Trying to figure out what is normal or what needs medical attention can be hard to do on your own. From leaks to embarrassing smells and the weird things our bodies do, people often feel too embarrassed to discuss their concerns with a medical professional. In the age of the internet and technology, people often go online to look for answers before they even consider discussing them with someone else.
As a nurse, I have spent my career listening to patients ask questions or tell me things about their body that are clearly uncomfortable. However, I am here to tell you it is hard to surprise a nurse. Nurses, as well as other healthcare professionals, have seen and heard a lot. These are the questions patients are often too embarrassed to ask me and what to do about them.
How Much Urine Leakage is Too Much?
Incontinence is a common problem, especially as we age. However, incontinence and bladder control issues are actually not considered a normal part of aging. It can start with occasional leaks when laughing, sneezing, or being more active, such as running or going to the gym. For some people, occasional leaks may feel manageable, but incontinence can worsen or become more bothersome over time. Often, people try to manage or ignore incontinence but can end up asking themselves, how much urine leakage is too much?
Urinary incontinence is technically defined as any involuntary loss of urine, even small leaks. There is no set amount of leakage that makes it go from normal to not normal. When leakage or incontinence occurs, it indicates that the bladder’s normal mechanisms are not working.
Some instances of urinary incontinence can be short-term or made worse only when doing certain activities. Even if the conversation can feel embarrassing, it is always a good idea to discuss it with a medical professional to help determine the cause. While waiting for an appointment or trying to learn more about incontinence, you can use online resources such as the LivDry Adult Learning Center or The National Association for Continence.
How Do I Clean Sensitive Areas?
Personal hygiene is often viewed as an intimate or personal care task. We learn how to do it ourselves at a young age and usually don’t need help. As we age, experience illness, surgery, or changes in mobility, completing these tasks can become more difficult. These are the embarrassing areas people often don’t want to ask me how to clean:
Perineal Area: This is the area typically covered by underwear for both males and females. It includes the genitals, anus, and surrounding tissues and skin. These areas come into contact with urine and feces, and tend to be moist and dark. All parts of the perineal area need to be gently cleansed with unscented soap and water, or with specially formulated wipes or cleansers, to help maintain a normal skin pH and natural skin barrier. When someone is unable to reach these areas to clean themselves, they may need assistance from a caregiver or family member or use adaptive tools, such as mobility aids, designed to help clean hard-to-reach areas. Items can include a peri-bottle, which is used to cleanse the vaginal and urethral area, or a wand that attaches to toilet paper or wipes and helps extend your reach to clean the anus after a bowel movement.
Skin Folds: Skin folds are often something people don’t want to talk about; they can be due to excess weight, loss of skin elasticity with age, or simply how some bodies are shaped. Skin folds increase the risk of redness, rashes, infection, and even open wounds. Skin folds need to be cleaned just like any part of the body to remove bacteria. Skin folds should be gently cleansed with non-scented soap and patted dry. If skin folds are prone to moisture, using a cotton cloth (such as a cut-up 100% cotton t-shirt) placed between the folds can help.
If you are having trouble keeping skin folds clean and redness or open areas occur, it is important to work with a healthcare provider to treat the area. Prevention through routine skin cleaning and maintenance can help avoid more serious issues.
What is That Smell?
Our bodies often tell us something when a bad smell occurs. For example, the odor from our armpits results from sweat mixing with bacteria on the skin. While body odor is generally harmless, it is a sign that there is bacteria on our skin; with good hygiene, this odor generally goes away. Some odors indicate issues that do need to be treated, so knowing what the different smells can mean is helpful.
Medical conditions that warrant treatment and can cause odor include
Yeast Infections: yeast infections in skin folds on the body do not always produce an odor, but when they do, they have a characteristic smell, often described as musty, yeasty, or bread-like. Yeast infections in warm, moist areas, such as abdominal folds or the groin, can have a more pronounced odor. Yeast infections occur due to overgrowth of fungus and can appear as a reddened area with white or yellow discharge. Yeast infections are typically itchy and uncomfortable. A medical provider can diagnose a yeast infection either by examining it or by taking a sample for a more definitive diagnosis.
Yeast infections are typically treated with antifungal medications. Prevention includes thorough skin cleansing, especially between folds, and separating yeast-prone areas with breathable fabrics such as 100% cotton or materials designed to inhibit yeast growth.
Urinary Tract Infections (UTIs): UTIs are caused by bacteria that enter the body and infect the ureters, bladder, or urethra. Symptoms of a UTI can include burning when going to the bathroom, feeling the need to go frequently but passing little or no urine, discolored urine such as red, brown, or dark yellow with a cloudy appearance, pelvic pain, and a strong odor. Anytime you have signs of a UTI, including a foul odor to your urine, it is important to see a medical provider for treatment.
Some foods and drinks can cause urine to change smell, so if you experience an odor without any other symptoms and recently ingested one of these, it may just be that:
- Asparagus
- Garlic and Onions
- Cruciferous Vegetables (broccoli, cauliflower, Brussels sprouts)
- Coffee
- Alcohol
Bacterial Vaginosis: BV is a vaginal infection that can be quite common among women. It is caused by a bacterial overgrowth inside the vagina that produces a fishy smell accompanied by discolored vaginal discharge (can be off-white, grey, or creamy)
Odors from the vagina can be embarrassing but are important to discuss with your provider, as it can be treated with antibiotics to help restore a normal bacterial balance.
Tips For Having Uncomfortable Conversations
Initiating uncomfortable conversations about embarrassing topics is hard for most people. Remember that healthcare professionals are trained to discuss these topics. These are some tips to get things started:
- Provide your concern when checking in or making the appointment so the doctor or nurse already knows what you want to discuss. This can be done either by telling the person on the phone (which can be easier than in person) or by writing it in the comments box when scheduling online. This way your provider knows what you want to discuss and takes some of the pressure off of you.
- Write down as much information as you can about the issue you want to discuss. This will help make sure you don’t forget important points.
- Try not to minimize symptoms and their impact on you. Minimizing symptoms because you feel embarrassed about them will not help you receive the best treatment. Being honest is the best way for a medical professional to help you.
What I Wish Every Patient Knew
Feeling embarrassed or uncomfortable about things happening to your body is quite normal. But trying to solve a problem that may be common or treatable on your own can be much harder without medical advice. As a patient, you should never feel like you need to apologize for needing help or that you must wait until an issue becomes severe before seeking treatment.
