Just Too Embarrassed

Got a health problem you don’t want to talk about? Here’s help.

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Almost everyone has at some time experienced an embarrassing health problem—leaking urine, profuse sweating, or bad breath that won’t go away. Although not life threatening, such problems can affect quality of life. What many don’t realize is that they can be cured or managed. Yet people often feel too self-conscious to speak to a doctor—and suffer in silence—even though doctors have heard it all before and are able to deal with these problems.

Bad Breath
Edwin Winkel, professor at the department of periodontology at the University of Groningen and at the Clinic for Periodontology in the Netherlands, has seen patients so embarrassed by their bad breath that they will only work from home or over the phone, to avoid being around people.

Bad breath, or halitosis, can be caused by tooth and gum disease, metabolic disorders like diabetes, and eating foods such as garlic, which make the body produce odors that escape through the mouth or nose. Foul breath can also result from throat and sinus infections, smoking, or drinking alcohol, and can be worsened by stress. But the major bad breath culprit is the mouth bacteria that form a coating film on the tongue, especially at the back. “About 400 to 500 bacterial species live in the oral cavity,” says Winkel, and some emit offensive-smelling gases.

Mints, gums, and most over-the-counter mouthwashes freshen your taste, but don’t clear your breath. “Taste has nothing to do with breath,” says Winkel. “You can have a very bad taste and very good breath or a very good taste and very bad breath.” Consistent good oral hygiene is important for clean breath, but adequate removal of the tongue coating may require special tongue-scrapers, visiting a dental hygienist, or using prescription mouthwashes containing zinc or chlorhexidine, which control the bacteria’s population.

It’s not clear why some people develop the coating while others don’t, but many avoid discussing it, and instead suffer unnecessary stress. But nearly all cases are treatable. “Most bad breath is manageable,” says Winkel.

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There’re treatments for incontinence problems, so it’s well worth visiting a doctor and being treated.

Marina Kaiser* , a 62-year-old designer from Germany, was devastated when she wet her trousers in the middle of a parking lot full of people. She had a sudden urge to urinate, but couldn’t find a parking spot, and didn’t make it to a nearby cafe in time.

Kaiser has been having incontinence problems since her early fifties. In the beginning, these little incidents happened infrequently. She thought she could manage it and didn’t seek help.  It grew worse, and then it began to happen once or twice a week. But after the parking lot accident, she decided to talk to her doctor. “I felt so embarrassed I knew I had to do something,” she says.

Incontinence issues are common. “There’re lots of people with the same problem,” says urologist Fiona Burkhard at Bern University Hospital in Switzerland. “About 38 percent of people over 30 and 77 percent of people in nursing homes [are affected].” But only a quarter of them seek care, Burkhard adds. “People don’t want to talk about it.”

The problem’s primary culprits are pregnancy and childbirth in women, and prostate issues in men, but women are affected more than twice as often. Chronic abdominal pressure, including constipation, heavy lifting, high impact exercise, and being overweight, are contributing factors, as can be spicy foods, acidic fruit, caffeinated drinks, and artificial sweeteners. Strokes and neurological disorders, such as Parkinson’s or multiple sclerosis, can cause incontinence too.

Urologists differentiate between stress incontinence, in which a person leaks urine when coughing, sneezing, jumping, or lifting, and urgency incontinence caused by uncontrollable bladder contractions. Pelvic floor exercises, weight loss, and avoiding bladder irritants can help. For some cases of stress incontinence, doctors recommend surgery to reestablish urethral support using a mesh, whereas patients with urinary incontinence are offered medication.

Kaiser, who didn’t give birth, was diagnosed with hydrocephalus, a neurological condition in which an excessive fluid build-up in her brain caused a loss of bladder control. To correct it, doctors implanted a shunt into her brain, which ensures that the excess cerebrospinal fluid is redirected to her abdomen, where it can be absorbed into the bloodstream. Followed by prescribed daily pelvic floor exercises, Kaiser’s condition significantly improved. “I am so happy that I can lead a normal life again,” she says.

“There’s a belief that not much can be done about it,” Burkhard says. But “there’re treatments for incontinence problems, so it’s well worth visiting a doctor and being treated.”

*Name changed to protect privacy

Excessive Perspiration
Heidi Barton, a 43-year-old housewife from Southport, England, changed her outfits several times a day, constantly re-applied deodorants, and wore a swimsuit underneath her clothes to absorb the sweat her body produced profusely; she felt people perceived her as unclean all the time. On her wedding day, she couldn’t finish the usual photography session because she was too worried about her sweat-smeared make-up and wet spots on her dress. “Every time the camera came out, I ran off,” she recalls. “The last picture of me on my wedding day is me running away.”

