I always have to strain when I go to the toilet, which hurts. What can I do to stop this?
Dr Ellie responds: This is a classic symptom of constipation, and usually occurs when stools are too hard to easily pass.
Under normal circumstances it shouldn’t take much effort to go to the toilet, and there certainly should be no discomfort as straining can also lead to other painful health problems.
This includes haemorrhoids, known as piles, which leads to swollen veins in the rectum and around the anus, as well as skin tears called fissures.
Poor diet is one of the main causes of constipation. Adults need to eat at least 30g of fibre a day to keep the bowels moving easily, which is found in root vegetables, certain fruits, nuts, seeds, legumes and pulses.
Constipation sufferers are advised to up their fibre intake and, usually, after a few weeks, this can make a difference.
A fibre supplement, such as Fybogel, can also help.
Dried prunes, apples, grapes and apricots are shown to help with constipation as they contain a natural sugar called sorbitol that has a laxative effect.
In severe cases, patients might be prescribed a laxative, but these only help in the short-term, unlike dietary changes. However, diet isn’t the only cause of constipation.
Straining on the toilet can lead to health issues, including haemorrhoids and skin tears
Certain medicines, plus stress and a lack of physical activity, can raise the risk of straining
A lack of physical activity can raise the risk, and those who regularly ignore the urge to go to the toilet will often find they have to strain more to go. Stress can also raise the risk of straining.
And there are medicines that make going to the toilet more difficult. These include opioid painkillers, iron supplements, some antidepressants and certain blood pressure tablets.
I’ve suffered with back pain for 20 years and I take ibuprofen occasionally to manage it. Is it safe to take ibuprofen this often?
Dr Ellie responds: The anti-inflammatory drug is one of the most commonly used over-the-counter medicines as it is both cheap and safe. However, over time, ibuprofen can irritate the stomach, increasing the chances of bleeding or agonising stomach ulcers.
For this reason, regular users may be advised to also take a drug called a proton pump inhibitor, or PPI. These, such as omeprazole, are designed to protect the stomach lining, however they also carry the risk of serious side effects, including the bone-thinning disease osteoporosis.
Ibuprofen overuse can also damage the kidneys, and can sometimes lead to breathing difficulties in asthma patients.
But limiting its use can be tricky when dealing with chronic pain. In the case of back pain – the most common form of pain in the UK – regular activity, such as running, swimming or cycling, can help ease the agony.
If the pain is too severe for exercise, then patients would likely benefit from seeing a physiotherapist who can provide specific exercises and stretches that will allow them to slowly increase their activity levels.
Many patients also find that talking therapy can help them manage the symptoms better.
I’ve been told I have an enlarged prostate and might need surgery. However, I’m worried about the risks. Is the procedure worth it?
Dr Ellie responds: Surgery for enlarged prostate is typically a safe and effective procedure. But there are other steps that patients can try first.
The prostate is a walnut-sized gland that helps produce semen. However, it can trigger problems later in life.
This includes difficulty peeing or needing to go more frequently. These symptoms always need to be reported to a GP as they can be signs of cancer.
The first drugs normally offered are called alpha-blockers. These relax the muscles in the prostate and bladder, making it easier to pass urine. Other tablets, such as finasteride and dutasteride, can gradually reduce the size of the prostate, but can also lower libido and cause erectile dysfunction.
There are a couple of different types of surgery, such as TUIP and TURP, performed through the penis, but they do have a risk of causing problems with sexual function.
Whether a patient should have prostate surgery is ultimately his decision – they need to weigh up the positives with the negatives, and decide whether the procedure will improve their quality of life.
Psoriasis is not taken seriously enough by the NHS
Left untreated, psoriasis patches can spread and cover the body, and even lead to the painful psoriatic arthritis, which reality TV star Kim Kardashian was diagnosed with in 2019
The itchy, red skin condition psoriasis is on the rise in Britain – and the NHS is failing to take it seriously.
It affects about 1.8million people and is often considered a minor skin condition.
But it’s far more serious. Left untreated, psoriasis patches can spread and cover the body, and even lead to the painful psoriatic arthritis – which affects US reality TV star Kim Kardashian.
But many NHS psoriasis patients do not receive the right drugs to manage it. I’ve heard from some who instead of being referred to a specialist are offered only over-the-counter moisturisers.
Have you had a similarly difficult experience getting treatment? Did you find a solution to the itching? Please write in and let me know.
Do you have a question for Dr Ellie Cannon? Write to her at [email protected]
