Women's Health: Your Doctor's Examination
Your internal organ systems are screened by your general doctor with a physical every or every other year if you are without risks. This includes the doctor's examination of your heart, lungs, abdomen, and skin; blood pressure and pulse measurements; blood tests to establish liver and kidney functions, blood cell count, iron levels, and cholesterol levels; and discussion of your lifestyle, disease risks, and health prevention techniques that are most effective. If you have any disease risk factors or take any regular medications, you might need to see your doctor more often than every year or two. As a woman, you should also see your gynecologist once a year for a Pap test and breast and pelvic examinations. Seeing your doctor regularly is an important step to preventing health problems.You might be referred to a specialist after a routine screening exam. There are medical specialists, who train in internal medicine and then continue with a specialty in their area or expertise, and surgical specialists, who train in surgery and go on to surgical specialties. Because medicine and surgery are so complex, you might need to see more than one specialist for the best care. For muscle, bone, or joint problems, you will likely be referred to an orthopedist, physiatrist, or sports medicine specialist. The following tables list different areas of speciality.
Medical Specialties and Their Areas of Expertise
| Cardiology | Heart and blood vessels |
| Dermatology | Skin |
| Gastroenterology | Stomach, intestines, colon |
| Gynecology | Women's reproductive systems |
| Hematology | Blood |
| Hepatology | Liver diseases |
| Neurology | Brain and nerves |
| Oncology | Cancer |
| Pediatrics | Children, adolescents |
| Physiatry | Muscles, nerves, bones; injury recovery |
| Pulmonology | Lungs and breathing |
| Rheumatology | Immune system, joints |
| Urology | Bladder, kidneys |
Surgical Specialties and Their Areas of Expertise
| Cardiothoracic | Heart and lungs |
| Neurosurgery | Brain and spinal cord |
| Obstetric and gynecologic | Women's reproductive organs |
| Oncology | Cancer removal |
| Orthopedic | Bones/joints |
| Plastic | Skin |
It is wise to proceed with any referrals and follow up with doctors or health-care providers as recommended. Return visits are extremely important to establish that treatment is working without undesirable side effects, measure any progression of the problem, and fine-tune methods to cure and prevent further disease processes. Many diseases can be prevented, at least from becoming life-threatening—they just need to be identified and treated early. Remember: Prevention is the best medicine.
Internal Systems
Heart and Lungs
Heart and lung disease is a concern to women as much as to men. Hopefully, you already know if you have any heart or lung trouble, as this can be established during your physical examination. Blood pressure and pulse measurements are very easy ways to rule out some serious heart and blood vessel diseases. Because heart and lung disease can be life-threatening, it is helpful to know the signs and symptoms. The heart pumps blood to and from the lungs and into the body to deliver oxygen and remove carbon dioxide. Because the heart and lungs are so closely connected and essential to life and movement, problems with either heart or lungs may cause similar symptoms.
Heart diseases can cause trouble with exertion, shortness of breath, swelling in your legs, chest pains, chest tightness, arm or shoulder pain or numbness, breathing trouble, lightheadedness, passing out, decreased energy, or decreased ability to exercise as efficiently. Symptoms more specific to the lungs include breathing difficulties, coughing, wheezing, tightness, chest pains, and blue lips or nails. Anxiety or feelings of doom are also recognized symptoms of possible heart or lung problems. These are all symptoms for which you should call your doctor immediately; if your doctor is unavailable, go to an emergency room.
Signs of Heart Problems
- Chest pain*
- Shortness of breath*
- Burning in your chest
- Easy fatigue
- Leg swelling
- Coughing
- Feeling your heart miss a beat
- Feeling your heart race
- Passing out*
- Feeling light-headed
- Shoulder or arm pain or numbness*
- Feelings of anxiety or doom*
- Chest heaviness*
- *Call your doctor as soon as possible if you have any of these symptoms or go to an emergency room.
- Wheezing
- Shortness of breath
- Coughing
- Blue nails or lips
- Easy fatique
- Feeling unable to catch your breath
- Chest pain
The most commonly diagnosed heart abnormality in women is mitral valve prolapse. This is a condition where the mitral valve in the heart does not completely close. It causes a heart murmur and might make you feel an occasional heart flutter, but unless it is associated with another heart abnormality, it usually does not cause any problems or limitations to activity.
