Doc, I’ve Got This, Um ... Er ...

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?

Especially when they’re happening to us.

Our modesty doesn’t end with the people in our lives, but extends to our doctors and dentists as well, the very people who can help us find relief. We shouldn’t be so bashful, experts urge. 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 UCLA’s School of Medicine. “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.”

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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 (which hosted an international meeting on oral malodor last August). “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.”

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Thus, while there are many reasons why one person has bad breath and another doesn’t, poor tongue hygiene--and how many of us of really brush our tongues?--is a lead cause.

But there are other causes and contributors. Chronic sinus infections harbor smell-producing bacteria and fungi. Chronic, drippy noses coat the tongue with mucus that encourages plaque build-up. 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 like kidney malfunction, stomach ulcers, hepatitis or diabetes (where the breath can have a sweet smell caused by chemicals called ketones). Some people with a rare genetic disorder called trimethylaminuria have distinct, fishy breath. (Dietary changes, such as avoiding eggs and fish, can help control this odor.)

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, experts stress.

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.

While bad breath is more common in older folks, another embarrassing condition often shows up first in people ill-equipped to handle it: adolescent girls. What could be more mortifying, at an age when one’s looks can be an all-consuming preoccupation, than unwanted face and body hair?

Excessive hairiness in women is just one sign of a poorly understood condition often referred to as Polycystic Ovarian Syndrome, or PCOS. Other signs of PCOS, which may affect 5% of women, include thinning head hair, irregular periods, infertility, weight gain and acne.

The cause of the condition, which often runs in families, is unclear. Levels of male hormones (which are naturally present in women in small amounts) are often abnormally high. The ovaries, when examined by ultrasound, often contain multiple cysts. And the body responds sluggishly to the blood-sugar-regulating hormone insulin.

A Condition Dismissed as a Vanity Issue

Doctors tend to either not diagnose PCOS or to pay insufficient attention to it, says Dr. Andrea Dunaif, chief of the Division of Women’s Health at Brigham and Women’s Hospital in Boston. “Physicians just have tended to dismiss complaints of hirsutism, even when women do bring it up--they consider it just a cosmetic, and vanity, issue.”

In fact, though, it’s more than just hard on the psyche.

Women with PCOS often have trouble conceiving. Obesity endangers their health. They are at high risk for developing type II diabetes and possibly heart disease and hypertension. They are also at higher risk for uterine cancer if the condition goes untreated. Thus, say experts, it’s very important that girls or women who may have PCOS are diagnosed so their condition can be managed.

Women with PCOS, for instance, may need to be extra vigilant with their diet and exercise. They should have their blood lipids regularly checked, and their doctors should watch out for any early signs of diabetes. Drugs such as oral contraceptives, Provera (an injectable contraceptive) and a male hormone-blocking chemical called spironolactone help establish monthly periods and reduce the growth and thickness of hair.

For cosmetic help, such women can turn to laser treatment and electrolysis. Emotionally, they can glean strength from support groups such as the Polycystic Ovarian Syndrome Assn. (on the Web at https://www.pcosupport.org), which now has a special effort geared toward teens.

Though it’s common for PCOS to develop during the teen years, Kirsten (who asked that her last name not be used) was 22 when she noticed hair growing on her face and a steadily thickening mustache. (Kirsten, now 37, has been tweezing out those hairs ever since.) When she went to see the doctor, “he just flippantly said: ‘You have polycystic ovarian disease,’ ” she recalls. “He didn’t tell me about fertility problems. He said ‘You may have to go get electrolysis. There’s nothing I can do for you.’ ”

Kirsten, who lives in Redlands, did have fertility problems, though she eventually gave birth to a son. She’s always struggled with her weight, she’s had irregular periods all her life and her hair is thinning. And as for acne, “I’m still putting benzoyl peroxide on my face twice a day--just like I was as a teen.”

Today, she says, she is getting the care she needs. She takes birth control pills to stabilize her periods. She has regular checkups for her lipids and blood sugar. And she pays careful attention to diet and exercise.

Kirsten’s facial hair isn’t too noticeable; she’s a blond. But dealing with PCOS has still been embarrassing and isolating, she says.

“Everyone looks at your weight, and thinks, ‘Hmmm . . . ‘ “ Only recently, after reading a magazine article about PCOS, did she learn about support groups. “It’s been wonderful to talk to others,” she says. “I don’t feel so alone anymore.”

That Bleeding Could Be a Sign of Cancer

Bowel disorders are another area in which patients tend to wax bashful. Yet sometimes, someone’s very life may depend on seeking timely advice, says Dr. Robert Beart, chairman of colorectal surgery at the USC 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.

“I must see two or three patients a month where the physician just did a rectal exam with a finger--which just looks at a short segment, as you can imagine--and just above his or her finger was a cancer,” Beart says.

And while there are FDA-approved home tests on the market that screen for blood in the stool, Beart doesn’t encourage relying on such tests. They aren’t very sensitive, he says, and should not be considered a substitute for a physician visit.

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.

A Change in ‘Habits’ Should Be Checked Out

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--should contact their doctor or schedule a visit within a few days. If you’re over age 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 humans will always be shy and embarrassed about talking about certain very personal things. And while no one really wants to give Uncle Sid carte blanche to provide a blow-by-blow account of his bowel movements over dessert, the doctor’s office, at least, is the last place for gentility.

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