That is what I often hear right before so many confessions of problems.

People start out with, “I don’t really know how to say this, it is so embarrassing, but…”

After that phrase, I hear a myriad of subjects.

Women just have problems that are intimate and difficult to share. It may be a vaginal odor, a persistent itch in a hidden spot, a problem with sexual relations, or particularly anal challenges can be intimidating to share. Yes, gynecologists deal with anal problems also. And, may I say, we do it gently!

Let’s start with:

Hemorrhoids—I often joke with my patients and tell them they should name their hemorrhoids after each of their children. That is because the pressures of pregnancy and delivery often create the things we call hemorrhoids. You would think that with a name like “hemorrhoid,” we would be talking about some kind of growth. That is misleading.

Hemorrhoids are nothing more than dilated veins that have lost support and begun to protrude into the rectal or anal canal. They may even prolapse all the way outside the anal opening. When hemorrhoids do protrude, we call them anal tags. Hemorrhoids are so very common, just about everyone eventually gets the problem to some degree.

For women, in addition to having babies, jobs with heavy lifting or chronic straining while stooling, may also lead to an increased risk of hemorrhoid troubles.

Proper care of hemorrhoids involves trying to have regular, solid, but not hard stools.

Fiber is the key. Eating healthy with fruits, vegetables, salads and whole grains is the ticket. Fiber supplements may also be helpful.

Even being careful, inevitably, swelling of this hemorrhoid tissue will occur on occasion and result in pain, pressure, itching or possibly bleeding.

Preparation H is actually a useful medicine for routine flares. Other medicines, available by prescription, can be even more effective when needed. Uncommonly, one of these hemorrhoids will form a clot; we call that thrombosed. When a hemorrhoid thromboses, it stays persistently swollen and it hurts! A thrombosed hemorrhoid will require special care in the office to remove the clot, but that will provide significant relief.

Rarely, women and men will have such ongoing problems with hemorrhoids that hemorrhoid-reduction surgery may become necessary. You may need such surgery if you have daily discomfort or bleeding, and medical control is not adequate.

Anal irritation is another common problem.

Women literally squirm in their seats attempting to avoid admitting that they have anal itching or burning. In the vast majority of cases, once we know you have the problem, we can offer a solution. It can be evident during routine exam that the anal area is irritated and women will still be too embarrassed to talk about it.

The anal area can get swollen and raw. Fissures can develop that are actually small tears in the skin. These tears expand during bowel movements. As the anus opens, the tear pulls apart and burns. There can be all sorts of causes for these problems.

Preventing fissures is one of the reasons we always talk about drinking adequate fluids. If stools are too hard, they can scratch the anal skin as you pass the stool.

Other reasons for irritation of this sensitive skin can include being allergic to a perfume, soap or other substance that comes in contact with the skin. Because of the inherent embarrassment, I frequently see people who have put off coming as long as they can. By the time they come to me, multitudes of over-the-counter creams and salves have been applied. Often it is a reaction to one of these potions that prolongs the irritating problem. The baseline truth is that when the anus keeps feeling irritated, you need to get it checked out for your own comfort.

Incontinence—We always talk about urinary incontinence, and indeed it is a very prevalent problem.

We harp on urinary incontinence because it is so common and because it can usually be helped significantly. A much more hidden problem that women experience is poor control of their stool. It is hard to know how often this happens.

Studies give ranges of statistics all over the place. The problem with studies centers upon deciding how to define the incontinence. Additionally, it is difficult to get honest survey results with such an embarrassing problem.

Fecal incontinence, as we call it, most commonly results as a consequence of having babies. Overt, and much more commonly subtle, tears can occur to the muscles and nerves of the rectum as those baby heads pass by and stretch or overstretch the tissue. Some young women notice right away that they have less control. Others don’t develop the loss of control until they age somewhat.

For the most part, women who have minor control problems can get by OK.

As long as stools are solid, a woman may not have accidents except for an occasional surprise unexpected gas escape. Most women with just a minor degree of incontinence generally won’t lose stool as long as they maintain solid stools. If diarrhea occurs however, a woman may be in trouble and not be able to leave the house due to leakage and accidents. Other women, who have more of a problem, can have trouble even with solid stools.

In most cases, the control of anal incontinence is best managed by controlling the character of the stool. That means fiber, fiber, fiber. The more solid and consistent the stools, the easier the control. Guidance and help requires openness and honesty.

The bottom line here (pun intended) is that anal problems are commonplace.

Don’t let embarrassment prevent you from getting proper assistance. Believe me, it will be hard for you to come up with a problem that others have not already experienced and confessed!

Don’t allow yourself to feel hopeless, there is indeed hope and help out there! Just “fess up” and ask. The door to assistance is waiting to be opened.