3 Common Conditions Women Don't Talk About: Incontinence, Lack of Desire and Irritable Bowel Syndrome

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Even the most blunt, out-spoken women tend to clam up if they have one of these three potentially embarrassing medical problems: incontinence, irritable bowel syndrome (IBS), and diminished female sexual libido.

If you're like many other women, you'd rather live with the sometimes distressing symptoms of these conditions than broach the subject at your next doctor's office visit.

You're likely to be embarrassed, believe few others have the problem, just wish it would go away -- or all of the above.

But all of these conditions can affect your relationships and your sense of wellbeing. And treatment can provide relief of the symptoms, and in some cases, eliminate the condition altogether.

Here’s what you need to know about each of these conditions so you can get help, and start enjoying life again.

Overcoming Incontinence Symptoms

In recent years, incontinence has come out of the closet, thanks to U.S. Olympic speed skater Bonnie Blair and Olympic gymnast Mary Lou Retton, who both have publicly acknowledged their problems with incontinence, and raised public awareness.

Incontinence can affect women of all ages, but is more common as women get older. Incontinence is not, however, an inevitable part of aging.

Urinary incontinence affects an estimated 12 million U.S. adults.

Symptoms depend on the type of urinary incontinence you have, according to Halina Zyczynski, MD, director of the division of Urogynecology and Reconstructive Pelvic Surgery at Magee-Womens Hospital in Pittsburgh, Penn. The two most common types are stress and urge incontinence.

In stress incontinence, you often leak urine when you push or pull objects, cough, sneeze, laugh, or exercise. Your pelvic floor muscles, which support the bladder, are weakened -- often due to childbirth -- and that weakness causes leakage.

In urge incontinence, as the name implies, you have a sudden need to urinate and may not be able to get to the bathroom soon enough to avoid leaking urine. While it is not completely understood, experts think the bladder muscle may give the wrong message to the brain, because the bladder feels more full than it really is. You may feel the urge to void even if you have just done so.

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One treatment option for incontinence symptoms is to wear panty liners or protective garments if the urine leakage is small. You can also start performing Kegel exercises, which strengthen the pelvic floor muscles. Biofeedback training is sometimes given in combination with pelvic floor training.

Injection of a bulking agent around the bladder neck and the urethra (urine-carrying tube) can help reduce stress incontinence, Zyczynski says. Another option is a surgical procedure in which a strap of natural tissue or other materials helps support the urethra.

Overcoming Irritable Bowel Syndrome

One in five adult Americans is affected by irritable bowel syndrome (IBS), according to the Digestive Disease Clearinghouse of the National Institutes of Health (NIH). The problem is more likely to strike women than men. Half of those who suffer are affected before age 35.

As the name implies, irritable bowel syndrome is no fun. The condition is marked by diarrhea, constipation, or both at different times, as well as abdominal cramps, pain, and bloating.

Yet few patients discuss irritable bowel syndrome symptoms with their doctor, at least initially, says Peter Galier, MD, associate professor of medicine at the UCLA’s David Geffen School of Medicine and former chief of staff at the Santa Monica-UCLA Medical Center "Bowels are not the happiest subject to talk about," he says.

Up to 70% of those who have IBS don't get medical care, according to the NIH.

Experts have not yet found a specific cause for IBS, although some believe those who suffer have a colon (large bowel) that is very sensitive to certain foods and to high stress levels.

Most likely to be affected are people with hard-driving personalities and those under extreme stress. "All the symptoms tend to be aggravated by stress," Galier says.

Once irritable bowel syndrome symptoms really interfere with daily activities, women are more likely to broach the subject with their doctor, Galier says. Some people seek help because they worry that IBS symptoms are an indication of, or could lead to, colon cancer -- although that is not the case.

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Stress reduction is a crucial part of treatment, according to Galier. He sometimes recommends biofeedback to help patients learn stress reduction.

Medicines that relax intestinal muscles can help relieve irritable bowel syndrome symptoms. Medicines approved just for IBS symptoms are available, but people taking them need to be closely monitored to watch for side effects.

