A to Z of Medical Conditions

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Interstitial cystitis – signs, symptoms and causes.

Interstitial cystitis

Interstitial cystitis

Interstitial cystitis is a poorly understood bladder condition that causes long-term pelvic pain and problems with urination.

It’s also known as “painful bladder syndrome” or “bladder pain syndrome”.

The condition tends to first affect people in their 30s and 40s, and is much more common in women than men.

It can have a significant impact on your lifestyle, work, emotional health and relationships, but a number of different treatments can be tried to help relieve the symptoms.

Symptoms of interstitial cystitis

The main symptoms of interstitial cystitis are:

intense pelvic pain (felt below your bellybutton)

sudden, strong urges to pee

needing to pee more often than normal

waking up several times during the night to go to the toilet

The pain may be worse when your bladder is full and may be temporarily relieved when you go to the toilet. You might also find the pain is worse during periods or after having certain foods or drinks.

The symptoms will often come and go in phases. You may have episodes lasting days, weeks or months where your symptoms improve, followed by times when they’re worse.

When to see your GP

You should see your GP if you have persistent pelvic pain or you notice a change in your usual pattern of urination. These symptoms can have a number of causes, so it’s a good idea to get a proper diagnosis.

Your GP can refer you to a hospital specialist such as a urologist (a specialist in conditions affecting the urinary system) for further tests, such as a cystoscopy (a procedure to examine the inside of the bladder).

What causes interstitial cystitis?

The exact cause of interstitial cystitis isn’t clear. Unlike other types of cystitis, there’s no obvious infection in the bladder and antibiotics don’t help. In some people with the condition, the bladder is inflamed, ulcerated, scarred or stiff.

There are several theories about the possible cause of the condition, including:

damage to the bladder lining, which may mean urine can irritate the bladder and surrounding muscles and nerves

a problem with the pelvic floor muscles (used to control urination)

your immune system mistakenly attacking your bladder

an allergic reaction

It’s also been suggested that interstitial cystitis may be a symptom of a more widespread problem, as it’s been associated with conditions such as fibromyalgia, chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS) and lupus.

Treatments for interstitial cystitis

Unfortunately, there’s currently no cure for interstitial cystitis and it can be difficult to treat, although a number of treatments can be tried.

No single treatment works for everyone, however, and there’s disagreement about how effective some of them are. You may need to try several treatments to find one that works for you.

Lifestyle changes will usually be recommended first. Medications and other therapies may be used if these don’t help, and surgery may be necessary as a last resort.

Lifestyle changes

Lifestyle changes that may help improve your symptoms include:

reducing stress – anything that helps you relax, such as exercise or regular warm baths, may help reduce your symptoms

avoiding certain foods or drinks (such as tomatoes and alcohol) if you notice they make your symptoms worse – but don’t make significant changes to your diet without seeking medical advice first

stopping smoking – the chemicals you breathe in while smoking may irritate your bladder

controlling how much you drink – try to reduce the amount you drink before going to bed

planned toilet breaks – taking regular planned toilet breaks may help stop your bladder becoming too full

You may also find it useful to contact a support group, such as the Interstitial Cystitis Association or the Cystitis and Overactive Bladder (COB) Foundation for information and advice about living with interstitial cystitis.

 

Supportive therapies and treatments

Some people also find the following therapies and supportive treatments helpful:

physiotherapy – massaging the pelvic floor muscles may help reduce any strain on your bladder

bladder retraining – where you gradually learn to be able to hold more urine in your bladder before needing to go to the toilet

psychological therapy – to help you cope with your symptoms and their impact on your life

transcutaneous electrical nerve stimulation (TENS) – where a small battery-operated device is used to relieve pain by sending electrical impulses into your body

Surgery and procedures

Surgery and other procedures may be recommended if you have clear abnormal areas (lesions) in your bladder or other treatments don’t work.

Procedures that may be carried out include:

cauterisation – where ulcers inside the bladder are sealed using an electrical current or laser

bladder distension – where the bladder is stretched with fluid, which can aid diagnosis and may temporarily relieve your symptoms

botulinum toxin injections – where a substance called botulinum toxin (such as Botox) is injected directly into your bladder to temporarily relieve your symptoms

neuromodulation – where an implant that stimulates your nerves with electricity is placed in your body to relieve pain and reduce sudden urges to pee

augmentation – making the bladder larger using part of the small intestine; this usually also includes removing any inflamed areas of the bladder

In very rare cases, it may be necessary to remove the bladder completely (cystectomy). If this is done, your surgeon will need to create an alternative way for urine to leave your body.

