Don’t Worry, It’s Normal

By Julie Stewart from AARP the Magazine

Oh, those embarrassing bodily functions! Here’s what happens to your body as you get older – and what you can do about it.

Don’t Worry, It’s Normal

1. Why have I sprung a leak?

Everybody loves to laugh, but what if a good joke makes you squirt a little? Stress urinary incontinence is pretty common, says Dr Alan Wein, chief of urology at the Perelman School of Medicine at the University of Pennsylvania. “The result is, people can leak when they laugh, cough or sneeze.”

Blame the ageing body. “The nerves and structures that hold things in place, and prevent the urethra from moving excessively when you laugh, cough or sneeze, deteriorate,” he says. Pelvic muscle tears suffered during childbirth increase risk in women, while prostate surgery increases risk in men, says Wein.

One solution? Hit the loo more often. This leaves less fluid to leak from your bladder. Also, learn to squeeze: contract your pelvic muscles as if stopping your urine midstream. Do this for ten seconds, ten contractions, ten times a day to strengthen your urinary sphincter muscles, and then squeeze when you cough or sneeze.

Noting what you eat and drink and when you go to the bathroom or leak will help your doctor determine whether you have stress incontinence or ‘urge incontinence’ (when your bladder muscles contract before your bladder is full). Your doctor may advise medication or surgery, and can check for infection or bladder cancer.

2. When did my breath get gross?

Most bad breath odour is bred on the back of your tongue, says Patricia Lenton, director of the Oral Health Clinical Research Center at the University of Minnesota. Your tongue is like a shag carpet, she says, and bacteria hide between the bumps. As we age, we take more medications, and many cause dry mouth, exacerbating bad breath.

Solutions include cleaning your tongue with a smooth-edged tongue scraper, says Lenton. “Start as far back as you can.” A mouthwash with zinc and cetylpyridinium chloride (CPC) is your best bet against stinky mouth bacteria, studies suggest.

When your mouth is at an alkaline pH, volatile sulphur compounds are released. When you eat, your mouth becomes more acidic, reducing the stench, adds Lenton.

Get checked to rule out tooth decay and gum disease, or even an underlying health problem, such as a chronic sinus infection or kidney disease.

3. What’s happening to my toenails?

Cracked, brittle, discoloured and thick nails from a fungal infection are embarrassing, especially if you like open-toed shoes. Fungus feeds on the nail, damaging it, says Dr David Tran, an assistant professor at the California School of Podiatric Medicine at Samuel Merritt University. Age is the biggest risk factor, according to a paper published in PLOS Pathogens. People with diabetes and conditions that limit circulation are also susceptible.

Early treatment with a prescription topical solution is best. A more severe infection may need oral medications that require liver checks for harmful side effects, Tran says. Laser treatment may be another option worth investigating.

See a doctor if your nails change markedly. A particular pattern of discolouration can be the result of skin cancer, which is often diagnosed late when it occurs under nails.

4. Who moved the bathroom?

If you’ve ever lost control of your bowels before getting to the toilet, don’t freak out – you have plenty of company. A recent peer-reviewed US study reports that faecal incontinence, also known as accidental bowel leakage (ABL), affects around 15 per cent of people over 70.

“As we get older, our nerves and muscles degenerate,” says Dr Satish S.C. Rao, director of the Digestive Health Center at Augusta University in Georgia. The same squeezing exercises that help with urinary problems can also strengthen your anal sphincter, giving you extra time to get where you’re going.

Because certain foods can cause problems, ask a gastroenterologist for a breath test to see whether you properly metabolise foods that include the fruit sugar fructose, the milk sugar lactose, and fructan, a string of molecules in foods such as wheat products, onions, garlic and artichokes, recommends Rao.

In some people, the rectum – usually a ‘compliant reservoir’ – stiffens into a tube that can’t accommodate pile-ups. In this case, your doctor may use a balloon to stretch your rectum, or recommend surgery. Also see your doctor if you have chronic diarrhoea, blood or pus in your stool, fever, diarrhoea at night, dehydration or unexpected weight loss.

5. Where did these spots come from?

Most dark spots caused by the sun are not dangerous, but a dermatologist can help you stay on top of changing patterns that can signal problems, says Dr Jane Grant-Kels, director of dermatopathology at the University of Connecticut.

