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Abdominal aortic aneurysm

Abdominal aortic aneurysm | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Heart and blood vessels Conditions Abdominal aortic aneurysm Abdominal aortic aneurysm About abdominal aortic aneurysms Symptoms of an abdominal aortic aneurysm Causes of an abdominal aortic aneurysm Diagnosing an abdominal aortic aneurysm Treating an abdominal aortic aneurysm Preventing an abdominal aortic aneurysm About abdominal aortic aneurysms An abdominal aortic aneurysm (AAA) is a swelling (aneurysm) of the aorta the main blood vessel that leads away from the heart, down through the abdomen to the rest of the body. The abdominal aorta is the largest blood vessel in the body and is usually around 2cm wide roughly the width of a garden hose. However, it can swell to over 5.5cm what doctors class as a large AAA. Large aneurysms are rare, but can be very serious. If a large aneurysm bursts, it causes huge internal bleeding and is usually fatal. The bulging occurs when the wall of the aorta weakens. Although what causes this weakness is unclear, smoking and high blood pressure are thought to increase the risk of an aneurysm. AAAs are most common in men aged over 65. A rupture accounts for more than 1 in 50 of all deaths in this group. This is why all men are invited for a screening test when they turn 65. The test involves a simple ultrasound scan , which takes around 10-15 minutes. Symptoms of an AAA In most cases, an AAA causes no noticeable symptoms. However, if it becomes large, some people may develop a pain or a pulsating feeling in theirabdomen (tummy)or persistent back pain. An AAA doesnt usually pose a serious threat to health, but theres a risk that a larger aneurysm could burst (rupture). A ruptured aneurysm can cause massive internal bleeding, which is usually fatal. Around 8 out of 10 people with a rupture either die before they reach hospital or dont survive surgery. The most common symptom of a ruptured aortic aneurysm is sudden and severe pain in the abdomen. If you suspect that you or someone else has had a ruptured aneurysm, call 999 immediately and ask for an ambulance. Read more about the symptoms of an AAA . Causes of an AAA Its not known exactly what causes the aortic wall to weaken, although increasing age and being male are known to be the biggest risk factors. There are other risk factors you can do something about, including smoking and having high blood pressure and cholesterol level. Having a family history of aortic aneurysms also means that you have an increased risk of developing one yourself. Read more about the causes of an AAA . Diagnosing an AAA Because AAAs usually cause no symptoms, they tend to be diagnosed either as a result of screening or during a routine examination for example, if a GP notices a pulsating sensation in your abdomen. The screening test is an ultrasound scan ,which allows the size of your abdominal aorta to be measured on a monitor. This is also how an aneurysm will be diagnosed if your doctor suspects you have one. Read more about diagnosing an AAA . Treating an AAA If a large AAA is detected before it ruptures, most people will be advised to have treatment, to preventit rupturing. This is usually done with surgery to replace the weakened section of the blood vessel with a piece of synthetic tubing. If surgery is not advisable or if you decide not to have it there are a number of non-surgical treatments that can reduce the risk of an aneurysm rupturing. They include medications to loweryour cholesterol and blood pressure , and quitting smoking . You will also have the size of your aneurysm checked regularly with ultrasound scanning. Read more about treating AAAs . Prevention The best way to prevent getting an aneurysm or reduce the risk of an aneurysm growing bigger and possibly rupturing is to avoid anything that could damage your blood vessels, such as: smoking eating a high-fat diet not exercising regularly being overweight or obese Read more about preventing aneurysms . Screening Read more about screening for an AAA . Symptoms of an abdominal aortic aneurysm In most cases, an unruptured abdominal aortic aneurysm (AAA) will cause no symptoms, unless it becomes particularly large. Symptoms of an unruptured AAA may include: a pulsating feeling in your stomach (abdomen), usually near your belly button, thats usually only noticeable when you touch it persistent back pain persistent abdominal pain If you have any of the symptoms above, you should see your GP as soon as possible. Ruptured AAA If your aortic aneurysm ruptures, you will feel a sudden and severe pain in the middle or side of your abdomen. In men, the pain can also radiate down into the scrotum. Other symptoms include: dizziness sweaty and clammy skin rapid heartbeat (tachycardia) shortness of breath feeling faint loss of consciousness Medical emergency A ruptured aortic aneurysm is a medical emergency, and its important to get to hospital as soon as possible. Around 80% of people with a rupture die before they reach hospital or dont survive emergency surgery. This is why the NHS AAA Screening Programme was introduced, so dangerously large aneurysms can be treated before they burst. If you suspect that you or someone in your care has had a ruptured aneurysm, call 999 immediately and ask for an ambulance. Causes of an abdominal aortic aneurysm The aorta is the largest blood vessel in the body. It transports oxygen-rich blood away from the heart to the rest of the body. An abdominal aortic aneurysm (AAA) occurs when part of the aorta wall becomes weakened and the large amount of blood that passes through it puts pressure on the weak spot, causing it to bulge outwards to form an aneurysm. The abdominal aorta is usually around 2cm wide about the width of a garden hosepipe but can swell to over 5.5cm, which is what doctors classify as a large aneurysm. Risk factors for an AAA Its not known exactly what causes the aortic wall to weaken, although increasing age and being male are known to be the biggest risk factors. One study found that people aged over 75 are seven times more likely to be diagnosed with an AAA than people under 55 years old. Men are around six times more likely to be diagnosed with an AAA than women. However, there are other risk factors that you can do something about described below the most important of which is smoking. Smoking Research has found that smokers are seven times more likely to develop an AAA than people who have never smoked. The more you smoke, the greater your risk of developing an AAA. People who regularly smoke more than 20 cigarettes a day may have more than 10 times the risk of non-smokers. The risk may increase because tobacco smoke contains harmful substances that can damage and weaken the wall of the aorta. Atherosclerosis Atherosclerosisis a potentially serious condition where arteries become clogged up by fatty deposits, such as cholesterol. An AAA is thought to develop because these deposits (called plaques) cause the aorta to widen in an attempt to keep blood flowing through it. As it widens, it also gets weaker. Smoking, eating a high-fat diet and high blood pressure all increase your risk of developing atherosclerosis. High blood pressure As well as contributing to atherosclerosis, high blood pressure (hypertension) can place increased pressure on the aortas wall. Family history Having a family history of AAAs means that you have an increased risk of developing one. One study found that people who had a brother or sister with an AAA were eight times more likely to develop one than people whose siblings were unaffected. This suggests that certain genes you inherit from your parents may make you more vulnerable to developing an AAA. However, no specific genes have yet been identified. Read about how to reduce your risk of developing an AAA . Diagnosing an abdominal aortic aneurysm An abdominal aortic aneurysm (AAA) usually causes no symptoms. Therefore, they tend to be diagnosed as a result of screening, or during a routine physical examination when a GP notices a distinctive pulsating sensation in your abdomen. A diagnosis can be confirmed using an ultrasound scan. Ultrasound can also determine the size of the aneurysm, which is an important factor in deciding on a course of treatment. Screening All men in the UK who are 65 or over are offered an ultrasound scan to check for AAAs. All men should receive an invitation in the year they turn 65 years old. Men who are older than 65 can refer themselves for screening by contacting their local NHS AAA screening service . For more information, visit our page on AAA screening . Treating an abdominal aortic aneurysm Treatment for an abdominal aortic aneurysm (AAA) depends on several factors, including the aneurysms size, your age and general health. In general, if you have a large aneurysm (5.5cm or larger) you will be advised to have surgery, either to strengthen the swollen section of the aorta or to replace it with a piece of synthetic tubing. This is because the risk of the aneurysm rupturing is usually greater than the risk of having it repaired. If you have a small (3.0-4.4cm) or medium (4.5-5.4cm) aneurysm, you will be offered regular scans to check its size. You will also be given advice on how to slow its growth and reduce the risk of it rupturingfor example, stopping smoking and perhaps medications to reduce your blood pressure and cholesterol level. If you have a large AAA If you are diagnosed with an AAA that is 5.5cm or larger, you will be referred to a vascular surgeon (a surgeon who specialises in diseases of the blood vessels), who may recommend an operation. The surgeon will discuss treatment options with you, taking into account your general health and fitness, as well as the size of your aneurysm. If its decided that surgery isnt suitable for you, its still possible to reduce the risk of the aneurysm bursting, and you will have regular scans to check its size in the same way people with small or medium aneurysms are treated. See below for more information on treating small and medium aneurysms. There are two surgical techniques used to treat a large aneurysm: endovascular surgery open surgery Although both techniques are equally effective at reducing the risk of the aneurysm bursting, each has its own advantages and disadvantages. The surgeon will discuss with you which is most suitable. Endovascular surgery Endovascular surgery is a type of keyhole surgery where the surgeon makes small cuts in your groin. A small piece of tubing called a graft made of metal mesh lined with fabric is then guided up through the leg artery, into the swollen section of aorta, and sealed to the wall of the aorta at both ends. This reinforces the aorta, reducing the risk of it bursting. This is the safest of the two types of surgery available. Around 98-99% of patients make a full recovery, and recovery time from the operation is shorter than if you have open surgery. There are also fewer major complications, such as wound infection or deep vein thrombosis (DVT). However, the way the graft is attached is not as secure as open surgery. Youll need regular scans to make sure the graft hasnt slipped, and in some patients, the seal at each end of the graft starts to leak and will need to be resealed. You will need to have surgery again if either of these occurs. Open surgery In open surgery, the surgeon cuts into your stomach (abdomen) to reach the abdominal aorta and replaces the enlarged section with a graft. This type of graft is a tube made of a synthetic material. Because the graft is stitched (sutured) into place by the surgeon, its more likely to stay in place, and will usually work well for the rest of your life. The risk of complications linked to the graft after surgery is lower than in people who have endovascular surgery. Open surgery isnt usually recommended for people who are in poor health as it is a major operation. It is slightly more risky than endovascular surgery, with 93-97% of patients making a full recovery. The main risk of open surgery is death or heart attack, and recovery time is longer than with endovascular surgery. There is also a greater risk of complications, such as wound infection, chest infection and DVT. If you have a small or medium AAA If you are diagnosed with a small (3.0-4.4cm) or medium (4.5-5.4cm) aneurysm, you wont be referred to see a vascular surgeon, as its unlikely youd benefit from surgery. Youll be invited back for regular scans to check the size of the aneurysm, in case it gets bigger every year if you have a small aneurysm and every three months if you have a medium aneurysm. You will also be given advice on how to prevent the aneurysm from getting bigger, including: stopping smoking eating a balanced diet ensuring you maintain a healthy weight taking regular exercise If you smoke, the most important change you can make is to quit. Aneurysms have been shown to grow faster in smokers than in non-smokers. Read more about stopping smoking and nicotine replacement therapies (NRTs) that can make it easier to stop smoking. Your GP will be sent your test result and may decide to change your current medication or start you on a new one, especially if you have: high blood pressure which you will probably be treated for with a medication called an angiotensin-converting enzyme (ACE) inhibitor high cholesterol which you will probably be treated for with a medication called a statin Treating a ruptured AAA Emergency treatment for a ruptured AAA is based on the same principle as preventative treatment. Grafts are used to repair the ruptured aneurysm. The decision on whether to perform open or endovascular surgery is made on a case-by-case basis by the surgeon carrying out the operation. Preventing an abdominal aortic aneurysm The best way to prevent getting an aneurysm, or reduce the risk of an aneurysm growing bigger and possibly rupturing, is to avoid anything that could damage your blood vessels. This includes: smoking eating a high-fat diet not exercising regularly being overweight or obese If your GP finds out you have high blood pressure or a high cholesterol level, you may be prescribed medication for both. This will reduce the risk of developing an abdominal aortic aneurysm (AAA). Smoking Smoking is a major risk factor for aneurysms because it causes atherosclerosis (hardening of the arteries) and raises your blood pressure. Tobacco smoke contains substances that can damage the walls of the arteries. It is known that smokers are seven times more likely than non-smokers to develop an AAA. The more you smoke, the greater your risk. People who regularly smoke more than 20 cigarettes a day may have more than 10 times the risk of non-smokers. If you want to stop smoking, your GP will be able to refer you to an NHS Stop Smoking Service, which will give you dedicated help and advice about the best ways to quit. You can also call or chat online with Quit Your Way Scotland .The specially trained helpline staff can offer you free expert advice and encouragement. Read more about stopping smoking and nicotine replacement therapies (NRTs) , which can make it easier to quit. Diet Eating a high-fat diet increases your risk of atherosclerosis. Its especially important to limit the amount of foods you eat that are high in saturated fat, such as biscuits, cakes, butter, sausages and bacon. This is because eating too much saturated fat can lead to high cholesterol, which can build up in the artery walls. Read more about high cholesterol . Find out more about healthy eating and how to reduce the amount of saturated fat you eat . Exercise Being active and doing regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. Regular exercise can also help you lose weight, which will also help lower your blood pressure. Adults should do at least 150 minutes (two hours and 30 minutes) of moderate-intensity aerobic activity every week. Examples of moderate intensity activity include cycling or fast walking. For it to count, the activity should make you feel warm and slightly out of breath. Someone who is overweight may only have to walk up a slope to get this feeling. Physical activity can include anything from sport to walking and gardening. Get more ideas on being active . Weight Being overweight forces your heart to work harder to pump blood around your body. This can raise your blood pressure, which in turn puts pressure on your arteries. Use a BMI healthy weight calculator to find out if you need to lose weight. If you need to shed some weight, its worth remembering that losing just a few pounds will make a big difference to your blood pressure and overall health. Get tips on losing weight safely and read more about preventing high blood pressure

Acne

Acne symptoms & treatments - Illnesses & conditions Illnesses and conditions Skin, hair and nails Acne Acne About acne Causes of acne Diagnosing acne Treating acne Complications of acne About acne Acne is a common skin condition that affects most people at some point. It causes spots, oily skin and sometimes skin thats hot or painful to touch. Acne most commonly develops on the: face this affects almost everyone with acne back this affectsmore thanhalf of people with acne chest this affectsabout 15% ofpeople with acne Types of spots There are 6main types of spot caused by acne: blackheads small black or yellowish bumps that develop on the skin;theyre not filled with dirt, but are black because the inner lining of the hair follicle produces pigmentation (colouring) whiteheads have a similar appearance to blackheads, butmay be firmer and wont empty when squeezed papules small red bumps that may feel tender or sore pustules similar to papules, but have a white tip in the centre, caused by a build-up of pus nodules large hard lumps that build up beneath the surface of the skin and can bepainful cysts the most severe type of spot caused by acne; theyre large pus-filled lumps that look similar to boilsand carry the greatest risk of causing permanent scarring Papules are small red bumps that may feel tender or sore. Source: https://dermnetnz.org/ Blackheads are small black or yellow lumps that form on the skin. Source: https://dermnetnz.org/ What can I do if I have acne? The self-help techniques below may be useful: Dont wash affected areas of skin more than twice a day. Frequent washing can irritate the skin and make symptoms worse Wash the affected area witha mild soap or cleanser and lukewarm water. Very hot or cold water can make acne worse Dont try to clean out blackheads or squeeze spots.This can make them worse and cause permanent scarring Avoid using too much make-up and cosmetics. Use water-based products that are described as non-comedogenic (this means the product is less likely to block the pores in your skin) Completely remove make-up before going to bed If dry skin is a problem, use a fragrance-free, water-based emollient Regular exercise cant improve your acne, but it can boost your mood and improve your self-esteem.Shower as soon as possible once you finish exercising, as sweat can irritate your acne Wash your hair regularlyand try to avoid lettingyour hair fall across your face Although acne cant be cured, it can be controlled with treatment. Several creams, lotions and gelsfor treating spots are available at pharmacies. If you develop acne, its a good idea to speak to your pharmacist for advice. Treatments can take up to 3months to work, so dont expect results overnight. Once they do start to work, the results are usually good. When to get professional advice Pharmacy First Scotland: Acne treatment from your pharmacy If you have acne you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotlands Service Directory. Search for a pharmacy near you Acne isnt usually serious and can be treated by a pharmacist. If your acne is severe or appears on your chest and back,it may need to be treated with antibiotics or stronger creams that are onlyavailable on prescription. Your pharmacist can advise on whether you need to see your GP for further treatment. If you develop nodules or cysts, they need to be treated properly through your GP to avoid scarring.Try to resist the temptation to pick or squeeze the spots, as this can lead to permanent scarring. Why do I have acne? Acne is most commonlylinked to the changes in hormone levels during puberty, but can start at any age. Certain hormones causethe grease-producing glands next to hair follicles in the skin to produce larger amounts of oil (abnormal sebum). This abnormal sebum changes the activity of a usually harmless skin bacterium called P. acnes, which becomes more aggressive and causes inflammation and pus. The hormones also thicken the inner lining of the hair follicle, causing blockage of the pores (opening of the hair follicles). Cleaning the skin doesnt help to remove this blockage. Other possible causes Acne is known to run in families. If both your mother and father had acne, its likely that youll also have acne. Hormonal changes, such as those that occur during the menstrual cycle or pregnancy, can also lead to episodes of acne in women. Theres no evidence that diet, poor hygiene or sexual activity play a role in acne. Read more about the causes of acne ,including some common acne myths. Whos affected? Acne is very common in teenagers and younger adults. About 80% of people aged 11to 30are affected by acne. Acne is most common in girls from the ages of 14to 17, and in boys from the ages of 16to 19. Most people have acne on and off for several years before their symptoms start to improve as they get older. Acne often disappears when a person is in their mid-twenties. In some cases, acne can continue into adult life. About5% ofwomen and 1% of men have acne over the age of 25. Further information You can find support and information from organisations like: Changing Faces a charity for people who have a visible difference or facial disfigurement, who can be contacted on 0300 012 0275 for counselling and advice Causes of acne Acne is caused when tiny holes in the skin, known as hair follicles, become blocked. Sebaceous glands are tiny glands found near the surface of your skin. The glands are attached to hair follicles, which are small holes in your skin that an individual hair grows out of. Sebaceous glands lubricate the hair and the skin to stop it drying out. They do this by producing an oily substance called sebum. In acne, the glands begin to produce too much sebum. The excess sebum mixes with dead skin cells and both substances form a plug in the follicle. If the plugged follicle is close to the surface of the skin, it bulges outwards, creating a whitehead. Alternatively, the plugged follicle can be open to the skin, creating a blackhead. Normally harmless bacteria that live on the skin can then contaminate and infect the plugged follicles, causing papules, pustules, nodules or cysts. Testosterone Teenage acneis thought to be triggered by increased levels of a hormone called testosterone, which occurs during puberty. The hormone plays an important role in stimulating the growth and development of the penis and testicles in boys, and maintaining muscle and bone strength in girls. The sebaceous glands are particularly sensitive to hormones.Its thought that increased levels oftestosterone cause the glands to produce much more sebum than the skin needs. Acne in families Acnecan run in families. If your parents had acne, its likely that youll also develop it. One study has found that if both your parents had acne, youre more likely to get more severe acne at an early age. It also found that if one or both of your parents had adult acne, youre more likely to get adult acne too. Acne in women More than80% ofcases of adult acneoccur in women. Its thought that many cases of adult acne arecaused bythe changes in hormone levels that many women have at certain times. These timesinclude: periods some women have a flare-up of acne just before their period pregnancy many women have symptoms of acne at this time, usually during the first 3months of their pregnancy polycystic ovary syndrome a common condition that can cause acne, weight gain and the formation of small cysts inside the ovary Other triggers Other possible triggers of an acne flare-up include: some cosmetic productshowever, this is less common as most products are now tested,so they dont cause spots(non-comedogenic) certain medicationssuch as steroid medications , lithium(used to treat depression and bipolar disorder ) andsome anti-epileptic drugs (used to treat epilepsy ) regularly wearing items that place pressure on an affected area of skin, such asa headband or backpack smoking which can contribute to acne in older people Acne myths Despite being one of the most widespread skin conditions, acne is also one of the most poorly understood.There aremany myths and misconceptions about it: Acne is caused by a poor diet So far, research hasnt found any foods that cause acne. Eating a healthy, balanced diet is recommended because its good for your heart and your health in general. Acne is caused by having dirty skin and poor hygiene Most of the biological reactions that trigger acne occur beneath the skin, not on the surface, sothe cleanliness of your skinhasno effect on your acne. Washing your face more than twice a day could just aggravate your skin. Squeezing blackheads, whiteheads and spots is the best way to get rid of acne This could actually make symptoms worse and may leave you with scarring. Sexual activity can influence acne Having sex or masturbating wont make acne any better or worse. Sunbathing, sunbeds and sunlamps help improve the symptoms of acne Theres no conclusive evidence that prolonged exposure to sunlight or using sunbeds or sunlamps can improve acne. Many medications used to treat acne can make your skin more sensitive to light, so exposure could cause painful damage to your skin, and also increase your risk of skin cancer. Acne is infectious You cant pass acne on to other people. Diagnosing acne Your pharmacist can diagnose acne by looking at your skin. This involves examining your face and possibly your chest and back for different types of spot, such as blackheads or sore, red nodules. How many spots you have and how painful and inflamed they are will help determine how severe your acne is. This isimportant in planning your treatment. 4grades can be used to measure the severity of acne: grade 1 (mild) acne is mostly confined to whiteheads and blackheads, with just a few papules and pustules grade 2 (moderate) there are multiple papules and pustules, which are mostly confined to the face grade 3 (moderately severe) theres a large number of papules and pustules, as well as the occasional inflamed nodule, and the back and chest are also affected by acne grade 4 (severe) theres a large number of large, painful pustules and nodules More severe acne can affect the back and neck. Source: https://dermnetnz.org/ Acne in women If acne suddenly startsin adult women, itcan be a sign of a hormonal imbalance, especially if its accompanied by other symptoms such as: excessive body hair (hirsutism) irregular or light periods The most common cause of hormonal imbalances in women ispolycystic ovary syndrome (PCOS). PCOS can be diagnosed using a combination of ultrasound scans and blood tests . Treating acne Treatment for acne depends on how severe it is. It can take several months of treatment before acne symptoms improve. The various treatments for acne are outlined below. If you just have a few blackheads, whiteheads and spots, you should be able to treat them successfully with over-the-counter gels or creams (topical treatments) that contain benzoyl peroxide. Treatments from your GP See your GP if your acne is more widespread,as you probably need prescription medication.For example, if: you have a large number of papules and pustules over-the-counter medication hasnt worked Prescription medications that can be used to treat acne include: topical retinoids topical antibiotics azelaic acid antibiotic tablets in women, the combined oral contraceptive pill isotretinoin tablets If you have severe acne,your GP can refer you to an expert in treating skin conditions (dermatologist). For example, if you have: a large number of papules and pustules on your chest and back, as well as your face painful nodules A combination ofantibiotic tablets and topical treatments is usually the first treatment option for severe acne. If this doesnt work, a medication calledisotretinoin may be prescribed. Hormonal therapies or the combined oral contraceptive pill can also be effective in women who have acne. However, the progestogen-only pill or contraceptive implant can sometimes make acne worse. Many of these treatments can take 2to 3months before they start to work. Its important to be patient and persist with a recommended treatment, even iftheres no immediate effect. Topical treatments (gels, creams and lotions) Benzoyl peroxide Benzoyl peroxide works as an antiseptic to reduce the number of bacteria on the surface of the skin. It also helps to reduce the number of whiteheads and blackheads, and has an anti-inflammatory effect. Benzoyl peroxide is usually available as a cream or gel. Its used either once or twice a day. It should be applied 20 minutes after washing to all of the parts of your face affected by acne. It should be used sparingly, as too much can irritate your skin. It also makes your face more sensitive to sunlight, so avoid too much sun and ultraviolet (UV) light, or wear sun cream. Benzoyl peroxide can have a bleaching effect, so avoid getting it on your hair orclothes. Common side effects of benzoyl peroxide include: dry and tense skin a burning, itching or stinging sensation some redness and peeling of the skin Side effects are usually mild and should pass once the treatment has finished. Most people need a 6 week course of treatment to clear most or all of their acne. You may be advised to continue treatment less frequently to prevent acne returning. Topical retinoids Topical retinoids work byremoving dead skin cells from the surface of the skin (exfoliating)which helpsto prevent them building up within hair follicles. Tretinoin and adapalene are topical retinoids used to treat acne. Theyre available in a gel or cream and are usually applied once a day before you go to bed. Apply to all the parts of your face affected by acne 20 minutes after washing your face. Its important to apply topical retinoids sparingly and avoid excessive exposure to sunlight and UV. Topical retinoids arent suitable for use during pregnancy, as theres a risk they might cause birth defects. The most common side effects of topical retinoids are mild irritation and stinging of the skin. A 6 week course is usually required, but you may be advised to continue using the medication less frequently after this. Topical antibiotics Topical antibiotics help kill the bacteria on the skin that can infect plugged hair follicles. Theyre available as a lotion or gel that is applied once or twice a day. A 6 to 8week course is usually recommended. After this, treatment is usually stopped, as theres a risk that the bacteria on your face could become resistant to the antibiotics. This could make your acne worse and cause additional infections. Side effects are uncommon, but can include: minor irritation of the skin redness and burning of the skin peeling of the skin Azelaic acid Azelaic acid is often used as an alternative treatment for acne if the side effects of benzoyl peroxide or topical retinoids are particularly irritating or painful. Azelaic acid works by getting rid of dead skin and killing bacteria. Its availableas acream or gel and is usually applied twice a day (or once a day if your skin is particularly sensitive). The medication doesnt make your skin sensitive to sunlight, so you dont have to avoid exposure to the sun. Youll usually need to use azelaic acid for a month before your acne improves. The side effects of azelaic acid are usually mild and include: burning or stinging skin itchiness dry skin redness of the skin Antibiotic tablets Antibiotic tablets (oral antibiotics) are usually used in combination with a topical treatment to treat more severe acne. In most cases, a class of antibiotics called tetracyclines is prescribed, unless youre pregnant or breastfeeding. Pregnant or breastfeeding women are usually advised to take an antibiotic called erythromycin, which is known to be safer to use. It usually takes about 6weeks before you notice an improvement in your acne. Depending on how well you react to the treatment, a course of oral antibiotics can last 4to 6months. Tetracyclines can make your skin sensitive to sunlight and UV light, and can also make the oral contraceptive pill less effective during the first few weeks of treatment. Youll need to use an alternative method of contraception, such as condoms , during this time. Hormonal therapies Hormonal therapies can often benefit women with acne, especially if the acne flares up aroundperiods oris associated with hormonal conditions such as polycystic ovary syndrome. If you dont already use it, your GP may recommend the combined oral contraceptive pill , even if youre not sexually active. This combined pill can often help improve acne in women, but may take up to a year before the full benefits are seen. Co-cyprindiol Co-cyprindiol is a hormonal treatment that can be used for more severe acnethat doesnt respond to antibiotics. It helps to reduce the production of sebum. Youll probably have to use co-cyprindiol for 2to 6months before you notice a significant improvement in your acne. Theres a small riskthat women taking co-cyprindiol may develop breast cancer in later life. For example, out of a group of 10,000 women who havent taken co-cyprindiol, you would expect 16 of them to develop breast cancer by the time they were 35. This figure rises to 17 or 18 for women who were treated with co-cyprindiol for at least 5years in their early twenties. Theres also a very small chance of co-cyprindiol causing a blood clot. The riskisestimated tobe around 1 in 2,500 in any given year. Its not thought to be safe to take co-cyprindiol if youre pregnant or breastfeeding.Women may need to have a pregnancy test before treatment can begin. Other side effects of co-cyprindiol include: bleeding and spotting between your periods, whichcan sometimes occur for the first few months headaches sore breasts mood changes loss of interest in sex weight gain or weight loss Isotretinoin Isotretinoinhas a number of beneficial effects: it helps to normalise sebum and reduce how much isproduced it helps to prevent follicles becoming clogged it decreases the amount of bacteria on the skin it reduces redness and swelling in and around spots However,the drugcan also cause a wide range of side effects. Its only recommended for severe cases of acne that havent responded to other treatments. Because of the risk of side effects, isotretinoin can only be prescribed by a specially trained GP or adermatologist. Isotretinoin is takenas atablet. Most people take a 4to 6 month course. Your acne may get worse during the first 7 to 10 days of treatment. However, this is normal and soon settles. Common side effects of isotretinoin include: inflammation, dryness and cracking of the skin, lips and nostrils changes in your blood sugar levels inflammation of your eyelids (blepharitis) inflammation and irritation of your eyes (conjunctivitis) blood in your urine Rarer side effects of isotretinoin include: inflammation of the liver (hepatitis) inflammation of the pancreas (pancreatitis) kidney disease Because of the risk of these rarer side effects, youll need a blood test before and during treatment. Isotretinoin and birth defects Isotretinoin will damage an unborn baby. If youre a woman of childbearing age: dont use isotretinoin if yourepregnant or you think youre pregnant use 1, or ideally 2, methods of contraception for 1month before treatment begins, during treatment and for 1month after treatment has finished have a pregnancy test before, during and after treatment Youll be asked to sign a form confirming that you understand the risk of birth defects and are willing to use contraceptives to prevent this risk, even if youre not currently sexually active. If you think you mayhave become pregnant when taking isotretinoin, contact your dermatologist immediately. Isotretinoin is also not suitable if youre breastfeeding. Isotretinoin and mood changes There have been reports of people experiencing mood changes while taking isotretinoin. Theres no evidence that these mood changes were the result of the medication. However, as a precaution, contact your doctor immediately if you feel depressed or anxious, have feelings of aggression or suicidal thoughts. Non-pharmaceutical treatments Several treatments for acne dont involve medication. These include: comedone extractor a small pen-shaped instrument that can be used to clean out blackheads and whiteheads chemical peels where a chemical solution is applied to the face, causing the skin to peel off and new skin to replace it photodynamic therapy where light is applied to the skin in an attempt to improve symptoms of acne However, these treatments may not work and cant be routinely recommended. Complications of acne Acne scarring can sometimes develop as a complication of acne. Any type of acne spot can lead to scarring, but its more common when the most serious types of spots (nodules and cysts) burst and damage nearby skin. Scarringcan also occur if you pick or squeeze your spots, so its important not to do this. There are 3main types of acne scars: ice pick scars small, deep holes in the surface of your skin that look like the skin has been punctured with a sharp object rolling scars caused by bands of scar tissue that form under the skin, giving the surface of the skin a rolling and uneven appearance boxcar scars round or oval depressions, or craters, in the skin Treating acne scarring Treatments for acne scarring are regarded as a type of cosmetic surgery, which isnt usually available on the NHS. However, in the past, exceptions have been made when its been shown that acne scarring has caused serious psychological distress. See your GP if youre considering having cosmetic surgery. Theyll be able to discuss your options with you and advise you about the likelihood of having the procedure carried out on the NHS. Many private clinics offer treatment for acne scarring. Prices can vary widely (from 500 tomore than10,000) depending on the type of treatment needed. The British Association of Plastic, Reconstructive and Aesthetic Surgeons website has more information about private treatment available in your area. Its important to have realistic expectations about what cosmetic treatment can achieve. While treatment can certainly improve the appearance of your scars, it cant get rid of them completely. After treatment for acne scarring, most people notice a 50-75% improvement in their appearance. Some of the available treatments for acne scarring are explained below. Dermabrasion Dermabrasion involves removing the top layer of skin, either using lasers or a specially made wire brush. After the procedure, your skin will look red and sore for several months, but as it heals you should notice an improvement in the appearance of your scars. Laser treatment Laser treatment can be used to treat mild to moderate acne scarring. There are 2types of laser treatment: ablative laser treatment where lasers are used to remove a small patch of skin around the scar to produce a new, smooth-looking area of skin non-ablative laser treatment where lasers are used to stimulate the growth of new collagen (a type of protein found in skin), which helps to repair some of the damage caused by scarring, and improves the appearance Punch techniques Punch techniques are used to treat ice pick scars and boxcar scars. There are 3types of punch technique: punch excision used to treat mild ice pick scars. The scar is surgically removed and the remaining wound is sealed. After the wound heals, it leaves a smoother and more even area of skin. punch elevation used to treat boxcar scars. The base of the scar is surgically removed, leaving the sides of the scar in place. The base is then reattached to the sides, but lifted up so its level with the surface of the skin. This makes the scar much less noticeable. punch grafting used to treat very deep ice pick scars. As with a punch excision, the scar is removed, but the wound is plugged with a sample of skin taken from elsewhere on the body (usually from the back of the ear). Subcision Subcision is a surgical treatment that can be used to treat rolling scars. During surgery, the upper layer of the skin is removed from the underlying scar tissue. This allows blood to pool under the affected area. The blood clot helps form connective tissue, which pushes up the rolling scar so its level with the rest of the surface of the skin. Once subscision has been completed, additional treatment, such as laser treatment and dermabrasion, can be used to further improve the appearance of the scar. Depression Acne can often cause intense feelings of anxiety and stress, which can sometimes make people with the condition become socially withdrawn. This combination of factors can lead to people with acne becoming depressed . You may be depressed if during the last month youve often felt down, depressed or hopeless, and have little interest or pleasure in doing things. If you think that you or your child may have depression, its important to speak to your GP. Treatments for depression include: talking therapies such as cognitive behavioural therapy (CBT) a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs)