This will usually be through a small hole in your tummy called a stoma, but might involve making a new bladder using part of your small intestine (bladder reconstruction).

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Epiglottitis – what are the signs and symptoms of Epiglottitis?

Epiglottitis

Epiglottitis

Epiglottitis is inflammation and swelling of the epiglottis. In most cases, it’s caused by infection.

The epiglottis is a flap of tissue that sits beneath the tongue at the back of the throat. Its main function is to close over the windpipe (trachea) while you’re eating, to prevent food entering your airways.

Symptoms of epiglottitis

The symptoms of epiglottitis usually develop quickly and get rapidly worse, although they can develop over a few days in older children and adults. Symptoms include:

a severe sore throat

difficulty and pain when swallowing

difficulty breathing, which may improve when leaning forwards

breathing that sounds abnormal and high-pitched (stridor)

a high temperature (fever) of 38C (100.4F) or above

irritability and restlessness

muffled or hoarse voice

drooling

The main symptoms of epiglottitis in young children are breathing difficulties, stridor and a hoarse voice. In adults and older children, the main signs are a severe sore throat, swallowing difficulties and drooling.

When to seek medical advice

Epiglottitis is regarded as a medical emergency, as a swollen epiglottis can restrict the oxygen supply to your lungs.

Dial 999 to ask for an ambulance if you think you or your child has epiglottitis.

While waiting for an ambulance, you shouldn’t attempt to examine your child’s throat, place anything inside their mouth or lay them on their back, because this may make their symptoms worse. It’s important to keep them calm and to try not to cause panic or distress.

Epiglottitis can be fatal if the throat becomes completely blocked. However, with appropriate treatment, most people make a full recovery.

Treating epiglottitis

Epiglottitis is treated in hospital. The first thing the medical team will do is secure the person’s airways, to make sure they can breathe properly.

Securing the airways

An oxygen mask will be given to deliver highly concentrated oxygen to the person’s lungs.

If this doesn’t work, a tube will be placed in the patient’s mouth and pushed past their epiglottis into the windpipe. The tube will be connected to an oxygen supply.

In severe cases, where there’s an urgent need to secure the airways, a small cut may be made in the neck, at the front of the windpipe, so a tube can be inserted. The tube is then connected to an oxygen supply. This procedure is called a tracheostomy and it allows oxygen to enter the lungs while bypassing the epiglottis. An emergency tracheostomy can be carried out using local anaesthetic or general anaesthetic.

Once the airways have been secured and the person is able to breathe unrestricted, a more comfortable and convenient way of assisting breathing may be found. This is usually achieved by threading a tube through the nose and into the windpipe.

Fluids will be supplied through a drip into one of your veins, until the person is able to swallow.

Once this has been achieved and the situation is thought to be safe, some tests may be carried out, such as:

a fibre-optic laryngoscopy – a flexible tube with a camera attached to one end (laryngoscope) is used to examine the throat

a throat swab – to test for any bacteria or viruses

blood tests – to check the number of white blood cells (a high number indicates there may an infection) and to identify any traces of bacteria or viruses in the blood

an X-ray or a computerised tomography (CT) scan – sometimes used to check the level of swelling

The underlying infection will then be treated with a course of antibiotics, and most people with epiglottitis are well enough to leave hospital after five to seven days.

With prompt treatment, most people recover from epiglottitis after about a week and are usually well enough to leave hospital after five to seven days.

Why it happens

Epiglottitis is usually caused by an infection with Haemophilus influenzae type b (Hib) bacteria. As well as epiglottitis, Hib can cause a number of serious infections, such as pneumonia and meningitis.

It spreads in the same way as the cold or flu virus; the bacteria are in the tiny droplets of saliva and mucus propelled into the air when an infected person coughs or sneezes. You catch the infection by breathing in these droplets or, if the droplets have landed on a surface or object, by touching this surface and then touching your face or mouth.

Less common causes of epiglottitis include:

other bacterial infections – such as streptococcus pneumoniae (a common cause of pneumonia)

fungal infections – people with a weakened immune system are most at risk from these types of infection

viral infections – such as the varicella zoster virus (the virus responsible for chickenpox) and the herpes simplex virus (the virus responsible for cold sores)

trauma to the throat – such as a blow to the throat, or burning the throat by drinking very hot liquids

smoking – particularly illegal drugs, such as cannabis or crack cocaine

Hib vaccination

The most effective way to prevent your child getting epiglottitis is to make sure their vaccinations are up to date.

Children are particularly vulnerable to a Hib infection, because they have an underdeveloped immune system.