About 14 per cent of middle-aged people have harmless brown spots, also known as age spots, notes a study in PLOS One. These appear more as you age, in places exposed to UV rays, such as your face, hands and forearms. Use a skin-lightening cream. A dermatologist can zap them with liquid nitrogen or a laser.

Seborrheic keratoses – genetic wartlike growths that range in colour from yellow to brown to black – are harmless. Grant-Kels encourages most patients to leave the spots alone, but a dermatologist can freeze them for you.

Red bumps called cherry angiomas – clusters of dilated blood vessels – are benign, but a doctor can freeze them off or excise them with a laser or a scalpel.

If any skin spot concerns you, see your dermatologist. Australia and New Zealand have the highest incidences of skin cancer in the world, according to Cancer Council Australia and Melanoma New Zealand. Symptoms for basal and squamous cell cancers include an unusual growth that doesn’t heal. Signs of melanoma include a new spot, or one that itches or changes size, shape or colour, or a sore that doesn’t heal.

6. Is it me, or is my nose getting bigger?

Although the bones in our faces stop growing around age 15, the cartilage in our noses and ears continues to stretch, says Dr Steven Daveluy, an assistant professor of dermatology at Wayne State University in Michigan.

Around middle age, the bones and fat in our cheeks sink inwards, making our noses look more pronounced. “Maybe it got only less than one millimetre larger – because the cheeks shrunk, it adds up,” Daveluy says. In addition, gravity pulls your earlobes, especially if you’ve spent years wearing heavy earrings.

Applying sunscreen to your nose and ears daily will help stave off age-related damage that makes skin droopy, Daveluy says. But cosmetic surgery is the only way to shrink your nose or ears.

If your nose is thickening and red, you might have rhinophyma, a complication of untreated rosacea. See your doctor; medication, laser treatment or surgery can help.

7. Why did I get so gassy?

When the bacteria in your gut ferment food in your colon, gases such as hydrogen and carbon dioxide are released, causing even healthy people to pass gas up to 20 times a day. As we age, some people let go more often and with more odour. For instance, some develop trouble digesting lactose, making them feel bloated and causing more eruptions.

An over-the-counter anti-gas medicine with simethicone can break up gas bubbles. Swallow probiotics. When taken consistently, these good bacteria can help calm gas, bloating and other components of irritable bowel syndrome, according to a study review published in the American Journal of Gastroenterology. Or spoon up a daily helping of 140–230 grams of probiotic yoghurt.

Some people struggle with gas, bloating and belching because they suck in too much air when they drink fizzy beverages or smoke cigarettes. “It’s funny how often this comes up,” says Dr William Chey, director of the GI Nutrition and Behavioral Wellness program at the University of Michigan. “People come in for bloating and belching, and they’re drinking eight Diet Cokes a day.” Also, avoid consuming a lot of sugar-free sweets and gums containing sugar alcohols such as sorbitol, mannitol and xylitol. Your body can’t absorb them, and that can cause bloating and gas.

If gas, bloating or burping strikes often, a gastroenterologist can help determine if you have a chronic problem digesting certain foods, says Rao of Augusta University.

8. What did you say?

Many people suffer some age-related hearing loss in one or both ears: 8.5 per cent of those aged 55-64; 25 per cent of those aged 65-74; and half of all people over 75. While all those rock concerts didn’t help, there are other contributors, including ageing, genetics, smoking, a poor diet and diabetes, says Dr Craig Newman, section head of audiology at the Cleveland Clinic. These all destroy hair cells in the inner ear that send auditory signals to your brain.

Get a hearing aid. Once hair cells are damaged, they’re kaput. And the longer you wait, the harder it will be to treat. Fortunately, the brain can ‘relearn’ the ability to hear. “That means you have to ‘teach’ your brain to hear again, by wearing hearing aids regularly,” Newman says.

But if you suddenly lose most, or all, of your hearing, “get to the doctor within hours,” Newman cautions. Depending on the cause – virus, reaction to medication or, in rare cases, benign tumours called acoustic neuromas – steroids or antiviral medications can help. Sudden dizziness and hearing loss with ringing in the ears should also get you to a doctor as soon as possible. 

AARP the Magazine (August–September, 2015) © 2015 by Julie Stewart, AARP.

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