Chapter 1
How Uncouth: Stomach Shame
“For marriage to be a success, every woman and every man should have her and his own bathroom. The end.”
—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 with the digestive tract below the chest (the abdomen or belly).
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 bathroom sprays!
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:
1. “What if I can’t make it to a toilet in time?”
Are you one of those women who can’t go to the movies or the theater because you’re constantly scrambling for a restroom? Or when you’re on the highway, you’re always searching for a sign pointing to the next exit with a possible bathroom. So many women end up altering their social lives or reducing them to nothing because it’s just too embarrassing. Some of my patients have actually ranked public restrooms (note: hotels are usually safe bets) or highway rest stops because they so fear inopportune bowel explosions.
Try to use the bathroom before you leave the house. If you have frequent diarrhea associated with stress or IBS, you can take a half or a full dose of Imodium (loperamide) before you leave. (Check with your doctor if you have inflammatory bowel disease before taking loperamide.) If your bowel movement can be timed with your meals, eat earlier than usual, eat lighter than usual or delay eating until you get to your destination. If the diarrhea can be urgent and you can’t hold it, you could wear an adult diaper (e.g., Depend). You’re the only one who knows! It can give you security. Pack an extra set of underwear and clothing in your car, just in case.
2. “How can I go completely when my kids are banging at the door?”
I see countless mothers