The most common lung problem among women is asthma. This can be life-threatening if not managed properly. There are many types of medications available to control asthma, and if you feel you have any shortness of breath, wheezing, or chest tightness, even if just once in a while, see your doctor as soon as possible for treatment options. Exercise-induced asthma is coughing, wheezing, or chest tightness related to exercise, especially in cold environments, extremely dry or humid conditions, polluted air, or during allergy seasons. Exercise-induced asthma is often overlooked by physicians because the symptoms only occur during exercise, so be sure to emphasize this to your doctor.
Digestive System
Your digestive system, medically termed the gastrointestinal (GI) system, includes your esophagus, stomach, intestines, and colon, and gallbladder. These organs are in a delicate balance; disturbing that balance is a common source of frustration for many women as it leads to such unpleasant side effects as indigestion, heartburn, abdominal pain, nausea, gas, diarrhea, and constipation. The GI system is regulated by the same nerves that react to stress, so physical and emotional stress can negatively affect the GI tract.
Irritable bowel syndrome (IBS) is a condition occurring in women more than men and is characterized by cramping, gas, and diarrhea after eating certain foods or also due to stress (including pre-competition stress). Foods that can trigger an attack include fatty foods, milk products, leafy greens, and certain fruits. If irritable bowel syndrome is a daily problem, it can interfere with nutrition and electrolyte balance. In mild cases, limiting triggering foods to smaller portions, combining them with nonirritating foods, or eliminating them altogether can solve the problems. Stress management and relaxation techniques along with diet modification can also help control flare-ups. Because IBS can be so disturbing to life activities, especially sports, if you have these symptoms frequently, see a gastroenterologist, who might prescribe medication.
Vomiting and diarrhea due to viruses or bacteria can make you dehydrated, weak, dizzy, and light-headed. You should avoid intense exercise for at least 24 hours if you have been vomiting or have had repeated diarrhea, and especially if you have a fever. As much as you can, replenish your electrolytes with sports drinks, and try to eat bland foods to restore your strength. A recommended prescribed diet for gastrointestinal infection is the BRAT diet: bananas, rice, applesauce, and tea.
One of the most common causes of gastrointestinal problems is medications, especially pain medicines. Medications can disrupt the acid and bacterial balance in the stomach and intestines, leading to diarrhea or vomiting. Strong (narcotic) painkillers often cause nausea and vomiting; narcotics specifically can cause constipation. Anti-inflammatories, steroids, and antibiotic medications tend to cause stomach upset and occasional diarrhea.
Constipation is usually due to poor diet or not enough fluids; rarely is it a sign or cause of serious bowel problems. Iron and calcium supplements can lead to constipation. Constipation can be resolved with stool softeners or laxatives, although you should not make these a habit, as your body can develop a tolerance to them. Drinking warm fluids, especially caffeinated coffee or tea, can provide relief from constipation. (Cutting down on them can lead to constipation as your bowel readjusts to not having that trigger.) The most natural way to resolve and prevent constipation is to increase the amount of fiber and fluids in your diet.
Bladder and Kidneys
Some women, especially those who are sexually active, are prone to urinary tract infections (UTIs). These can be very irritating, as they cause pain, burning, and frequent urination. Urinary tract infections can be prevented by drinking plenty of water and urinating before and after sex; the uncomfortable symptoms can be avoided by drinking cranberry juice or eating cranberries or cranberry products. (Blueberries have also recently been found to provide similar relief.) Urinary tract infections can become serious if they are left untreated, as they can spread into the kidneys. See your doctor if you have pain or burning with urination or cloudy or foul-smelling urine lasting for more than a few days and especially if you have a fever. Thorough treatment of UTIs is with antibiotics.
Another problem among women that can occur after childbirth is stress incontinence, the condition where physical pressure, such as that caused by running and jumping, causes urine to leak out. This is usually due to loosening and stretching of the supporting muscles and ligaments around the bladder and urethra. Stress incontinence improves with Kegel exercises and can be managed by avoiding caffeine or other diuretic foods or products. Fluids can be limited before impact exercise, although this should not be done in hot weather. Wearing an absorbable pad is helpful; occasionally inserting a tampon into the vagina during exercise helps close flow of urine. There are also medications that sometimes help, and in severe cases, surgery can resolve the problem.
Kegel exercises are important for every woman to preserve urogenital health and are especially beneficial during and after pregnancy. These exercises strengthen the muscles that support your bladder and uterus, the same muscles you use to stop the flow of urine. To perform Kegel exercises, contract your internal pelvic muscles as if you are holding back urine. Do this 10–15 times, 5 times a day, increasing the time you hold each contraction to up to 10 seconds.