Acute cholecystitis

Acute cholecystitis Illnesses and conditions Stomach, liver and gastrointestinal tract Acute cholecystitis Acute cholecystitis Acute cholecystitis is swelling (inflammation) of the gallbladder. It is a potentially serious condition that usually needs to be treated in hospital. Themain symptomof acute cholecystitis is a sudden sharp pain in the upper right side of your tummy (abdomen) that spreads towards your right shoulder. The affected part of the abdomen is usually extremely tender, and breathing deeply can make the pain worse. Unlike some others types of abdominal pain , the pain associated with acute cholecystitis is usually persistent, and doesnt go away within a few hours. Some people may additional symptoms, such as: a high temperature (fever) nausea and vomiting sweating loss of appetite yellowing of the skin and the whites of the eyes (jaundice) a bulge in the abdomen When to seek medical advice Contact your GP practice if: you develop sudden and severe abdominal pain, particularly if the pain lasts longer than a few hours or you have other symptoms, such as jaundice and a fever If your GP practice is closed, phone 111. Its important for acute cholecystitis to be diagnosed as soon as possible, because there is a risk that serious complications could develop if the condition is not treated promptly. What causes acute cholecystitis? The causes of acute cholecystitis can be grouped into 2main categories: calculous cholecystitis and acalculous cholecystitis. Calculous cholecystitis Calculous cholecystitis is the most common, and usually less serious, type of acute cholecystitis. It accounts for around 95% of all cases. Calculous cholecystitis develops when the main opening to the gallbladder, called the cystic duct, gets blocked by a gallstone or by a substance known as biliary sludge. Biliary sludge is a mixture of bile (a liquid produced by the liver that helps digest fats) and small crystals of cholesterol and salt. The blockage in the cystic duct results in a build-up of bile in the gallbladder, increasing thepressure inside it and causing it tobecome inflamed. In around 1in every 5cases, the inflamed gallbladder also becomes infected by bacteria. Acalculous cholecystitis Acalculous cholecystitis is a less common, but usually more serious, type of acute cholecystitis. Itusually develops as a complication of a serious illness, infection or injury that damages the gallbladder. Acalculous cholecystitis is often associated with problems such as accidental damage to the gallbladder during major surgery, serious injuries or burns , blood poisoning (sepsis) , severe malnutrition or AIDS . Who is affected Acute cholecystitis is a relatively common complication of gallstones. Its estimated that around 10%to 15% of adults in the UK have gallstones. Thesedont usually cause any symptoms, but in a small proportion of people they can causeinfrequent episodes of pain (known as biliary colic) or acute cholecystitis. Diagnosing cholecystitis To diagnose acute cholecystitis, your GP will examine your abdomen. They will probably carry out a simple test called Murphys sign. You willbe asked to breathe in deeply with your GPs hand pressed on your tummy, just below your rib cage. Your gallbladder will move downwards as your breathe in and, if you have cholecystitis, you will experience sudden pain as your gallbladder reaches your doctors hand. If your symptoms suggest you have acute cholecystitis, your GPwill refer you to hospital immediately for further tests and treatment. Tests you may have in hospital include: blood tests to check for signs of inflammation in your body an ultrasound scan of your abdomen to check for gallstones or other signs of a problem with your gallbladder Other scans such as an X-ray , a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan may also be carried out to examine your gallbladder in more detail if there is any uncertainty about your diagnosis. Treating acute cholecystitis If you are diagnosed with acute cholecystitis, you will probably need to be admitted to hospital for treatment. Initial treatment Initial treatment will usually involve: fasting (not eating or drinking) to take the strain off your gallbladder receiving fluids through a drip directly into a vein (intravenously) to prevent dehydration taking medication to relieve your pain If you have a suspected infection, you will also be given antibiotics . Theseoften need to be continued for up to a week, during which time you may need to stay in hospital or you may be able to go home. With this initial treatment, any gallstones that may have caused theconditionusually fall back into the gallbladder and the inflammationoften settles down. Surgery In order to prevent acute cholecystitis recurring, and reduce your risk of developing potentially serious complications, the removal of your gallbladder will often be recommended at some pointafter the initial treatment.This type of surgeryis known as a cholecystectomy . Although uncommon, an alternative procedure called a percutaneous cholecystostomy may be carried out if you are too unwell to have surgery. This is where a needle is inserted through your abdomen to drain away the fluid that has built up in the gallbladder. If you are fit enough to have surgery, your doctors willneed to decide when the best time to remove your gallbladder may be. In some cases, you may need to have surgery immediately or in the next day or 2, while in other cases you may be advised towait for the inflammation to fully resolve over the next few weeks. Surgery can be carried out in two main ways: laparoscopic cholecystectomy a type of keyhole surgery where the gallbladder is removed using special surgical instruments inserted through a number of small cuts (incisions) in your abdomen open cholecystectomy where the gallbladder is removed through a single, larger incision in your abdomen Although some people who have had their gallbladder removed have reported symptoms of bloating and diarrhoea after eating certain foods, youcan lead a perfectly normal life without a gallbladder. The organ can be useful but its not essential, as your liver will still produce bile to digest food. Possible complications Without appropriate treatment, acute cholecystitis can sometimes lead to potentially life-threatening complications. The main complications of acute cholecystitis are: the death of the tissue of the gallbladder, called gangrenous cholecystitis, which can cause a serious infection that could spread throughout the body the gallbladder splitting open, known as a perforated gallbladder, which can spread the infection within your abdomen (peritonitis) or lead to a build-up of pus (abscess) In about 1in every 5cases of acute cholecystitis, emergency surgery to remove the gallbladder is needed to treat these complications. Preventing acute cholecystitis Its not always possible to prevent acute cholecystitis, but you can reduce your risk of developing the condition by cutting your risk of gallstones. One of the main steps you can take to help lower your chances of developing gallstones isadopting ahealthy, balanced diet and reducing the number of high-cholesterol foods you eat, as cholesterol is thought to contribute to the formation of gallstones. Being overweight, particularly being obese, also increases your risk of developing gallstones. You should therefore control your weight by eating a healthy diet and exercising regularly. However, low-calorie, rapid weight loss diets should be avoided, because there is evidence they can disrupt your bile chemistry and actually increase your risk of developing gallstones. A more gradual weight loss plan is best.

Acute lymphoblastic leukaemia

Acute lymphoblastic leukaemia Illnesses and conditions Cancer Cancer types in adults Acute lymphoblastic leukaemia Acute lymphoblastic leukaemia About acute lymphoblastic leukaemia Symptoms of acute lymphoblastic leukaemia Causes of acute lymphoblastic leukaemia Diagnosing acute lymphoblastic leukaemia Treating acute lymphoblastic leukaemia Complications of acute lymphoblastic leukaemia About acute lymphoblastic leukaemia Leukaemia is cancer of the white blood cells. Acute leukaemia means the condition progresses rapidly and aggressively and requires immediate treatment. Acute leukaemia is classified according to the type of white blood cells affected by cancer. There are 2 main types: lymphocytes, which are mostly used to fight viral infections neutrophils, which perform several functions, such as fighting bacterial infections, defending the body against parasites and preventing the spread of tissue damage These pages focus on acute lymphoblastic leukaemia, which is cancer of the lymphocytes. The following other types of leukaemia are covered elsewhere: chronic lymphocytic leukaemia chronic myeloid leukaemia acute myeloid leukaemia Warning signs of acute leukaemia Symptoms of acute lymphoblastic leukaemiausually begin slowly before rapidly getting severe as the number of immature white blood cells in your blood increases. Symptomsinclude: pale skin tiredness breathlessness having repeated infections over a short space of time unusual and frequent bleeding Read more about the symptoms of acute lymphoblastic leukaemia What happens in acute leukaemia All of the blood cells in the body are produced by bone marrow a spongy material found inside bones. Bone marrow produces specialised cells called stem cells which have the ability to develop into three important types of blood cells: red blood cells, which carry oxygen around the body white blood cells, which help fight infection platelets, which help stop bleeding The bone marrow usually produces stem cells which are allowed to fully develop before being released into the blood. But in acute leukaemia, bone marrow starts releasing large numbers of immature white blood cells known as blast cells. As the number of blast cells increases there is a drop in the number of red blood cells and platelet cells. This drop causes the symptoms of anaemia, such as tiredness, and increases the risk of excessive bleeding. Also, blast cells are less effective than mature white blood cells at fighting bacteria and viruses, making you more vulnerable to infection. Despite being uncommon overall, acute lymphoblastic leukaemia is the most common type of cancer to affect children. The cause or causes of acute leukaemia are uncertain, but known risk factors include: exposure to high levels of radiation exposure to benzene, a chemical used in manufacturing that is also found in cigarettes Read more information about the causes of acute lymphoblastic leukaemia Symptoms of acute lymphoblastic leukaemia Symptoms of acute lymphoblastic leukaemia usually begin slowly before rapidly getting severe as the number of blast cells (immature white blood cells) in your blood increases. Most of the symptoms are caused by the lack of healthy blood cells in your blood supply. Symptoms of acute lymphoblastic leukaemia include: pale skin feeling tired and breathless having repeated infections over a short space of time unusual and frequent bleeding, such as bleeding gums or nose bleeds high temperature (fever) of 38C (100.4F) or above night sweats bone and joint pain easily bruised skin swollen lymph nodes (glands) abdominal pain caused by a swollen liver or spleen unexplained weight loss a purple skin rash (purpura) In some cases of acute lymphoblastic leukaemia, the affected cells can spread from your bloodstream into your central nervous system. This can cause a series of neurological symptoms (related to the brain and nervous system), including: headaches seizures (fits) vomiting blurred vision dizziness When to seek medical advice If you or your child has some or even all of these symptoms, it is still highly unlikely that acute leukaemia is the cause. However, see your GP as soon as possible because any condition that causes these symptoms needs to be promptly investigated and treated. Causes of acute lymphoblastic leukaemia Acute lymphoblastic leukaemia is caused by a DNA mutation in the stem cells causing too many white blood cells to be produced. The white blood cellsare also released from the bone marrow before they are matureand able to fight infection like fully developed white blood cells. As the number of immature cells increases,the number ofhealthy red blood cells and platelets fall, and its thisfallwhich causes many of thesymptoms of leukaemia. It is not known exactly what causes this DNA mutation to occur, but there area fewfactors which may increase therisk ofdeveloping acute lymphoblastic leukaemia. Risk factors Genetic disorders A small numberof childhood acute lymphoblasticleukaemia cases are thought to be caused by related genetic disorders. For example, rates of leukaemia tend to be higher in children with Downs syndrome . Radiation exposure Exposure to very high levels of radiation, either before birth or afterwards, is a known risk factor. However, it would require a significant level of radiation, such as the amount released during the nuclear reactor accident at Chernobyl. Due to the potential risk of radiation to unborn babies, medical techniques and equipment that use radiation, such as X-rays , are rarely used on pregnant women. Most cases of childhood leukaemia occur in children with no history of genetic disorders or exposure to radiation. Possible environmental factors Experts have also carried out extensive research to determine whether the following environmental factors could be a trigger for leukaemia: living near a nuclear power station living near a power line living near a building or facility that releases electromagnetic radiation, such as a mobile phone mast At the moment there is no evidence to confirm that any of these environmental factors increase the risk of developing leukaemia. Benzene Exposure to the chemical benzene is a known risk factor for adult acute leukaemia. Benzene is found in petrol and is also used in the rubber industry. However, there are strict controls to protect people from prolonged exposure. Benzene is also found in cigarettes, which could explain why smokers are three times more likely to develop acute leukaemia than non-smokers. People who have had chemotherapy and radiotherapy to treat earlier, unrelated cancers also have an increased risk of developing acute leukaemia. Other risk factors There is some evidence to show an increased risk ofacute lymphoblasticleukaemia in people who: are obese have a weakened immune system due to HIV or AIDS or taking immunosuppressants after an organ transplant Diagnosing acute lymphoblastic leukaemia The first step in diagnosing acute lymphoblastic leukaemia is for your GP to check for physical signs of the condition, such as swollen glands, and to take a blood sample. A high number of abnormal white blood cells in the blood sample could indicate the presence of acute leukaemia and you will then be referred to a haematologist (a specialist in treating blood conditions). Bone marrow biopsy To confirm a diagnosis of acute leukaemia, the haematologist will take a small sample of your bone marrow to examine under a microscope. The haematologist will use a local anaesthetic to numb the skin over a bone usually the hip bone and then use a needle to remove a sample of bone marrow. You may experience some pain once the anaesthetic wears off and some bruising and discomfort for a few days afterwards. The procedure takes around 15 minutes to complete and you shouldnt have to stay in hospital overnight. The bone marrow will be checked for cancerous cells and if found the type of acute leukaemia will be determined at the same time. Further tests There are various additional tests that can be used to help reveal more information about the progress and extent of the leukaemia. They can also provide an insight into how the leukaemia should be treated. These tests are described below. Cytogenetic testing Cytogenetic testing involves identifying the genetic make-up of the cancerous cells. There are specific genetic variations that can occur during leukaemia, and knowing what these variations are can have an important impact on treatment. Immunophenotyping Immunophenotyping is a test to help identify the exact type of acute lymphoblastic leukaemia. A sample of blood, bone marrow or another type of fluid is studied. This testing is important as the treatment needed may be slightly different for each type. Polymerase chain reaction (PCR) A polymerase chain reaction (PCR) test can be done on a blood sample. This is an important test to diagnose and monitor the response to treatment. The blood test is repeated every three months for at least two years after starting treatment, then less often once remission is achieved. Lymph node biopsy If you have been diagnosed with acute leukaemia, further biopsies may be carried out on any enlarged lymph nodes that you have. These will be able to establish how far the leukaemia has spread. CT scans If you have acute leukaemia, a computerised tomography scan (CT scan) may be used to check that your organs, such as your heart and lungs, are healthy. Chest X-ray An X-ray may be performed to examine the chest for any swollen lymph nodes. Lumbar puncture If it is felt that there is a risk that acute leukaemia has spread to your nervous system, a lumbar puncture may be carried out. A lumbar puncture is a test where a needle is used under local anaesthetic to extract a sample of cerebrospinal fluid (fluid that surrounds and protects your spine) from your back. The fluid is tested to determine whether the leukaemia has reached your nervous system. Treating acute lymphoblastic leukaemia Treatment for acute lymphoblastic leukaemia usually begins a few days after diagnosis as its an aggressive condition that develops rapidly. Stages of treatment Treatment for acute lymphoblastic leukaemia is carried out in stages: induction the aim of the initial stage of treatment is to kill the leukaemia cells in your bone marrow, restore the balance of cells in your bloodand resolve any symptoms you may have consolidation this stage aims to kill any remaining leukaemia cells in your central nervous system maintenance the final stage involves taking regular doses of chemotherapy tablets to prevent the leukaemia returning Maintenance only seems to be effective in treating acute lymphoblastic leukaemia; its not usually used in the treatment of acute myeloid leukaemia . Induction The induction stage of treatment is carried out in hospital or in a specialist centre. This is because you will probably need to have regular blood transfusions as its likely that your blood will not contain enough healthy blood cells. You will also be vulnerable to infection, so it is important that you are in a sterile environment where your health can be carefully monitored and any infection that you have can be promptly treated. You may also be prescribed antibiotics to help prevent further infection. Chemotherapy You will be given chemotherapy to kill the leukaemia cells in your bone marrow. Although some medications may be given as pills, you will need more than one medication given as an injection. To make things easier and avoid repeated injections, they can all be given via one flexible tubeinto a vein in your chest (called a central line). Some chemotherapy medication may also be directly administered into your cerebrospinal fluid to kill any leukaemia cells that may have spread to your nervous system. Thisis given using a needle that is placed into your spine, in a similar way to a lumbar puncture . Side effects that occur following chemotherapy are common. They can include: nausea vomiting diarrhoea loss of appetite mouth ulcers tiredness skin rashes infertility hair loss The side effects should resolve once treatment has finished. Your hair will usually take between three to six months to grow back. Steroid therapy You may also be given corticosteroid injections or tablets to help improve the effectiveness of chemotherapy. Imatinib If you have a type of leukaemia known as Philadelphia chromosome-positiveacute lymphoblastic leukaemia, you will also be given a medicine called imatinib. Imatinib works by blocking the signals in the cancerous cells that cause them to grow and reproduce. This kills the cancerous cells. Imatinib is taken orally (as a tablet). The side effects of imatinib are usually mild and should improve over time. They include: nausea vomiting swelling in the face and lower legs muscle cramps rash diarrhoea Depending on how well you respond to treatment, the induction phase can last from two weeks to several months. In some cases, you or your child may be able to leave hospital and receive treatment on an outpatient basis if your symptoms improve. Consolidation Leukaemia can return if just one cancerous cell remains in your body. Therefore the aim of consolidation treatment is to ensure that any remaining leukaemia cells are killed. Treatment involves receiving regular injections of chemotherapy medication. This is usually done on an outpatient basis, which means you will not have to stay in hospital overnight. However, you may require some short stays in hospital if your symptoms suddenly get worse or if you develop an infection. The consolidation phase of treatment lasts several months. Maintenance The maintenance phase is designed to act as further insurance against the possibility of the leukaemia returning. It involves taking regular doses of chemotherapy tablets while undergoing regular check-ups to monitor how effective your treatment is proving. The maintenance phase can often last for two years. Other treatments As well as chemotherapy and imatinib, other treatments are used in some circumstances. These are described below. Dasatinib Dasatinib is a new type of medication used to treat Philadelphia chromosome-positive acute lymphoblastic leukaemia, when all other treatments have proved unsuccessful. Dasatinib blocks a protein called tyrosine kinase that helps stimulate the growth of cancer cells. Dasatinib cannot cure acute leukaemia but it can slow its growth, helping to relieve symptoms and prolong life. The National Institute for Health and Care Excellence (NICE) has not yet made a decision about whether the NHS should provide treatment with dasatinib for people with acute lymphoblasticleukaemia. This means it will be at the discretion of your localclinical commissioning groupas to whether you will be offered the drug. Radiotherapy Radiotherapy involves using high doses of controlled radiation to kill cancerous cells. There are two main reasons why radiotherapy is usually used to treat acute leukaemia: to sometimes treat advanced cases of acute lymphoblastic leukaemia that have spread to the nervous system or brain to prepare the body for a bone marrow transplant (see below) Side effects of both types of radiotherapy include: hair loss nausea fatigue The side effects should pass once your course of radiotherapy has been completed. However, your skin may be very sensitive to the effects of light for several months after the treatment has finished. If this is the case, avoid sunbathing or exposure to sources of artificial light, such as sunbeds, for several months. Many younger children treated with radiotherapy will go on to have restricted physical growth during puberty. A small number of people develop cataracts several years after radiotherapy. Cataracts are cloudy patches in the lens (the transparent structure at the front of the eye) that can make your vision blurred or misty. Cataracts can usually be successfully treated using surgery. Read more about cataracts Bone marrow and stem cell transplants If you or your child do not respond to chemotherapy, a possible alternative treatment option is bone marrow or stem cell transplantation. Transplantations are more successful if the donor has the same tissue type as you, so the ideal donor is usually a brother or sister. Before transplantation can take place, the person receiving the transplant will need to have aggressive high-dose chemotherapy and radiotherapy to destroy any cancerous cells in their body. This can put a bigstrain on the bodyso transplantations are usually only successful when they are carried out in children and young people, or older people who are in good health, and when there is a suitable donor, such as a brother or sister. Readabout bone marrow transplantation for more information Complications of acute lymphoblastic leukaemia Being immunocompromised (having a weakened immune system) is a possible complication for some patients with acute leukaemia. There are 2 reasons for this: the lack of healthy white blood cells means that your immune system is less able to fight infection many of the medicines used to treatacute leukaemiacan weaken the immune system This means thatyou are more vulnerable to developing an infection, and that any infection you have has an increased potential to cause serious complications. You may be advised to take regular doses of antibiotics to prevent infections occurring. You should immediately report any possible symptoms of an infection to your GP orcare teambecause prompt treatment may be required to prevent serious complications. Symptoms of infection include: high temperature (fever) of 38C (101.4F) or above headache aching muscles diarrhoea tiredness Avoid contact with anyone who is known to have an infection, even if it is a type of infection that you were previously immune to, such as chickenpox or measles. This is because your previous immunity to these conditions will probably be lower. While it is important to go outside on a regular basis, both for exercise and for your psychological wellbeing, avoid visiting crowded places and using public transport during rush hour. Also ensure that all of your vaccinations are up-to-date. Your GP or care team will be able to advise you about this. You will be unable to have any vaccine containing activated particles of viruses of bacteria such as: themumps, measles and rubella (MMR) vaccine the polio vaccine the oral typhoid vaccine the BCG vaccine (used to vaccinate against tuberculosis) the yellow fever vaccine Bleeding If you have acute leukaemia, you will bleed and bruise more easily due to the low levels of platelets (clot-forming cells) in your blood. Bleeding may also be excessive when it does occur. Bleeding can occur: inside the skull (intracranial haemorrhage) inside the lungs (pulmonary haemorrhage) inside the stomach (gastrointestinal haemorrhage) The symptoms of an intracranial haemorrhage include: severe headache stiff neck vomiting change in mental state, such as confusion The most common symptoms of a pulmonary haemorrhage are: coughing up blood from your nose and mouth breathing difficulties a bluish skin tone (cyanosis) The 2 most common symptoms of a gastrointestinal haemorrhage are: vomiting blood passing stools (faeces) that are very dark or tar-like All 3 types of haemorrhages should be regarded as medical emergencies. Phone 999 to request an ambulance if you suspect that you or your child is experiencing a haemorrhage. Infertility Many of the treatments that are used to treat acute leukaemia can cause infertility. Infertility is often temporary, although in some cases it may be permanent. People who are particularly at risk of becoming infertile are those who have received high doses of chemotherapy and radiotherapy in preparation for bone marrow or stem cell transplantation. It may be possible to guard against any risk of infertility before you begin your treatment. For example, men can have samples of their sperm stored. Similarly, women can have fertilised embryos stored, which can then be placed back into their womb following treatment. Read more about infertility Psychological effects of leukaemia Receiving a diagnosis of leukaemia can be very distressing, particularly if it is unlikely that your condition can be cured. At first, the news may be difficult to take in. The situation can be made worse if you are confronted with the knowledge that even though your leukaemia may not currently be causing any symptoms, it could be a serious problem in later life. Having to wait many years to see how the leukaemia develops can be immensely stressful and can trigger feelings of stress, anxiety and depression . If you have been diagnosed with leukaemia, talking to a counsellor or psychiatrist (a doctor who specialises in treating mental health conditions) may help you to combat feelings of depression and anxiety. Antidepressants or medicines that help to reduce feelings of anxiety may also help you cope better with the condition. You may find it useful to talk to other people who are living with leukaemia. Your GP or multidisciplinary team may be able to provide you with details of local support groups. Another excellent resource is Macmillan Cancer Support . Their helpline number is 0808 808 00 00 and is open Monday to Friday, 9am8pm. Further information You can read more information on all aspects of living and coping with cancer at the following links: living with cancer including information on treatment, support and personal experiences of cancer living with acute lymphoblastic leukaemia Cancer Research

