belly troubles diarrhoea and dysentry

Delhi belly Your Health DR GITA MATHAI I receive many letters from people who complain of having “dysentery” or “always” having “diarrhoea”, which stops them from functioning effectively in their jobs or studies. The terms diarrhoea and dysentery are freely interchanged, leading to confusion in the minds of patient and physician. Diarrhoea occurs when the consistency and frequency of the bowel movement changes. It becomes either watery or frequent (usually more than three times a day) or both. Dysentery occurs when there is blood and mucous in the stool. Our intestines are full of good bacteria. These colonise the bowel and produce essential vitamins of the B group as well as vitamin K. They also kill disease-causing bacteria ingested with food. Antibiotics, prescribed for various infections, kill these good bacteria too. So harmful bacteria can gain a foothold, leading to diarrhoea. This accounts for the mild tummy upset that may follow a course of antibiotics. Infective diarrhoea can be viral, bacterial or parasitic. Organisms are ingested with every meal. The acid in the stomach, the first line of defence, destroys these. Acidity in the stomach is reduced by antacids and medications such as ranitidine, omeprazole and pantaprazole. Large numbers of disease-causing bacteria in contaminated food can overwhelm even normal stomach defences. Bacterial overgrowth can also occur in food if it is left outside and reheated and used the next day. A very common form of this occurs if leftover rice is eaten the next day. Even if it is fried, the bacterial toxins withstand the heating process. In victims of diarrhoea, rehydration is important. You can use commercial ORS (oral rehydrating solution), tender coconut water, salted lime juice, buttermilk or a watery mixture of rice and dal. Make an estimate of the amount of fluid lost and replenish it. If diarrhoea continues for more than three days, or if urine output decreases, consult a physician immediately. Anti motility agents such as lomotil and lomofen do not cure diarrhoea. They merely reduce the movement of the intestine so that the frequency becomes less. They are contraindicated in children under the age of five. They do not work in dysentery. Viral diarrhoeas do not respond to antibiotics. They subside on their own. Bacterial and parasitic diarrhoeas can be treated with specific medications. Make sure to complete the course, otherwise the organism becomes resistant, causing diarrhoea to recur after 2-3 days. Dysentery means that there is blood and mucous in the stool. It is usually caused by an infecting organism (such as bacteria and amoebae) invading the large intestine. There may by paroxysms of pain and fever. The full course of medication should be followed. “Probiotic” capsules are often prescribed to restore intestinal flora to its original state. They are expensive and of dubious efficacy. A similar effect can be obtained by swallowing one tablespoonful of home-made curd early in the morning on an empty stomach. Curd is not a true probiotic but contains sufficient lactobabillus and other bacteria to repopulate the intestine. Taking zinc supplements also reduces the duration and frequency of diarrhoea. If diarrhoea or dysentery persists for two weeks, it is classified as chronic and needs to be re-evaluated by a physician. It may be an ordinary or exotic infection that has been missed in the preliminary round of investigations. Also, not all diarrhoeas, or dysentery-like diseases, are due to infections. Mucous may appear as a part of IBS (idiopathic bowel syndrome). Blood may appear in diverticulosis of the large intestine or if there are polyps present. In children milk allergy or lactose intolerance can read as recurrent diarrhoea or dysentery. Haemorrhoids (piles) or a fissure can be the reason for blood in the stool. On very rare occasions, cancer of the large intestine can also be the reason for blood in the stool. Cholera, typhoid (which can also cause diarrhoea) and rotavirus infections are preventable by timely immunisation. The cholera vaccine is now given by mouth in two doses and the typhoid as an injection repeated every three years. Rotavirus is likely to affect children and can be fatal. The vaccine is administered orally and is best given before the age of six months as two doses a month apart. Diarrhoea falls just behind respiratory illness in frequency and mortality. One of the reasons is that 50 per cent of 1.2 billion Indians lack toilets and defecate in the open, perpetuating the cycle of diarrhoeal illness. Tourists and travellers to India expect and dread the onset of diarrhoea. In the long term, improvements in sanitation, safe water supply, regulated food safety and community awareness of preventive measures will go a long way towards reducing the frequency of diarrhoeal diseases. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

