I'm a 35-year old mum and already I notice my hair thinning. How now?

There are many causes of hair thinning. Some women suffer hair loss similar to male pattern baldness. We call this condition Androgenetic alopaecia. Hair loss can also occur in reaction to stress - for example after a severe illness, a major operation or after childbirth. Nutritional deficiencies, hormonal causes like thyroid disease and skin diseases of the scalp can also contribute to hair loss. Sometimes, systemic diseases (diseases affecting a particular body system or systems), of which lupus erythematosus is an example, or scalp tumours like cysts and malignant tumours could also be the cause. As hair thinning can be attributed to several causes, do consult your doctor for proper management.

How do I get rid of unsightly nail fungal infection?

Accurate diagnosis is important. Unsightly nails can be due to many other causes besides fungus. They can range from skin diseases and growths on the nail folds to more serious diseases. Most of these conditions are treatable. If indeed it is a fungal infection, there are several treatment options, including potions or pills. Do see your doctor for a proper diagnosis.

What can I do about smelly feet?

Smelly feet could be a combination of excessive sweating, skin diseases involving the feet such as bacterial, fungal or yeast infections, use of unsuitable creams or lotions, prolonged wearing of enclosed footwear and adverse hot and humid environmental conditions. Avoiding these factors, maintaining proper foot hygiene, and using a sweat-absorbing foot powder will help. But if the condition persists, do consult a doctor.

Why do I burp so much?

Belching and burping could arise from simple situations such as eating or drinking too fast, during which air is swallowed and therefore needs to be expelled. It could also be due to drinking carbonated drinks, such as beer or soft drinks. Certain foods like cabbage, beans and milk may also predispose one to excess gas formation, causing bloating and burping. In such cases, over-the-counter medications like simethicone and carbon may help.

However, burping may also be a reflection of underlying medical conditions such as peptic ulcer disease, irritable bowel syndrome and even malabsorption, with associated symptoms like acid regurgitation in the case of gastroesophageal reflux disease. If there is a concern about possible underlying medical diseases, do consult a doctor. He can do the initial evaluation, and if there is a need, organise further diagnostic tests or refer you to a gastroenterologist.

For patients with underlying medical conditions, specific medications may help to improve the symptoms; one example is acid suppressants (eg omeprazole) in the context of gastroesophageal reflux disease.

Is there any cure for varicose veins?

Varicose veins are enlarged superficial veins that develop due to abnormal pressures. It is a common problem, which gets more common as we age. Physical examination is usually enough to diagnose varicose veins.

Compression stockings relieve most symptoms and conceal the veins. Surgery involves removing the veins through an incision at the groin crease and several smaller incisions along the leg. Patients can usually walk on the same day. Convalescence takes one to two weeks, and recurrence is uncommon. As there are safe treatments, and newer techniques for selected patients, do see your doctor.

I sometimes experience leaks - not blood, but faeces.

Faecal incontinence is a result of difficulty controlling bowel movement. You may pass faeces at the wrong time or in the wrong place, or pass wind without control. It is also quite common to have concomitant urinary incontinence (unable to control urination). Many research studies have suggested that faecal continence occurs in two to 15 per cent of adults.

There are several causes, among them:
Diet: Things that increase the fluidity of stools will aggravate this problem, for example, a diet low in fibre, or certain "weight loss "diet or medications.

Medications: Some "weight loss" pills prevent absorption of fat that we take.This unabsorbed fat can make the stools "oily" and leak out of the anus.

Large, hard stools in the lower rectum may result in watery stools leaking around them and be hard to control. This is caused by low fibre or fluid intake.

Disease of lower rectum or anus.
Faecal incontinence can also be a result of cancer, anal fissure (ulcer) or fistula (abnormal passage between two internal organs),or haemorrhoids. Please seek assessment by a doctor so that such embarrassing conditions can be treated.

Will childbirth make my vagina less elastic? Will I be less desirable?

