The lowdown on hemorrhoids

This week’s column focuses on common day-to-day health issues that you may have wanted to know more about but were too embarrassed to ask your doctor about. Hope you’ll find the questions and answers interesting.

Hemorrhoids

Q. I have bleeding hemorrhoids. It’s also quite uncomfortable. What can I do about it? Help! — D.M., Legazpi City.

A. Here’s the lowdown on hemorrhoids: Most people develop hemorrhoids at some time in their lives. The word comes from the Greek hemo (blood) plus rhoos (flowing or discharging), and indeed, the first sign of hemorrhoids is typically blood on toilet paper or in the stool or water after a bowel movement. These clusters of swollen, inflamed blood vessels and tissue are usually internal (in the lower rectum) but sometimes external (on the edge or just outside the anus). Often there are no symptoms other than bleeding, but external hemorrhoids, in particular, can be painful and itchy, especially if they have “thrombosed” — that is, formed a blood clot and hard lump. Despite the possible pain and discomfort, hemorrhoids are not tumors or growths, usually go away or greatly diminish on their own, and are rarely a serious risk to your health.

There’s no sure way to prevent hemorrhoids but these measures can ease the discomfort and possibly reduce recurrences:

• Avoid constipation. Eat a high-fiber diet (mainly vegetables, fruits, grains, beans) and drink plenty of fluids; this will increase fecal bulk and help prevent straining. Exercising regularly helps promote bowel movements. If you’re chronically constipated, try a fiber supplement such as psyllium or methylcellulose. Don’t use harsh laxatives that cause diarrhea, which can make hemorrhoids worse. Your doctor may also recommend a stool softener.

• Don’t strain or hold your breath when moving your bowels. Go when you feel the urge; don’t put it off. When possible, choose a time for defecating when you aren’t rushed, and when the internal action of peristalsis can be helpful for you — perhaps after breakfast, or soon after drinking water. But try not to sit on the toilet for long periods.

• For painful hemorrhoids, try soaking in a warm bath to relieve irritation and itching. Cold compresses or ice packs, several times a day, may also help, particularly if there is swelling.

• You can try over-the-counter topical hydrocortisone cream, but not for more than a week, since prolonged use can damage skin. Products ending in “-caine” are local anesthetics and should be used only briefly. Topical analgesic wipes, and suppositories marketed for hemorrhoids can provide some temporary relief for pain and itching, at best.

• Keep your anal area clean, but clean gently. Avoid using rough toilet paper. Wipe with wet tissue, premoistened wipes, or a perianal cleansing lotion.

• Lose weight if you are overweight.

• Don’t waste your money on dietary supplements promoted as hemorrhoid treatments or preventives. Horse chestnut extract is one possible exception.

Bad breath

Q. When I awaken in the morning, I have terrible bad breath. My breath seems okay during the rest of the day, but I worry about developing halitosis. What causes bad breath? What can I do about it? — R.Q., Caloocan City.

A. Bad breath is a common problem, especially first thing in the morning (“morning breath”) and also during the day (halitosis). Foods can cause bad breath; garlic (the “stinking rose”) and onions are classic examples. Reflux of stomach contents can do the same, as can serious diseases of the liver or kidneys. Infections of the tonsils, sinuses or respiratory tract can also be responsible for bad breath. But the usual culprits are oral bacteria.

Morning breath is caused by breathing through the mouth during sleep; saliva dries out, allowing bacteria to multiply and produce sulphides, amines, and other bad-smelling gases. Any medication or condition that reduces saliva flow can do the same. Although morning breath is unpleasant, it can be quickly relieved by rinsing the mouth with water.

Halitosis is also triggered by the wide range of bacteria that are present in every mouth. Poor oral hygiene, abundant dental plaque, and especially periodontal disease can allow these bacteria to get the upper hand and cause halitosis. And even when teeth and gums are healthy, dentists suspect that bacteria on the tongue contribute.

If you have bad breath, here’s what to do:

• Keep your saliva flowing. Drink plenty of water, chew gum (sugarless, please), and avoid antihistamines and other medications with cholinergic actions that dry the mouth.

• See your dentist regularly and get prompt treatment for any problems.

• Practice meticulous oral hygiene by flossing regularly and brushing your teeth and, yes, it’s true — your tongue too, diligently.

• Avoid food that seem to contribute to your problems. Don’t smoke or chew tobacco.

• Use an antibacterial mouthwash.

• Keep breath mints on hand for a quick, if temporary, cover-up.

•Relax. Halitosis is a common problem and it’s usually much less bothersome to other people than to the person with bad breath.

Foot odor

Q. I’m ashamed to take my shoes off because of foot odor. I bathe regularly, but it doesn’t seem to make much of a difference. What else would help? — P.M., Manila.

A. Daily bathing is a good start. Using an antibacterial detergent or soap on your feet can help keep the number of odor-causing bacteria on your skin in check. After bathing, thoroughly dry your feet, including between your toes. Consider using a nonprescription foot powder to help absorb sweat. At bedtime, apply an anti-perspirant to the soles of your feet.

Choose socks made of cotton or wool. Some cotton blends and wool socks absorb moisture, so they help keep your feet dry. If necessary, change your socks once or twice a day. Shoes made of natural materials allow feet to breathe and can help prevent sweating. Rotate the shoes you wear, allowing them to dry between wearing. If possible, remove the inner sole linings when you’re not wearing the shoes. Go barefoot now and then or at least slip off your shoes. If you still experience problems, consider a visit to your doctor who can determine if another issue — such as excessive perspiration or overgrowth of bacteria —requiring a prescription medication, might be the cause of your problem. 

Bedbugs

Q. I live in a dormitory near the university belt area. My fellow boarders and I found bedbugs in our mattresses. How do we get rid of these bugs and how do we prevent a re-infestation? — M.P., Manila.

A. Yes, bedbugs appear to have made their way back into our homes. But the cause of their return is not completely clear. Most likely, increased travel has something to do with it. In addition, some evidence suggests the bugs have become more resistant to available pesticides. The good news is that the bites are not usually harmful. In a review study on bedbugs in the Journal of the American Medical Association, researchers report that no study to date has proved that these bugs can transmit or carry disease.          

If you have bedbugs, contact a licensed pest control operator. Place all clothes, beddings, and other fabrics into the drier for 45 minutes in high heat (over 140°F). Vacuum your furniture, focusing on crevices. Place the legs of beds in dishes with water. You should purchase a special encasement to cover your mattress. Getting rid of bedbugs is difficult but not impossible. With patience and diligent cleaning and washing, it can be done.

Toilet seat covers

Q. Should I use those paper toilet seat covers found in some public restrooms? — A.B., Cebu City.

A. They serve no hygienic purpose. If the seat is clean and dry, you don’t need a paper cover. If the seat has drops of urine, they will seep through the paper (just wipe off the seat). People worry about contracting a disease from a toilet seat, but this fear is unfounded. As long as the skin of your buttocks and thighs is unbroken, you have no chance of getting a disease from the seat. The many layers of skin form a fairly impenetrable barrier; in addition, the skin is laced with certain immune cells that protect against microorganisms. The most important thing, of course, is to wash your hands with soap and water after using the toilet, since microorganisms can be transmitted from hand to mouth.