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HEALTHY-FOOD NATURAL WORKOUT

Respiratory health harms often follow flooding: Taking these steps can help

Aerial view of a city in Texas with flooding in  streets and buildings in the foreground

Heavy rains and sea level rise contribute to major flooding events that are one effect of climate change. Surging water rushing into buildings often causes immediate harms, such as drowning deaths, injuries sustained while seeking shelter or fleeing, and hypothermia after exposure to cold waters with no shelter or heat.

But long after news trucks leave and public attention moves on, flooding continues to affect communities in visible and less visible ways. Among the less visible threats is a higher risk of respiratory health problems like asthma and allergic reactions. Fortunately, you can take steps to minimize or avoid flooding, or to reduce respiratory health risks after flooding occurs.

How does flooding trigger respiratory health issues?

Flooding may bring water contaminated with toxic chemicals, heavy metals, pesticides, biotoxins, sewage, and water-borne pathogens into buildings. Afterward, some toxic contaminants remain in dried sediments left behind. When disturbed through everyday actions like walking and cleaning, this turns into microscopic airborne dust. Anything in that dried flood sediment — the toxic chemicals, the metals, the biotoxins — is now in the air you breathe into your lungs, potentially affecting your respiratory health.

Buildings needn’t be submerged during flooding to spur respiratory problems. Many homes we studied after Hurricane Ida suffered water intrusion through roofs, windows, and ventilation ducts — and some were more than 100 miles away from coastal regions that bore the brunt of the storm.

The growth of mold can also affect health

Another common hazard is mold, a fungal growth that forms and spreads on damp or decaying organic matter. Indoor mold generally grows due to extensive dampness, and signals a problem with water or moisture. Damp materials inside buildings following a flood create perfect conditions for rapid mold growth.

Mold can be found indoors and outdoors in all climates. It spreads by making tiny spores that float through the air to land in other locations. No indoor space is entirely free from mold spores, but exposure to high concentrations is linked with respiratory complications such as asthma, allergic rhinitis, and sinusitis. Thus, flooding affects respiratory health by increasing the risk of exposure to higher concentrations of mold spores outdoors and indoors.

For example, after Hurricane Katrina in New Orleans in 2005, the average outdoor concentration of mold spores in flooded areas was roughly double that of non-flooded areas, and the highest concentrations of mold spores were measured indoors. A study on the aftermath of Hurricane Katrina and the flooding in the UK in 2007 showed that water damage accelerated mold growth and respiratory allergies.

Children are especially vulnerable to health problems triggered by mold. All respiratory symptoms — including asthma, bronchitis, eye irritation, and cough — occurred more often in homes reporting mold or dampness, according to a study on the respiratory health of young children in 30 Canadian communities. Other research demonstrates that mold contributes to development of asthma in children.

What can you do to protect against the health harms of flooding?

Our research in New Orleans, LA after Hurricane Ida in 2021 identified common factors — both in housing and flooding events — with great impact on respiratory health. Preliminary results suggest two deciding factors in whether substantial indoor mold appeared were the age of a building’s roof and how many precautionary measures people took after flooding from the hurricane. The impact on respiratory health also varied with flood water height, days per week spent at home, and how many precautionary measures were taken after Ida swept through.

Informed by this and other research, we offer the following tips — some to tackle before flooding or heavy rains, and some to take afterward. While you may not be able to entirely prevent flooding from hurricanes or major storms, taking these and other steps can help.

Before seasonal storms, flooding, or heavy rains start: Protect against water intrusion

  • Repair the roof, clean gutters, and seal around skylights, vent pipes, and chimneys to prevent leaks. These are some of the most vulnerable components of a building during storms and hurricanes.
  • Declutter drains and empty septic tanks.
  • Construct barriers and seal cracks in outer walls and around windows, to prevent heavy rain and floodwater from entering.
  • Install a sump pump to drain water from the basement, and backflow valves on sewer lines to prevent water from backing up into the home.

After flooding or major rainstorms: Move quickly to reduce dampness and mold growth

The Environmental Protection Agency recommends limiting contact with flood water, which may have electrical hazards and hazardous substances, including raw sewage. Additionally:

  • Minimize your stay in flooded regions (particularly after hurricanes) or buildings until they are dry and safe.
  • Check building for traces of water intrusion, dampness, and mold growth immediately after flooding.
  • Drain floodwater and dispose of remaining sediment.
  • Remove affected porous materials. If possible, dry them outdoors under sunlight.
  • Increase the ventilation rate by leaving all windows and doors open, or use a large exhaust fan to dry out the building as fast as possible.
  • Use dehumidifiers in damp spaces such as basements.
  • Upgrade the air filters in your HVAC system to at least MERV 13, or use portable air cleaners with HEPA filters to reduce your exposure to airborne mold spores.

What to do if you spot mold growth

  • Wear a well-fitted N95 face mask, gloves, and rubber boots to clean.
  • Clean and disinfect anything that has been in contact with water using soap, detergents, and/or antibacterial cleaning products.
  • Dispose of moldy materials in sealed heavy-duty plastic bags.

Taking steps like these — before and after a major storm — goes a long way toward protecting your respiratory health.

Read Flooding Brings Deep Trouble in Harvard Medicine magazine to learn more about the health hazards related to floods.