Children should receive their Hib as part of the 5 in 1 DTaP/IPV/Hib vaccine, which also protects against diphtheria, tetanus, whooping cough and polio.

Children should receive three doses of the vaccine: one at two months, one when they are three months and one when they are four months old. This is followed by an additional Hib/Men C “booster” vaccine at 12 months.

As children from developing countries may not have received the vaccination, children who have immigrated to the UK should take part in the UK immunisation programme. Contact your GP if you are not sure whether your child’s vaccinations are up to date.

Read more about the childhood vaccination schedule.

Who is affected

Because of the success of the Hib vaccination programme, epiglottitis is rare in the UK, and most cases now occur in adults. Deaths from epiglottitis are also rare, occurring in less than 1 in 100 cases.

During 2013-14, around 600 people were admitted to hospitals in England with acute epiglottitis.

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Dyslexia – what are the signs and symptoms of dyslexia ?

dyslexia

dyslexia

The signs and symptoms of dyslexia differ from person to person. Each individual with the condition will have a unique pattern of strengths and weaknesses.

Some of the most common signs of dyslexia are outlined below.

Preschool children

In some cases, it’s possible to detect symptoms of dyslexia before a child starts school. Symptoms can include:

delayed speech development compared with other children of the same age (although this can have many different causes)

speech problems, such as not being able to pronounce long words properly and “jumbling” up phrases – for example, saying “hecilopter” instead of “helicopter”, or “beddy tear” instead of “teddy bear”

problems expressing themselves using spoken language, such as being unable to remember the right word to use, or putting together sentences incorrectly

little understanding or appreciation of rhyming words, such as “the cat sat on the mat”, or nursery rhymes

difficulty with, or little interest in, learning letters of the alphabet

School children

Symptoms of dyslexia usually become more obvious when children start school and begin to focus more on learning how to read and write.

Symptoms of dyslexia in children aged 5-12 include:

problems learning the names and sounds of letters

spelling that is unpredictable and inconsistent

putting letters and figures the wrong way round – such as writing “6” instead “9”, or “b” instead of “d”

confusing the order of letters in words

reading slowly or making errors when reading aloud

visual disturbances when reading – for example, a child may describe letters and words as seeming to move around or appear blurred

answering questions well orally, but having difficulty writing down the answer

difficulty carrying out a sequence of directions

struggling to learn sequences, such as days of the week or the alphabet

slow writing speed

poor handwriting

problems copying written language, and taking longer than normal to complete written work

poor phonological awareness and “word attack” skills (see below)

Phonological awareness

Phonological awareness is the ability to recognise that words are made up of smaller units of sound (phonemes) and that changing and manipulating phonemes can create new words and meanings.

A child with poor phonological awareness may not be able to correctly answer these questions:

what sounds do you think make up the word “hot”, and are these different from the sounds that make up the word “hat”?

what word would you have if you changed the “p” sound in ‘pot’ to an “h” sound?

how many words can you think of that rhyme with the word “cat”?

Word attack skills

Young children with dyslexia can also have problems with “word attack” skills. This is the ability to make sense of unfamiliar words by looking for smaller words or collections of letters that a child has previously learnt.

For example, a child with good word attack skills may read the word “sunbathing” for the first time and gain a sense of the meaning of the word by breaking it down into “sun”, “bath”, and “ing”.

Teenagers and adults

As well as the problems mentioned above, the symptoms of dyslexia in older children and adults can include:

poorly organised written work that lacks expression – for example, even though they may be very knowledgeable about a certain subject, they may have problems expressing that knowledge in writing

difficulty planning and writing essays, letters or reports

difficulties revising for examinations

trying to avoid reading and writing whenever possible

difficulty taking notes or copying

poor spelling

struggling to remember things such as a PIN or telephone number

struggling to meet deadlines

Getting help

If you’re concerned about your child’s progress with reading and writing, first talk to their school teacher.

If you or your child’s teacher has an ongoing concern, take your child to visit a GP so they can check for signs of any underlying health issues, such as hearing or vision problems, that could be affecting their ability to learn.

If your child doesn’t have any obvious underlying health problems to explain their learning difficulties, different teaching methods may need to be tried, or you may want to request an assessment to identify any special needs they may have.

If you’re an adult and think you may have dyslexia, you may want to arrange a dyslexia assessment through your local dyslexia association.

Read more about diagnosing dyslexia.

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Corticobasal degeneration – what are the signs and symptoms of corticobasal degeneration (CBD)?

Corticobasal degeneration

Corticobasal degeneration

Corticobasal degeneration (CBD) is a condition that can cause gradually worsening problems with movement, speech, memory and swallowing.

