A Woman’s Guide to a Healthy Stomach
Taking Control of your Digestive Health
Jacqueline L. Wolf, M.D.
To the Loves of My Life:
My husband, David,
and
My daughters, Laura and Rebecca
CONTENTS
Introduction
Chapter 1
How Uncouth: Stomach Shame
Chapter 2
Endometriosis and Feminine GI Troubles: Symptoms Every Woman Should Understand
Chapter 3
“Do These Pants Come with an Elastic Waist?” The Truth about Gas, Bloating and Irritable Bowel Syndrome
Chapter 4
When You Know Every Bathroom in Town: Diarrhea
Chapter 5
When You Just Can’t Go: Constipation
Chapter 6
Stinky Burps: Heartburn and Halitosis
Chapter 7
When It’s Really Bad: Time to Get Help
Chapter 8
Nine Months of This? Minimizing Stomach Problems During Pregnancy
Chapter 9
Eating Your Way to Health
Chapter 10
Doctors’ Visits and Medications
Appendix 1
Glossary
Appendix 2
GI Tests
Appendix 3
Resources
References
Acknowledgments
Introduction
“Part of the secret of a success in life is to eat what you like and let the food fight it out inside.”
—Mark Twain
This is a different kind of bathroom book. It’s a book about bowel function—blowing the lid (so to speak) off the secrecy and shame surrounding female digestive ailments once and for all. This is a reassuring guide for women by a woman. It explains the causes and cures for our most embarrassing, urgent and common stomach problems. Wondering what those PMS cramps might mean? Always guzzling Pepto-Bismol before a big meeting? Read on.
Stomach ailments might just be the last great taboo in American culture. Women are the ones who suffer (I’m not just saying this—statistics back me up), and yet we’re not whining about it! Seems silly, doesn’t it? Bowel function is a necessary fact of life. We all go. But how many times have you hunched in the office bathroom stall, waiting for the boss to comb her hair and wash her hands, before letting loose with a massive explosion? Or wondered if your bad breath was caused by the onions you had for lunch—or something more sinister, like acid reflux? You’re not going to cry about this over cocktails with your friends or coffee with your mother. No, it’s easy to think everyone else is clean and pure, while you’re the only woman alive with gas, acid, pain and cramping. But I’m here to tell you that your glamorous coworker with the designer clothes and perfect hair has stomach problems just like you, and it isn’t always pretty.
It’s during times like these, when things aren’t pretty, that our stomachs become the center of our universe. The stomach is where we feel stress, nervousness, anxiety, pain. Just ask Freud. Yet, strangely, there aren’t any books or websites that deal with stomach problems in a way that isn’t completely satirical (ratemypoo.com) or incredibly technical (I won’t bore you).
As a physician, I see this as a huge problem. Because when legitimate illnesses become shrouded in shame, they pose life-altering consequences for those who suffer from them. The repercussions range from the severe (undiagnosed ovarian cancer) to the annoying (planning out your driving route based on the nearest rest stop). By the time many patients reach my office, they’ve suffered alone for years, or they’ve been brushed off by doctors or told to take an over-the-counter medication.
Why? Bowel issues are hard to diagnose, thanks to symptoms that could really mean anything, and they’re tough to talk about. They involve bad smells and strange noises. You might have constant gas, but who wants to go to a doctor complaining of humiliating farting? You might get constipated during your period, but would this move you to get a GI referral? No, probably not. That’s where I come in. Consider this book your cheat sheet to bowel problems. This isn’t a substitute for a doctor’s visit—and please, if you have unusual symptoms, don’t hesitate to get checked out—but this is a jumping-off point for women who need answers.
Just as important, I think it’s helpful to recognize that men have it easier in this arena. (Sorry, guys.) As I’ve seen in my practice, stomach complaints are largely a “woman thing.” Like it or not, men are more apt to boast about farting or joke about bathroom escapades. Prostate exams are a rite of passage that men fret about—and joke about, too. You can’t turn on the TV without seeing a bronzed man in a hot tub singing the praises of Viagra. It’s okay for men to talk about and make light of their issues! Why not women?
I’m not sure why. But I do know that when it comes to the stomach, women are more prone to suffer quietly, with physical and emotional consequences. We also suffer from issues, like PMS and endometriosis, that just don’t affect men. And women are more likely than men to get gallbladder disease, autoimmune disease, irritable bowel syndrome (IBS) and constipation.
This shame and reluctance to seek help—or the tendency to seek it too late—have real-life repercussions. According to the National Institutes of Health, more than seventy million Americans suffer from digestive diseases. In 2004 more than 236,000 Americans died from digestive ailments. Over half of the deaths were due to cancer—colorectal cancer accounting for almost 40 percent of all cancer deaths. And in many of these cases, deaths could have been prevented if routine screening had been done and treatment had been sought at the outset of symptoms. In the United States, Canada and Northern Europe, women are more than twice as likely as men to seek the advice of physicians for changes in bowel function. In my gastroenterology practice at Beth Israel Deaconess Medical Center in Boston, 70 percent of my patients are women. And almost universally, these women feel alone and scared. There’s no road map, no resource to reassure them that they’re not imagining their problems or that they’re going to be okay.
Instead, symptoms mean fear: Could my bloating mean cancer? Could my endometriosis mean that I can’t get pregnant? I often find myself in the role of psychologist as much as gastroenterologist. And my message for the afflicted woman is this: you’re not alone!
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