About the Authors

photo of Parham Azimi, PhD

Parham Azimi, PhD, Contributor

Dr. Parham Azimi is a research associate in the department of environmental health at the Harvard T.H. Chan School of Public Health, investigating the indoor environment’s impact on occupant health and wellness and strategies to improve … See Full Bio View all posts by Parham Azimi, PhD photo of Joseph Allen, DSc, MPH, CIH

Joseph Allen, DSc, MPH, CIH, Contributor

Dr. Joseph Allen is an associate professor in the department of environmental health at the Harvard T.H. Chan School of Public Health, and the director of Harvard’s Healthy Buildings Program. He is the coauthor of Healthy … See Full Bio View all posts by Joseph Allen, DSc, MPH, CIH

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HEALTHY-FOOD NATURAL WORKOUT

IBD and LGBTQ+: How it can affect sexual health

The rainbow-plus colors of the LGBTQIA flag shown as if the flag was wavingEveryone who lives with inflammatory bowel disease (IBD) knows their illness has a major impact on daily life. Many people are diagnosed in their 20s or 30s, a time when we might hope for few health challenges.

Medications, and sometimes surgery, may be used to treat IBD. If you identify as LGBTQ+, you might wonder how all of this may affect you — your physical health, of course, but also your sexual health and pleasure. Below are a few things to understand and consider.

What is inflammatory bowel disease?

IBD is a condition that causes inflammation along the gastrointestinal (GI) tract. The two main types are Crohn's disease and ulcerative colitis:

  • Crohn's disease: inflammation can occur anywhere along the GI tract (from the mouth to the anus)
  • Ulcerative colitis: typically affects the large intestine (colon) only.

IBD can cause diarrhea, bloody stool, weight loss, and abdominal pain, and is typically diagnosed with blood and stool tests, imaging, and colonoscopy. A diagnosis of IBD may increase the risk of developing anxiety or depression, and can also have an impact on sexual health. People with IBD may require long-term medical treatment or surgery for their condition.

The starting point: Talking to your doctor

Talking to your medical team about IBD and sexual health may not be easy. This may depend on how comfortable you feel disclosing your LGBTQ+ identity with your health care providers. Ideally, you should feel comfortable discussing sexuality with your medical team, including what types of sexual partners and activities you participate in and how IBD may affect this part of your life.

Be aware that health care providers may not be able to address all LGBTQ+-specific concerns. Optimal care for people with IBD who identify as LGBTQ+ is not fully understood. However, this is an active area of research.

How might medicines for IBD affect sexual health?

Many effective IBD medications subdue the immune system to decrease inflammation. These immunosuppressive medicines may raise your risk for sexually transmitted infections (STIs) such as HIV, chlamydia, syphilis, and gonorrhea.

What you can do: Discuss these concerns with your doctor so you can take appropriate protective measures. This might include:

  • ensuring that your vaccinations, such as hepatitis B and HPV, are up to date.
  • engaging in sex using barrier protection to prevent STI transmission.
  • taking pre-exposure prophylaxis (PrEP). This safe and effective medicine helps prevent the spread of HIV. Ask your primary care doctor or gastroenterologist if PrEP is appropriate for you.

How might surgery for IBD affect sexual health?

For some people with IBD, gut inflammation is severe enough to require surgery to remove part of the intestine. For example:

  • Abscesses or fistulas (abnormal connections between two body parts) sometimes form when someone has Crohn's disease around the anus. This may require surgical treatment.
  • Active inflammation in the rectum or anus may make sex painful, particularly for people who engage in anal receptive sex.
  • We don't yet know whether anal receptive sex is safe for people who have had surgery to remove the colon and create a J-pouch, which is formed from small intestine to create an internal pouch that enables normal bowel movements.

What you can do: Discuss your concerns with your gastroenterologist and colorectal surgeon.

If you engage in anal sex, you may be confused about whether it is safe to do so. While you may feel uncomfortable discussing this concern and others with your doctor, try to be as honest and open as you can. That way, you'll receive the best information on how to engage in safe and enjoyable sex after an IBD diagnosis or surgery.

What else to consider if you are transgender

People with IBD who are transgender may have additional concerns to address.

For example, there may be a risk for sexual side effects from gender-affirming surgery. These procedures may include vaginoplasty (surgical creation of a vagina) for transgender females, or phalloplasty (surgical creation of a penis) for transgender males. The safety of these procedures in people with IBD is not currently well understood.

What you can do: If you identify as transgender, ask your doctor if any gender-affirming surgeries you've had or medicines you take, such as hormones, might affect your IBD, recommended treatments, or sexual health.

If you're considering gender-affirming surgery, discuss your options with your medical team. Be aware that gender-affirming surgery may be more challenging, or may not be advisable, for people with complex or active IBD. It's important to discuss your specific risks with your doctor when pursuing gender-affirming care. Having access to a team of physicians, including a surgeon and a gastroenterologist, may improve outcomes.

The bottom line

Try to talk to your gastroenterologist about how your sexual practices and gender identity may affect — and be affected by — your IBD. A conversation like this may feel uncomfortable, but being candid about your symptoms and concerns will help you receive the best possible care.

Often, a multidisciplinary approach to care is helpful. Your health care providers, including your gastroenterologist and surgeon, may suggest seeing additional specialists.

Much remains unknown about sexual health and practices in LGBTQ+ people with IBD. While more research is needed, open communication on the impact of medications, surgery, and other aspects of living with IBD can do a lot to improve your quality of life.

About the Authors

photo of Andrew Eidelberg, MD

Andrew Eidelberg, MD, Contributor

Dr. Andrew Eidelberg is a third-year internal medicine resident at Beth Israel Deaconess Medical Center. After graduating from the University of Miami and Weill Cornell Medical College, he decided to pursue a career in gastroenterology, specifically … See Full Bio View all posts by Andrew Eidelberg, MD photo of Loren Rabinowitz, MD

Loren Rabinowitz, MD, Contributor

Dr. Loren Rabinowitz is an instructor in medicine Beth Israel Deaconess Medical Center and Harvard Medical School, and an attending physician in the Inflammatory Bowel Disease Center at BIDMC. Her clinical research is focused on the … See Full Bio View all posts by Loren Rabinowitz, MD