body odor

Body odour? No sweat

Your Health DR GITA MATHAI

Tips to fight body odour ● Bathe twice a day using a loofah and a medicated soap ● Remove hair in the underarm and groin areas ● Use a deodorant spray after bathing ● Wear cotton clothes and change them daily ● Use sweat wicking garments while exercising ● Wear cotton or sweat wicking socks ● Wear leather or canvas shoes ● Give your shoes and slippers time to dry by wearing a pair only once in 24 hours Sweating is a very individual phenomenon. It is difficult to categorise the amount a person sweats as normal or excessive. Some people and families perceptibly sweat more (and smell). Also, increased sweating is normal in hot weather, with exercise or extreme emotions like fear or anger. Sweat is a clear fluid secreted by two types of glands. The eccrine glands are situated all over the body. They open directly on to the skin. They secrete a clear and odourless sweat composed of water, electrolytes and a little urea. The apocrine sweat glands develop at puberty. They are situated in the hairy areas of the body, the scalp, armpits and groin. They open into the hair follicles. The sweat mixes with the fatty secretions in the hair follicles. This provides a good medium for the overgrowth of bacteria, which are normally present on the skin. The bacteria breakdown the “fatty” portion of the sweat, causing body odour. (Children do not smell even if they sweat because they lack apocrine glands). Everyone has a distinctive body odour. It is influenced by diet (especially garlic and onions). It becomes distinctive in certain diseases. In diabetes, the body smells fruity, in liver disease, particularly cirrhosis, and in renal failure there is a musty odour. Lung abscesses smell like apple blossoms. Non healing ulcers smell like rotting compost. Schizophrenics have a distinct odour in their sweat owing to a chemical called trans-3-methylhexanoic acid. Some people sweat excessively, in quantities far greater than needed to cool their bodies. This is a condition is known as “hyperhidrosis”. It usually affects the palms, soles and underarms. It becomes a social embarrassment as such people have wet and smelly clothes, cold clammy hands, are unable to write or hold a pen, and feet which slip out of foot wear or smell bad, especially if they wear socks. The constant dampness may cause the nails (both fingers and toes) to develop fungal infections, which are difficult to eradicate. Bacterial infection may occur on the hair follicles or the area between the toes. The armpits may be wet and foul smelling. Focal hyperhidrosis affects only the palms and soles and is usually an exaggerated response to emotions. It may be inherited. In generalised hyperhidrosis, sweating affects the whole body. It can be normal or occur unexpectedly at different times of the day or week during the peri-menopausal period when the female hormone levels fluctuate. It can occur during certain infections like malaria or tuberculosis. It can be precipitated by low blood sugars. It can be one of the symptoms of an overactive thyroid gland. The ingestion of medication like aspirin, paracetemol or even caffeine found in tea, coffee or aerated beverages can precipitate an attack. It may also be the first sign of a heart attack. Hyperhidrosis can be tackled with antiperspirants containing aluminium chloride. This should be applied to the armpits, palms and soles at night after washing and drying the area. They should be washed off in the morning. They work well in mild cases. Antiperspirants are different from deodorants, which contain perfume to mask body odour. The label on the container should be read carefully. A group of drugs called “anticholinergics” reduce sweating. They are effective but can react with other medications and cause side effects like dryness of the mouth, blurred vision, constipation, retention of urine, dizziness and loss of taste. Dermatologists do a procedure called “iontophoresis”. The body is immersed in water and a low electric current is passed using a battery-operated device. Initially, daily therapy is required, but eventually maintenance treatment once in 10-15 days is all that is needed. Injections of botulinium toxin (Botox) have become very popular. They act by blocking the nerves. They need to be given by a qualified cosmetic surgeon. Inexpert administration can cause side effects like weakness of the muscles. The action is not permanent but lasts around 4-6 months. Sweat glands can be surgically removed from troublesome areas like the armpits. If the problem is more widespread, the nerves carrying the messages to the sweat glands can be cut with an endoscope. This is specialised surgery and should be reserved for severe cases. Excessive sweating may only be part of the problem. People are usually more concerned about the unpleasant body odour it causes. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

