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Bad breath, hemorrhoids: How do you talk to your doctor about them?

Tuesday, May 16, 2000

By Rosie Mestel, The Los Angeles Times

There are things we'd rather not wax eloquent about with others: embarrassing things. Breath that isn't as fresh as it might be. Hair that sprouts where hair doesn't usually sprout on women. Rectal bleeding and hemorrhoids. Who, other than frat boys, giggling adolescents and possibly your ever-sharing Uncle Sid, relishes chatting about such things?

 
  (Stacy Innerst, Post-Gazette)
Especially when they're happening to us.

We shouldn't be so bashful. Such reticence prolongs needless discomfort -- for ourselves and sometimes those we live or work with. And sometimes it can delay identifying serious, even life-threatening, maladies.

Excessive hairiness in women, for instance, can signify a hormonal imbalance that places the sufferer at a greater risk for serious conditions such as diabetes.

Bad breath can signify a host of underlying problems requiring treatment: gum disease, chronic sinus infections, tooth-rotting dry mouth syndrome -- even ulcers or diabetes.

And changes in bowel movements, while they often signify nothing more than a change in diet or lifestyle, can also be a sign of colorectal cancer.

"People come to me, and I ask them how long it's been going on. And they say, six weeks, two months, or four: 'I kept waiting for it to go away,' " says Dr. Bennett Roth, a gastroenterologist and director of the Digestive Disease Center at the School of Medicine at the University of California, Los Angeles. "If they had a big boil on their neck, they wouldn't wait two to four months for it to go away. They'd go to a doctor and fix this."

Fixing something, of course, first requires you to recognize the complaint -- and when it comes to bad breath, the word usually comes from someone else. We aren't very good at smelling our own breath, even when we cup a hand over our mouth, a fact providing a niche for businesses with names like Caring Suggestions and Gentlehints.com. In a backhanded mutation of the Hallmark card, such services -- for a fee -- will send an anonymous letter politely informing the offender of a problem like bad breath, including "gifts" like toothpaste or mouthwash.

More people, of course, are likely to get the news at their dentist's office or from their spouse. "The spousal report is the gold standard," says Dr. Glenn Clark, founder of the Fresh Breath Clinic at the UCLA School of Dentistry. "It's like snoring. The spouse always knows."





Science still has much to learn about bad breath, but it's known that a bouquet of chemicals produced by mouth or sinus bacteria are the cause. Thus, to assess bad breath, scientists like George Preti, a human odor specialist at the Monell Chemical Senses Center in Philadelphia, sample air from people's mouths. Preti uses a machine called a gas chromatograph to measure several key gases, with odors he describes as "rotten egg" or "sewer gas smell."

For other tests, breath scientists rely on specially trained human sniffers who assess the breath or the odors wafting up from a scraping of film from the back of the tongue. Why the back of the tongue? It is a perfect breeding ground for stinky breath.

"A magnifying glass will reveal that the tongue has lots of nooks and crannies, especially at the back," Preti explains. "This area doesn't flap up against the hard palate when we talk or eat -- it's a good area to lay down an undisturbed surface of plaque."

Thus, while there are many reasons one person will have bad breath and another won't, poor tongue hygiene is a leading cause.

But there are other causes and contributors. Chronic sinus infections harbor smell-producing bacteria and fungi. Chronic, drippy noses coat the tongue with ucus that encourages plaque buildup. Periodontal disease can also be a cause, as can the dry mouths that often come with age -- because saliva contains chemicals that inhibit the growth of bacteria. With less saliva to hold them in check, bad-breath bugs can breed with wild abandon.

Sometimes, bad breath even provides clues to serious problems such as kidney malfunction, stomach ulcers, hepatitis or diabetes (where the breath can have a sweet smell caused by chemicals called ketones). Since periodontal disease ravages our gums, since high counts of mouth bacteria may contribute to heart disease and ulcers and since untreated dry mouth causes tooth decay, bad breath is not just a

social problem.

Tooth decay, dry mouth and gum disease should be treated. Patients should improve their brushing and flossing. Tending to the tongue with toothbrush and tongue scrapers helps reduce the crop of bacteria. Gargling probably helps, too. Brand names aren't important, says Clark, who hasn't seen convincing studies demonstrating differences among brands. Using the product is what matters.





Bowel disorders are another subject about which patients tend to be bashful. Yet sometimes, someone's life may depend on seeking timely advice, says Dr. Robert Beart, chairman of colorectal surgery at the University of Southern California's School of Medicine.

Perhaps you've noticed some rectal bleeding. Or you think you have hemorrhoids. The bleeding may indeed be due to hemorrhoids, and the blood may be from a small tear (called a fissure) in the anus. But it's also possible that a cancer of the bowel, rectum or anus, or a polyp, could be the cause. A lump or swelling at the anus could also be a tumor, not a hemorrhoid. A tumor blocking the passageway could be slightly torn by the passage of a stool, releasing blood.

Your doctor should do more than a simple finger exam to help rule out this possibility, Beart says. An exam using a device called a proctoscope allows the doctor to see inside the rectum and get a better idea of a potential problem.

Changes in bowel habits may also indicate something seriously amiss. A tumor could be blocking the bowel -- a possibility your doctor can explore with tests like a sigmoidoscopy or colonoscopy.

An 18-year-old with constipation is very unlikely to have colorectal cancer. But in older people it's more likely, although constipation can also be caused by diet, certain medications and "withholding," medical jargon for people who are so busy that they don't use the restroom when the urge strikes, resulting in stools that lose water and harden.

Persistent diarrhea and cramping are other changes to take note of and seek help for: You may be infected with a parasite like Giardia. Alternatively, the gut inflammation that sometimes causes such discomfort could signify a cancer -- or another inflammatory condition such as Crohn's disease or ulcerative colitis.

Over time, chronic inflammation can itself raise the risk of developing cancer, as well as cause

ulcers, perforations, infection, weight loss and exhaustion. It can be treated with steroids and other drugs that dampen the intestines' immune reactions.

For all these reasons, the American Cancer Society recommends that people who notice an unexplained change in their "habits" -- bleeding, narrowing of the stool, constipation, diarrhea or pain -- consult their doctors. If you're older than 50 (or if you're younger and have a family history of colon cancer or other bowel disorders), talk to your doctor about establishing regular checkups for colon cancer.

We will always be shy and embarrassed about talking about certain very personal things, but the doctor's office is the last place for gentility.

So clear your throat, speak up -- and get this stuff seen to.



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