Sweating is primarily caused by heat, fear, stress, and exercise, and can be intensified by caffeine and spicy foods. Men tend to sweat a bit more than women, and menopausal women often sweat a lot due to hormonal activity.

“Sweating is a physiological reaction. It is designed to cool the body,” says Dr. Anton Alexandroff, Leicester-based dermatologist with a special interest in hyperhidrosis. But some people have an unusually high number of sweat glands, which can result in a medical condition called hyperhidrosis and can be a social nightmare. Many people feel so embarrassed about constantly being hot and wet that they keep it secret from family and friends.

Medical treatments for hyperhidrosis include antiperspirants of varying strengths, but they’re only effective where applied, can cause skin irritation and can be overridden by the body’s need to sweat. For patients with anxiety-triggered sweating spells, beta-blocking medications may help. Another way to quell hyperhidrosis is iontophoresis—an electrical stimulation of the skin in sweat-prone areas using simple over-the-counter kits.

More recently, botox injections proved to be very effective in blocking sweat released in specific areas, but the procedure can be expensive and painful, and must be repeated every four to six months. A newer method uses microwave technology to “fry” the patients’ sweat glands, but its long-term effects aren’t yet known. In extreme cases, surgery is used to cut the nerves to the sweat glands.

For Heidi, who battled hyperhidrosis since she was 13 and had quit her hairdresser job over anxieties of dripping sweat onto her clients, botox proved that her condition can be managed. “It’s life-changing,” she says. “I became more outgoing, more able to talk to people, more able to go places.” She is now considering the nerve-cutting surgery.

At first, Alexandroff recommends avoiding dietary triggers, and using medical-grade antiperspirants. “If this is not effective,” he adds, “then you really need to see a [general practitioner] or a dermatologist.”

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Your feet contain about 250,000 sweat glands and are capable of producing one cup of sweat a day.

Smelly Feet
Your feet contain about 250,000 sweat glands and are capable of producing one cup of sweat a day. However, some people produce much more, depending on their genetic makeup, activity level, and physiological and hormonal factors, says Veera Keltanen, a podiatrist at the Foot Center in Helsinki, Finland. The smell comes from bacteria on the skin, which breaks down the sweat, excreting offensive-smelling waste.

Luckily, simple remedies can help. The basics include washing feet daily, using mildly acidic soap, drying thoroughly in between toes, and wearing socks made of synthetic materials rather than cotton, because cotton keeps moisture 10 times longer than acrylic.

‘’Keltanen recommends using odor-absorbing insoles (but avoiding others such as silicon insoles), wearing roomier shoes to make sure there’s plenty of room for the feet to breathe and, where possible, barefoot sneakers.“ Barefoot shoes or minimalist shoes that are very light allow the feet to function normally and will decrease sweating in feet, Keltanen says, adding that being barefoot when you can, to “just free your feet,” also helps. For more persistent problems doctors can also recommend prescription medicines.

Gas Problems
“Normally people pass gas eight to 20 times a day, and that’s considered to be normal,” says Jonna Jalanka, who studies intestinal microbiome at the University of Helsinki. “The gas you’re producing is a combination of the environment that you have in your gut, and that varies day to day.” However, anything above 25 times may sometimes signal a health problem.

Intestinal wind is a combination of the air we swallow when we eat meals or drink fizzy beverages, and the normal digestion process, in which gut bacteria break down our food. Belching comes from releasing air swallowed when eating and drinking too fast, chewing gum or smoking. Flatulence results from the gut bacteria that produce gases, including methane and hydrogen, which are odorless, as well as hydrogen sulfide with its smell of rotten eggs.

Flatulence can increase from the digestion of foods like beans, cereals, Brussels sprouts, onions, apples, or bananas, which are high in complex sugars that gut bacteria ferment, releasing gas. There’s no clear answer why some people experience more gas discomfort than others, but limiting offending foods helps reduce it. Anti-spasmodic medications and peppermint tea may help too, says gastroenterologist Giles Major at the England’s Nottingham University Hospitals. Occasionally, gas can be a sign of an underlying health problem, such as the irritable bowel syndrome. In some cases, prescription drugs may be called for.

“[Gas] is a normal function of your intestine, and the bacteria is supposed to be there, and the fact that you pass gas just means that they’re doing what they’re supposed to,” Jalanka says. “However, if you are feeling ill or having a lot of pain and bloating—then it may be worth to see a doctor.”

So, if you have any of the above problems, don’t suffer in silence. And don’t let embarrassment keep you from living life to the fullest!

Adapted from “Just Too Embarrassed” by Paula Wild

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Originally Published in Reader's Digest