body odour? don't sweat

Front Page > KnowHOW > Story Share on emailShare on printShare on facebookShare on twitterMore Sharing Services Body odour? No sweat Your Health DR GITA MATHAI Tips to fight body odour ● Bathe twice a day using a loofah and a medicated soap ● Remove hair in the underarm and groin areas ● Use a deodorant spray after bathing ● Wear cotton clothes and change them daily ● Use sweat wicking garments while exercising ● Wear cotton or sweat wicking socks ● Wear leather or canvas shoes ● Give your shoes and slippers time to dry by wearing a pair only once in 24 hours Sweating is a very individual phenomenon. It is difficult to categorise the amount a person sweats as normal or excessive. Some people and families perceptibly sweat more (and smell). Also, increased sweating is normal in hot weather, with exercise or extreme emotions like fear or anger. Sweat is a clear fluid secreted by two types of glands. The eccrine glands are situated all over the body. They open directly on to the skin. They secrete a clear and odourless sweat composed of water, electrolytes and a little urea. The apocrine sweat glands develop at puberty. They are situated in the hairy areas of the body, the scalp, armpits and groin. They open into the hair follicles. The sweat mixes with the fatty secretions in the hair follicles. This provides a good medium for the overgrowth of bacteria, which are normally present on the skin. The bacteria breakdown the “fatty” portion of the sweat, causing body odour. (Children do not smell even if they sweat because they lack apocrine glands). Everyone has a distinctive body odour. It is influenced by diet (especially garlic and onions). It becomes distinctive in certain diseases. In diabetes, the body smells fruity, in liver disease, particularly cirrhosis, and in renal failure there is a musty odour. Lung abscesses smell like apple blossoms. Non healing ulcers smell like rotting compost. Schizophrenics have a distinct odour in their sweat owing to a chemical called trans-3-methylhexanoic acid. Some people sweat excessively, in quantities far greater than needed to cool their bodies. This is a condition is known as “hyperhidrosis”. It usually affects the palms, soles and underarms. It becomes a social embarrassment as such people have wet and smelly clothes, cold clammy hands, are unable to write or hold a pen, and feet which slip out of foot wear or smell bad, especially if they wear socks. The constant dampness may cause the nails (both fingers and toes) to develop fungal infections, which are difficult to eradicate. Bacterial infection may occur on the hair follicles or the area between the toes. The armpits may be wet and foul smelling. Focal hyperhidrosis affects only the palms and soles and is usually an exaggerated response to emotions. It may be inherited. In generalised hyperhidrosis, sweating affects the whole body. It can be normal or occur unexpectedly at different times of the day or week during the peri-menopausal period when the female hormone levels fluctuate. It can occur during certain infections like malaria or tuberculosis. It can be precipitated by low blood sugars. It can be one of the symptoms of an overactive thyroid gland. The ingestion of medication like aspirin, paracetemol or even caffeine found in tea, coffee or aerated beverages can precipitate an attack. It may also be the first sign of a heart attack. Hyperhidrosis can be tackled with antiperspirants containing aluminium chloride. This should be applied to the armpits, palms and soles at night after washing and drying the area. They should be washed off in the morning. They work well in mild cases. Antiperspirants are different from deodorants, which contain perfume to mask body odour. The label on the container should be read carefully. A group of drugs called “anticholinergics” reduce sweating. They are effective but can react with other medications and cause side effects like dryness of the mouth, blurred vision, constipation, retention of urine, dizziness and loss of taste. Dermatologists do a procedure called “iontophoresis”. The body is immersed in water and a low electric current is passed using a battery-operated device. Initially, daily therapy is required, but eventually maintenance treatment once in 10-15 days is all that is needed. Injections of botulinium toxin (Botox) have become very popular. They act by blocking the nerves. They need to be given by a qualified cosmetic surgeon. Inexpert administration can cause side effects like weakness of the muscles. The action is not permanent but lasts around 4-6 months. Sweat glands can be surgically removed from troublesome areas like the armpits. If the problem is more widespread, the nerves carrying the messages to the sweat glands can be cut with an endoscope. This is specialised surgery and should be reserved for severe cases. Excessive sweating may only be part of the problem. People are usually more concerned about the unpleasant body odour it causes. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in Share on emailShare on printShare on facebookShare on twitterMore Sharing Services