Women's Wellness

Clinic Treats Female GI Disease

Bathroom behavior is rarely a comfortable topic of conversation. Yet a gastroenterologist in Virginia is working diligently to provide a knowledgeable ear for those women interested in speaking about their digestive woes.

"I think GI illness is one of those things that women have a hard time even talking to their friends about," says Cynthia Yoshida, MD. The associate professor of clinical internal medicine helped create the Women's Digestive Health Clinic within the University of Virginia Health System several years ago.

"We can talk to our friends about our sex lives or our weight, but it is hard to talk about flatulence and incontinence."

Yoshida recognized the need after answering dozens of questions from referred patients.

"A female health gynecologist colleague of mine was sending me all of her patients to do their flexible sigmoidoscopies," she says. "At the time that was the biggest thing people were doing for colorectal cancer screening. So I got 10 or 15 minutes with these women and basically many of them were saying, 'Well I have you for these 15 minutes while you are doing my flex sig, I also want to ask you about my diarrhea and my gas and bloating and belching. I haven't really felt comfortable about talking to anyone about this.' And I thought, 'Why not? Why aren't these people feeling comfortable about doing this?' So we really felt strongly that there needed to have a GI health clinic for women, run by women."

The clinic opened September 2000 and now has more than 50 patients a week. Gastroenterology, endoscopy, nutrition counseling and pain psychology are incorporated to provide the best care for patients.¹

"We are lucky enough to have plenty of female practitioners here who are actually able to see patients," she says. "We also thought we needed to take a more holistic approach to patients. Not only GI -- many women are interested in preventive health, alternative therapies and nutrition. So we have all of those components. I have a behavioral psychologist who works with us who is wonderful. If someone needs to be referred for yoga or acupuncture, I have people in the community we can work with. If a patient needs nutritional counseling, we can do that as well. There are a lot of things at our fingertips that can really help patients take a more holistic approach to their GI health."

According to a research presented at the Society for Women's Health Research conference, women are more prone to heart disease, musculoskeletal health problems and metabolic/digestive diseases. Although the researchers did not know why the female body was more apt to succumb to heart attacks, irritable bowel syndrome and sports injuries, evidence to show such occurrences was presented from more than a dozen studies.²

The research showed women suffering from irritable bowel syndrome (IBS) also had longer pain episodes, excessive bloating, nausea and vomiting. Men, according to the research, more frequently reported having diarrhea.

Women were also more likely to suffer from autoimmune hepatitis and were more likely to reject a liver after transplantation.²

Yoshida says she sees many patients with illness specific to women.

"Endomitriosis and associated GI symptoms, things that are related to migraines and GI symptoms, pelvic floor disfunction problems," she says, listing off several illnesses treated at the clinic. "Some patients have constipation, which can be pelvic floor related. Others have fecal incontinence due to birthing trauma, or from getting older. We see a lot of constipation related to menopause. We try to be very aware of women's hormonal issues at the time that we see them."

The Digestive Health Center of Excellence, encompasses a nutrition clinic and an obesity clinic, among others. Healthcare workers at the nutrition clinic work with patients suffering from a variety of digestive diseases including: celiac sprue, radiation enteritis, pancreatic insufficiency, short-bowel syndrome, subtotal and total gastrectomies, gastroparesis, diarrheal states requiring IV hydration, malnutrition, necessary weight gain, enteral/paraenteral nutrition and PEG placement.

"Nutrition comes under the auspice of gastroenterology, so the women's clinic does have a nutritionist who works with us," Yoshida says. "There are a lot of nutrition aspects for people who are on tube feedings, people who cannot eat, people who have obesity, people who have anorexia or bulimia -- it goes the whole gamut of gastrointestinal disease. I think there is a huge support of things we give our clinic."

Yoshida has seen the clinic impact the community during the last two years.

"There is a need in our community and there is a need in general," she says. "There are not a lot of specialty clinics in these areas. This has filled a nice market."

The women's center of the University of Virginia Health Center also frequently refers patients to the clinic. Yoshida says there is no shortage of patients who need to be treated.

"Today, just as the OBGYN field was seeing 10 to 15 years ago, women want women to do their procedures," she says. "Now that colorectal cancer screening is out there, thanks to Katie Couric, many women are active about their preventive health and are having are having their screening colonoscopies. If possible, they want a woman to do their procedure. We are booked."

In addition to running the clinic and seeing a plethora of patients, Yoshida is writing a book in association with the American Gastroenterology Association (AGA).

"We are writing the book to educate women about GI problems and what they can do," she says. "I don't advocate only seeing a woman doctor. I think a women's clinic is great. I would say, find yourself a woman-friendly physician. I have a male physician and I am happy with him. I have had a male OBGYN. I don't think the person has to be a woman necessarily. I think you have to find someone you are comfortable with."

As for healthcare workers, Yoshida emphasizes education.

"When many of us went through residency, there wasn't a lot of women's health issues (covered)," she says. "Residents and fellows today are being educated about these issues and I think it is wonderful that we are realizing gender differences. There is now more information about differences (in gender) regarding to illness. The AGA has worked hard to develop a program by which trainees have to be trained in gender specific GI and I think that is important."

The University of Virginia Health System's Women's Digestive Health Clinic is located in Charlottesville, VA. For more information, visit: http://hsc.virginia.edu/internal/digestive-health/woman.html. 

For a complete list of references, visit: www.endonurse.com

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