June 10, 2004

Individuals silently suffer due to common but extremely embarrassing health conditions. Shabnam Nasir suggests that they seek medical guidance as their problems are treatable

Amongst the many different types of illnesses that may affect people, there are also ailments that can cause sufferers extreme embarrassment and uneasiness. In some cases, this self-consciousness may prove to be so severe that patients find it difficult to talk to a doctor, and continue to suffer silently from an illness that in many cases can be easily cured.

In view of this predicament, an attempt is made to identify some of the most common ‘embarrassing problems’ after having talked to various people who have been suffering from them. For the protection of their identities, all names have been changed. Solutions based on medical advice are also given.

Excessive sweating/body odour:
“I have a terrible problem with excessive sweating,” says Amir. “I also have quite a bad odour when I perspire and life has become hell for me. I am so conscious of this that I have started to avoid going out to any social gatherings — just getting through a day at work is torture enough. My condition gets worse when I am nervous, or obviously when the weather gets hotter. I know that everyone at the office talks about my problem. Deodorants don’t really help that much and I have tried showering every day. Sometimes I get so depressed I just want to stay at home and never go out anywhere. I can’t talk to a doctor because I know they won’t understand how much of an embarrassment this has become for me.”

“My feet smell awful!” exclaims Naveed. “I play a lot of sports and my feet sweat so much that I get really uncomfortable. I always have the fear that I may have to take off my shoes in front of someone, and then I would just die of embarrassment. I really need help with this problem.”

How to treat this problem:
Excessive sweating or hyperhidrosis is a condition that affects about one in 200 people. Those afflicted with this condition may suffer extreme embarrassment as they may also perspire a great deal from their palms and feet.

It is not sweat itself that causes body odour, but when the perspiration from our body reaches the skin, then bacteria acting on the sweat can produce an offensive smell. Two types of sweat are produced by the body- eccrine and apocrine, and it is the apocrine that reacts with bacteria causing bad odour.

Some people have larger and more active apocrine glands than others causing them to have more of a body odour. In any of these cases regular bathing, washing clothes and the application of deodorants/anti-perspirants can make a big difference. Washing armpits with an anti-bacterial soap is very important as that is where the body’s two to three million sweat glands are based. Using a deodorant that contains zinc or aluminum is very effective, and using anti-perspirant will actually block sweat from leaving the body.

Also, avoid eating strong smelling foods like onions, garlic and spices, as they can also intensify the smell of sweat. Sufferers should wear cotton clothes instead of artificial fibres so that sweat can be absorbed and allowed to evaporate.

“The main way to deal with this problem is to maximize your body hygiene,” says Dr Sadaf Khan, a medical officer. “Daily showers and a constant change of fresh clothes should benefit a person immensely. It should also be noted that certain drugs and medications may cause side-effects where they are excreted in the sweat causing body odour.

“If someone feels that they have suddenly developed such an offensive smell in their perspiration, then they should contact a doctor immediately, as this could also be a sign of a serious illness.” It should be noted that an acetone smell may indicate diabetes and similarly liver disease or a metabolic disorder could be the reason of other odours being excreted by the body.

Feet contain over two million sweat glands and when they are confined to being in socks and shoes for most of the day, then foot odour may be a problem. As it is the bacteria on the skin causes the smell, and feet need to be exposed to fresh air and washed regularly. Trimming nails and wearing cotton socks also reduces the amount of bacteria accumulating in this area, as feet will be able to ‘breathe and allow sweat to evaporate from the skin.

“Foot talcs, charcoal soles and open feet sandals should be used to cure smelly feet,” adds Dr Sadaf Khan. “A regular change of socks and shoes will also help to stop odours from collecting on surfaces.” In some cases foot odour may be because of a fungal infection and if itchiness or redness accompanies it, a doctor must be seen.

Dr Sadaf Khan feels that public awareness of personal hygiene needs to be improved. “It is sometimes very difficult to examine a patient when they have not had a bath for days, and then I counsel them on the importance of staying clean. In many cases I have given patients money to buy soap and have regular baths, as patients complain that they can’t afford to buy such items. I then tell them that staying clean should be one of their topmost priorities, and that they must spend time and money on this.”

Diseases of the skin and scalp:
Every person has the right to want to look good, and feel satisfied about their appearance. When a person has a disease that affects their looks, then they are obviously going to be worried and may be a little reluctant to discuss this problem with a doctor.

“I started losing my hair two years ago,” says Roma. “At the time I noticed that my hair had started thinning and I was absolutely petrified that I was going bald. I remember that I was scared of talking to a doctor about my problem because I did not really want to admit the panic I was feeling to myself. Deep inside I felt really ashamed at the fact that I was losing my femininity.”

“Can you believe it if I said that dandruff has nearly destroyed my life?” said Shoaib. “I had tried different types of shampoos but my condition had started getting worse. I was mortified that people could see the specks of dandruff that were always on my shoulders and my scalp itched like it was on fire. After I gathered the courage to go and see a skin specialist, I was diagnosed with a fungal type of dandruff that was relieved after I took a specific medicine. If I had not been able to talk to the doctor then I would ultimately have stopped going out and meeting people. This disease had taken over my life.”