It’s often also called corticobasal syndrome (CBS).

CBD is caused by increasing numbers of brain cells becoming damaged or dying over time.

Most cases of CBD develop in adults aged between 50 and 70.

CBD symptoms

The symptoms of CBD get gradually worse over time. They are very variable and many people only have a few of them.

Symptoms can include:

difficulty controlling your limb on one side of the body (a “useless” hand)

muscle stiffness

shaking (tremors), jerky movements and spasms (dystonia)

problems with balance and co-ordination

slow and slurred speech

symptoms of dementia, such as memory and visual problems

slow, effortful speech

difficulty swallowing

One limb is usually affected at first, before spreading over several years to affect other parts of the body. The rate at which the symptoms progress varies widely from person to person.

One limb is usually affected at first, before spreading to the rest of the body. The rate at which the symptoms progress varies widely from person to person.

Read more about the symptoms of CBD.

What causes CBD?

CBD occurs when brain cells in certain parts of the brain are damaged as a result of a build-up of a protein called tau.

The surface of the brain (cortex) is affected, as well as a deep part of the brain called the basal ganglia.

Tau occurs naturally in the brain and is usually broken down before it reaches high levels. In people with CBD, it isn’t broken down properly and forms harmful clumps in brain cells.

CBD has been linked to changes in certain genes, but these genetic links are weak and the risk to other family members is very low.

Diagnosing CBD

There’s no single test for CBD. Instead, the diagnosis is based on the pattern of your symptoms. Your doctor will try to rule out other conditions that can cause similar symptoms, such as Parkinson’s disease or a stroke.

You may need to have a brain scan to look for other possible causes of your symptoms, as well as tests of your memory, concentration and ability to understand language.

The diagnosis must be made or confirmed by a consultant with expertise in CBD. This will usually be a neurologist (a specialist in conditions affecting the brain and nerves).

Read more about how CBD is diagnosed.

Treatments for CBD

As someone with CBD can be affected in many different ways, treatment and care is best provided by a team of health and social care professionals working together. Treatments may include:

medication – to improve stiffness and muscle spasms, sleep and mood, pain or memory

physiotherapy – to help with movement and balance difficulties

speech and language therapy – to help with communication and swallowing problems

occupational therapy – to improve the skills and abilities needed for daily activities at home

palliative care and advanced care planning

Read more about how CBD is treated.

Outlook

There is currently no treatment that has been shown to stop CBD getting gradually worse, although treatments can reduce many of the symptoms.

Good care and assistance can help someone with CBD be more independent and enjoy a better quality of life, but the condition will eventually put them at risk of serious complications.

CBD usually changes very slowly. Many people find it helpful to plan ahead with their doctors (GP and specialist) to make decisions about what to do in later stages of the illness.

Difficulty swallowing can cause choking, or inhaling food or liquid into the airways. This can lead to pneumonia, which can be life-threatening.

As a result of these complications, the average life expectancy for someone with CBD is around six to eight years from when their symptoms start. However, this is only an average and CBD is very variable.

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Haemorrhoids – how to treat Haemorrhoids ?

Haemorrhoids

Haemorrhoids

Haemorrhoids (piles) often clear up by themselves after a few days. However, there are many treatments that can reduce itching and discomfort.

Making simple dietary changes and not straining on the toilet are often recommended first.

Creams, ointments and suppositories, which you insert into your bottom, are available from pharmacies without a prescription. They can be used to relieve any swelling and discomfort.

If more intensive treatment is needed, the type will depend on where your haemorrhoids are in your anal canal – the lower third closest to your anus, or the upper two-thirds. The lower third contains nerves that can transmit pain, while the upper two-thirds do not.

Non-surgical treatments for haemorrhoids in the lower part of the canal are likely to be very painful, as the nerves in this area can detect pain. In these cases, haemorrhoid surgery will usually be recommended.

The various treatments for haemorrhoids are outlined below. You can also read a summary of the pros and cons of haemorrhoid treatments, allowing you to compare your treatment options.

Dietary changes and self care

If constipation is thought to be the cause of your haemorrhoids, you need to keep your stools soft and regular so you don’t strain when going to the toilet.

You can do this by increasing the amount of fibre in your diet. Good sources of fibre include wholegrain bread, cereal, fruit and vegetables.

You should also drink plenty of water and avoid caffeine.

When going to the toilet, you should:

avoid straining to pass stools, as it may make your haemorrhoids worse

use baby wipes or moist toilet paper, rather than dry toilet paper, to clean your bottom after passing a stool

pat the area around your bottom rather than rubbing it

Read more about preventing constipation.

