. Also, women
just seem more likely to react sensitively to the issues that stomach ailments
cause. The gut can become the center of a woman’s life if she has belly pain,
has too few or too many stools, has a hard time having a bowel movement, is
worried about finding a toilet in time or has a problem with gas.
How can something so central to our well-being cause such embarrassment?
The results of silence can be serious and life-altering: Some women I
know won’t leave their homes until they feel it’s "safe" and they’ve done all they
can do in the bathroom, lest they risk going to the bathroom in their underwear,
or interrupting their commute or a work meeting to flee to the nearest
toilet. Many wake up extra early and spend hours laboring in the bathroom,
without anything to show for it except strained muscles. This may result in lateness
to work, lost jobs, even depression and isolation. Many women are afraid
to go out for dinner, to exercise or to travel. They fabricate elaborate excuses to
stay home or just say they don’t feel well. More than anything, they feel alone.
So you feel less alone, here are some of the most common complaints and
concerns I hear from my patients. Can you relate? Short easy-to-follow solutions
are suggested for each concern. I’ll address all these topics in detail in the book!
|Dr. Wolf's Top Ten Most Common Issues