Acute lymphoblastic leukaemia: Children

Acute lymphoblastic leukaemia: Children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Acute lymphoblastic leukaemia: Children Acute lymphoblastic leukaemia: Children Acute lymphoblastic leukaemia (ALL) is a type of blood cancer. One third of all childhood cancers are leukaemia. Approximately, 3 out of 4 of these are acute lymphoblastic (ALL). ALL can affect children of any age but is more common in children aged 1 to 4 years old. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information, and if you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. Leukaemia Leukaemia is a cancer of the white blood cells. All blood cells are made in the bone marrow, the spongy substance at the core of some bones in the body. Bone marrow contains: red blood cells, which carry oxygen around the body platelets, which help the blood to clot and control bleeding white blood cells, which help fight infection There are 2 different types of white blood cells: lymphocytes and myeloid cells (including neutrophils). These white blood cells work together to fight infection. Normally, white blood cells develop, repair and reproduce themselves in an orderly and controlled way. In leukaemia, however, the process gets out of control and the cells continue to divide in the bone marrow, but do not mature. These immature dividing cells fill up the bone marrow and stop it from making healthy blood cells. As the leukaemia cells are not mature, they cannot work properly. This leads to an increased risk of infection. There are 4 main types of leukaemia: acute lymphoblastic (ALL) acute myeloid (AML) chronic lymphocyte (CLL) chronic myeloid (CML) Chronic leukaemias usually affect adults and each type of leukaemia has its own characteristics and treatment. ALL is a cancer of immature lymphocytes, called lymphoblasts or blast cells. There are two different types of lymphocytes; T-cells and B-cells. Often, leukaemia occurs at a very early stage in the immature lymphocytes, before they have developed into either T-cells or B-cells. However, if the cells have developed this far before becoming leukaemic, the type of leukaemia may be known as T-cell or B-cell leukaemia. This page is about acute lymphoblastic leukaemia (ALL). Causes The exact cause of ALL is unknown. Research is going on all the time into possible causes of this disease. Children with certain genetic disorders, such asDowns syndrome, are known to have a higher risk of developing leukaemia. Brothers and sisters of a child with ALL (particularly identical twins) have a slightly increased risk of developing ALL themselves, althoughthis risk is still small. Like all cancers, ALL is not infectious and cannot be passed on to other people. Signs and symptoms As the leukaemia cells multiply in the bone marrow, the production of normal blood cells is reduced. Children may therefore become tired and lethargic because of anaemia, which is caused by a lack of red blood cells. Children may develop bruises, and bleeding may take longer to stop because of the low number of platelets present in their blood (which help blood to clot). Sometimes, children suffer from infections because of low numbers of normal white blood cells. A child is likely to feel generally unwell and may complain of aches and pains in the limbs or may have swollen lymph glands. At first, the symptoms are just like those of a viral infection, but when they continue for more than a week or two, the diagnosis usually becomes clear. How ALL is diagnosed A blood test usually shows low numbers of normal white blood cells and the presence of the abnormal leukaemia cells. A sample of bone marrow is usually needed to confirm the diagnosis. A sample is also sent to the genetics department to look for any abnormal chromosomes, and for a test called MRD (minimal residual disease) analysis. A test called a lumbar puncture is done to see if the spinal fluid contains any leukaemia cells. A chest X-ray is also done, which will show if there are any enlarged glands in the chest. Other tests may be necessary, depending on your childs symptoms. These tests will help to identify the precise type of leukaemia and help doctors decide on the best treatment. Treatment The aim of treatment for ALL is to destroy the leukaemia cells and enable the bone marrow to work normally again. Chemotherapy is the main treatment for ALL and is given according to a treatment plan (often called a protocol or regimen). The treatment is given in several phases, or blocks. Induction This phase involves intensive treatment, aimed at destroying as many leukaemia cells as possible and is usually started within days of being diagnosed. The induction phase lasts 4 to 6 weeks. A bone marrow test is taken at the end of induction treatment to confirm whether or not the child still has leukaemia. The sample that is taken is looked at under a microscope and when there is no evidence of leukaemia, the childs condition is referred to as being in remission. Consolidation and central nervous system (CNS) treatment The next phase of treatment is aimed at maintaining the remission and preventing the spread of leukaemia cells into the brain and spinal cord (the central nervous system, or CNS). CNS treatment involves injecting a drug, usually methotrexate lumbar puncture. After this consolidation treatment there is a recovery period which is called interim maintenance. This is when more drugs will be given to try to keep the leukaemia in remission. The exact details will depend on which arm of treatment your child follows and will be discussed in detail by your childs doctor as it depends on your childs response to treatment so far. Further doses of chemotherapy treatment, called delayed intensification, are given to kill off any remaining leukaemia cells. Maintenance treatment This phase of treatment lasts for 2 years from the start of interim maintenance for girls and 3 years from the start of interim maintenance for boys. It involves the child taking daily and weekly tablets, some children also have monthly injections of chemotherapy and oral pulses of steroids and 3-monthly intrathecal treatment. Children will be able to take part in their normal daily activities as soon as they feel able to. Most children return to school before beginning maintenance treatment. Bone marrow transplantation Bone marrow treatment is only needed by a minority of patients and is used for children with ALL that is likely to come back following standard chemotherapy. Testicular radiotherapy In some situations, it may be necessary for boys to have radiotherapy to their testicles. This is because leukaemia cells can survive in the testicles despite chemotherapy. Central nervous system (CNS) radiotherapy Children who have leukaemia cells in their CNS when they are first diagnosed with ALL need more frequent lumbar punctures with intrathecal chemotherapy. Your childs specialist will discuss with you which treatment and how much of it your child needs, and will answer any questions you have. Side effects of treatment Many cancer treatments will cause side effects . This is because while the treatments are killing the cancer cells, they can also damage some normal cells. Some of the main side effects of chemotherapy are: hair loss reduction in the number of blood cells produced by the bone marrow, which can cause anaemia (increased risk of bruising, bleeding and infection loss of appetite feeling sick (nausea) and being sick (vomiting) Steroid medicines can also cause side effects such as: increased appetite mood changes and irritability weight gain muscle weakness (especially in the legs) Most side effects are temporary, and there are ways of reducing them and supporting your child through them. Your childs doctor or nurse will talk to you about any possible side effects. Its important to discuss any side effects your child is having with the team treating them, so that they know how your child is feeling. Late side effects of treatment A small number of children may develop late side effects, sometimes many years later. These include possible problems with puberty and fertility, a change in the way their heart works and a small increase in the risk of developing another cancer later in life. Your childs doctor or nurse will talk to you about any possible late side effects. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for ALL. If appropriate, your childs medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given enough time to decide if it is right for your child. Treatment guidelines Sometimes, clinical trials are not available for your child. This may be because a recent trial has just finished, or because the condition is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the UK. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Most children with ALL are cured. If the leukaemia recurs after initial treatment, it usually does so within the first three years. Further treatment can then be given. Long-term side effects (late side effects) are rare, and most children with ALL grow and develop normally. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor, who knows the situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience with cancer. The Parents Guide discusses these further and talks about how you can support your child.

Acute lymphoblastic leukaemia: Teenagers and young adults

Acute lymphoblastic leukaemia Illnesses and conditions Cancer Cancer types in teenagers and young adults Acute lymphoblastic leukaemia: Teenagers and young adults Acute lymphoblastic leukaemia: Teenagers and young adults Introduction Leukaemia, blood tests and bone marrow Tests for ALL Treating ALL Introduction This section is for teenagers and young adults and is about a type of cancer called acute lymphoblastic leukaemia (ALL). The other main type of leukaemia that can affect teenagers and young adults is acute myeloid leukaemia. If youre looking for information about ALL in people of all ages, please see our general ALL section. Leukaemia is a cancer of the white blood cells. In leukaemia, the process for making new white blood cells gets out of control.Immature white blood cells (called blasts) keep being made and build up in the bone marrow until there isnt enough room for the bone marrow to make healthy white blood cells, red blood cells and platelets. The body needs these cells to: help fight infection (white cells) carry oxygen from the lungs aroundthe body (red blood cells) stop cuts bleeding by clotting blood (platelets) Symptoms Many of the symptoms of ALL are caused by having fewer than normal healthy blood cells in the body. Symptoms can include: looking paler than usual and feeling tired because of too few red blood cells (anaemia) bruises you may bruise more easily and it could take longer for bleeding to stop, if you have less blood clotting cells (platelets) than normal infections because there are too few mature white blood cells to fight infection aches and pains in your bones swollen glands (lymph nodes) in your neck, under your arm or in your groin feeling unwell and run down fever and sweats you may have a high temperature without any obvious cause, such as an infection headaches and visual disturbance There can be other reasons you may have these symptoms. But if you are worried that you may have ALL, you should speak to your GP. Theyll examine you and refer you to a hospital if they think you need to see a specialist doctor. Causes Its not known exactly what causes ALL. Research is going on to try to find out. Young people with some genetic conditions, such as Downs syndrome or Li-Fraumeni syndrome, are at an increased risk of developing ALL. A genetic condition is something you are born with. If youre worried about ALL If you think you have some of the symptoms of ALL you should speak to your GP. They can talk to you about your symptoms and arrange any tests they think you might need. Leukaemia, blood tests and bone marrow To understand leukaemia, it can help to know a little about the blood and bone marrow. Leukaemia is a cancer of the white blood cells. All blood cells are made in the bone marrow, which is like a blood cell factory inside bones. A type of cell in the bone marrow, called a stem cell, can make any kind of blood cell your body needs. There are 3 main types of blood cells: white blood cells which help fight infection red blood cells which carry oxygen from the lungs around the body platelets which clot blood to stop cuts bleeding The bone marrow normally makes millions of blood cells every day. To begin with, these new blood cells, called blasts, are not fully developed (theyre immature). The main job of blast cells is to make more blood cells like themselves. They cant do any of the jobs that mature blood cells can do, like carrying oxygen or fighting infection. Blast cells normally stay inside the bone marrow until theyve matured into fully-developed blood cells. Once blood cells are mature, theyre ready to do their jobs. They leave the bone marrow and go into the bloodstream, where they can be carried to wherever theyre needed. How leukaemia develops In leukaemia, the process for making new white blood cells gets out of control and immature white blood cells (blasts) keep being made. They build up in the bone marrow until there isnt enough room for the bone marrow to make healthy white cells, red cells and platelets. Types of leukaemia Leukaemia is a cancer of the white blood cells. Healthy white blood cells are made from two types of blood cells: lymphoblasts that make lymphocytes myeloid cells (myeloblasts) that make other types of white blood cells such as neutrophils Leukaemias are named after the type of white blood cell that has become abnormal and started growing out of control. The most common types in teenagers and young adults are AML and ALL: acute myeloid leukaemia (AML) is leukaemia that starts from abnormal myeloid cells acute lymphoblastic leukaemia (ALL) is leukaemia that starts from abnormal lymphoblasts There are other types of leukaemia that are more common in older people. The information in this section is about ALL, but if you have a different type of leukaemia and want to know more,contact Macmillan . We also have more information about: symptoms and causes of ALL having tests for ALL being treated for ALL If youre looking for information about ALL in people of all ages, read our general ALL section. Tests for ALL Its important to remember that the symptoms of ALL can be caused by lots of different things. But you should go to your GP if youre worried. They can talk to you about your symptoms and arrange any tests they think you might need. Visiting your GP Your GP will examine you and arrange for you to have blood tests. There can be different reasons for your symptoms, so youll need a blood test to help diagnose acute lymphoblastic leukaemia (ALL). If you have ALL, a blood test will usually find leukaemia cells and youll be referred to a specialist at the hospital. This specialist is called a haematologist and is a doctor who treats people with blood problems. At the hospital The haematologist will examine you and ask you about your symptoms and any recent illnesses. They will also arrange for you to have some more tests. These may include: blood tests youll need more blood tests even if youve had some alreadyto look at the changes in the leukaemia cells and helpthe doctors decide on the best treatment for you bone marrow testto count the numbers of leukaemia cells in the bone marrowand get samples for cytogenetic and immunophenotyping testing lumbar puncture a small sample of the fluid that surrounds your brain and spinal cord is taken to check for leukaemia cells chest X-ray this may also be done to see if there are any swollen lymph nodes (glands) in your chest If you have ALL, you might need a few more tests to check how your body is working in general. These could be blood tests, or an ultrasound scan of the tummy (abdomen) to look at your liver, spleen and kidneys, and an echocardiogram (an ultrasound of the heart). This may seem like a lot of tests, but they give the doctors important information that will help them give you the right treatment. Waiting for test results can be a scary time, but understanding a little about them what will happen, how youll feel and when youll get the results can help you cope. Thinking about how you feel and getting support from family, friends or your specialist nurse and doctor can also make it a bit easier. You could also talk to a Macmillan cancer support specialist ontheir free helpline. We also have more information about: symptoms of ALL being treated for ALL leukaemia, blood cells and bone marrow If youre looking for information about ALL in people of all ages, readour general ALL section. Treating ALL The main treatment for acute lymphoblastic leukaemia (ALL) is chemotherapy . This means having anti-cancer drugs to destroy the leukaemia cells. Youll also have drugs called steroids , which help the chemotherapy to work. The treatment for ALL is pretty intensive at times and can cause unpleasant side effects. But youll be in close contact with the hospital when youre most likely to feel unwell and the staff will be able to help if things get tough. Dont feel you have to be brave. Be honest about how you are feeling with your doctors and nurses. They can give you medicines that can help you feel better. ALL is treated in3phases: getting rid of the leukaemia remission induction keeping the leukaemia away consolidation and delayed intensification therapy keeping the leukaemia away long-term continuing or maintenance therapy You usually start chemotherapy pretty quickly after finding out that you have ALL. Youll be in hospital for your treatment to begin with.If youre 18 or younger, youll be treated in a specialist Principal Treatment Centre (PTC) for teenagers and young adults (TYA).If youre 19 or older, youll be offered the choice of having treatment at the PTC or another hospital closer to home called a TYA designated hospital. Youll be given chemotherapy as tablets, by injection and into your bloodstream (intravenously). Youll also be given chemotherapy into the fluid around the spinal cord to make sure the leukaemia cells cant hide there. This is called central nervous system (CNS) therapy. Its also known as intrathecal therapy. Youll have a line put in to one of your main veins to make it easier for you to have intravenous treatment. Your nurses and doctors can also use the line to take blood samples for blood tests. There are different kinds of lines. Having chemotherapy can be hard. But the staff looking after you will give you medicines to help you cope with any side effects so you can stay strong enough to have treatment. And youll be given medicines to stop you feeling sick and antibiotics to help prevent infections. There will probably be times when you feel rough and other times when youll feel better. You might also feel upset, down or irritable. Talking to someone you trust can help you cope with these feelings. Being in hospital or coming up to hospital for clinics and treatment can be frustrating, especially when you miss out on stuff happening at school, college, university or work, or on things your friends are doing. You could try talking to your friends and family about this and see what they can do to help you. It can also help to talk to any new friends youve made who are going through similar experiences to you. We have more information about chemotherapy that has been written for people of all ages, not just teens and young adults. Getting rid of the leukaemia (remission induction) The first phase of your treatment is about getting rid of the leukaemia. Youll be given chemotherapy to kill as many leukaemia cells as possible. Remission means there is no sign of leukaemia cells in your blood or bone marrow. This type of treatment involves: chemotherapy to kill the leukaemia cells (including CNS therapy) steroids to help the chemotherapy work drugs (allopurinol or rasburicase) to help protect your kidneys from problems that can happen when lots of leukaemia cells are destroyed at once another tablet (for example ranitidine or lansoprazole) to stop indigestion or ulcers You need to stay in hospital during this phase of your treatment so the doctors can check how things are going. Treatment to get you into remission takes about5 weeks, sometimes a bit longer. Being in hospital that long can be really difficult at times. If youre struggling to cope, try and talk to your friends, family, doctors and nurses. Its important not to bottle up your feelings otherwise your might end up finding it hard to cope. Drugs you may be given include: vincristine asparaginase daunorubicin mercaptopurine methotrexate Side effects Different chemotherapy can cause different side effects. There is information about the specific ones inMacmillans chemotherapy section . Central nervous system therapy Chemotherapy given as tablets or into the blood can reach most places in your body. But it isnt good at getting into the brain or spinal cord (called the central nervous system or CNS). So youll be given treatment into the fluid that goes around the CNS to target any leukaemia cells that might be hiding there. This is called CNS therapy. CNS therapy is given during remission induction treatment (to get rid of the leukaemia) and continues right until the end of maintenance therapy. Chemotherapy is given into the fluid, called cerebrospinal fluid or CSF, around your spinal cord. Drug treatment given into the CSF is called intrathecal therapy. Its a bit like having a lumbar puncture but with chemotherapy added. A doctor puts a needle into the space between 2 small bones (vertebrae) near the bottom of your spine. Then they inject chemotherapy into the CSF. The CSF will carry the chemotherapy around your CNS so it can reach any leukaemia cells that might be there. The chemotherapy drug used for CNS therapy is called methotrexate. Side effects Most people dont have side effects after having intrathecal methotrexate. But occasionally it can cause headaches, dizziness, tiredness or blurry vision for a few hours. Rarely other side effects like seizures (fits), weakness of your arms or legs and changes in how awake you are can happen. But these almost always go away completely and you can still have the intrathecal injections in the future. Keeping leukaemia away This treatment is called consolidation and delayed intensification therapy. When youre in remission, it means the doctors cant see any leukaemia cells in your blood or bone marrow samples when they check them under the microscope. But there may still be leukaemia cells hiding in your body, so you need further treatment to get rid of these cells. Youll be given different types of chemotherapy drugs. This is so the leukaemia cells dont have a chance to get used to them (which is called drug resistance). This phase of treatment takes about 5 to 6 months. Most of the treatment can be given as an outpatient but you might need to stay in hospital for some parts of it. Drugs you may be given include: cyclophosphamide cytarabine (ara-C) mercaptopurine methotrexate vincristine asparaginase doxorubicin Side effects Chemotherapy does cause side effects. There is information about the specific ones inMacmillans chemotherapy section . Keeping the leukaemia away long term (maintenance therapy) This treatment is given to prevent the leukaemia from returning (known as relapse). The chemotherapy is given in low doses. You have it as an outpatient so you can keep doing all your normal, everyday activities when youre having maintenance therapy. Maintenance therapy is given in 12-week cycles. Youll have: mercaptopurine tablets each day methotrexate tablets once a week steroid tablets for 5 days every4weeks vincristine chemotherapy every 4 weeks methotrexate chemotherapy into your cerebrospinal fluid (CSF) every 12 weeks At the moment, boys have just over3 years of maintenance therapy and girls have just over2 years. This is because it takes a bit longer in boys to get rid of any remaining leukaemia cells. During this time, youll have regular check-ups usually every week or two to check if your drug doses need to be adjusted and to make sure youre OK. Very often, things like blood tests can be done at your GP practice or at home by a district nurse.