“What do I do about the excessive facial hair I have started to grow?” asks a worried Sania. “I have hair growing from my chin that is dark and tough, and I am so ashamed and depressed about it I sometimes think I will go crazy. I’ve tried hair removal products but the hair grows back even tougher than it was before. I can’t dare to go and talk to a doctor about it. I would be too embarrassed!”

Doctor’s advice:
“Skin conditions must be seen by a dermatologist to prevent a person’s condition from deteriorating and causing them to lose their self-confidence,” says Dr Farida Ahmad, a skin specialist.

“Hair loss may occur due to many reasons and the specific cause can only be determined by a physician. In some cases the side-effects of certain medicines can trigger hair to fall out, and in other cases it may be a hormonal problem. Stress or excessive worrying can also contribute, and contraceptive pills may cause hair loss in certain women. Illnesses such as typhoid can also cause hair to fall out. A woman who has just delivered a baby or is breast-feeding can also experience a loss of hair.”

Whether male or female, this problem can only be treated once a proper diagnosis as to its cause is made, enabling a doctor to prescribe the specific treatment needed. Dr Farida Ahmad also said that certain hair dyes and heat appliances can damage hair follicles or cause an allergic reaction in the scalp. To prevent this, people using hair colouring agents must do a patch test as advised on the instructions on the packet.

“Dandruff is generally of two different types,” states Dr Farida Ahmed. “The first is normal dandruff which is usually treated by finding the right type of shampoo to suit your scalp, and the second type is caused by a specific disease of the scalp. Oily skin may give rise to chronic dandruff, and skin diseases such as psoriasis may cause a different type of dandruff. If a person is suspected of having a fungal infection then they will be given a culture test, where a strand of hair is plucked from the root and tested to see if a fungal growth is present. If it is, then medicines and anti-fungal shampoo is prescribed.”

“Excessive facial hair growth in women may be attributed to hormonal abnormalities,” according to the doctor, “and in some cases there are increased levels of testosterone which can cause this growth, and specific medication is given to balance the levels needed by the body. After a hormone test, the doctor will be able to determine if this is the cause. The use of steroids in face creams can also cause this condition. However, if there is no oral treatment available, then laser therapy or electrolysis can provide a permanent removal of any unwanted hair. Less expensive remedies are threading or waxing.”

Another skin disease that causes a lot of embarrassment to patients is psoriasis. It is a chronic inflammatory skin condition where patches of thick, scaly skin of a silvery colour begin to form on the skin. As not all scaly skin conditions are necessarily psoriasis, its diagnosis must be made by a dermatologist. This disease is both unpredictable and the causes for having it are not fully understood. A genetic factor may cause this disease and also medications, infections and stress. Whatever the reasons, it proves to be very disturbing as patients are acutely aware of their skin peeling.

“Patients who have psoriasis need psychiatric counselling as well as other medications,” says Dr Farida Ahmad. “Sufferers become chronically depressed at their condition and start to avoid any sort of exposure to other people. They tend to be ashamed of the state their skin is in, especially if scales are falling off. I always encourage my patients to read all the different types of information that is available on the Internet. In the West, there are many awareness groups and associations that cater for the needs of sufferers of psoriasis as there is quite a lot of research going on about this condition.”

Speech disorders and bed-wetting in children:
“What do I do about my seven-year-old daughter who stammers while she talks?” asks her extremely distressed father, Hamid. “At first we used to think it was cute when she was very small, but now her problem is getting worse. You cannot imagine how depressing this is for us, as she is so full of life and very intelligent. This stammering is holding her back since she is too upset to talk in front of other people. It breaks my heart when I see her struggling to keep up with other children when she is just bursting to say something. I have to hold back tears when she tells me that the other kids in her class tease her because of the way she speaks.”

“My five-year-old son wets the bed every night, and this problem is giving me a lot of stress,” says Shehla, mother of three young children. “Every night I can hardly sleep as I worry if he will wet the bed again. I know it’s not really his fault but I can’t help losing my temper occasionally. I find it so embarrassing that I can no longer stay the night at any of my relatives’ and I have to hide this fact from any guests that come to our home.” Doctor’s advice:

“Speech disorders may be apparent in a child who is hyperactive or very intelligent,” says Dr Nasera Bhatti, a child specialist. “What usually happens is that the child is bursting with something to say or has observed something they can’t wait to comment about, but they find that they cannot speak as fast as they are thinking.

“A child who stammers is suffering a lot. They are extremely conscious of the fact that they cannot deliver their thoughts as the rest of the children do, and they also feel that they are an embarrassment to themselves and their parents. When dealing with such a case, parents need to be extra patient and reassure the child that nothing is wrong with them. A tense and anxious parent will make the child feel worse and will actually make the condition harder to treat.”