Medication

Over-the-counter topical treatments

Various creams, ointments and suppositories are available from pharmacies without a prescription. They can be used to relieve any swelling and discomfort.

These medicines should only be used for five to seven days at a time. They may irritate the sensitive skin around your anus if you use them longer than this.

Any medication should be combined with the diet and self care advice discussed above.

There’s no evidence to suggest that one method is more effective than another.

Ask your pharmacist for advice about which product is most suitable for you, and always read the patient information leaflet that comes with your medicine before using it.

Don’t use more than one product at once.

Corticosteroid cream

If you have severe inflammation in and around your back passage, your GP may prescribe corticosteroid cream, which contains steroids.

You shouldn’t use corticosteroid cream for more than a week at a time as it can make the skin around your anus thinner and the irritation worse.

Painkillers

 

Your GP may prescribe products that contain local anaesthetic to treat painful haemorrhoids. Like over-the-counter topical treatments, these should only be used for a few days because they can make the skin around your back passage more sensitive.

Laxatives

If you’re constipated, your GP may prescribe a laxative. Laxatives are a type of medicine that can help you empty your bowels.

Non-surgical treatments

If dietary changes and medication don’t improve your symptoms, your GP may refer you to a specialist. They can confirm whether you have haemorrhoids and recommend appropriate treatment.

If you have haemorrhoids in the upper part of your anal canal, non-surgical procedures such as banding and sclerotherapy may be recommended.

Banding

Banding involves placing a very tight elastic band around the base of your haemorrhoids to cut off their blood supply. The haemorrhoids should then fall off within about a week of having the treatment.

Banding is usually a day procedure that doesn’t need an anaesthetic, and most people can get back to their normal activities the next day.

You may feel some pain or discomfort for a day or so afterwards. Normal painkillers are usually adequate, but your GP can prescribe something stronger if needed.

You may not realise that your haemorrhoids have fallen off, as they should pass out of your body when you go to the toilet.

If you notice some mucus discharge within a week of the procedure, it usually means that the haemorrhoids have fallen off.

Directly after the procedure, you may notice blood on the toilet paper after going to the toilet. This is normal, but there shouldn’t be a lot of bleeding.

If you pass a lot of bright red blood or blood clots, go to your nearest accident and emergency (A&E) department immediately.

Ulcers can occur at the site of the banding, although these usually heal without needing further treatment.

Injections (sclerotherapy)

A treatment called sclerotherapy may be used as an alternative to banding.

During sclerotherapy, a chemical solution is injected into the blood vessels in your back passage. This relieves pain by numbing the nerve endings at the site of the injection.

It also hardens the tissue of the haemorrhoid so a scar is formed. After about four to six weeks, the haemorrhoid should decrease in size or shrivel up.

You should avoid strenuous exercise for the rest of the day after having the injection.

You may experience minor pain for a while and may bleed a little. You should be able to resume normal activities, including work, the day after the procedure.

Electrotherapy

Electrotherapy, also known as electrocoagulation, is another alternative to banding for people with smaller haemorrhoids.

During the procedure, a device called a proctoscope is inserted into the anus to locate the haemorrhoid.

An electric current is then passed through a small metal probe placed at the base of the haemorrhoid, above the dentate line. The specialist can control the electric current using controls attached to the probe.

The aim of electrotherapy is to cause the blood supplying the haemorrhoid to thicken, which shrinks it. If necessary, more than one haemorrhoid can be treated during each session.

Electrotherapy can either be carried out on an outpatient basis using a low electric current, or a higher dose can be given while the person is under a general anaesthetic or spinal anaesthetic.

You may experience some mild pain during or after electrotherapy, but in most cases this doesn’t last long. Rectal bleeding is another possible side effect of the procedure, but this is usually short-lived.

Electrotherapy is recommended by the National Institute for Health and Care Excellence (NICE), and has been shown to be an effective method of treating smaller haemorrhoids.

It can also be used as an alternative to surgery for treating larger haemorrhoids, but there’s less evidence for its effectiveness.

Surgery

Although most haemorrhoids can be treated using the methods described above, around 1 in every 10 people will eventually need surgery.

Surgery is particularly useful for haemorrhoids that have developed below the dentate line – unlike non-surgical treatments, anaesthetic is used to ensure you don’t feel any pain.

There are many different types of surgery that can be used to treat haemorrhoids, but they all usually involve either removing the haemorrhoids or reducing their blood supply, causing them to shrink.

Read more about surgery for haemorrhoids.