Acute myeloid leukaemia

Acute myeloid leukaemia Illnesses and conditions Cancer Cancer types in adults Acute myeloid leukaemia Acute myeloid leukaemia About acute myeloid leukaemia Symptoms of acute myeloid leukaemia Causes of acute myeloid leukaemia Diagnosing acute myeloid leukaemia Treating acute myeloid leukaemia Complications of acute myeloid leukaemia About acute myeloid leukaemia Leukaemia is cancer of the white blood cells. Acute leukaemia means it progresses rapidly and aggressively, and usually requires immediate treatment. Acute leukaemia is classified according to the type of white blood cells affected. The 2 main types of white blood cells are: lymphocytes mostly used to fight viral infections myeloid cells which perform a number of different functions, such as fighting bacterial infections, defendingthe body against parasites and preventing the spread of tissue damage This topic focuses on acute myeloid leukaemia (AML), which is an aggressivecancer of the myeloid cells. The following types of leukaemia are covered separately: acute lymphoblastic leukaemia chronic myeloid leukaemia chronic lymphocytic leukaemia Signs and symptoms of AML The symptoms of AML usually develop over a few weeks and become increasingly more severe. Symptoms can include: pale skin tiredness breathlessness frequent infections unusual and frequent bleeding, such as bleeding gums or nosebleeds In more advanced cases, AML can make you extremely vulnerable to life-threatening infections or serious internal bleeding. Read more about the complications of AML Seeking medical advice You should see your GP if you or your child have possible symptomsof AML. Although its highly unlikely that leukaemia is the cause,these symptoms should be investigated. If your GP thinks you may have leukaemia, theyll arrange blood tests to check your blood cell production. If the tests suggest theres a problem, youll be urgently referred to a haematologist (a specialist in treating blood conditions) for further tests and any necessary treatment. Read more about diagnosing AML What causes AML? AMLoccurs when specialised cells called stem cells, which are found in the bone marrow (a spongy material inside the bones),produce too many immature white blood cells. These immature cells are known as blast cells. Blast cells dont have the infection-fighting properties of healthy white blood cells, and producing too many canlead to adecrease in the number of red blood cells (which carry oxygen in the blood) and platelets (cells that help the blood to clot). Its not clear exactly why this happens and, in most cases, theres no identifiable cause. However,a number of factors that can increase your risk of developing AML have been identified. These include: previous chemotherapy or radiotherapy exposure to very high levels of radiation(including previous radiotherapytreatment) exposure to benzene a chemical used in manufacturing thats also found in cigarette smoke having an underlying blood disorder or genetic disorder, such as Downs syndrome Read more about the causes of AML Whos affected AMLis a rare type of cancer.The risk of developing AML increases withage. Itsmost common in people over 65. How AML is treated AML is an aggressive type of cancer that can develop rapidly, so treatment usually needs to begin soon after a diagnosis is confirmed. Chemotherapy is the main treatment for AML. Its used to kill as many leukaemia cells in your body as possible and reduce the risk of the condition coming back (relapsing). In some cases, intensive chemotherapy and radiotherapy may be needed, in combination with a bone marrow or stem cell transplant , to achieve a cure. Read more about treating AML Symptoms of acute myeloid leukaemia The symptoms of acute myeloid leukaemia (AML) usually develop over a few weeks, becoming more severe as the number of immature white blood cells (blast cells) in your blood increases. Symptoms of AML caninclude: pale skin tiredness breathlessness a high temperature (fever) excessive sweating weight loss frequent infections unusual and frequent bleeding, such as bleeding gums or nosebleeds easily bruised skin flatred or purple spots on the skin (petechiae) bone and joint pain a feeling of fullness or discomfort in your tummy (abdomen), caused by swelling of the liver or spleen Inrare cases of AML, the affected cells can spread into the central nervous system. This can cause symptoms such as headaches , fits (seizures), vomiting, blurred vision and dizziness. When to seek medical advice See your GP if you or your child have these symptoms. Although its highly unlikely that AML is the cause, these symptoms need to be investigated and treatedpromptly. Causes of acute myeloid leukaemia Acute myeloid leukaemia (AML) is caused by a DNA mutation in the stem cells in your bone marrow that produce red blood cells, platelets and infection-fighting white blood cells. The mutationcauses the stem cellsto produce many more white blood cells that are needed. The white blood cells produced are still immature, so they dont have the infection-fighting properties of fully developed white blood cells. These immature cells are known as blast cells. As the number of immature cells increases, the amount of healthy red blood cells and platelets decrease, and its this fall that causes many of the symptoms of leukaemia . Increased risk Its not known what triggers the genetic mutationin AML, although a number of different factors thatcan increase your risk of developing the condition have been identified. The main risk factors for AML areoutlined below. Radiation exposure Being exposed toa significant level of radiationcan increase your chances of developing AML, although this usually requires exposureat very high levels. For example, rates of AML are higher in people who survivedthe atomic bomb explosions in Japan in 1945. In the UK, most peopleare unlikely to be exposed to levels of radiation high enough to cause AML.However, some people who have had radiotherapy as part of their treatment for previous cancer (see below) can be the exception. Benzene and smoking Exposure to the chemical benzene is a known risk factor for AML in adults. Benzene is found in petrol, and its also used in the rubber industry, although there are strict controls to protect people from prolonged exposure. Benzene is also found in cigarette smoke, which could explain why people who smoke have an increased risk of developing AML. Previous cancer treatment Treatment with radiotherapy and certain chemotherapy medications foran earlier, unrelated cancer can increase your risk of developing AML many years later. Leukaemia that develops as a result of previous cancer treatment is called secondary leukaemia or treatment-related leukaemia. Blood disorders People with certain blood disorders such as myelodysplasia, myelofibrosis or polycythaemia vera (PCV) have an increased risk of developing AML. Genetic disorders People with certain genetic disorders, including Downs syndrome and Fanconis anaemia, have an increased risk of developing leukaemia. Other suggested triggers A number of other environmental factors that could trigger AML have also been suggested, including childhood vaccinations and living near a nuclear power station or a high-voltage power line. However, theres no clearevidence to suggest that these can increase your risk of developing AML. Diagnosing acute myeloid leukaemia In the initial stages of diagnosing acute myeloid leukaemia (AML), your GP will check for physical signs of the condition and arrange for you to have blood tests . A high number of abnormal white blood cells, or a very low blood count in the test sample, could indicate the presence of leukaemia. If this is the case, youll be urgently referred to a haematologist (a specialist in treating blood conditions). A haematologist may carry out further blood tests, in addition to some of the tests outlined on this page. Bone marrow biopsy To confirm a diagnosis of AML, the haematologist will take a small sample of your bone marrow to examine under a microscope. This procedure is known as a bone marrow biopsy, which is usually carried out under a local anaesthetic . The haematologist will numb an area of skin at the back of your hip bone, before using a thin needle to remove a sample of liquid bone marrow. In some cases, a larger needle may also be used to remove a small amount of bone and bone marrow together. You wont feel any pain during the procedure, but you may experience some bruising and discomfort for a few days afterwards. The procedure takes around 15 minutes to complete, and you shouldnt have to stay in hospital overnight. The bone marrow sample will be checked for cancerous cells. If cancerous cells are present, the biopsy can also be used to determine the type of leukaemia you have. Further tests Additional tests can be used to reveal more information about the progress and extent of your AML. They can also provide insight into how the condition should be treated. These tests are described below. Genetic testing Genetic tests can be carried out on blood and bone marrow samples to identify the genetic makeup of the cancerous cells. There are many specific genetic variations that can occur in AML, and knowing the exact type of AML you have can help doctors make decisions about the most appropriate treatment. For example, people who have a type of AML known as acute promyelocytic leukaemia (APML) are known to respond well to a medicine called All Trans-Retinoic Acid (ATRA). Scans If you have AML, a computerised tomography (CT) scan , X-ray or echocardiogram (an ultrasound scan of the heart) may be used to check that your organs, such as your heart and lungs, are healthy. These tests are carried out because its important for doctors to assess your general health before they can decide on the most appropriate treatment for you. Lumbar puncture In rare situations where its thought theres a risk that AML has spread to your nervous system, a lumbar puncture may be carried out. In this procedure, a needle is used to extract a sample of cerebrospinal fluid (which surrounds and protects your spine) from your back, so it can be checked for cancerous cells. If cancerous cells are found in your nervous system, you may need to have injections of chemotherapy medication directly into your cerebrospinal fluid as part of your treatment. Treating acute myeloid leukaemia Acute myeloid leukaemia (AML) is an aggressive condition that develops rapidly, so treatment will usually begin a few days after a diagnosis has been confirmed. As AML is a complex condition, its usually treated by a multidisciplinary team (MDT) a group of different specialists working together. Your treatment plan Treatment for AML is often carried out in 2 stages: induction the aim of this initial stage of treatment is to kill as many leukaemia cells in your blood and bone marrow as possible, restore your blood to proper working order and treat any symptoms you may have consolidation this stage aims to prevent the cancer returning (relapsing), by killing any remaining leukaemia cells that may be present in your body The induction stage of treatment isnt always successful and sometimes needs to be repeated before consolidation can begin. If you have a relapse after treatment, both re-induction and consolidation may need to be carried out. This may be the same as your first treatment, although its likely to involve different medications or a stem cell transplant. If youre thought to have a high risk of experiencing complications of AML treatment for example, if youre over 75 years of age or have another underlying health condition less intensive chemotherapy treatment may be carried out. This is less likely to successfully kill all of the cancerous cells in your body, but it can help control your condition. Induction The initial treatment you have for AML will largely depend on whether youre fit enough to have intensive chemotherapy , or whether treatment at a lower dosage is recommended. Intensive chemotherapy If you can have intensive induction chemotherapy, youll usually be given a combination of chemotherapy medication at a high dose to kill the cancerous cells in your blood and bone marrow. This stage of treatment will be carried out in hospital or in a specialist centre, as youll need very close medical and nursing supervision. Youll have regular blood transfusions because your blood wont contain enough healthy blood cells. Youll also be vulnerable to infection, so its important that youre in a clean and stable environment where your health can be carefully monitored and any infection you have can be promptly treated. You may also be prescribedantibiotics to help prevent further infection. Depending on how well you respond to treatment, the induction phase can last from four weeks to a couple of months. You may be able to leave hospital and receive treatment on an outpatient basis if your symptoms improve. For intensive treatment, the chemotherapy medications will be injected into a thin tube thats inserted either into a blood vessel near your heart (central line) or into your arm (a peripherally inserted central catheter, or PICC). In very rare cases, chemotherapy medication may also be directly administered into your cerebrospinal fluid to kill any leukaemia cells that may have spread to your nervous system. This is done using a needle thats placed into your spine, in a similar way to a lumbar puncture . Side effects of intensive chemotherapy for AML are common. They can include: nausea vomiting diarrhoea loss of appetite sore mouth and mouth ulcers (mucositis) tiredness skin rashes hair loss infertility which may be temporary or permanent (see complications of AML for more information) Most side effects should resolve once treatment has finished. Tell a member of your care team if side effects become particularly troublesome, as there are medicines that can help you cope better with certain side effects. Read more about the side effects of chemotherapy Non-intensive chemotherapy If your doctors dont think youre fit enough to withstand the effects of intensive chemotherapy, they may recommend non-intensive treatment. This involves using an alternative type of chemotherapy to the standard intensive therapy, whichis designed more to control leukaemia rather than cure it. The main aim of this treatment is to control the level of cancerous cells in your body and limit any symptoms you have, while reducing your risk of experiencing significant side effects of treatment. The medications used during non-intensive chemotherapy may be given through a drip into a vein, by mouth or by injection under the skin, and can often be given on an outpatient basis. All Trans-Retinoic Acid (ATRA) If you have the sub-type of AML known as acute promyelocytic leukaemia, youll usually be given capsules of a medicine called ATRA, in addition to chemotherapy. ATRA works by changing the immature white blood cells (blast cells) into mature healthy cells, and can reduce symptoms very quickly. Side effects of ATRA can include headaches , nausea, bone pain, and dry mouth , skin and eyes. Consolidation If induction is successful, the next stage of treatment will be consolidation. This often involves receiving regular injections of chemotherapy medication that are usually given on an outpatient basis, which means that you wont have to stay in hospital overnight. However, you may need some short stays in hospital if your symptoms suddenly get worse or if you develop an infection. The consolidation phase of treatment lasts several months. Other treatments Many other treatments are used for AML. Radiotherapy Radiotherapy involves using high doses of controlled radiationto kill cancerous cells. There are 2 main reasons why radiotherapy is usually used to treat AML: to prepare the body for a bone marrow or stem cell transplant to treat advanced cases that have spread to the nervous system and/or brain, although this is uncommon Side effects of radiotherapy can include hair loss, nausea and fatigue. The side effects should pass once your course of radiotherapy has been completed. Bone marrow and stem cell transplants If chemotherapy doesnt work, a possible alternative treatment option is a bone marrow or stem cell transplant . Before transplantation can take place, the person receiving the transplant will need to haveintensive high-dose chemotherapy and possibly radiotherapy to destroy the cells in their bone marrow. The donated stem cells are given through a tube into a blood vessel, in a similar way to chemotherapy medication. This process can put an enormous amount of strain on the body and cause significant side effects and potential complications, so youll usually need to stay in hospital for a few weeks. Transplantations have better outcomes if the donor has the same tissue type as the person receiving the donation. The best candidate to provide a donation is usually a brother or sister with the same tissue type. Transplantations are most successful when theyre carried out on children and young people, or older people who are otherwise in good health, and when theres a suitable donor, such as a brother or sister. Readabout bone marrow donation Azacitidine Azacitidine is a possible alternative treatment for adults with AML who cant have a stem cell transplant. Its recommended by the National Institute for Health and Care Excellence (NICE) for usein certain circumstances for example, depending on the characteristics of the persons blood and bone marrow. Azacitidine is a chemotherapy medication thats given by injection under the skin. It interferes with the growth of cancer cells and destroys them, and also helps bone marrow to produce normal blood cells. NICE hasmore information about azacitidine for the treatment of AML Clinical trials andnewer unlicensed treatments In the UK, a number of clinical trialsare currently underway that aim to find the best way of treating AML. Clinical trials are studies that use new and experimental techniques to see how well they work in treating, and possibly curing, AML. As part of your treatment, your care team may suggest taking part in a clinical trial to help researchers learn more about the best way to treat yourAML, and AML in general. Search for clinical trials for AML . If you take part in a clinical trial, you may be offered medication that isnt licensed for use in the UK and isnt normally available. However, theres no guarantee that the techniques being studied in the clinical trial will work better than current treatments. Your care team can tell you whether there are any clinical trials available in your area, and can explain the benefits and risks involved. Complications of acute myeloid leukaemia If you have acute myeloid leukaemia (AML), you may experience a number of complications. These can be caused by the condition itself, although they can also occur as a side effect of treatment. Weakened immune system Having a weakened immune system being immunocompromised is a common complication of AML. Even if your blood is restored to normal working order with treatment, many of the medications that are used to treatAML can temporarily weaken your immune system. This means youre more vulnerable to developing an infection, and any infection you develop could be more serious than usual. Complications arising from infection are the leading cause of death in people with AML. However, if treated early, nearly all infections respond to appropriate treatment. Therefore, you may be advised to: take regular doses of antibiotics to prevent bacterial infections maintain good personal and dental hygiene avoid contact with anyone whosknown to have an infection even if its a type of infection that you were previously immune to, such as chickenpox or measles check with your GP to ensure that all of your vaccinations are up to date, althoughyou wont be able to have any vaccine that contains live viruses or bacteria, such as the shingles vaccine and MMR vaccine (against measles, mumps and rubella) Report any possible symptoms of an infectionto yourtreatment unit immediately because prompt treatment may be needed to prevent complications. Symptoms of an infection caninclude: a high temperature (fever) a headache aching muscles diarrhoea tiredness Bleeding If you have AML, youll bleed and bruise more easily due to the low levels of platelets (clot-forming cells) in your blood. Bleeding may also be excessive. People with advanced AML are morevulnerable to excessive bleeding inside their body, which is the second most common cause of death in people with the condition. Serious bleeding can occur: insidethe skull (intracranial haemorrhage) causing symptoms such as asevere headache, stiff neck, vomiting and confusion inside the lungs (pulmonary haemorrhage) causingsymptoms such as coughing up blood,breathing difficulties and abluish skin tone (cyanosis) inside the stomach (gastrointestinal haemorrhage) causing symptoms such asvomiting blood andpassing stools (faeces) that are very dark or tar-like in colour All these types of haemorrhage should be regarded as medical emergencies. Dial 999 immediately and ask for an ambulance if you think a haemorrhage is occurring. Infertility Many of the treatments that are used to treat AML can cause infertility .This is often temporary, but in some cases can be permanent. People who are particularly at risk of permanent infertility, are those who have received high doses of chemotherapy and radiotherapy in preparation for a bone marrow or stem cell transplant . Your treatment team can give a good estimation of the risk of infertility in your specific circumstances. It may be possible to guard against any risk of infertility before you begin your treatment. For example, men can have their sperm samples stored. Similarly, women can have eggs orfertilised embryos stored, which can then be placed back into their womb, following treatment. However, as AML is an aggressive condition that develops rapidly, there may not always be time to do this before treatment needs to start.

Acute myeloid leukaemia: Children

Acute myeloid leukaemia: Children Illnesses and conditions Cancer Cancer types in children Acute myeloid leukaemia: Children Acute myeloid leukaemia: Children Acute myeloid leukaemia (AML) is a type of blood cancer. A third of all childhood cancers are leukaemia. Less than a quarter of these are acute myeloid leukaemia (AML). AML can affect children of any age. Girls and boys are equally affected More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information and if you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. Leukaemia Leukaemia is a cancer of the white blood cells. All blood cells are produced in the bone marrow, the spongy substance at the core of some of the bones in the body. Bone marrow contains: red blood cells, which carry oxygen around the body platelets, which help the blood to clot and control bleeding white blood cells, which help to fight infection There are 2 different types of white blood cells: lymphocytes and myeloid cells (including neutrophils). These white blood cells work together to fight infection. Normally, white blood cells develop, repair and reproduce themselves in an orderly and controlled way. In leukaemia, however, the process gets out of control and the cells continue to divide in the bone marrow, but do not mature. These immature dividing cells fill up the bone marrow and stop it from making healthy blood cells. As the leukaemia cells are not mature, they cannot work properly. This leads to an increased risk of infection. There are 4 main types of leukaemia: acute lymphoblastic (ALL) acute myeloid (AML) chronic lymphocytic (CLL) chronic myeloid (CML) Chronic leukaemias occur mostly in adults. CLL is exclusively an adult condition, whereas CML does occur rarely in children and young people. Each type of leukaemia has its own characteristics and treatment. This page is about acute myeloid leukaemia (AML). Acute myeloid leukaemia (AML) Acute myeloid leukaemia is an overproduction of immature myeloid white blood cells (blast cells). Cells that have started to show some of the features of myeloid cells are said to show differentiation. Cells that do not show signs of becoming a particular type of white blood cell are known as undifferentiated. There are different sub-types of AML, depending on exactly which type of cell has become leukaemic, the stage of development (maturation) the cells are at, and whether the cells are differentiated. Knowing the sub-type of AML is important, as it helps doctors decide on the best treatment. There are several classification systems for the sub-types of AML. The most commonly used system in the UK is the French-American-British (FAB) system. FAB classification of AML M0 AML with minimal evidence of myeloid differentiation M1 AML without maturation M2 AML with maturation M3 Acute promyelocytic leukaemia (APL) M4 Acute myelomonocytic leukaemia M5 Acute monocytic/monoblastic leukaemia M6 Acute erythroleukaemia M7 Acute megakaryoblastic leukaemia A newer system known as the WHO (World Health Organization) classification system is also sometimes used. Causes The exact cause of AML is unknown. Research into possible causes of this disease is ongoing. Children with certain genetic disorders, such as Downs syndrome or Li-Fraumeni syndrome, are known to have a higher risk of developing leukaemia. Brothers and sisters of a child with AML have a slightly increased risk of developing it, although this risk is still small. Other non-cancerous conditions, such as aplastic anaemia or the myelodysplastic syndromes (MDS), may increase a childs risk of developing AML. AML, like all types of cancer, is not infectious and cannot be passed on to other people. Signs and symptoms As the leukaemia cells multiply in the bone marrow, the production of normal blood cells is reduced. Children may therefore become tired and lethargic because of anaemia, which is caused by a lack of red blood cells. Children may develop bruises, and bleeding may take longer to stop because of the low number of platelets present in their blood. Sometimes they may suffer from infections because of low numbers of normal white blood cells. A child is likely to feel generally unwell and may complain of aches and pains in the limbs or may have swollen lymph glands. At first, the symptoms are just like those of a viral infection, but when they continue for more than a week or two, the diagnosis usually becomes clear. How AML is diagnosed A blood test usually shows low numbers of normal white blood cells and the presence of abnormal leukaemia cells. A sample of bone marrow is needed to confirm the diagnosis. The bone marrow sample is also examined to check for any abnormalities in the chromosomes of the leukaemia cells. A test called a lumbar puncture is done to see if the spinal fluid contains any leukaemia cells. A chest X-ray is also done, which will show if there are any enlarged glands in the chest. Other tests may be necessary, depending on your childs symptoms. These tests will help to identify the precise type of leukaemia, and help doctors to decide on the best treatment. Treatment The aim of treatment for AML is to destroy the leukaemia cells and enable the bone marrow to work normally again. Chemotherapy is the main treatment for AML. Usually a combination of chemotherapy drugs is given, according to a treatment plan (often called a protocol or regimen). The treatment usually has different phases. Induction This phase involves intensive treatment, aimed at destroying as many leukaemia cells as possible. It usually involves 2 courses (cycles) of a combination of chemotherapy drugs. A bone marrow test is taken at the end of induction treatment to confirm whether or not the child still has leukaemia. When there is no evidence of leukaemia, the childs condition is referred to as being in remission. Post-remission treatment When there are no signs of the leukaemia in the blood or bone marrow, further treatment is often given. This phase of the treatment aims to destroy any leukaemia cells that may be left and to help stop the AML from coming back. This treatment usually involves 2 more courses of chemotherapy. Bone marrow transplant This treatment is usually only used for children with AML that is likely to come back or has come back (recurred) following standard chemotherapy. Central nervous system (CNS) treatment AML may sometimes develop in the brain and spinal cord. This can be prevented by injecting chemotherapy drugs directly into the spinal fluid during a lumbar puncture (intrathecal chemotherapy). Intrathecal chemotherapy is usually given after each of the first 2 courses of chemotherapy. Sometimes a more intensive treatment is needed, and the intrathecal drugs are given more frequently until all the regular chemotherapy has been completed. Occasionally, radiotherapy to the brain is also necessary. Side effects of treatment Many cancer treatments will cause side effects . This is because while the treatments are killing the cancer cells, they can also damage some normal cells. Some of the main side effects are: hair loss reduction in the number of blood cells produced by the bone marrow, which can cause anaemia (increased risk of bruising, bleeding and infection) loss of appetite and weight feeling sick (nausea) and being sick (vomiting) Most side effects are temporary, and there are ways of reducing them and supporting your child through them. Your childs doctor or nurse will talk to you about side effects. Late side effects of treatment A small number of children may develop late side effects, sometimes many years later. These include possible problems with puberty and fertility, a change in the way the heart works, and a small increase in the risk of developing a second cancer in later life. Your childs doctor or nurse will talk to you about any possible late side effects. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for AML. If appropriate, your childs medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is often provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide if its right for your child. Treatment guidelines Sometimes, clinical trials are not available for your childs cancer. This may be because a recent trial has just finished, or because the cancer is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Many children with AML are cured. If the leukaemia comes back after initial treatment, it usually does so within the first 3 years. Most children with AML grow and develop normally. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor, who knows the situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to addresshere all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience of cancer. The Parents Guide discusses these further and talks about how you can support your child.

