October 10, 2008

Hotline on Gastric Woes in Women

By Lois M. Collins Deseret News

Women hate to discuss certain things, even with a trusted physician. So they often wait a long time before mentioning chronic diarrhea, fecal incontinence, urinary urgency, flatulence and other digestive tract woes, according to Dr. Holly Clark, a gastroenterologist at LDS Hospital.

Those silent women's health issues -- "silent" because they are often unacknowledged or discussed -- are the topic of Saturday's Deseret News/Intermountain Healthcare Hotline. Clark and Dr. Richard Labasky, a urologist at Alta View Hospital, will take called-in questions from 10 a.m. to noon. All calls are confidential. The number is 1-800-925-8177.

As many as 15 percent of women have irritable bowel syndrome at some point, according to Clark -- a cluster of symptoms that can include pain, gas, bloating, diarrhea, constipation or the two alternating. They may have multiple symptoms and it "can evolve as it goes on," she said.

When women do seek medical help, they may face blood work, a colonscopy, a scope into the stomach or a CT scan or other tests to try to determine a cause.

"In irritable bowel, all those tests are going to be normal, which is frustrating. You may be told it's in your head. It's not. It is a disorder of function and you cannot see function on a scan," said Clark, who called it a "complicated disorder that's sometimes frustrating to treat." Certain foods can make it worse. So can stress.

"Everyone has a mind-gut connection that's active," said Clark. "It's why we have butterflies and we get anxious feelings in our stomach."

Anxiety can make someone literally sick to her stomach. When stress changes to IBS, it can be debilitating, which is why stress management and learning to deal with issues is so important for treating IBS. Symptom management is also important.

Fecal incontinence can exist alone or with other conditions, including IBS.

"It's very, very common," stressed Clark, who noted that pregnancy and delivery can damage the anal sphincters. When you're young, you can compensate. "When you're older, those mechanisms may not compensate any longer." So women in their 50s and 60s suddenly suffer symptoms that had their roots 30 years in the past.

The important thing to know, Clark said, is that there are effective treatments, both surgical and nonsurgical. And it frequently overlaps with urinary incontinence.

Women are more likely than men to battle constipation because they're smaller and their colons are packed into smaller spaces, then sometimes stretched out or rearranged with pregnancy. Hormones also impact how long it takes stool to make its journey through the colon. One of the best things you can do is eat plenty of fiber, but you should start slowly and make sure you drink lots of water, she said.

Every woman should be screened for colon cancer at appropriate times, usually starting at age 50 unless there's a family history of the cancer. The notion that it's a man's disease is "incorrect." One in 18 women get colon cancer if they don't participate in screening. With men it's a very similar one in 17.

Prevention includes a high-fiber diet low in animal or saturated fat and high in fruits and vegetables, with adequate folic acid, magnesium and calcium. Exercise and not smoking have major impact, as well.

Tomorrow: Prolapse and urinary incontinence

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