The concept of "vaginal elasticity" refers to the wider issue of the pelvic floor, which is composed of different muscles and tissues acting in concert to support the pelvic organs - the uterus (womb), the bladder and the rectum. Weakness of the floor results in poorer support of these organs, which in turn could lead to a variety of conditions ranging from mild prolapse to severe incontinence.

Childbirth, which has been blamed for causing stretching of pelvic floor muscles and ligaments, is just one contributing factor. Studies also show that just being pregnant would contribute to increased laxity of the pelvic floor muscles independently of childbirth. Other factors include weight gain, and if there are respiratory conditions such as chronic coughing. There is also a natural decline in elasticity with age.

A good vaginal repair after delivery of the baby is therefore very important. During your pregnancy, pelvic floor exercises such as Kegel exercises, performed diligently and regularly,are also useful to maintain the tone of the pelvic floor and therefore the support of the pelvic organs. The principle is similar to why one goes to the gym to tone one's arms and abdominal crunches to firm one's tummy.

For first timers the specialist may refer them to the physiotherapist who will help them identify and "feel" their pelvic muscles and perfect their technique.

Having said that, being desirable to your husband should not depend solely on the elasticity (or lack of elasticity) of the vagina. But if you feel you may have a problem, consult your gynaecologist. In more severe cases of pelvic floor weakness, particularly where there is prolapse and incontinence, a surgical repair may be necessary.

Sex with my husband is painful, but I dare not mention it to him.

Pain during sexual intercourse (dyspareunia) is not normal, and you should not have to live with it, as there are treatments. It's caused by many reasons ranging from endometriosis and hypersensitivity of the vulva to ovarian problems such as a cyst, and emotional issues, such as a history of sexual abuse in the past.

As there are many possible causes, do consult your gynaecologist for a thorough evaluation.You may be asked specific questions regarding the nature of the pain, eg location of the pain and its characteristics.

Further investigations such as an ultrasound of the pelvis and sometimes even keyhole surgery may be ordered. Treatment obviously depends on the underlying cause, and range from simple measures such as lubrication, relaxation therapy, to medication or even surgery.

You don't need to be embarrassed. Pain during sexual intercourse is not as uncommon as you think - about 10 per cent of women may experience it at some point in their lives.

It's embarrassing why I am so prone to urinary infection.

The vast majority of urinary tract infections (UTI) are due to bacteria from the bowels.The main reason why women are more prone to getting UTI is due to the fact that they have a short urethra ie the urinary passage, which connects the neck of the bladder to the vaginal outlet. Bacteria therefore have an easier access to the bladder where they multiply and cause cystitis.

If there is an underlying structural abnormality in the bladder or urinary system, the risk of getting recurrent UTIs increases.The risk also increases in conditions of vaginal dryness, which is common in women who have had their menopause. The state of your natural immunity is also important.

If you suffer from UTI, consult your doctor. Antibiotics may be prescribed as a preventive measure for a longer term. If vaginal dryness is an important contributing factor, the doctor may recommend an oestrogen-based medication. Meanwhile, to reduce your risk of developing UTIs:

• Drink sufficient water to ensure a regular flushing of urine from the bladder which prevents any bacteria from multiplying.
• Empty your bladder after sex. During sexual intercourse, bacteria can enter the bladder and infection could result.
• Avoid constipation. As bacteria from the bowels is the source of infection in UTI, constipation could result in an increased presence of bacteria between the anus and the vagina.
• Take cranberry juice or tablets. Cranberry juice helps to acidify urine in the bladder and this will prevent bacteria from multiplying.

Contributed by Dr Liu Tsun Tsien, Dr Ang Tiing Leonq, and Dr Chen Chung Ming, Changi General Hospital; Dr Tan Lay Kok, Singapore General Hospital.

This story was first published in SingHealth's AllWoman! magazine. For more stories on women's health, visit www.singhealth.com.sg