Acute myeloid leukaemia: Teenagers and young adults

Acute Myeloid Leukaemia in young adults Illnesses and conditions Cancer Cancer types in teenagers and young adults Acute myeloid leukaemia: Teenagers and young adults Acute myeloid leukaemia: Teenagers and young adults Introduction Leukaemia, blood tests and bone marrow Tests for AML Treating AML Introduction This section is for teenagers and young adults and is about a type of cancer called acute myeloid leukaemia (AML). The other main type of leukaemia that can affect teenagers and young adults is acute lymphoblastic leukaemia . For information about AML in people of all ages,read our general AML section. Leukaemia is a cancer of the white blood cells. In leukaemia, the process for making new white blood cells gets out of control. Immature white blood cells (called blasts) keep being made and build up in the bone marrow until there isnt enough room for the bone marrow to make healthy white blood cells, red blood cells and platelets. The body needs these cells to: help fight infection (white cells) carry oxygen from the lungs around the body (red blood cells) stopcuts bleeding by clotting blood (platelets) Symptoms Many of the symptoms of AML are caused by having fewer than normal healthy blood cells in the body. Symptoms can include: looking paler than usual and feeling tired because of too few red blood cells (anaemia) bruises or bleeding you may bruise more easily and it could take longer for bleeding to stop, if you have less blood clotting cells (platelets) than normal infections because there are too few mature white blood cells to fight infection aches and pains in your bones swollen glands (lymph nodes) in your neck, under your arm or in your groin feeling unwell and run down fever and sweats you may have a high temperature without any obvious cause, such as an infection headaches and blurred vision because of too many white blood cells breathlessness because of too many white blood cells. Causes Its not knownexactly what causes AML. Research is going on to try to find out. We do know some things might increase the risk of AML: some genetic conditions, like Downs Syndrome (agenetic condition is something you are born with) some non-cancerous conditions of the bone marrow, such as aplastic anaemia or myelodysplastic syndromes If youre worried about AML If you think you might have any of the symptoms of AML, you should go to your GP. Theyll talk to you about your symptoms, examine you and can arrangetests or refer you to see a specialist.Remember that the symptoms can be caused by other things, but its important to go and get checked if you are worried. Leukaemia, blood tests and bone marrow To understand leukaemia, it can help to know a little about the blood and bone marrow. Leukaemia is a cancer of the white blood cells. All blood cells are made in the bone marrow, which is like a blood cell factory inside bones. A type of cell in the bone marrow, called a stem cell, can make any kind of blood cell your body needs. There are3 main types of blood cells: white blood cells which help fight infection red blood cells which carry oxygen from the lungs around the body platelets which clot blood to stop cuts bleeding The bone marrow normally makes millions of blood cells every day. To begin with, these new blood cells, called blasts, are not fully developed (theyre immature). The main job of blast cells is to make more blood cells like themselves. They cant do any of the jobs that mature blood cells can do, like carrying oxygen or fighting infection. Blast cells normally stay inside the bone marrow until theyve matured into fully-developed blood cells. Once blood cells are mature, theyre ready to do their jobs. They leave the bone marrow and go into the bloodstream, where they can be carried to wherever theyre needed. How leukaemia develops In leukaemia, the process for making new white blood cells gets out of control and immature white blood cells (blasts) keep being made. They build up in the bone marrow until there isnt enough room for the bone marrow to make healthy white cells, red cells and platelets. Types of leukaemia Leukaemia is a cancer of the white blood cells. Healthy white blood cells are made from2 types of blood cells: lymphoblasts that make lymphocytes myeloid cells (myeloblasts) that make other types of white blood cells such as neutrophils Leukaemias are named after the type of white blood cell that has become abnormal and started growing out of control. The most common types in teenagers and young adults are AML and ALL: acute myeloid leukaemia(AML) is leukaemia that starts from abnormal myeloid cells acute lymphoblastic leukaemia (ALL) is leukaemia that starts from abnormal lymphoblasts There are other types of leukaemia that are more common in older people. The information in this section is about ALL, but if you have a different type of leukaemia and want to know more,contact Macmillan . We also have more information about: symptoms and causes of AML having tests for AML being treated for AML If youre looking for information about ALL in people of all ages, read general AML section. Tests for AML You should speak to your GP as soon as possible if you think you have some of the symptoms of AML. But remember that the symptoms of AML can be caused by other things. Visiting your GP Your GP will examine you and arrange for you to have blood tests. There can be different reasons for your symptoms, so youll need to have a blood test to help diagnose acute myeloid leukaemia (AML). If you have AML, a blood test will usually find leukaemia cells and youll be referred to a specialist at the hospital. This specialist is called a haematologist and is a doctor who treats people with blood disorders. At the hospital The haematologist will examine you and ask you about your symptoms and any recent illnesses. They will also arrange for you to have some more tests. These may include: blood tests youll need more blood tests even if youve had some already tolook at the changes in the leukaemia cells and help the doctors decide on the best treatment for you; these tests may be called cytogenetics and immunophenotyping bone marrow test to count the numbers of leukaemia cells in the bone marrowand get send samples for cytogenetic and immunophenotyping testing lumbar puncture a small sample of the fluid that surrounds your brain and spinal cord is taken to check for leukaemia cells chest X-ray this may also be done to see if there are any swollen lymph nodes (glands) in your chest If you have AML, you might need a few more tests to check how your body is working in general. These could be blood tests, an ultrasound scan of the tummy (abdomen) to look at your liver, spleen and kidneys, or an echocardiogram (which is an ultrasound of the heart). This may seem like a lot of tests, but they give the doctors important information that will help them give you the right treatment. Waiting for test results can be a scary time, but understanding a little about them what will happen, how youll feel and when youll get the results can help you cope. Thinking about how you feel and getting support from family, friends or your specialist nurse and doctor can also make it a bit easier. You could also talk to a cancer support specialist on Macmillans free helpline . We also have more information about: symptoms and causes of AML being treated for AML leukaemia, blood cells and bone marrow If youre looking for information about AML in people of all ages, read our general AML section. Treating AML The main treatment for acute myeloid leukaemia (AML) is chemotherapy. This means having anti-cancer drugs to destroy the leukaemia cells. Youll also have drugs called steroids, which help the chemotherapy to work. The treatment for AML is pretty intensive at times and can cause unpleasant side effects. But youll be in hospital when youre most likely to feel unwell, and the staff can help if things get tough. Dont feel you have to be brave. Be honest about how youre feeling with your doctors and nurses. They can give you medicines to help you feel better. There are different phases of treatment for AML: getting rid of the leukaemia remission induction keeping the leukaemia away consolidation and delayed intensification therapy central nervous system (CNS) therapy (mainly for teenagers under 16) Very often, treatment is given as part of a clinical trial or research study, but it will be your decision whether to take part in the trial or not. Clinical trials help doctors to keep improving treatment for leukaemia. You usually start chemotherapy pretty quickly after finding out that you have AML. Youll be in hospital for your treatment to begin with.If youre 18 or younger, youll be treated in a specialist Principal Treatment Centre (PTC) for teenage and young adults (TYA).If youre 19 or older, youll be offered the choice of having treatment at the PTC or another hospital closer to home called a TYA designated hospital. Most chemotherapy for AML is given into the bloodstream (intravenously). So youll have a line put into one of your main veins to make it easier for you to have intravenous chemotherapy. There are different kinds of lines. Youll also be given chemotherapy into the fluid around your spinal cord and brain. This is to get rid of any leukaemia cells that might be hiding there. This type of treatment is called central nervous system (CNS) therapy. Having chemotherapy can be hard, but the staff looking after you will give you medicines to help you cope with any side effects so you can stay strong enough to have treatment. And youll be given medicines to help you feel less sick and antibiotics to help prevent infections. There will probably be times when you feel rough and other times when youll feel better. You might also feel upset, down or irritable. Talking to someone you trust can help you cope with these feelings. Being in hospital for long periods can be frustrating, especially when you miss out on stuff happening at school, college, university or work or on things your friends are doing. You could try talking to your friends and family about this and see what they can do to help you. Getting rid of the leukaemia (remission induction) The first phase of your treatment is about getting rid of the leukaemia. Youll be given chemotherapy to kill as many leukaemia cells as possible. Remission means there is no sign of leukaemia cells in your blood or bone marrow. You have chemotherapy over a few days, then you have a few weeks off so that your body can recover from any side effects. The days you have the chemotherapy and the rest period afterwards is called a cycle. Youll usually have4 cycles of chemotherapy overall with2 courses in the induction phase. Some people might also need to have a bone marrow transplant. This normally happens after 2 cycles of chemotherapy. Youll probably need to stay in hospital most of the time that youre having remission induction. This is so that the doctors can check how things are going. Chemotherapy drugs Drugs you may have include: cytarabine (Ara-C) daunorubicin, doxorubicin or idarubicin etoposide thioguanine Side effects Different chemotherapy can cause different side effects. There is information about the specific ones inMacmillans chemotherapy section . As well as the chemotherapy drugs, youll be given other drugs to: help prevent you from feeling sick or being sick help prevent infections protect your kidneys as sometimes when lots of leukaemia cells are destroyed at once it can cause kidney problems Youll probably also need blood and platelet transfusions to top up the numbers of red cells and platelets in your blood. Chemotherapy can cause side effects. Most of them are short-term (temporary) and gradually disappear once treatment stops. The most common side effects are: being more at risk of infections feeling sick hair loss a sore mouth Sometimes side effects can be long-term. For example, some chemotherapy treatments can affect fertility (your ability to have a baby). If you are a young man, you will be offered the chance to store sperm before chemotherapy is started. There may be other late effects of treatment and your specialist can talk to you about this. Remission induction is pretty intense treatment and youll probably feel a bit wiped out sometimes. Youll need to stay in hospital for most of the time and you might not have the energy to do much. You might feel fed up, tearful or irritable. Its normal to feel like this. Its hard to be in hospital and you might worry about losing touch with your friends or falling behind at school or college. It can help to talk about this with a friend, doctor, nurse or counsellor. Keeping the leukaemia away (post-remission treatment) This phase of treatment is sometimes also called consolidation or intensification treatment. Its given to prevent the leukaemia from returning (known as a relapse). When youre in remission, it means the doctors cant see any leukaemia cells in your blood or bone marrow samples under the microscope. But there may still be leukaemia cells hiding in your body, so further treatment is needed to get rid of these cells. You start post-remission treatment soon after you complete remission induction. Youll usually have2 courses of treatment. You might be given the same chemotherapy drugs youve had before (perhaps at similar or higher doses) or you might be given different chemotherapy drugs. When your doctors decide what chemotherapy treatment plan to give you, they will take into account: how well your leukaemia responded to the first lot of treatment (remission induction) the results of the tests that were done when you were diagnosed The following drugs may be used to treat you: cytarabine (ara-C) methotrexate Central nervous system therapy (CNS) You usually wont need this treatment if youre 16 or over. But if youre under 16, youll probably have it. CNS therapy is given to get rid of any leukaemia cells that might be in the brain or spinal cord. (The CNS or central nervous system is the name for the brain and spinal cord.) CNS therapy involves giving chemotherapy into the fluid, called cerebrospinal fluid or CSF, around the spinal cord and brain. Its a bit like having a lumbar puncture but with chemotherapy added. A doctor puts a needle into the space between two small bones (vertebrae) near the bottom of your spine. Then they inject chemotherapy into the CSF. The CSF will carry the chemotherapy around your CNS so it can reach any leukaemia cells that might be there. Youll have a lumbar puncture before you start treatment to check for leukaemia cells in the CSF. If there is no sign of leukaemia cells, youll have2 lots of CNS therapy,1 after each cycle of remission induction therapy. If there are leukaemia cells in the CSF, youll have CNS therapy twice a week until all traces of leukaemia cells in your CSF have gone. Youll then have2 more lots of CNS therapy just to make sure. For CNS therapy for AML, youll have chemotherapy drugs called methotrexate and cytarabine and a steroid called hydrocortisone. Side effects The most common side effect is feeling sick but you can be given anti-sickness treatment to help this. Rarer side effects include a headache, dizziness, tiredness or blurry vision for a few hours afterwards. We also have more information about: symptoms and causes of AML having tests for AML leukaemia, blood cells and bone marrow If youre looking for information about AML in people of all ages, read our general AML section.

Acute pancreatitis

Acute pancreatitis Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Acute pancreatitis Acute pancreatitis About acute pancreatitis Symptoms of acute pancreatitis Causes of acute pancreatitis Diagnosing acute pancreatitis Treating acute pancreatitis Complications of acute pancreatitis Preventing acute pancreatitis About acute pancreatitis Acute pancreatitis is a serious condition where the pancreas becomes inflamed over a short period of time. The pancreas is a small organ located behind the stomach and below the ribcage. Most people withacute pancreatitis improve within a week and experience no further problems, but severe cases can have serious complications and can even be fatal. Acute pancreatitis is different to chronic pancreatitis , where the inflammation of the pancreas persists for many years. The most common symptoms of acute pancreatitis include: suddenly getting severe pain in the centre of your abdomen (tummy) feeling or being sick diarrhoea Read more about the symptoms of acute pancreatitis and diagnosing acute pancreatitis . When to seek medical help Contact your GP immediately if you suddenly develop severe abdominal pain. If this isnt possible, contact NHS 24s 111service or your local out-of-hours service for advice. Why it happens Its thought that acute pancreatitis occurs when a problem develops with some of the enzymes (chemicals) in the pancreas, which causes them totry to digestthe organ. Acutepancreatitisis most often linked to: gallstones which accounts for around half of all cases alcohol consumption which accounts for about a quarter of all cases By reducing your alcohol intake and altering your diet to make gallstones less likely, you canhelp to reduce your chances of developing acute pancreatitis. Read more about the causes of acute pancreatitis and preventing acute pancreatitis . Who is affected? Acute pancreatitisis more common in middle-aged and elderly people, but it can affect people of any age. Men are more likely to develop alcohol-related pancreatitis, while women are more likely to develop it as a result of gallstones. How its treated Treatment for acute pancreatitis focuses on supporting the functions of the body until the inflammation has passed. Thisusually involves admission to hospital so you can be given fluids into a vein (intravenous fluids), as well as pain relief, nutritional support and oxygen through tubes into your nose. Most people with acute pancreatitis improve within a week and are well enough to leave hospital after 5 to 10 days. However, recovery takes longer in severe cases, as complicationsthat require additional treatmentmay develop. Read more about treating acute pancreatitis . Complications About 4out of 5cases of acute pancreatitis improve quickly anddont cause any serious further problems. However, 1in 5cases are severe andcan result in life-threatening complications, such asmultiple organ failure. In severe cases wherecomplications develop, theres a highrisk ofthe conditionbeing fatal. If a person survives the effects of severe acute pancreatitis, its likely to be several weeks or months before theyre well enough to leave hospital. Read more about the possible complications of acute pancreatitis . Symptoms of acute pancreatitis The main symptom of acute pancreatitis is a severe, dull pain around the top of your stomach that develops suddenly. This aching pain often gets steadily worse and can travel along your back or below your left shoulder blade. Eating or drinkingmay also make you feel worse very quickly, especially fatty foods. Leaning forward or curling into a ball may help to relieve the pain, but lying flat on your back often increases the pain. Acute pancreatitis caused by gallstones usually develops after eating a large meal. If the condition is caused by alcohol, the pain often develops 6 to 12 hours after drinking a significant amount of alcohol. Other symptoms Other symptoms of acute pancreatitis can include: nausea (feeling sick) or vomiting diarrhoea indigestion a high temperature (fever) of 38C (100.4F) or above jaundice yellowing of the skin and the whites of the eyes tenderness or swelling of the abdomen (tummy) When to seek medical advice Contact your GP immediately if you suddenly develop severe abdominal pain. If this isnt possible,contact NHS 24 111 Service or your local out-of-hours service for advice. Causes of acute pancreatitis Most cases of acute pancreatitis are closely linked to gallstones or to alcohol consumption, although the exact cause isnt always clear. Gallstones Gallstones are hard pieces of stone-like material that form in your gallbladder. They can trigger acute pancreatitis if they move out of the gallbladder and block the opening of the pancreas. The blockage can disrupt some of the enzymes (chemicals) produced by the pancreas. These enzymes are normally used to help digest food in your intestines, but theycanstart to digest the pancreas instead ifthe opening isblocked. However, not everyone with gallstones will develop acute pancreatitis. Most gallstones dont cause any problems. Alcohol consumption Its not fully understood how alcohol causes the pancreas to become inflamed. One theory is that it interferes with the normal workings of the pancreas, causing the enzymes to start digesting it. Whatever the cause, there is a clear link between alcohol use and acute pancreatitis. A very large study found that people who regularly drank more than 35 units of alcohola week were 4times more likely to develop acute pancreatitis than people who never drank alcohol (35 units is the equivalentof drinking around 16 cans of strong lager or 4bottles of wine a week). Binge drinking ,which is drinking a lot of alcohol in a short period of time, is also thought to increase your risk of developing acute pancreatitis. Other causes Less common causes of acute pancreatitis include: accidental damage or injury to the pancreas for example, duringa procedureto remove gallstones or examine the pancreas certain types of medication,such as some antibiotics or chemotherapy medication acute pancreatitis can bean unexpected side effect of these in a small number of people a viral infection such as mumps or measles a complication of cystic fibrosis certain rare conditions including hyperparathyroidism, Reyes syndromeand Kawasaki disease Severe pancreatitis Little is known about why some people develop severe acute pancreatitis. Factors thought to increase your risk include: being 70 years of age or over being obese (a person is considered obese if they have a body mass index (BMI) of 30 or above) having 2or more alcoholic drinks a day smoking Researchers have also discovered that people with a specific genetic mutation, known as the MCP-1 mutation, are 8times more likely to develop severe acute pancreatitis than the general population. A genetic mutation is where the instructions (DNA) found in all living cells become scrambled, resulting in a genetic disorder or a change in characteristics. Diagnosing acute pancreatitis Most cases of acute pancreatitis are diagnosed in hospital because of the risk of serious complications. The doctor in charge of your care will ask you about the history of your symptoms. They may also carry out a physical examination. If you have acute pancreatitis, certain areas of your abdomen will be very tender to touch. A blood test will be carried out to help confirm a diagnosis. Thiscan detect signs of acute pancreatitis,such asa high level of 2chemicals called lipase and amylase. At first, it can be difficult to tell whether your acute pancreatitis is mild or severe. Youll be monitored closely for signs of serious problems, such as organ failure. People with mild acute pancreatitis tend to improve within a week and experience either no further problems or problems that resolve within 48 hours. People with severe acute pancreatitis develop persistent serious problems. Further testing Several tests may be used to help determine the severity of your condition andassess your risk of developing more serious complications. You may have any of the following tests: a computerised tomography (CT) scan where a series of X-rays are taken to build up a more detailed, 3D image of your pancreas a magnetic resonance imaging (MRI) scan where strong magnetic fields and radio waves are used to produce a detailed image of the inside of your body an ultrasound scan where high-frequency sound waves are used to create an image of part of the inside of the body endoscopic retrograde cholangiopancreatography (ERCP) An ERCP uses a narrow, flexible tube known as an endoscope, which has a camera on one end. The endoscope will be passed through your mouth and towards your stomach. A special dye that shows up on X-rays is then injected through the endoscope into your bile and pancreatic ducts. After the dye has been injected, X-rays will be taken. This test can be useful in cases of gallbladder-associated acute pancreatitis, because it can pinpoint exactly where the gallstone is located. In some cases, it may be possible to pass surgical instruments down the endoscope, so the gallstone can be removed. Treating acute pancreatitis Acute pancreatitis is treated in hospital, where youll be closely monitored for signs of serious problems and given supportive treatment, such as fluids and oxygen. Many people are well enough to leave hospital after 5 to 10 days. In severe cases, complications can develop that require specific additional treatment and youll need to be admitted to a high dependency unit or intensive care unit (ICU). In these cases, recoverymay take much longer, and the condition can be fatal. Read about the potential complications of acute pancreatitis for more informationon severe cases. Fluids Your body can become dehydrated during an episode of acute pancreatitis, so fluids are provided through a tube connected to one of your veins (this is known as intravenous, or IV, fluid). In severe cases of acute pancreatitis, IV fluids can help to prevent a serious problem called hypovolemic shock, which occurs when a drop in your fluid levels lowers the amount of blood in your body. Nutritional support Although the diet of many people with mild acute pancreatitis isnt restricted, somepeople are advised not toeat. This is because trying to digest solid food could place too much strain on your pancreas. Depending on the severity of the condition, you may not be able to eat solid foodsfor a few days or longer. If youneed to avoid solid food, a feeding tube may beused to provide your body with nutrients. This is known as enteral feeding andoften involves usinga tube inserted into your stomach through your nose (nasogastric tube). Oxygen To ensure your vital organs have enough oxygen, it will usually be supplied through tubes into your nose. The tubes can be removed after a few days, once your condition is improving. In severe cases, ventilation equipment may also be used to assist with your breathing. Painkillers Acute pancreatitis often causes severe abdominal (tummy) pain, so strong painkilling medication will probably be required, such as morphine. Some of the painkillers used can make you feel very drowsy. If youre visiting someone who is in hospital with acute pancreatitis, dont be alarmed or concerned if they appear drowsy or unresponsive. Treating the underlying cause Oncethe condition is under control, the underlying cause may need to be treated. Gallstones If a gallstone is responsible for the pancreatitis,you may needa procedure calledendoscopic retrograde cholangiopancreatography (ERCP),or your gallbladder may need to be removed. Gallbladder removal surgery may be done while youre in hospital, or itmay be planned for several weeks time. Having your gallbladder removed should have no significant effect on your health, other than making it more difficult to digest certain foods, such as fatty or spicy foods. An ERCP procedure is an alternative treatment for gallstones. It involves using a narrow, flexible tube known as an endoscope, which has a camera on one end. X-rays guide the endoscope into your digestive system, andsurgical instrumentsare passeddown the endoscopeto removethe gallstones. Alcohol consumption After recovering from acute pancreatitis, alcohol should be completely avoidedif this was the cause of the condition. If you find this difficult, youll probably need additional treatment. Treatment options for alcohol dependence include: one-to-onecounselling self-help groups such as Alcoholics Anonymous a medication called acamprosate which helps to reduce your alcohol cravings Complications of acute pancreatitis Although most people with acute pancreatitis recover without experiencing further problems, severe cases can have serious complications. Pseudocysts Pseudocysts are sacs of fluid that can develop on the surface of the pancreas. Theyre a common complication of acute pancreatitis, thought to affect around 1 in 20 people with the condition. Pseudocysts usually develop 4 weeks after the symptoms of acute pancreatitis start. In many cases, they dont cause any symptoms and are only detected during a computerised tomography (CT) scan . However, in some people, pseudocysts can cause bloating, indigestion and a dull abdominal (tummy) pain. If the pseudocysts are small and not causing any symptoms, there may be no need for further treatment, as they usually go away on their own. Treatment is usually recommended if youre experiencing symptoms or ifthe pseudocysts are large. Larger pseudocysts are at risk of bursting, which could cause internal bleeding or trigger an infection. Pseudocysts can be treated by draining the fluid out of the cyst by inserting a needle intoit through your skin. This can also be done by carrying out an endoscopy, wherea thin, flexible tube called an endoscope is passed down your throat, and tiny tools are used to drain away the fluid. Infected pancreatic necrosis In around 1in 3severe cases of acute pancreatitis,a serious complication called infected pancreatic necrosis occurs. In infected pancreatic necrosis, high levels of inflammation cause an interruption to the blood supply of your pancreas. Without a consistent supply of blood, some of the tissue of your pancreas will die. Necrosis is the medical term for the death of tissue. The dead tissue is extremely vulnerable to infection from bacteria. Once an infection has occurred, it can quickly spread into the blood ( blood poisoning ) and cause multiple organ failure. If left untreated, infected pancreatic necrosis is almost always fatal. Infected pancreatic necrosis usually develops 2to 6weeks after thesymptoms of acute pancreatitis starts. Symptoms include increased abdominal pain and a high temperature. The infectionis treated with injections of antibiotics , and the dead tissue needs to be removed to prevent the infection returning. In some cases, it may be possible to drain away the dead tissue using a thin tube called a catheter, which is placed through the skin. Alternatively, laparoscopic surgery (keyhole surgery) can be used.A small cutis made in your back and an endoscope is inserted to wash away any dead tissue. If laparoscopic surgeryisnt possible, a cutcan bemade in your abdomen to allow the dead tissue to be removed. Infected pancreatic necrosis is a very serious complication. Even with the highest standards of medical care, the risk of dying from organ failure is estimated to be around 1in 5. Systemic inflammatory response syndrome (SIRS) Another common complication of severe acute pancreatitis is systemic inflammatory response syndrome (SIRS). SIRS develops in an estimated 1 in 10 severe cases of acute pancreatitis. In SIRS, the inflammation affecting the pancreas spreads throughout the body, which can cause one or more organs to fail. It usually develops during the first week after thesymptoms start, with most cases developing on the same day. Symptoms of SIRS include: a rise in body temperature to above 38C (100.4F) or a fall in body temperature to below 36C (96.8F) a rapid heartbeat of more than 90 beats a minute an unusually fast breathing rate (more than 20 breaths a minute) Theres currently no cure for SIRS, so treatment involves trying to support the bodys functions until the inflammation has passed. The outcome depends on how many organs fail. The higher the number of organs affected, the greater the risk of death. Chronic pancreatitis If you have repeated episodes of acute pancreatitis, the damage to your pancreas may lead to chronic pancreatitis . Chronic pancreatitis is a long-term condition that can have a serious impact on your quality of life. Preventing acute pancreatitis As acute pancreatitis is often caused by gallstones or excessive alcohol consumption, a healthy lifestyle can reduce your chances of developing the condition. Gallstones The most effective wayof preventing gallstones is eating a healthy, balanceddiet that includes plenty of fresh fruit and vegetables (at least 5portions a day). Your diet should also include wholegrains, found in wholemeal bread, oats and brown rice. This helps lower the amount of cholesterol in your body. There is also evidence that regularly eating nuts, such as peanuts or cashews, can help reduce your risk of developing gallstones. Because of the role cholesterol appears to play in the formation of gallstones, its advisable to avoid eating too many fatty foods with a high cholesterol content. Foods high in cholesterol include: meat pies sausages and fatty cuts of meat butter and lard cakes and biscuits Being overweight also increases your chances of developing gallstones, so maintaining a healthyweight by eating abalanced diet and taking plenty of regular exercise can alsohelp reduce your risk of developingthe condition. Read more information and advice about exercise , healthy eating and losing weight . Alcohol Limiting the amount of alcohol you drink can help prevent your pancreas being damaged, andreduce your risk of developing acute pancreatitis. It can also lower your chances of developing other serious conditions, such as liver cancer . Read the pages on drinking and alcohol for more information and advice.