Dr Nasera Bhatti also explained that if the problem of stammering (whether child or adult) is causing a lot of embarrassment, then the help of a speech therapist is essential. “As stammering and speech disorders can affect adults too, this problem needs professional counselling, where expert advice can improve the situation immensely.”

Even though an adult may feel extremely embarrassed in talking about this situation, it is imperative that professional help be sought to treat speech disorders. With time, patience and the proper kind of therapy, many speech disorders can be improved significantly.

“There is one golden rule when you are dealing with a child who wets the bed,” says Dr Nasera Bhatti. “Never tell such a child off or make them feel it is their fault, as the condition will only get worse. A child in such a situation is feeling embarrassed and upset enough over this problem, and will need extra love and support from loved ones to see them through this phase. Bladder control is usually reached by the age of five to six years in a child, and if basic investigations indicate there is no physiological problem, then a child just needs reassurance and time to get over this problem.”

The doctor said that it was rare for a bed-wetting problem to be the sign of a serious condition, but nevertheless investigations for this condition should be done to rule out any other complications. She added that love, understanding and avoiding giving the child any drinks before going to bed should solve the problem. It is also a good idea to take such a child to the toilet once during the night to avoid any accidents.

Bad breath and oral problems:
Bad breath or halitosis can be an extremely embarrassing illness for the sufferer. It can result in creating social and emotional disturbances and can even affect marriages. In many cases sufferers are completely unaware that they have a problem or how severe it is, and in other cases a person may feel they have a condition more serious then it actually is. In both cases this illness causes extreme discomfiture and an immense lack of self-confidence in the affected individuals.

Bad breath is actually caused by a sulphur compound that is produced by bacteria in the oral cavity that accumulates on the tongue and teeth. If bad breath is because of bad oral hygiene, then proper treatment will cure the problem significantly. It should also be noted that other physiological problems such as infections, diabetes and kidney or liver diseases could also be a reason for halitosis.

“There are mainly three reasons for having bad breath,” says Dr Asma Jawad, a dental surgeon and orthodontist. “People who have bad oral hygiene or gum diseases or gastric trouble may develop bad breath. In order to properly clean their teeth, a person must brush for at least two minutes making sure they reach every angle of their teeth. They should also brush their tongue where bacteria can accumulate. When properly done, you will find that this duration of two minutes is actually quite a long one. Mouth washes make a big difference in killing bacteria and controlling the build up of plaque that results in breath having a bad smell.”

Dr Asma Jawad added that crooked or ‘out of line’ teeth can be a hugely embarrassing problem for certain people. She said that it is basically the problem of unawareness amongst the public that leads to the neglect of dental and oral care.

“Some patients come to see me when they have a case called ‘anterior open bite’ which means that they cannot even close their mouth properly. Such patients are usually highly irritable or angry as they have usually been suffering needlessly from this condition which is fully treatable. I insist to my patients that oral care is just as important as caring for the rest of their body, and that they must not let fully treatable cases deteriorate. I recommend six monthly check ups for my patients so that any problem can be identified and treated before it gets serious.

“Patients with dentures usually come to me with concerns that their artificial teeth will fall out or become dislodged while eating. They get very tense and anxious about having to use dentures, and I usually give such patients counselling to build their confidence. Once they get used to eating outside at restaurants or at parties, then their fears are usually overcome.”

Psychological conditions and social phobias:
Some of the most embarrassing conditions that can affect an individual are psychological or emotional disturbances that interfere with the normal daily functioning of the sufferer. Such conditions may be specific phobias, panic or anxiety attacks, or just situations that cause a person to become terrified in what should be a relatively ‘normal’ everyday-life situation.

Examples of such conditions include situations where people find their hands shake when they have to sign something in public, have a fear of speaking in front of strangers, or develop a phobia to a specific situation or object. Common types of phobias include agoraphobia, fear of open spaces; claustrophobia, fear of closed spaces; fear of certain animals or insects; fear of thunderstorms or lightning; fear of catching a specific disease or illness. In all cases treatment of these phobias needs the help of a clinical psychologist or psychiatrist to help the sufferer regain control over his/her life.

Social phobia is also a common disorder where the sufferer acquires a persistent fear of embarrassment or humiliation in public or in a social gathering. This results in a damaging effect on personal and professional relationships and an immense feeling of depression. Although sufferers are fully aware that their fear is unreasonable, they are unable to control it.

Symptoms of social phobia include sweating, trembling, blushing, increased heartbeat, light-headedness and anxiety. This condition needs to be treated immediately with the help of a psychiatrist or clinical psychologist, as in extreme cases it can cause a person to become housebound and avoid any social interaction at all, resulting in a disruption of family and work life.

Individuals must realize that health professionals are trained to help people with a variety of illnesses. What may seem immensely embarrassing to the sufferer may in fact be just an easily treatable condition, which when cured will give a person back their lost confidence and self-esteem.

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