For the past two months I have been getting up three to four times in the night to empty my bowels. A colonoscopy ruled out cancer – I recently had treatment for prostate cancer – and I was told it might be diverticulitis so I should just eat more fibre. Do you have any suggestions? I’m 75.
Dr Ellie Cannon replies: Bowel issues can be a common consequence of prostate cancer treatment, as radiotherapy can damage the lower part of the intestines – the colon and rectum.
This is called radiation proctopathy and is understood to affect as many as one in five people having treatment. If it first happens more than three months after the radiotherapy, it is called chronic proctopathy rather than acute, which happens straight away.
Typical features of this condition include incontinence and bleeding from the back passage as well as feeling the need to strain, diarrhoea and urgency – when you have to run to the toilet to open your bowels.
It can also cause you to pass mucus, and how often you go to the toilet can also change, so starting to open your bowels at night could be a symptom.
Increasing soluble fibre in your diet can help those who have bowel issues
Emptying the bowels is controlled by the pelvic floor – a sling of muscle between the legs that supports the pelvic organs. Exercises to strengthen these muscles may help to control the urgency and frequency of the bowels from proctopathy. The GP can request a referral to a pelvic physiotherapist, who will be able to advise on these.
Another consequence of radiotherapy can be tenesmus, which means you want to strain even if you don’t need to empty your bowels. This may result in needing to go to the toilet overnight, when cramps in bowel muscles occur.
Increasing soluble fibre in your diet, or taking a fibre supplement which the GP can prescribe, might help to reduce this.
I would advise seeking support from the Pelvic Radiation Disease Association (prda.org.uk).
I have type 2 diabetes and have been prescribed gliclazide to help bring my blood sugar down. However, I’ve heard the drug can cause liver damage and jaundice. Should I be worried?
Dr Ellie replies: All medications come with side effects, but we prescribe them on the basis that the benefits outweigh the risks.
Gliclazide is a very effective diabetes medication that encourages your pancreas to make more of the hormone insulin, which in turn brings down blood sugar levels.
High blood sugar, over time, can cause kidney, eye and nerve damage. Amputations, due to non-healing wounds, and blindness are just a few of the more serious issues that diabetes patients often face. It also dramatically increases the risk of heart attacks and stroke.
We know that gliclazide can trigger liver problems – caused by inflammation in the organ – in approximately one in 1,000 people using it.
Thankfully, this reverses after stopping the medication.
Jaundice – yellowing of the skin – is a sign of problems with the liver. If this occurs, it should prompt a GP visit and blood tests, whatever medication you are taking.
Inflammation of the liver is also a rare side effect of metformin, another diabetes medication. But for many patients who have type 2 diabetes, which is associated with obesity, the drug improves liver function because it reduces the amount of fat in the liver.
Could the shingles vaccine give you chickenpox if you never had the virus as a child – because I’m not sure if I have? I’m approaching the age when I’ll be eligible for the jab.
Dr Ellie replies: Shingles can occur only if you’ve had chickenpox.
A small amount of the virus that causes chickenpox – a type of herpes virus called varicella – remains dormant in the nerves for the rest of their life.
But at some point, when the immune system is weak or the person is just generally run down, the virus can reactivate down the path of a nerve, causing a blistering rash in one focused area. This is shingles.
Older people in the UK are now vaccinated against shingles because it can cause long-term and very severe pain which is debilitating.
The standard vaccine, called Shingrix, is used because it provides higher levels of protection than the previous jab, Zostavax.
Shingrix contains a small protein part of the chickenpox or shingles virus, which helps prime the immune system so that, if the real virus enters the body, it fights it off.
The vaccine – given as an injection – does not contain the actual virus itself so it cannot give anybody shingles or chickenpox, regardless of whether or not they’ve had chickenpox before.
Most children growing up in the UK will get chickenpox, but that is not the same around the world as there are many communities where it is not a common childhood illness.
I can talk as AI listens – but will you let it?
I had long been sceptical about claims that artificial intelligence (AI) could revolutionise the NHS – until I started using it.
One of the most time-consuming tasks for GPs is writing up patient notes – the permanent record of what has taken place during an appointment.
But a colleague recently recommended I try an AI program called Heidi Health. It’s an app that listens to conversations between patients and doctors and then automatically writes up the notes.
It’s quickly becoming a must-have tool for GPs, and I have to say I’m a big fan. It means I can spend more time listening and talking with my patients, rather than focusing on writing notes.
I always ask patients first before using the AI, and the information doesn’t go anywhere except into their confidential NHS health records.
I’m interested to know what you think. Would you
be happy for your GP to use AI to listen in on your appointment and transcribe the conversation?
Please write in on the email below and let me know.
Two homes is where the heart is
I was interested to read a study which concluded that older couples who live apart are more likely to be happy than those who live together.
The research, carried out by the University of Central Lancashire and UCL, found that they experience the same mental health gain as a married or co-habiting couple, but suffer far less anguish if the relationship breaks downs.
The practice even has a name – living apart together.
The study struck a chord as a close family friend of mine lives in a similar relationship to that described in the study. He and his partner live on the same road but in separate houses. They’re both in their 80s and have been together for 45 years, and seem like they’ve never been happier.
Are you happily living apart together with your other half? I’d love to hear your story. Please write in and let me know how it works for you.
Dr Cannon cannot enter into personal correspondence and her replies should be taken in a general context.
***
Read more at DailyMail.co.uk