Adenomyosis

Adenomyosis Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Healthy living Women's health Girls and young women (puberty to around 25) Periods and menstrual health Adenomyosis Adenomyosis | | Polski | | | British Sign Language (BSL) | Easy Read Adenomyosis is a condition that causes the lining of the womb (the endometrium) to bury into the muscular wall of the womb. It can affect the whole womb or just one part of the womb. Adenomyosis is not a life-threatening condition, but the symptoms can have a big impact on your day-to-day life so its important to get the support you need. Symptoms Its possible to have adenomyosis and have no symptoms. Symptoms you might experience include: heavy periods that last for a long time severe period pain a feeling of pressure in your tummy bloating (your tummy sticks out more than normal) Causes Its not known exactly why adenomyosis happens. Adenomyosis is not an infection and its not contagious. It is benign (not cancerous). Diagnosis When you see your doctor about your symptoms, theyll carry out what is called a pelvic examination. Theyll look at your vulva, vagina and cervix (the opening between the vagina and the womb) to see if there is something that could be causing your symptoms. Sometimes other tests might be needed. Your doctor will discuss this with you and you can ask any questions that you might have. As this is an intimate examination, the doctor who performs it will have another person (chaperone) present. You can ask for a female doctor to carry it out. If there isnt a female doctor available, you can ask if theres a female health professional who could carry out the examination. You might be referred to a specialist wholl carry out more tests. This might include an ultrasound or an MRI, which will allow a doctor to look at your womb. This can also help rule out any other health conditions. Treatment Depending on your symptoms, there are different options to treat adenomyosis, including: anti-inflammatory medication to help relieve mild pain treatment during your period to help reduce the amount of menstrual blood loss hormone therapy such as the contraceptive pill, to help control heavy or painful periods a hysterectomy (removal of the womb) this would only be considered in extreme cases, where other treatments do not work and if you do not wish to become pregnant Your doctor will discuss this with you and you can ask any questions that you might have.

Addisons disease

Addison's disease Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Glands Addisons disease Addisons disease About Addisons disease Symptoms of Addisons disease Causes of Addisons disease Diagnosing Addisons disease Treating Addisons disease About Addisons disease Addisons disease (also known as primary adrenal insufficiency or hypoadrenalism) is a rare disorder of the adrenal glands. The adrenal glands are 2 small glands that sit on top of the kidneys. They produceessential hormones: cortisol,aldosterone and adrenaline. In Addisons disease, the adrenal gland is damaged, and not enough cortisol and aldosterone are produced. About 8,400 people in the UK have Addisons disease. It can affect people of any age. Its most common between the ages of 30 and 50.Its also more common in women thanmen. Early-stage symptoms of Addisons disease are similar to other more common health conditions, such as depression or flu .You may experience: fatigue (lack of energy or motivation) muscle weakness low mood loss of appetite and unintentional weight loss increased thirst Over time, theseproblems may become more severe and you may experience further symptoms, such as dizziness, fainting,crampsand exhaustion. You may also develop small areas of darkened skin, or darkened lips or gums. Although these symptoms arent always caused by Addisons disease, you shouldsee your GP, so they can be investigated. Read more about the symptoms of Addisons disease and diagnosing Addisons disease Why it happens The conditionisusually the result of a problem with the immune system, which causes it to attack the outer layer of the adrenal gland (the adrenal cortex), disrupting the production of steroid hormones aldosterone and cortisol. Its not clear why this happens, but its responsible for 70% to 90% of cases in the UK. Other potential causes include conditions that can damage the adrenal glands, such as tuberculosis (TB) , although this is uncommon in the UK. Read more about the causes of Addisons disease Treating Addisons disease Addisons disease is treated with medication to replace the missing hormones. Youll need to take the medication for the rest of your life. With treatment, symptoms of Addisons disease can largely be controlled. Most people with the condition live a normal lifespan andare able tolive an active life, with few limitations. However,many people with Addisons disease also find they must learn to managebouts of fatigue and there may be associated health conditions, such as diabetes or an underactive thyroid . People with Addisons disease must be awareof the risk of a sudden worsening of symptoms, called an adrenal crisis. Thiscan happenwhen the levels of cortisolin your body fallsignificantly due to not taking your medicines, or during another illness. An adrenal crisis is a medical emergency and warning signs include severe nausea, confusion, fever, headache and weakness. If left untreated, it can be fatal. If you or someone you know has Addisons disease and is experiencing severe symptoms, phone 999 for an ambulance. Read more about treating Addisons disease Information about you If you have Addisons disease, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register Symptoms of Addisons disease Addisons disease can be difficult to detect at first, because early symptoms are similar to symptoms of many other health conditions. Initial symptoms of Addisons disease caninclude: fatigue (lack of energy or motivation) lethargy (abnormal drowsiness or tiredness) muscle weakness low mood (mild depression ) or irritability loss of appetite and unintentional weight loss the need to urinate frequently increased thirst craving for salty foods Dehydration can also be an early sign of Addisons disease. Its caused by lack of the hormone aldosterone in your body, which is used to regulate the balance of salt and water. Later symptoms Furthersymptoms of Addisons disease tend to develop gradually over months or years. However,additional stress, caused by another illness or an accident, for example, may cause your symptoms to suddenly get worse. You may go on to develop: low blood pressure when you stand up, which can cause dizziness and fainting feeling sick (nausea) vomiting diarrhoea abdominal,joint or back pain muscle cramps chronic exhaustion, which may cause depression brownish discolouration of the skin, lipsand gums (hyperpigmentation), particularly in the creases on your palms, on scars or on pressure points, such as your knuckles or knees a reduced libido (lack of interest in sex) , particularly in women Some women may also have irregular periodsor miss some periods completely.Children with Addisons disease may experience pubertylater than usual. Some people with Addisons disease also develop low blood sugar (hypoglycaemia) . This can cause symptoms such asdifficulty concentrating, confusion, anxiety and even unconsciousness (particularly in children). If youre experiencingsymptoms of Addisons disease, see your GP so they can diagnose or rule out the condition.These symptomswill usually improve withappropriate treatment. Read more about diagnosing Addisons disease and treating Addisons disease Adrenal crisis If Addisons disease is left untreated, the levels of hormones produced by the adrenal glandgradually decrease in the body. This causes your symptoms to get progressively worse and eventually lead to a life-threatening situationcalledan adrenal or Addisonian crisis. During an adrenal crisis, the symptoms of Addisons disease appear quickly andseverely. This could happen whenyoure already experiencing initial symptoms or without any symptoms at all. Signs of an adrenal crisis include: severe dehydration pale, cold, clammy skin sweating rapid, shallow breathing dizziness severe vomiting and diarrhoea severe muscle weakness headache severe drowsiness or loss of consciousness An adrenal crisis is a medical emergency. If left untreated, it can be fatal. If you think you or someone you knowwith Addisons diseaseis having an adrenal crisis, phone 999 for an ambulance. If an adrenal crisis isnt treated, it can lead to a coma and death. Theres also a risk your brain wont get enough oxygen if treatment is delayed, whichcan cause permanent disability. Causes of Addisons disease Addisons disease develops when the outer layer of your adrenal glands (your adrenal cortex) is damaged, reducing the levels of hormones it produces. Problems with the immune system In the UK, a problem with the immune system is the most common cause of Addisons disease, accounting for 70% to 90% of cases. Theimmune system is your bodys defence against infection and disease. If youre ill, your immune system produces antibodies (a special type of protein that destroys disease-carrying organisms and toxins). These antibodies attack the cause of the illness. However, if you develop a problem with your immune system, it can start to attack your own healthy tissues and organs. This is known as an autoimmune disorder. Addisons disease can develop if your immune system attacks your adrenal glands and severely damages your adrenal cortex. When 90% of the adrenal cortex is destroyed, your adrenal glands wont be able to produce enough of the steroid hormones cortisol and aldosterone. Once levels of these start decreasing, youll experience symptoms of Addisons disease . Its not clear why some people develop this problem with their immune system, although it can run in families. Genetics Research has shown that some people withcertain genesare more likely to develop autoimmune disorders. Its not clear how these genes lead to Addisons diseaseandsimilar conditions, but it does meanyour risk of developing Addisons disease is increased if you or aclose family memberhave another autoimmune condition, such as: vitiligo a chronic (long-term) condition that causes pale, white patches to develop on the skin type 1 diabetes a chronic condition caused by too much glucose in the blood underactive thyroid gland (hypothyroidism) Other causes Tuberculosis (TB) is the most common cause of Addisons disease worldwide, but is rare in the UK. TB is a bacterial infection that mostly affects the lungs, but can also spread to other parts of your body.It can cause Addisons disease if it damages your adrenal glands. Other possible causes of Addisons disease include: infections such as those linked to AIDS , or fungal infections a haemorrhage very heavy bleeding into the adrenal glands, sometimes associated with meningitis or other types of severe sepsis cancer if cancer cells from elsewhere in your body spread to your adrenal glands amyloidosis a disease where amyloid, a protein produced by your bone marrow cells, builds up in your adrenal glands and damages them surgical removal ofboth adrenal glands (adrenalectomy) for example, to remove a tumour adrenoleukodystrophy (ALD) a rare, life-limiting, inherited condition affecting the adrenal glands and nerve cells in the brain thatmost oftenaffects young boys certain treatments needed for Cushings syndrome a collection of symptoms caused by very high levels of cortisol in the body Diagnosing Addisons disease To help diagnose Addisons disease, your GP will first ask about your symptoms and review your medical history. Theyre also likely to ask if anyone in your family hasan autoimmune disorder (a condition caused by a problem with their immune system). Your GP will examine your skin for any evidence of brownish discolouration (hyperpigmentation), particularly in certain areas, such as: where skin creases on your palm in your elbow crease on any scars your lips and gums However, hyperpigmentation doesnt occur in all cases of Addisons disease. Youll also be tested for low blood pressure (hypotension) while youre lying down and again shortly after you stand up. This is to see whether you have postural or orthostatic hypotension (low blood pressure when you change position). Blood tests If Addisons disease is suspected, blood tests will be carried out to measure the levels ofsodium, potassium and cortisolin your body. A low sodium, high potassium or low cortisol level may indicateAddisons disease. You may need to see a hospital hormone specialist (endocrinologist) for your bloodto be tested for the following: a low level of the hormone aldosterone a high level of adrenocorticotrophic hormone (ACTH) a low level of glucose (sugar used for energy) positive adrenal antibodies (antibodies designed to attack the adrenal gland) Any of these could be a sign of Addisons disease. Synacthen stimulation test If cortisolin your bloodislow, or your symptoms strongly suggest Addisons disease, youll need to have a synacthen stimulation test to confirm the diagnosis. Your GP may refer you to an endocrinology unit (a unit that specialises in the study of hormones) for the test. How urgently youre referred depends on how severe your symptoms are. Synacthen is a man-made (synthetic) copy of the adrenocorticotrophic hormone (ACTH). ACTH is naturally produced by the pituitary gland (a pea-sized gland below the brain) to encourage the adrenal glands to release the hormones cortisol and aldosterone. When synacthen is administered, the adrenal glands should respond in the same way as they would to ACTH, and release cortisol andother steroid hormonesinto the blood. A blood sample will be taken and tested for cortisol, before an injection ofsynacthen is given into your arm. After 30 and 60 minutes, a furtherblood sample will be taken for cortisol measurement. If the ACTH level is high, but the cortisol and aldosterone levels are low, its usually confirmation of Addisons disease. Thyroid function test As well as a synacthen stimulation test, your thyroid gland may also be tested to see if its working properly. Your thyroid gland is found in your neck. It produces hormones that control your bodys growth and metabolism. People with Addisons disease often have an underactive thyroid gland (hypothyroidism) , where the thyroid gland does not produce enough hormones. By testing the levels of certain hormones in your blood, your endocrinologist (a specialist in hormone conditions) can determine whether you have hypothyroidism. Scans In some cases, yourspecialist may refer you for a scan of your adrenal glands. This could be a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan . Diagnosis during an adrenal crisis If Addisons disease is left untreated, it eventually leads to an adrenal crisis. This is wherethe symptoms of Addisons disease appear quickly and severely. During an adrenal crisis, theres not enough time to perform a synacthen stimulation test to confirm Addisons disease. If possible, blood will be taken and tested for any of the abnormalities listed above. While youre waiting for the results, treatment may be started with steroid injections, and fluids containing salt and glucose. Read more about treatingAddisons disease Driving If youre diagnosed with Addisons disease andhave a bus, coach or lorry licence, its your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA). Readabout driving andAddisons disease on the GOV.UK website. Treating Addisons disease If you have Addisons disease, youll need to take daily medication to replace the lost hormones. This should help you to live an active life, although many people find they still need to manage their fatigue. Insome cases, the underlying causes of Addisons disease can be treated. For example, tuberculosis (TB) is treated with a course of antibiotics over a period of at least 6 months. However, most cases are caused by a problem with the immune system that cant be cured. Medication forAddisons disease Treatment usually involves corticosteroid (steroid) replacement therapy for life. Corticosteroid medication is used to replace the hormones cortisol and aldosterone thatyour body no longer produces.Its usually taken in tablet form 2 or 3 times a day. In most cases, a medication calledhydrocortisoneis used to replace the cortisol. Other possible medicines areprednisolone or dexamethasone, though these are less commonly used. Aldosterone is replaced with a medication called fludrocortisone. Your GP may also ask you to add extra salt to your daily diet, although if youre taking enough fludrocortisone medicine thismay not be necessary.Unlike most people, if you feel the urge to eat something salty, then you should eat it. In general, the medications used for Addisons disease dont have side effects, unless your dose is too high. If you take a higher dose than necessary for a long time, theres a risk of problems such as weakened bones (osteoporosis) , mood swings and difficulty sleeping (insomnia) . Living with Addisons disease Many people with Addisons disease findthat taking their medication enables them to continuewith theirnormal diet and exercise routines. However, bouts of fatigue are also common, and it cantake some time to learn how to manage these periods of low energy. Some people find that needing to take regular doses of medication is restrictive and affects their daily life or emotional health.Missing a dose of medication, or taking it late,can also lead to exhaustion or insomnia. Some people can develop associated health conditions, such as diabetes or an underactive thyroid , which require extra treatment and management. Youll usually need to have appointments with an endocrinologist every 6 to 12 months, so they can review your progress and adjust your medication dose, if necessary.Your GP can provide support and repeat prescriptions in between these visits. Failing to take your medication could lead to a serious condition called an adrenal crisis, soyou must: remember to collect your repeat prescriptions keep spare medication as necessary for example, in the car or at work, and always carry some spare medication with you take your medication every day at the right time pack extra medication if you are going away usually double what you would normally need, plus your injection kit (see below) carry your medication in your hand luggage if you are travelling by plane, with a note from your doctor explaining why it is necessary You could also inform close friends or colleagues of your condition. Tell them about the signs of adrenal crisis and what they should do if you experience one. Medical alert bracelets Its also a good idea to wear a medical alert bracelet or necklace that informs peopleyou have Addisons disease. After a serious accident, such as a car crash, a healthy person produces morecortisol. This helps you cope with the stressful situation and additional strain on your body that results from serious injury. As your body cannot produce cortisol, youll need a hydrocortisone injection to replace it and prevent an adrenal crisis. Wearing a medical alert bracelet will inform any medical stafftreating you about your condition, and what medication you require. Medical alert bracelets or necklaces are pieces of jewellery engraved with your medical condition and an emergency contact number. They are available from a number of retailers. Ask your GP if theres one they recommend, or go to the MedicAlert website. If you need to stay in hospital, the healthcare professionals responsible for your care will also need to know you need steroid replacement medication throughout your stay. Its important to note that this advice still applies if youre not supposed to eat or drink (nil by mouth) for any reason. Adjusting your medication At certain times, your medication may need to be adjusted to take into account any additional strain on your body. For example, you may need to increase the dosage of your medication if you experience any of the following: an illness or infection particularly if you have a high temperature of 37.5C (99.5F) an accident, such as a car crash an operation, dental or medical procedure (such as a tooth filling or endoscopy) youre taking part in strenuous exercisenot usually part of your daily life This will help your body cope with the additional stress. Your endocrinologist will monitor your dosage and advise about any changes. Over time, as you get used to the condition and learn what can trigger your symptoms, you may learn how to adjust your medication yourself. However, always consult your GP or specialist if youre unsure. Emergency treatment You and a partner or family member may be trained to administer an injection of hydrocortisone in an emergency. This could be necessary if you go into shockafter an injury, or if you experience vomiting or diarrhoea and are unable to keep down oral medication. This may occur if youre pregnant and have morning sickness. Yourendocrinologist will discuss with you when an injection might be necessary. If you need to administer emergency hydrocortisone, always phone your GP immediately afterwards. Check what out-of-hours services are available in your local area, in case the emergency is outside normal working hours. You can alsoregister yourself with your local ambulance service , so they have a record of your requirement for a steroid injection or tablets, if you need their assistance. Treating adrenal crisis Adrenal crisis, or Addisonian crisis, needs urgent medical attention. Phone 999 for an ambulance if you or someone you know are experiencing adrenal crisis. Signs of an adrenal crisis include: severe dehydration pale, cold, clammy skin sweating rapid, shallow breathing dizziness severe vomiting and diarrhoea severe muscle weakness headache severe drowsiness or loss of consciousness In hospital, youll be given lots of fluid through a vein in your arm to rehydrate you. This will contain a mixture of salts and sugars (sodium, glucose and dextrose) to replace those that your body is lacking. Youll also be injected with hydrocortisone to replace the missing cortisol hormone. Any underlying causes of the adrenal crisis, such as an infection, will also be treated.