Managing Incontinence
- Kegel exercises
- Avoid caffeine or diuretics
- Limit fluids before impact activities
- Wear an absorbable pad
- Try inserting a tampon
- Medications
- Surgery
The fluid systems in your body circulate nutrients into your cells and eliminate waste products. Blood is made up of red cells, which carry oxygen; white cells, which carry disease fighters; platelets, which allow clotting; and plasma, the fluid. Lymph is a fluid drainage system in addition to blood that is especially active in eliminating wastes produced by infection.
The most important function of blood is to transport oxygen, without which we cannot live. Oxygen is carried by the iron in the red cells of your blood. If there are not enough red cells, or not enough iron, this is called anemia. Anemia is more common in women, due to menstruation. Signs of anemia include feeling easily cold, tired, and out of breath. Anemia can occur in women who exercise a lot, as the body breaks down the iron and red cells during vigorous exercise. Anemia is diagnosed with a blood test. The best sources of iron are red meats; therefore, vegetarians are at greater risk of having anemia. Do not try to treat anemia by yourself by taking iron supplements; this is not the only answer for anemia, and the dose should be monitored. Consult your doctor if you think you might be anemic.
The lymphatic system does not usually cause problems unless you have an infection, cancer, or lymphedema. During an infection, lymph nodes become swollen and tender. In cases of cancer, they can become hard. If you notice bumps (lymph nodes) that you have not noticed before that are present for longer than one week, see your doctor for an evaluation. Lymphedema is a swelling of one arm or leg that can develop after surgery, such as in the arm after mastectectomy, after injury, or for unknown reasons. Lymphedema should be managed daily with movement exercises to promote circulation. In more severe cases, compressive wraps are used to reduce uncomfortable swelling. Light weight training or exercises such as swimming are helpful, but heavy lifting should be avoided.
Brain and Nerves
Problems with the brain and nerves include weakness, numbness, headaches, vision or hearing problems, and seizures. These problems can be due to a pinched nerve, stroke, or lesion on the spinal cord, nerve, or brain. Neurological diseases such as multiple sclerosis, Parkinson's, meningitis, or viruses can cause other problems. If you have any of the above-mentioned symptoms, see a neurologist and limit exercise until you have been evaluated. The most common neurological problem in active women is headaches. Because there are many causes and treatments, headaches that occur frequently or interfere with your daily or sports activities should be evaluated by a neurologist.
Hormones
Hormones are proteins that have special controlling and signaling functions in the body and maintain the body's delicate metabolic and functional balance. Important hormones include insulin, made by the pancreas; thyroxine and triiodothyronine, made by the thyroid; and estrogen and progesterone, made by the ovaries. Other important hormones are made in the pituitary gland, the hypothalamus, and the adrenal gland. Occasionally, they can be over- or underproduced. Diabetes, a lack of insulin or resistance to insulin's effect in the body, is classified into two types. Type I, juvenile
onset, "insulin dependent," diabetes, starts early in life and is managed with insulin. Type II, adult-onset, "insulin resistant," diabetes is a condition where your body does not respond to insulin and is managed sometimes with diet alone, but often with other medications. Signs you might have diabetes include increased urination, thirst, and hunger; sudden weight loss; fatigue; blurry vision; numbness; and frequent infections of the bladder, vagina, and skin. Diabetes does have genetic risk factors, although its exact causes are not known. Type II diabetes is associated with obesity and lack of exercise. Also, gestational diabetes (in pregnancy) is a strong risk factor for type II diabetes later in life.
Diabetes is a life-long condition, with sometimes life-threatening complications, although strict diet control, a consistent exercise regime, and monitoring of blood sugars can allow a life without the other complications that makes diabetes a life-threatening disease. Exercise plays a vital role in this process, as it helps lower and control blood sugar, increases blood flow, and reduces heart and other risk factors associated with diabetes.
Thyroid hormones control metabolism, temperature, heart rate, and other body systems including fertility and bone metabolism. Many women become hypothyroid, or have low thyroid levels. An overactive thyroid is called Graves' disease. These treatable conditions should be managed by an endocrinologist. Signs you might have thyroid problems include a change in appetite or weight, trouble with tolerating heat or cold, dry skin, brittle fingernails, or a swelling at the base of the neck.
From The Active Woman's Health and Fitness Handbook by Nadya Swedan. Copyright © 2003 by Nadya Swedan. Used by arrangement with Perigee, a member of Penguin Group (USA) Inc.
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