Dietary changes can also help. Adding more fiber, for example, may bring relief if constipation is your primary IBS symptom. Eating smaller meals can also relieve irritable bowel syndrome symptoms, as can avoiding caffeinated drinks.

Galier says to tackle the psychological aspects of IBS first, by focusing on stress reduction. Next, improve your diet, and move to medications only if you need to. "If you exercise, watch your diet, and minimize your stress, you could often be OK without the drugs," he says. But, he adds, "Some do all that and still need medicine."

Increasing Female Libido

About 35-45% of women in the U.S. have a problem with lagging sexual desire at some point in their lives, says Beverly Whipple, PhD, RN, professor emerita at Rutgers, the State University of New Jersey. Whipple is known for her sex research and co-discovery of the “G spot,” an area in the genitals that, some believe, when stimulated, can produce excitement and orgasm.

With age, lagging sexual desire is more likely, says Whipple, who prefers the term lack of desire to lack of libido. Suddenly, or over time, women just don't have the interest in sex that they used to.

Women often decide to get help when they realize that their lack of desire is affecting their relationship, says Whipple. When treating a woman with diminished libido, a doctor is likely to first take a detailed medical history.

"Many medications can affect your lack of desire," Whipple says, including antidepressants, tranquilizers and oral contraceptives. "If your ovaries have been removed, it can affect desire."

"Stress decreases testosterone in both men and women, and that affects desire," she says. Incontinence can diminish sexual desire, too, she says.

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Ruling out or treating medical problems that may affect desire, such as diabetes, and eliminating medications (or switching to other medications) may help restore desire.

Communication with your partner about what he can do to help you feel aroused can increase female libido too, Whipple says.

A dietary supplement that includes ginseng, multivitamins, minerals, and ginkgo, may help increase female libido, Whipple found in a recent study published in the Journal of Sex and Marital Therapy.

Another option is a botanical oil that, some studies indicate, improves desire when massaged into the female genitals.

Simply changing your routine may help boost your desire. Try having sex in different positions or at different times of the day.

Tackling the Subject

Bringing up sensitive topics with your doctor such as bladder, bowel, and libido problems isn't easy, but it could bring you tremendous relief. Here are some tips to remember:

  • Be straightforward, clear, and honest. Try to remind yourself that, as sensitive as these topics are, your physician is trained to deal with all types of physical complaints, and will not judge or embarrass you.
  • Prepare for a conversation with your doctor by noting when symptoms began, how severe they are, and how the problem interferes with your daily routine. Have a list of medications you take, too. Focusing on these practical details may help you overcome any embarrassment.
  • Keep your problem in perspective. None of the conditions is life-threatening and all can be helped by an array of treatments. And consider how great you are going to feel when you don’t have to live with the symptoms anymore!
WebMD Feature Reviewed by Brunilda Nazario, MD on May 05, 2008

Sources

SOURCES: Halina Zyczynski, MD, director, division of urogynecology and reconstructive pelvic surgery, Magee-Womens Hospital; associate professor of obstetrics and gynecology, University of Pittsburgh School of Medicine, Pittsburgh, Pa. Peter Galier, MD, former chief of staff, Santa Monica—UCLA Medical Center, Santa Monica, Calif.; associate professor of medicine, University of California Los Angeles David Geffen School of Medicine. Beverly Whipple, PhD, RN, professor emerita at Rutgers, the State University of New Jersey. National Digestive Diseases Information Clearinghouse: "Irritable Bowel Syndrome." Laumann, E. JAMA, Feb.10, 1999, vol. 281, pp. 537-544. Ferguson, D. Journal of Sex and MaritalTherapy, Supplement 2003, vol. 29, pp. 33-44. American Academy of Family Physicians: "Sexual Dysfunction in Women: What Can I Do If Sex Isn't Working for Me?" Ito, T. Journal of Sex and Marital Therapy, Oct-Dec. 2006, vol. 32, pp. 369-78. WebMD Biography: "Bonnie Blair." WebMD Biography: "Mary Lou Retton." The American Geriatric Society Foundation for Healthy Aging: "Incontinence."

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