Alcohol-related liver disease

Alcohol-related liver disease Illnesses and conditions Stomach, liver and gastrointestinal tract Alcohol-related liver disease Alcohol-related liver disease About alcohol-related liver disease Symptoms of alcohol-related liver disease Causes of alcohol-related liver disease Diagnosing alcohol-related liver disease Treating alcohol-related liver disease Complications of alcohol-related liver disease About alcohol-related liver disease Alcohol-related liver disease (ARLD) refers to liver damage caused by excess alcohol intake. There are several stages of severity and a range of associated symptoms. ARLDdoesnt usually cause any symptoms until the liver has been severely damaged. When this happens, symptoms can include: feeling sick weight loss loss of appetite yellowing of the eyes and skin (jaundice) swelling in the anklesand tummy confusionor drowsiness vomiting blood or passing blood in your stools This means ARLD is frequently diagnosed during tests for other conditions, or at a stage of advanced liver damage. If youregularly drink alcohol to excess, tell your GP so they can check if your liver is damaged. Read more about: symptoms of ARLD diagnosing ARLD Alcohol and the liver With the exception of the brain, the liver is the most complex organ in the body.Its functions include: filtering toxins from the blood aiding digestion of food regulating blood sugar and cholesterol levels helping fight infection and disease The liver is very resilient and capable of regenerating itself. Each time your liver filters alcohol, some of the liver cells die. The liver can develop new cells, but prolonged alcohol misuse (drinking too much)over many years can reduce its ability to regenerate. This canresult in serious andpermanent damage to your liver. ARLD isvery common in the UKthe number of people with the condition has been increasing over the last few decadesas a result ofincreasing levels of alcohol misuse. Read more about the causes of ARLD . Stages of ARLD There are 3main stages ofARLD, although theres often an overlap between each stage.These stages are explained below. Alcoholic fatty liver disease Drinking a large amountof alcohol, even for just a few days, can lead to a build-up of fats in the liver. This iscalled alcoholic fatty liver disease, and is the first stage of ARLD. Fatty liver disease rarely causes any symptoms, but its an important warning sign that youre drinking at a harmful level. Fatty liver disease is reversible. If you stop drinking alcohol for 2weeks, your liver should return to normal. Alcoholic hepatitis Alcoholichepatitis which is unrelated to infectious hepatitisis a potentially serious condition that can be caused by alcohol misuse over a longer period. When this develops, it may be the first time a person is aware theyre damaging their liver through alcohol. Less commonly, alcoholic hepatitis can occur if you drink a large amount of alcohol in a short period of time (binge drinking) . The liver damage associated with mild alcoholic hepatitis is usually reversible if you stop drinking permanently. Severe alcoholic hepatitis, however, is a seriousand life-threatening illness. Many people die from the condition each year in the UK, and some people only find out they have liver damage when their condition reaches this stage. Cirrhosis Cirrhosis is a stage ofARLD where the liver has become significantly scarred.Even at this stage, there may not be any obvious symptoms. Its generally not reversible, but stopping drinking alcohol immediately can prevent further damage and significantly increase your life expectancy. A person who hasalcohol-related cirrhosis and doesnt stop drinking has a less than 50% chance of living for at least 5more years. How ARLD is treated Theres currently no specific medical treatment for ARLD. The main treatment is to stop drinking, preferably for the rest of your life. This reduces the risk offurther damage to your liver andgivesit the best chance of recovering. Ifa person isdependent on alcohol, stopping drinking can be very difficult. However, support, advice and medical treatment may be available through local alcohol support services . A liver transplant may be required in severe cases where the liver has stopped functioning and doesnt improve when you stop drinking alcohol. Youll only be considered for a liver transplant if youve developed complications of cirrhosis , despite having stopped drinking. All liver transplant units require a person to not drink alcohol while awaiting the transplant, and for the rest oftheir life. Read more about treating ARLD . Complications Death rates linked to ARLD haverisen considerably over the lastfew decades. Alcohol is now one of the most common causes of death in the UK, along with smoking and high blood pressure . Life-threatening complications of ARLD include: internal (variceal) bleeding build-up of toxins in the brain (encephalopathy) fluid accumulation in the abdomen (ascites) with associated kidney failure liver cancer Read more about the complications of ARLD . Preventing ARLD The most effective way to preventARLD is to stop drinking alcohol or stick to the low-risk drinking guidelines . Even if youve been a heavy drinker for many years, reducing or stopping your alcohol intake will have important short- and long-term benefitsfor your liver and overall health. Read our drinking and alcohol pages for more information and advice. Symptoms of alcohol-related liver disease In many cases, people with alcohol-related liver disease (ARLD) dont have any noticeable symptoms until their liver is badly damaged. Early symptoms If you do experience early symptoms of ARLD, theseare often quite vague, such as: abdominal pain loss of appetite fatigue feeling sick diarrhoea feeling generally unwell Advanced symptoms Asthe liver becomes more severely damaged, more obvious and serious symptoms can develop, such as: yellowing of the skin and whites of the eyes (jaundice) swelling in the legs, ankles and feet, due toa build-up of fluid (oedema) swelling in your abdomen, due toa build-up of fluid known as ascites a high temperature (fever)and shivering attacks very itchy skin hair loss unusually curved fingertips and nails (clubbed fingers) blotchy redpalms significant weight loss weakness and muscle wasting confusion and memory problems, trouble sleeping ( insomnia ) and changes in your personality due to a build-up of toxins in the brain vomiting blood and black, tarry stools due tointernal bleeding a tendency to bleed and bruise more easily, such as frequent nosebleeds and bleeding gums increased sensitivity to alcohol and drugs (because the liver cant process them) When to seek medical advice ARLDdoesnt often cause symptoms until its reached an advanced stage. If you misuse alcohol, you may have liver damage, even though you have none of these symptoms. Read about alcohol misuse (drinking too much) . Contact your GP for adviceif you have a history of regular alcohol misuse. A good way to assess your history and pattern of drinking is to use a short test known as the CAGE test, which consists of 4questions: Have you ever thought you should cut down on your drinking? Have people annoyed you by criticising your drinking? Have you ever felt guilty about your drinking? Have you ever drunk an eye-opener, which means: have you ever drunk alcohol first thing in the morning to get over a hangover and steady your nerves? If you answer yes to 1or more of the questions, you may have an alcohol problem and are advised to see your GP. See your GP as soon as possibleif you have symptoms of advanced ARLD. Read more about how ARLD is diagnosed . Causes of alcohol-related liver disease Alcohol-related liver disease (ARLD) is caused by drinking too much alcohol. The more you drink above the recommended limits, the higher your risk of developing ARLD. There are 2ways alcohol misuse (drinking too much)can cause ARLD. These are: drinking a large amount of alcohol in a short amount of time (binge drinking) can cause fatty liver disease and, less commonly, alcoholic hepatitis drinking more than the recommended limits of alcohol over many years can causehepatitis and cirrhosis , the more serious types of ARLD Evidence suggests people whoregularly drink more than the recommended maximum amounts are most at risk of developing ARLD. Read more about alcohol units and how to calculate them. Additional factors As well as drinking excessive amounts of alcohol, other factors can increase your chances of developing ARLD. Theseinclude: being overweight or obese being femalewomen appear to be more vulnerable than men to the harmful effects of alcohol having a pre-existing liver condition, such as hepatitis C geneticsalcohol dependence and problems processing alcohol often run in families Diagnosing alcohol-related liver disease Alcohol-related liver disease (ARLD) is often first suspected when tests for other medical conditions show a damaged liver. This is becausethe conditioncauses few obvious symptoms in the early stages. If a doctor suspects ARLD, theyll usually arrange a blood test to check how well your liver is working. They may also ask about your alcohol consumption. Its important to be totally honest about how much and how often you drink alcohol to avoid further unnecessary testing. This could lead to a delay in the treatment you need. Blood tests Blood tests used to assess the liver are known as liver function tests. However, liver function tests can be normalat many stages of liver disease. Blood tests can also detect if you have low levels of certain substances, such as a protein called serum albumin, which is made by the liver. A low level of serum albumin suggests your liver isnt functioning properly. A blood test may also look for signs of abnormal blood clotting, which can indicate significant liver damage. Lab Tests Online has more information on liver function tests . Further testing If your symptoms or liver function test suggest an advanced form of ARLD eitheralcoholic hepatitis or cirrhosis you may need further tests. Imaging tests Scans may be needed toproduce detailed images of your liver. This may include: an ultrasound scan a computerised tomography (CT) scan a magnetic resonance imaging (MRI) scan Some scans may also measure the stiffness of the liver, which is a good indication of whether your liver is scarred. Liver biopsy During a liver biopsy ,afine needle is inserted into your body (usually between your ribs). A small sample of liver cells is taken and sent to a laboratory to be examined under a microscope. Thebiopsy is usually carried out under local anaesthetic , either as a day case or with an overnight stay in hospital. Specialist doctors will examine the liver biopsy tissue under the microscope to determine the degree of scarring in the liver and the cause of the damage. Endoscopy An endoscope is a long, thin, flexible tube with a light and a video camera at one end.During an endoscopy,the instrument ispassed down your oesophagus (the long tube that carries food from the throat to the stomach) and into your stomach. Pictures of your oesophagus and stomach are transmitted to an external screen. The doctor will be looking for swollen veins (varices), which are a sign of cirrhosis. Treating alcohol-related liver disease Successful treatment for alcohol-related liver disease (ARLD) often depends on whether someone is willing to stop drinking alcohol and make changes to their lifestyle. Stopping drinkingalcohol Treatment forARLD involves stopping drinking alcohol. This is known as abstinence, which can be vital, depending on what stage the condition is at. If you have fatty liver disease, the damage may be reversed if you abstain from alcohol for at least 2weeks. After this point, its usually safe to start drinking again if you stick to the NHS guidelines on alcohol consumption . If you have a more serious form of ARLD alcoholic hepatitisor cirrhosis life-long abstinence is recommended.This is because stopping drinking is the only way to prevent your liver damage getting worse and potentially stop you dying of liver disease. Stopping drinking isnt easy, especially as an estimated 70% of people with ARLD have an alcohol dependency problem. Nevertheless, if you have alcohol-related cirrhosis or alcoholic hepatitis and dont stop drinking, no medical or surgical treatment can prevent liver failure. Withdrawal symptoms If youre abstaining from alcohol, you may suffer withdrawal symptoms. These will be at their worst for the first 48 hours, but should start to improve as your body adjusts to being without alcohol. This usually takes 3to 7days from the time of your last drink. Many people initially experiencedisturbed sleep when abstaining from alcohol, butin most cases their sleep pattern returns to normal within a month. In some cases,you may be advised to reduce your alcohol intake in a gradual and planned way to help avoid withdrawal problems. You may also be offereda medication called a benzodiazepine and psychological therapy, such as cognitive behavioural therapy (CBT), to help you through the withdrawal process. Some peopleneed to stay in hospital or a specialist rehabilitation clinic during the initial withdrawal phases, sotheirprogress can be closely monitored. If yourestaying at home, youll regularly see a nurse or other health professional. You might see them at home, at your GP surgery or at a specialist NHS service. Preventing relapses Once youve stoppeddrinking, you mayneed furthertreatment to help ensure you dontstart drinking again. The first treatment usually offeredis psychological therapy. This involvesseeing a therapist to talk about your thoughts and feelings, and how these affect your behaviour and wellbeing. If psychological therapy alone isnt effective, you may also need medication to help you abstain from alcohol, such as: acamprosate naltrexone disulfiram Read our page on treating alcohol misuse formore information on the treatments offered. Self-help groups Many people with alcohol dependence find it useful to attend self-help groups to help them stop drinking. One of the most well-known is Alcoholics Anonymous , but there aremany other groups that can help. Read the alcohol support page for more information about the help available. Diet and nutrition Malnutrition is common in people with ARLD, so its important to eat a balanced diet to help ensure you get all the nutrients you need. Avoiding salty foods and not adding salt to foods you eat can reduce your risk of developing swelling in your legs, feet and abdomen (tummy) caused by a build-up of fluid. The damage to your liver can also mean its unable to store glycogen acarbohydrate that provides short-term energy. When this happens, the body uses its own muscle tissue to provide energy between meals, which leads to muscle wasting and weakness. Therefore, you may need extra energy and protein in your diet. Healthy snacking between meals can top up your calories and protein. It may also be helpful to eat 3or 4small meals a day, rather than 1or 2large meals. Your GP can advise you on a suitable diet or, in some cases, refer you to a dietitian. In the most serious cases of malnutrition, nutrients may need to be provided through a feeding tubeinserted through the nose and into the stomach. Medicationforsymptoms The use of medication to directlytreatARLD is controversial. Many experts have arguedtheres limited evidence for its effectiveness. For people with severe alcoholic hepatitis, treatment in hospital may be necessary. Specific treatment withcorticosteroidsor pentoxifylline medication may be used to reduce inflammation of the liver in some people with this condition. Nutritional support is also an important part of treatment in these cases. Other medications that have been used to treat liver damage include: anabolic steroids (a more powerful type of steroid medication) ropylthiouracil (a type of medicine originally designed to treat overactive thyroid glands ) However, theres a lack of good evidence that these help and theyre no longer used for severe alcoholic hepatitis. Liver transplants In the most serious cases of ARLD, the liver loses its ability to function, leading toliver failure. A liver transplant is currently the only way to cure irreversible liver failure. A liver transplant may be considered if: you develop progressive liver failure, despite not drinking alcohol youre otherwise well enough to survive such an operation you commit to not drinking alcohol for the rest of your life Complications of alcohol-related liver disease A number of serious complications can develop if you have alcohol-related liver disease (ARLD). Portal hypertension and varices Portal hypertension is a common complication of cirrhosis and, less commonly, alcoholic hepatitis.It occurs whenthe blood pressure inside your liver has risen to a potentially serious level. When the liver becomes severely scarred, its harder for blood to move through it. This leads to an increase in the pressure of blood around the intestines. The blood must also find a new way to return to your heart. It does this by opening up new blood vessels, usually along the lining of your stomach or oesophagus (the long tube that carries food from the throat to the stomach). These new blood vessels are known as varices. If the blood pressure rises to a certain level, it can become too high for the varices to cope with, causing thewallsof the varicesto split and bleed. This can cause long-term bleeding, which can lead to anaemia . Alternatively, the bleeding can be rapid and massive, causing you to vomit blood and pass stools that are very dark or tar-like. Split varices can be treated by using anendoscope to locate the varices. A tiny band can then be used to seal the base of the varices. Ascites A person with portal hypertension may also develop a build-up of fluid in their abdomen (tummy) and aroundthe intestines. This fluid is known as ascites. Initially, this can be treated with water tablets (diuretics). If the problem progresses, many litres of fluid can build up, which needs to be drained. This is a procedure known as paracentesis and involves a long, thin tube being placed into the fluid through the skin under local anaesthetic . One of the problems associated with the development of ascites is the risk of infection in the fluid (spontaneous bacterial peritonitis). This is a potentially very serious complication and is linked to an increased risk of kidney failure and death. Hepatic encephalopathy One of the most important functions of the liver is to remove toxins from your blood. Ifthe liver is unable to do this due to hepatitis or cirrhosis, the levels of toxins in theblood increase. A high level of toxins in the blood due to liver damage is known as hepatic encephalopathy. Symptoms of hepatic encephalopathy include: agitation confusion disorientation muscle stiffness muscle tremors difficulty speaking in very serious cases, a coma Hepatic encephalopathymay require hospital admission. In hospital, body functions are supported and medication is used to remove toxins from the blood. Liver cancer Liver damage due to heavy drinking over many years can also increase your risk of developing liver cancer . Over the past few decades, rates of liver cancer in the UK have risen sharply due to increased levels of alcohol misuse . Its estimated that, every year, 3-5% of people with cirrhosis will develop liver cancer.

Allergic rhinitis

Allergic rhinitis Illnesses and conditions Ears, nose and throat Allergic rhinitis Allergic rhinitis Allergic rhinitis is inflammation (redness and swelling) of the inside of the nose. Its caused by an allergen, such as pollen, dust, mould, or flakes of skin from certain animals. Its a very common condition. For most people its easy to treat with medicines from a pharmacist. Symptoms of allergic rhinitis Allergic rhinitis usually causes cold-like symptoms , such as: sneezing itchiness a blocked or runny nose These symptoms usually start soon after coming into contact with something youre allergic to. Some people only get allergic rhinitis seasonally because theyre allergic to things like tree or grass pollen. Other people get allergic rhinitis all year round. When to get medical advice Speak to your GP practice if: you have allergic rhinitis and your symptoms get worse you also have asthma and its getting worse your symptoms are affecting your sleep and everyday life youre not sure whats causing your symptoms treatments from a pharmacist are not working Diagnosing allergic rhinitis Your GP will usually be able to diagnose allergic rhinitis from your symptoms and any triggers you may have noticed. If the cause of your condition is uncertain, you may be referred for allergy testing. Treatment for allergic rhinitis Treatment for allergic rhinitis depends on how severe your symptoms are. Things you can do to help your symptoms If you have mild allergic rhinitis, you can often treat the symptoms yourself. Do take over-the-counter medications, such as antihistamines clean your nasal passages with a salt water solution avoid triggers if you can Always read the leaflet that comes with your medicine before taking it. Follow the recommended dosage instructions. If youre not sure which treatments are suitable for you or your child, speak to a pharmacist for advice. How to clean your nose with a homemade salt water solution Boil a pint of water, then leave it to cool. Mix 1 teaspoon of salt and 1 teaspoon of bicarbonate of soda into the water. Wash your hands. Stand over a sink, cup the palm of 1 hand and pour a small amount of the solution into it. Sniff the water into 1 nostril at a time. Breathe through your mouth and allow the water to pour back into the sink. Try not to let the water go down the back of your throat. Repeat the first 5 steps up to 3 times a day until your nose feels more comfortable. You do not need to use all of the solution, but make a fresh solution each time you clean your nose. Medication Medication wont cure your allergy, but it can be used to treat the symptoms. Speak to your GP practice if your symptoms do not improve 2 weeks after starting medicine. They may prescribe a stronger medication such as a nasal spray containing corticosteroids . What causes allergic rhinitis? Allergic rhinitis is caused by breathing in tiny particles that youre allergic to. The most common allergens in the air that cause rhinitis are: house dust mites pollen and spores flakes of animal skin wood dust flour dust latex Youre more likely to develop an allergy if theres a history of allergies in your family. Complications of allergic rhinitis Allergic rhinitis can lead to complications in some cases. These include: nasal polyps abnormal but non-cancerous (benign) growths inside the nose and sinuses sinusitis inflammation that blocks the sinuses so mucus cannot drain into your nose as usual blockage of the middle ear due to a build-up of fluid behind the eardrum These problems can often be treated with medication. Surgery is sometimes needed in severe or long-term cases.

Allergies

Allergies - Illnesses & conditions Illnesses and conditions Immune system Allergies Allergies About allergies Symptoms of allergies Testing for allergies Treating allergies Preventing an allergic reaction About allergies An allergy is a reaction the body has to a particular food or substance. Allergies are very common. Theyre thought toaffect more than 1in 4people in the UK at some point in their lives. Theyare particularly common in children. Some allergies go away as a child gets older, althoughmany are lifelong. Adults can develop allergies to things they werent previously allergic to. Having an allergy can be a nuisance and affect your everyday activities, but most allergic reactions are mild and can be largely kept under control. Severe reactions can occasionally occur, but these are uncommon. Common allergies Substances that cause allergic reactions are called allergens.The more common allergensinclude: grass and tree pollen an allergy to theseis known as hay fever (allergic rhinitis) dust mites animal dander (tiny flakes of skin or hair) food particularlynuts, fruit, shellfish, eggs and cows milk insect bites and stings medication including ibuprofen , aspirin, and certain antibiotics latex used to makesome gloves and condoms mould these can release small particles into the air that you can breathe in household chemicals including those in detergents and hair dyes Most of theseallergensare generally harmless to people who arent allergic to them. Symptoms of an allergic reaction Allergic reactions usually happen quickly within a few minutes of exposure to an allergen. They can cause: sneezing a runny or blockednose red, itchy, watery eyes wheezing and coughing a red, itchy rash worsening of asthma or eczema symptoms Most allergic reactions are mild, but occasionally a severe reaction called anaphylaxis or anaphylactic shock can occur. This isa medical emergency and needs urgent treatment. Read more about the symptoms of allergies . When to get professional advice Pharmacy First Scotland: Allergies treatment from your pharmacy If you have allergies you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotlands Service Directory. Search for a pharmacy near you Getting help for allergies If your pharmacist thinks you might have amild allergy, they can offer advice and treatment to help manage the condition. See your pharmacist if you think you or your child might have had an allergic reaction to something. The symptoms of an allergic reactioncan alsobe caused by other conditions. Your pharmacist can help determine whether its likely you have an allergy. If your allergy is particularly severe or its not clear what youre allergic to, the pharmacist may advise you see your GPwho may refer you to an allergy specialist for testing and advice about treatment. Read more about allergy testing . How to manage an allergy Inmany cases, the most effective way of managingan allergy is to avoid the allergen that causes the reaction whenever possible. For example, if you have a food allergy, you should check a foods ingredients list for allergens before eating it. The Food Standards Agency has more information about food allergen labelling . There are also several medications available tohelp control symptoms of allergic reactions, including: antihistamines these can be taken when you notice the symptoms of a reaction, or before being exposed to an allergen to stop a reaction occurring decongestants tablets, capsules, nasal sprays or liquids that can be used as a short-term treatment for a blocked nose lotions and creams, such asmoisturising creams (emollients) these canreduce skin redness and itchiness steroid medication sprays, drops, creams, inhalers and tablets that can help reduce redness and swelling caused by an allergic reaction For some people with very severe allergies, a treatment called immunotherapy may be recommended. This involves being exposed to the allergen in a controlled way over a number of years, so your body gets used to it and doesnt react to it so severely. Read more about treating an allergy and avoiding allergic reactions . What causes allergies? Allergiesoccur when the bodys immune system reacts to a particular substance as though its harmful. Its not clear why this happens, but most people affected have a family history of allergies or have closely related conditions such as asthma or eczema. The number of people with allergies is increasing every year. The reasons for this are not understood, but one of the main theories is its the result of living in a cleaner, germ-free environment, which reduces the number of germs our immune system has to deal with. Its thought this maycause it to overreact when it comes into contact with harmless substances. Symptoms of allergies Symptoms of an allergic reaction usually develop within a few minutes of being exposed to something youre allergic to, although occasionally they can develop gradually over a few hours. Althoughallergic reactionscan be a nuisance and hamper your normal activities, most are mild. Very occasionally, a severe reaction called anaphylaxis can occur. Mainallergy symptoms Common symptoms of an allergic reaction include: sneezing and an itchy, runny or blocked nose ( allergic rhinitis ) itchy, red, watering eyes ( conjunctivitis ) wheezing,chest tightness, shortness of breath and a cough a raised, itchy, red rash ( hives ) swollenlips, tongue, eyesor face tummy pain , feeling sick, vomiting or diarrhoea dry, red and cracked skin The symptoms vary depending on what youre allergic to and how you come into contact with it. For example, youmayhave a runny noseif exposed to pollen, developa rash if you have a skin allergy, or feel sickif you eat something youre allergic to. See your pharmacist if you or your child might have had an allergicreaction to something. They can help determine whether the symptoms are caused by an allergy or another condition. Read more about diagnosing allergies . Severe allergic reaction (anaphylaxis) In rare cases, an allergy can lead to a severe allergic reaction, called anaphylaxis or anaphylactic shock, which can be life-threatening. This affects the whole body and usuallydevelops within minutes of exposure to something youre allergic to. Signs of anaphylaxis include any of the symptoms above, as well as: swelling of the throat and mouth difficulty breathing lightheadedness confusion blue skin or lips collapsing and losing consciousness Anaphylaxis is a medical emergency that requires immediate treatment. Read more about anaphylaxis for information about what to do if it occurs. Testing for allergies If you think you have an allergy, tell your pharmacist about the symptoms youre having, when they happen, how often they occur and if anything seems to trigger them. Your pharmacist can offer advice and treatment for mild allergies with a clear cause. If your allergy is more severe or its not obvious what youre allergic to, your pharmacist may advise you to see your GP as you may need referredfor allergy testing at a specialist allergy clinic. The tests that may be carried out are described below. Skin prick testing Skin prick testing is one of the most common allergy tests. It involves putting a drop of liquid onto your forearm that contains a substance you may be allergic to. The skin under the drop is then gently pricked with a needle. If you are allergic to the substance, an itchy, red bump will appear within 15 minutes. Skin prick testing is painless and very safe. Make sure you dont take antihistamines before the test, as they can interfere with the results. Blood tests Blood tests may be used instead of, or alongside, skin prick tests to help diagnose common allergies. A sample of your blood is removed and analysed for specific antibodies produced by your immune system in response to an allergen. Patch tests Patchtestsare used to investigate a type of eczema known as contact dermatitis, which can be caused by your skin being exposed to an allergen. A small amount of the suspected allergen is added to special metal discs, which are then taped to your skin for 48 hours and monitored for a reaction. Elimination diet If you have a suspected food allergy , you may be advised to avoid eating a particular food to see if your symptoms improve. After a few weeks, you may then be asked to eat the food again to check if you have another reaction. Dont attempt to do thisyourself without discussing it with a qualified healthcare professional. Challenge testing In a few cases, a test called afood challenge may also be usedto diagnose a food allergy. During the test, youre given the food you think youre allergic to in gradually increasing amounts, to see how you react under close supervision. This test is riskier than other forms of testing, as it could cause a severe reaction, but is the most accurate way to diagnose food allergies. And challenge testing is always carried out in a clinic where a severe reaction can be treated if it does develop. Treating allergies The treatment for an allergy depends on what youre allergic to. In many cases your pharmacist will be able to offer advice and treatment. Theyll advise you about taking steps to avoid exposure to the substance youre allergic to, andcan recommend medication to control your symptoms. Avoiding exposure to allergens The best way to keep your symptoms under control is often to avoid the things youre allergic to,although this isnt always practical. For example, youmay be able to helpmanage: food allergies by being careful about what you eat animal allergies by keeping pets outside as much as possible and washing them regularly mould allergies bykeeping your home dry and well-ventilated, and dealing with any damp and condensation hay fever bystaying indoors and avoiding grassy areas when the pollen count is high dust mite allergies byusing allergy-proof duvets and pillows, and fitting wooden floors rather than carpets Read more about preventing allergic reactions . Allergy medications Medications for mild allergies are available from pharmacies on the Pharmacy First Scotland service without a prescription, but always ask your pharmacist for advice before starting any new medicine, as theyre not suitable for everyone. Antihistamines Antihistaminesare the main medicines for allergies. Theycan be used: as and when you noticethe symptoms ofan allergic reaction to prevent allergic reactions for example, you may take them in the morningif you have hay fever and you know the pollen count is high that day Antihistaminescan be takenas tablets, capsules, creams, liquids, eye drops or nasal sprays, depending on which part of your body is affected by your allergy. Decongestants Decongestants can be used as a short-term treatment for a blocked nose caused by an allergic reaction. Theycan be taken as tablets, capsules, nasal sprays or liquids. Dont use them for more than a week at a time, as using them for long periods can make your symptoms worse. Lotions and creams Red and itchy skin caused by an allergic reaction can sometimes be treated with over-the-counter creams and lotions, such as: emollients (moisturising creams)to keep the skin moist and protect it from allergens calamine lotion to reduce itchiness steroids to reduce inflammation (see below) Steroids Steroid medications can help reduce inflammation caused by an allergic reaction.Theyre available as: nasal sprays and eye drops for an inflamednose and eyes creams for eczema andcontact dermatitis inhalers for asthma tablets for hives (urticaria) Sprays, drops and weak steroid creams are available without a prescription. Stronger creams,inhalers and tablets are available on prescription from your GP. Immunotherapy (desensitisation) Immunotherapy may be an option for a small number of people with certain severe and persistent allergies who are unable to control their symptoms using the measures above. The treatment involves being given occasional small doses of the allergen either as an injection, or as drops or tablets under the tongue over the course of several years. The injectioncan only be performed in a specialist clinic under the supervision of a doctor, as there is a small risk of a severe reaction. The drops or tablets can usually betaken at home. The aim of treatment is to helpyour body get used to the allergen so it doesnt react to it so severely.This wont necessarily cureyour allergy, but it will make it milder and mean you can take less medication. Treating severe allergic reactions (anaphylaxis) Some people with severe allergies may experience life-threatening reactions,known as anaphylaxis or anaphylactic shock. If youre at risk of this, youll be given special injectors containing a medicine called adrenaline to use in an emergency. If you develop symptoms of anaphylaxis, such as difficulty breathing, you should inject yourself in the outer thigh before seeking emergency medical help. Read more about the treating anaphylaxis . Preventing an allergic reaction The best way to prevent an allergic reaction is to avoid the substance that youre allergic to, although this isnt always easy or practical. Below is some practical advice that should help you avoid the most common allergens. House dust mites One of the biggest causes of allergies are dust mites, which are tiny insects found in household dust. You can limit the number of mites in your home by: choosing wood or hard vinyl floor coverings instead of a carpet fitting roller blinds that can be easily wiped clean choosingleather, plastic or vinyl furniture instead of upholstered furniture cleaning cushions, soft toys, curtains and upholstered furniture regularly, either by washing (at a high temperature) or vacuuming using tested allergy-proof covers on mattresses, duvets and pillows using a vacuum cleaner fitted with a HEPA (high-efficiency particulate air) filter, because it can trap more dust mites than ordinary vacuum cleaners regularly wiping surfaces with a damp, clean cloth avoid dry dusting, as this can spread dust into the air Concentrate your efforts of controlling dust mites in the areas of your home where you spend the most time, such as the bedroom and living room. You can find more information on indoor allergies in the home on the Allergy UK website. Pets Its not the pet fur that causes an allergic reaction. Instead, its flakes of their dead skin, saliva and dried urine. If you cant permanently remove a pet from the house, you could try: keeping pets outside as much as possible, or limiting them to a particular area of the house, preferablyan areawithout carpet not allowing pets in bedrooms washing pets at least once aweek regularly groomingpets outside regularly washing all bedding and soft furnishings on which a pet has lain using an air filter in rooms where you spend most of your time increase ventilation with fans, air-conditioning or by opening windows If youre visiting a friend or relative with a pet, ask them not to dust or vacuum on the day youre visiting, as this will stir up the allergens into the air. Taking an antihistamine medicine about an hour before entering a pet-inhabited house can also help reduce your symptoms. The Allergy UK website has more information about domestic pet allergies . Mould spores Tiny particles released by moulds can cause an allergic reaction in some people. You can help prevent this by: keeping your home dry and well-ventilated removing any indoor pot plants from your home not drying clothes indoors, store clothes in damp cupboards or packing clothes too tightly in wardrobes dealing with any damp and condensation in your home avoiding damp buildings, damp woods and rotten leaves, cut grass and compost heaps Food allergies By law, food manufacturers must clearly label any foods that contain something thats known to cause allergic reactions in some people. By carefully checking the label for the list of ingredients, you should be able to avoid an allergic reaction. People with food allergiesmost often experience an allergic reaction while eating out at a restaurant. You can avoid this by: not relying on the menu description alone (remember, many sauces or dressings could contain allergens) communicating clearly with the waiting staff and asking for their advice avoiding places where theres a chance that different types of food could come into contact with each other, such as buffets or bakeries let restaurant staff you know your dietary requirements, including how severe your food allergy or intolerance is always check what allergens are in the dish even if you have eaten it before, as recipes and ingredients can change Remember, simple dishes are less likely to contain hidden ingredients. If youre not sure about a dish, dont risk it Read more about living with a food allergy and advice from the Food Standards Agency onfood allergenlabelling . Hay fever Pollen allergies more commonly known as hay fever are caused when trees and grasses release pollen into the air. Doctors often call hay fever allergic rhinitis. Different plants pollinate at different times of the year, so the months that you get hay fever will depend on what sort of pollen(s) you are allergic to. Typically, people are affected during spring (trees) and summer (grasses). Tohelpkeep your hay fever under control,you can: check weather reports for the pollen count and stay indoors when its high, if possible avoid drying clothesand bedding outside when the pollen count is high wear wraparound sunglasses to protect your eyes keep doors and windows shut when possible shower and change your clothes after being outside avoid grassy areas, such as parks and fieldsparticularly in the early morning, evening or night, when the pollen count is highest if you have a lawn,try asking someone else to cut the grass for you Insect bites and stings If youve ever suffered a bad reaction to an insect bite or sting, its important to take precautions to minimise your risk. When youre outdoors, particularly in the summer, you could: cover exposed skin wear shoes apply insect repellent avoid wearing strong perfumes or fragrances, as these can attract insects Read more about preventing insect bites and stings . Preventing severe allergies (anaphylaxis) If youreat risk of experiencing asevere allergic reaction ( anaphylaxis ), make sure you carry two adrenaline auto-injectorswith youeverywhere. Wearing a MedicAlert or Medi-Tag medallion or bracelet can make others aware of your allergy in an emergency. Consider telling your teachers, work colleagues and friends, so they can give you your adrenaline injection in an emergency, while waiting for an ambulance. Read more about preventing anaphylaxis .

