Why can we talk about arthritis and cholesterol levels with our family, friends and coworkers, but when it comes to certain conditions that are just as common, we clam up? Embarrassing medical conditions, like incontinence or painful sex, can be difficult to talk about - but remember that you are not alone. You are in good company and there are good treatments. Feel free to read this in the privacy of your home, but then open up to a doctor (maybe even your friends?) and put an end to the embarrassment.
In the Bathroom
Even though 1 in 4 women over 40 suffer from some type of urinary incontinence, most are too embarrassed to talk about it. Whether it's leaking a little when you laugh too hard, being unable to hold it until you reach the bathroom, or spraying instead of urinating in a steady stream, many women suffer unnecessarily from highly treatable problems. In fact, only 1 in 12 women will ever get help and yet 80% of the time urinary problems can be completely cured.
What You May Be Experiencing
Stress incontinence Leaking with a cough, sneeze or other kind of physical exertion such as heavy lifting. If your pelvic floor (comprised of the muscles that support your reproductive system) is weak, it can't keep your urethra closed during everyday abdominal pressures. This is especially common for women who have given birth. It can range from being a slight nuisance to requiring you to wear pads.
Urge incontinence A sudden, strong urge to go and, often, an inability to make it to the toilet. With urge incontinence, your bladder contracts excessively giving you little warning and leading to embarrassing accidents. It can be caused by a number of factors including urinary infections, bowel problems, strokes, Parkinson's, Alzheimer's and other neurological conditions. If there is no obvious cause, the term for it is overactive bladder.
Mixed incontinence The most common kind of incontinence in women combines both stress and urge incontinence and doctors are unsure of the cause.
Spraying during urination For some women, the difficulty is not when they go to the bathroom, but how their body does it. Rather than coming out in a steady stream that can be aimed into a toilet, their urine sprays (kind of like when you put your thumb over the garden hose), wetting clothes, or even the bathroom. Several conditions can contribute to spraying, such as when muscles surrounding the urethra are too tight or there is a small growth at the end of the urethra called a caruncle, which is often found in postmenopausal women.
What you should do
Go see a doctor - a urogynecologist or an OB/GYN - that you trust. Talk to him or her and get a diagnosis.
What can be done
- Kegel exercises This is the first line of defense against incontinence and involves contracting your pelvic floor (the same muscles you use if you try to stop your urine mid-flow) throughout the day to strengthen them. Experts recommend holding the contraction for 5 to 10 seconds, then relaxing for 10 seconds and doing repetitions of 10 to 20 throughout the day (maybe at stoplights, while watching TV, or before you go to sleep).
- Vaginal weight training It sounds silly, but experts swear by the use of cone-shaped vaginal weights that you must hold in while you go about your daily business, working up to 30 minutes a day. As your muscles strengthen, you increase the weights.
- Behavioral therapy in which you set times to go to the bathroom, and avoid caffeine and liquids at certain times of the day.
- Physical therapy
- Hormone cream (for caruncles)
- Surgery to place a supportive sling under the urethra, help keep the bladder in its proper place, or bulk up the urethra to narrow the opening that urine flows through.
In Front of the Mirror
A balding man is so common, few of us take note when we see one, but did you know that 40% of women also lose their hair as they age? Like men, women can inherit this tendency, but it can also be caused by anemia or other conditions, especially those that affect the thyroid.
What can be done
If you are noticing hair thinning or loss, first know that you are not alone. Then, know that there are effective solutions to the problem, including:
- Changing your part so that it covers the space where hair has grown thinnest
- Highlighting your hair, which swells the diameter of the hair shafts and gives the appearance of thicker hair
- Getting more frequent haircuts, which will increase fullness
- Applying scalp make-up which mimics the color of your hair and minimizes the visibility of thinning spots
- Rogaine (minoxidil), a liquid that is applied to the scalp and stimulates hair growth
- Aldactone (spironolactone), an antiandrogen which helps slow or stop hair loss that begins before menopause
- Hormone replacement pills, used after menopause
- A laser comb, a new therapy that stimulates the growth of hair follicles but is still in the early stages of development
- Hair transplant surgery
In the Bedroom
Few people feel comfortable talking about sex, but it's even harder to be open about it when sex is uncomfortable or, even worse, painful. But nearly a quarter of women experience pain during sex, and they don't need to. There are techniques and treatments to help women overcome pain and experience what is supposed to be one of the most enjoyable parts of our lives.
What Causes It
- A "tipped" uterus In most women, the uterus is tipped toward the front, positioning the cervix at a deeper part of the birth canal. But for some women the uterus is tipped backward (which causes no health problems or other repercussions, it's just an anatomical variation like being left-handed), which positions the cervix closer to the opening of the vagina. During deep penetration, the penis can bump into the cervix causing serious pain. A uterus can also become retroverted after childbirth.
- Endometriosis in which the lining of the uterus grows beyond the interior of the uterus
- Interstitial Cystitis, a little understood condition in which there is pain surrounding the bladder or with urination
- Urethritis, an inflammation of the urethra caused by a number of different factors
- Vaginusmus An involuntary spasm of vaginal wall muscles that can make penetration painful
- Vestibulitis Unexplained stinging or burning around the opening of the vagina
- Loss of lubrication Especially after menopause when declining estrogen levels thin the lining of the vagina, creating greater friction and pain during sex. Medications, including birth control pills, antidepressants, sedatives, and antihistamines can also decrease lubrication
What you can do
- Talk to your doctor to make sure there is not an underlying condition or a medication causing the problem
- Change positions If your uterus position is causing you pain, being on top can help you control the depth of penetration to prevent pain. Knowing you're in charge can also help decrease the anxiety that you may be about to feel pain and help you relax and enjoy it more.
- Longer foreplay to ensure lubrication
- External lubricants
- Hormone replacement therapy in which you take female hormones to replace those lost in the course of menopause
- Low-dose hormonal topical creams for women who are uncomfortable with the risks associated with systemic hormones. These are applied to the labia and clitoris and need to be used daily for 2 weeks to see rejuvenation of the skin, increased lubrication, and a return of vaginal elasticity. After 2 weeks, you can maintain the benefits by applying a few times weekly. The same medication is offered in a suppository if that is more comfortable for you.
- Estring A ring that is inserted into the vagina and leeches estrogen daily over 3 months. You or your doctor can insert and remove it.
The Bottom Line
The most important thing is that you get the treatment you need to improve the quality of your life. The second most important thing? Talking to your friends and loved ones so that everyone can learn that we share common conditions that are nothing to be ashamed of and can be easily treated.