Alzheimers disease

Alzheimer's disease Illnesses and conditions Brain, nerves and spinal cord Alzheimers disease Alzheimers disease About Alzheimers disease Symptoms of Alzheimers disease Causes of Alzheimers disease Diagnosing Alzheimers disease Treating Alzheimers disease Preventing Alzheimers disease About Alzheimers disease Alzheimers disease is the most common type of dementia, affecting an estimated 850,000 people in the UK. Dementia is a progressive neurological disease which affects multiple brain functions, including memory. The exact causeof Alzheimers disease is unknown, although a number of things are thought to increase your risk of developing the condition. These include: increasing age a family history of the condition previous severe head injuries lifestyle factors and conditions associated with cardiovascular disease Its becoming increasingly understood that its very common to have both changes of Alzheimers and vascular dementia together (mixed dementia). Read more about the causes of Alzheimers disease Signs and symptoms of Alzheimers disease Alzheimers disease is a progressive condition, which means the symptoms develop gradually and become more severe over the course ofseveral years. It affects multiple brain functions. The first sign of Alzheimers disease is usually minor memory problems. For example, this could beforgetting about recent conversations or events, and forgetting the names of places and objects. As the condition develops, memory problems become more severe andfurther symptoms can develop, such as: confusion, disorientation and getting lost in familiar places difficulty planning or making decisions problems with speech and language problems moving around without assistance or performing self-care tasks personality changes, such as becoming aggressive, demanding and suspicious of others hallucinations(seeing or hearing things that arent there) and delusions (believing things that are untrue) low moodor anxiety Read more about the symptoms of Alzheimers disease Who is affected? Alzheimers disease is most common in people over the ageof65, and affects slightly more women than men. The risk of Alzheimers disease and other types of dementiaincreases with age,affecting an estimated 1 in 14 people over the age of 65 and 1 in every 6 people over the age of 80. However, around1 in every 20 cases of Alzheimers disease affects people aged 40 to 65. Receivinga diagnosis As the symptoms of Alzheimers disease progress slowly, it can be difficult to recognise that theres a problem. Many people feel that memory problems are simply a part of getting older. However,a timely diagnosis of Alzheimers disease can give youthe best chance to prepare and plan for the future, as well as receive any treatment or supportthat may help. If youre worried about your memory or think you may have dementia, its a good idea to see your GP. If youre worried about someone else, you should encourage them to make an appointment and perhaps suggest that you go along with them. Theres no single test that can be used to diagnose Alzheimers disease. Your GP will ask questions about any problems you are experiencing and may do some tests to rule out other conditions. If Alzheimers disease is suspected, you may be referred to a specialist memory service to: discuss the process of making the diagnosis organise testing create a treatment plan Read more about diagnosing Alzheimers disease How Alzheimers disease is treated Theres no cure for Alzheimers disease,but medication is available that can helprelieve some of the symptoms and slow down the progression of the condition in some people. Various other types of support are also available to help people with Alzheimers live as independently as possible, such as making changes to your home environment so its easier to move around and remember daily tasks. Psychological treatments such as cognitive stimulation therapy may also be offered tohelpsupport your memory, problem solving skills and language ability. Read more about treating Alzheimers disease Outlook On average, people with Alzheimers disease live for around8 to 10 years after they start to develop symptoms. However, this can vary considerably from person to person. Some people with the condition will live longer than this, but others will not. Alzheimers disease is a life-limiting illness, although many people diagnosed with the condition will die from another cause. AsAlzheimers disease is a progressive neurological condition, it can cause problems with swallowing. This can lead to aspiration (food being inhaled into the lungs) which can cause frequent chest infections. Its also common for people with Alzheimers disease to eventually have difficulty eating and to have a reduced appetite. Theres increasing awareness that people with Alzheimers disease need palliative care . This includes support for families, as well as the person with Alzheimers. Can Alzheimers disease be prevented? As the exact cause of Alzheimers disease isnt clear, theres no known way to prevent the condition. However, there are things you can do that may reduce your risk or delay the onset of dementia, such as: stoppingsmoking and cutting down on alcohol eating a healthy, balanced diet and maintaining a healthy weight staying physically fit and mentally active These measures have other health benefits, such as lowering your risk of cardiovascular disease and improving your overall mental health. Read more about preventing Alzheimers disease Symptoms of Alzheimers disease The symptoms of Alzheimers disease progress slowly over several years. Sometimes these symptoms are confused with other conditions and may initially be put down to old age. The rate at which the symptoms progress is different for each individual and its not possible to predict exactly how quickly it will get worse. In some cases,infections, medications, strokes or deliriumcan be responsible for symptoms getting worse. Anyone with Alzheimers disease whose symptoms are rapidly getting worse should be seen by a doctor, so these can be managed. Stages of Alzheimers disease Generally, the symptoms of Alzheimers disease are divided intothree main stages. Early symptoms In the early stages, the main symptom ofAlzheimers disease is memory lapses. For example, someone with early Alzheimers disease may: forget about recent conversations or events, or misplace items forget the names of places and objects, or have trouble thinking of the right word repeat themselves regularly, such as asking the same question several times show poor judgement or find it harder to make decisions become less flexible and more hesitant to try new things There are often signs ofmood changes, such as increasing anxiety or agitation, or periods of confusion. Middle-stage symptoms As Alzheimers disease develops, memory problems will get worse. Someone with the condition may find it increasingly difficult to rememberthe names of people they know and may struggle to recognise their family and friends. Other symptoms may also develop, such as: increasing confusion and disorientation for example, getting lost, or wandering and not knowing what time of day it is obsessive, repetitive or impulsive behaviour delusions (believing things that are untrue) or feeling paranoid and suspicious about carers or family members problems with speechorlanguage (aphasia) disturbed sleep changes inmood, such as frequent mood swings, depression and feelingincreasingly anxious, frustrated or agitated difficulty performingspatial tasks, such asjudging distances hallucinations By this stage, someone with Alzheimers disease usually needs support to help them with their everyday living. For example, they mayneed help eating, washing, getting dressed and using the toilet. Later symptoms In the later stages of Alzheimers disease, the symptoms become increasingly severe and distressing for the person with the condition, as well as their carers, friends and family. Hallucinations and delusions may come and go over the course of the illness, but can getworse as the condition progresses. Sometimes people with Alzheimers disease can beviolent, demanding and suspicious of those around them. A number of other symptoms may also develop as Alzheimers disease progresses, such as: difficulty eating and swallowing (dysphagia) difficulty changing position or moving around without assistance considerable weight loss although some people eat too much and put on weight unintentional passing ofurine (urinary incontinence) or stools ( bowel incontinence ) gradual loss of speech significant problems with short- and long-term memory In the severe stages of Alzheimers disease, people may need full-time care and assistance with eating, moving and using the toilet. Read more about how Alzheimers disease is treated Seeking medical advice If youre worried about your memory or think you may have dementia, its a good idea to see your GP. If youre worried about someone else, you should encourage them to make an appointment and perhaps suggest that you go along with them. Memory problems are not just caused by dementia theycan also be caused by depression, stress, medications or other health problems. Your GP can carry out some simple checks to try to find out what the cause may be, and they can refer you to a specialist for more tests, if necessary. Read more about diagnosing Alzheimers disease Causes of Alzheimers disease Alzheimers disease is caused by parts of the brain shrinking (atrophy), which affects the structure and function of particular brain areas. Its not known exactly what causes this process to begin. However,in the brains of people with Alzheimers disease, scientistshave foundamyloid plaques (abnormal deposits of protein), neurofibrillary tangles (containing tau) and imbalances in a chemical called acetylcholine. Its also common to have a degree of vascular damage in the brain. Thesereduce the effectiveness ofhealthy neurons (nerve cells that carry messages to and from the brain), gradually destroying them. Over time, this damage spreads toseveral areas of the brain. The first areas affected are responsible for memories. Increased risk Although its still unknown what triggersAlzheimers disease,several factors are known to increase your risk of developing the condition. Age Age is the single most significant factor in the development of Alzheimers disease. The likelihood of developing the condition doubles every five years after you reach 65 years of age. However, its not just older people who are at risk of developing Alzheimers disease. Around1 in20people with the condition are under 65.This is called early onset Alzheimers disease andit can affect people from around the age of 40. Family history The genes you inherit fromyour parents can contribute to your risk of developing Alzheimers disease, although the actual increase in risk is small if you have aclose family member with the condition. However, in a few families, Alzheimers disease is caused by the inheritance of a single gene, and the risks of the conditionbeing passed on are much higher. If several of your family members have developed dementia over the generations, it may be appropriate to seek genetic counsellingfor information and advice about your chances of developing Alzheimers disease when you are older. The AlzheimersSociety website has more information about the genetics of dementia . Downs syndrome People with Downs syndrome are at a higher risk of developing Alzheimers disease. This is because the genetic fault that causes Downs syndrome can also cause amyloid plaques to build up in the brain over time, which can lead to Alzheimers disease in some people. Head injuries People who have had a severe head injury have been found to be at higher risk of developing Alzheimers disease. Cardiovascular disease Research shows that several lifestyle factors and conditions associated with cardiovascular disease can increase the risk of Alzheimers disease. These include: smoking obesity diabetes high blood pressure high cholesterol You can help reduce your risk by: stopping smoking eating a healthy, balanced diet leading an active life, both physically and mentally losing weight if you need to drinking less alcohol havingregular health checks as you get older Read more about reducing your risk of Alzheimers disease Diagnosing Alzheimers disease Its best to see your GP if youre worried about your memory or think you may have dementia. If youre worried about someone else, encourage them to make an appointment and perhaps suggest going with them. Its often very helpful having a friend or family member there. A timelydiagnosis gives you the best chance to adjust, prepare and plan for the future, as well as accessing treatments and support that may help. Seeing your GP Memory problems arent just caused by dementia they can also be caused by: depression or anxiety stress medications alcohol or drugs other health problems such as hormonal disturbances or nutritional deficiencies Your GP can carry out some simple checks to try to find out what the cause may be. Theycan then refer you to a specialist for assessment, if necessary. Your GP will ask about your concerns and what you or your family have noticed. Theyll also checkother aspects of your health, and carry out a physical examination. They may also organise some blood tests and ask about any medication youre taking to rule out other possible causes of your symptoms. Youll usually be asked some questionsand carry outsomememory, thinking, and pen and paper tasks to check how different areas of your brain are functioning. This can help your GP decide if youneed tobe referred to a specialist for more assessments. Referral to a specialist Your GP may refer you to a specialist memory assessment service to help with your diagnosis. Memory clinics are staffed by professionals from multiple disciplines who are experts in diagnosing, caring for and advising people with dementia and their families. Memory clinic staff can include the following, depending on your local area: a nurse usually a trained mental health nurse who specialises in diagnosing and caring for people with dementia a psychologist a healthcare professional who specialises in the assessment and treatment of mental health conditions a psychiatrist a qualified medical doctor who has training in treating mental health conditions a neurologist a specialist in treating conditions that affect the nervous system (the brain and spinal cord) a geriatrician a physician with specialist training in the care of older people a social worker a trained member of staff able to advise and assist with accessing social services within the local area an occupational therapist a member of staff with specialist skills in assessing and supporting people with dementia and their families with adjusting to disabilities Theres no simple and reliable test for diagnosing Alzheimers disease,butthe staff will listen to the concerns of both you and your family about your memory or thinking. They will assess your skills and arrange more tests to rule out other conditions. Assessing your mental abilities A specialist will usually assess your mental abilities using a special series of questions. One widely used test is the mini mental state examination (MMSE). This involves being asked to carry out activities such as memorising a short list of objectscorrectly and identifying the current day of the week, month and year. Different memory clinics may also use other, longer tests. The MMSE isnt used to diagnoseAlzheimers disease,but its useful to initially assess areas of difficulty that a person withthe condition may have. This helps specialists to make decisions about treatment and whether more tests are necessary. Tests To rule out other possible causes of your symptoms and look for possible signs of damage caused by Alzheimers disease, your specialist may recommend having a brain scan. This could be a: computerised tomography (CT) scan where several X-rays of your brain are taken at slightly different angles and a computer is used to put the images together magnetic resonance imaging (MRI) scan where a strong magnetic field and radio waves are used to produce detailed images of the inside of your brain Some specialist centres offer scans which look at brain function and particular protein deposits. However, at the moment, these are mostly experimental and only used if the diagnosis is unclear. Afterdiagnosis It may take severalappointments and tests over months, or even years, before a diagnosis of Alzheimers disease can be confirmed. For some people, a diagnosis ofAlzheimers disease is a huge shock, especially as its not unusual for people with dementia to have less awareness of their difficulties. For others, the diagnosis can be very important in helping them and their families to make sense of symptoms theyve been concerned about for a long time. If youve just been given a diagnosis of dementia, you may be feeling numb, scared and unable to take everything in. It may be helpful to have the diagnosis explained again to help make sense of the idea over time. It might help to talkthings through with family and friends. It takes time to adapt to a diagnosis of dementia, for both you and your family. Some people find it helpful to seek information and plan for the future, but others may need a longer period to process the news. However, as dementia is a progressive illness, the weeks to months after a diagnosis is often a good time to think about legal, financial and healthcare matters for the future. Read more about what to do if youve just been diagnosed with dementia Treating Alzheimers disease Theres currently no cure for Alzheimers disease, although medication is available that can temporarily reduce some symptoms or slow down the progression of the condition in some people. Support is also available to help someone with the condition cope with everyday life. Care plan If youre diagnosed withAlzheimers disease, its helpful if your health and social care needs are assessed and plans made forthe future. A care plan is a way of ensuring you receive the right treatment for your needs. It involves identifying areas where you may need some assistance, such as: what support you or your carer need for you to remain as independent as possible whether there are any changes that need to be made to your home to make it easier to live in whether you need any financial assistance Healthcare professionals (such as your GP or psychiatrist) and social care services (which is normally your local council working with the NHS), will usually both be involved in helping draw up and carry out care plans. Medication Anumber of medicationsmay be prescribed for Alzheimers disease to help temporarily improve some symptoms and slow down the progression of the condition. Donepezil,galantamineand rivastigmine (known as AChE inhibitors)can be prescribed for people with early to mid-stage Alzheimers disease. Memantine may be prescribed for people with mid-stage disease who cannot take AChE inhibitors, orfor those withlate-stage disease. Theres no difference in how well each of the three different AChE inhibitors work, althoughsome peoplerespond bettertocertain types or have fewer side effects. All of these medications can only be prescribed by specialists such as psychiatrists, neurologists and geriatricians. They may be prescribed by your GP on the advice of a specialist. If youre caring for someone with Alzheimers disease, your views should be taken into account when prescribing medication, as well as at regular assessments. These assessments take place to ensure the medication is having a worthwhile effect and to identify and monitor side effects. Read guidance from the National Institute for Health and Care Excellence (NICE) on donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimers disease . Side effects Donepezil, galantamine and rivastigminecan cause side effectssuch as: feeling and being sick dizziness diarrhoea headache agitation insomnia muscle cramps more rarely, slowing of the heartbeatwhich can cause issues if you already have problems with your heart rhythm. These side effects are more likely to occur at the beginning of therapy or when the dose is increased. Your doctor should review your medical history and your other medications to check the suitability and risk of interactions. Common side effects of memantine include: dizziness headaches high blood pressure tiredness constipation shortness of breath more rarely, problems with walking or increased confusion very rarely, seizures For more information about the possible side effects of your specific medication, refer to the patient information leaflet that comes with it or speak to your doctor. Supportive measures and treatments In addition to medication, treatment for Alzheimers disease involves a wide range of other measures and treatments to helppeople with dementialive as independently as possible. For example, an occupational therapist can identify problems or unsafe areasin your everyday life and help you to develop strategies or use alternative tools to manage these. They may suggest: ways of prompting and reminding yourself of important taskssuch as using diaries or calendars assistive technologydevices or systems to help maintain the independence andsafety of people living with dementia adding grab bars and handrails to your home to help you move around safely other professionals visiting you at home and assisting with daily tasks to maintain your independence in the community Psychological treatments, such as cognitive stimulation,may be offered tohelp improve your memory, problem solving skills and language ability. Medication, other psychological therapies, such as cognitive behavioural therapy (CBT), music and art therapy, reminiscence and relaxation therapies may also be offered. These may help with managing depression , anxiety, agitation, hallucinations, delusions and challenging behaviour that can occur with Alzheimers disease. Read more about how dementia is treated Practical tips for people with Alzheimers If you have Alzheimers disease, you may find it useful to: keep a diary and write down things you want to remember pin a weekly timetable to the wall put your keys in an obvious place, such as in a large bowl in your living room have a daily newspaper delivered to remind you of the day and date put labels on cupboards and drawers keep useful telephone numbers by the phone write yourself remindersfor example, put a note on the front door to remind you to take your keys with you if you go out programme peoples names and numbers into your telephone set the alarm on your watch to act as a reminder install safety devices such as gas detectors and smoke alarms throughout your home It may also be helpful toget in touch with a local or national Alzheimers or dementia support group, such as the Alzheimers Society , for more information and advice about living with Alzheimers disease. Read more about living well with dementia Future care planning People with dementia often live for many years after their diagnosis. However, as its a progressive condition, it can be helpful and reassuring for both you and your family if you make plans for the future. Future care planning means considering, discussing and possibly recording your wishes and decisions for future care. Its about planning for a time when you may not be able to make some decisions for yourself. In the earlier stages of the disease, you should have the opportunity to discuss with health professionals and your family about the future. This may involve the use of: advance statements advance decisions to refuse treatment lasting power of attorney preferred prioritiesfor care Palliative care Although the outlook is variable, dementia is a life-limiting illness and can begin to affect multiple body systems in the later stages. End of life care, or palliative care, provides support for people with an incurable illness, so theyre able to live as well and as comfortably as possible until their death. It also involves support for family members. Caremay be provided at home, a hospice, a care home or hospital. For people nearing the end of life, their care team should assess their needs, make them feel comfortable and allow them to die with dignity in a place of their choosing. Read more about palliative care Telecare Self-Check online tool Visit the Telecare Self-Check online tool to find the right support for you in your area.This easy to use online tool allows you to find helpful information on telecare services that could help you live independently at home for longer. Preventing Alzheimers disease As the exact cause of Alzheimers disease is still unknown, theres no way to prevent the condition. However, there are steps you can take that may help to delay the onset of dementia. Reducing your risk of cardiovascular disease Cardiovascular disease has been linked with an increased risk of Alzheimers disease and vascular dementia. You may be able to reduceyour risk of developing these conditions as well as other serious problems, such as strokes and heart attacks by taking steps to improve your cardiovascular health, including: stopping smoking not drinking large amounts of alcohol eating a healthy, balanced diet , including at least five portions of fruit and vegetables every day exercising for at least 150 minutes (2 hours and 30 minutes) every week bydoing moderate-intensity aerobic activity (such as cycling or fast walking) this will improve both your physical and mental health make sure your blood pressure is checked and controlled through regular health tests if you have diabetes , make sure you keep to the diet and takeyour medication Read more about preventing dementia Staying mentally active Theres some evidence to suggest that rates of dementia are lower in people who remain as mentally, physically and socially active as possible throughout their lives, as well as among those who enjoy a wide range of different activities and hobbies. It may be possible to reduce your risk of Alzheimers disease and other types of dementia by: reading writing for pleasure learning foreign languages playing musical instruments taking part in adult education courses playing tennis playing golf swimming group sports, such as bowling walking Interventions such as brain training computer games have been shown to improve cognition over a short period, but research hasnt yet demonstrated whether this can prevent dementia. Future research Research into Alzheimers disease is continuing.As more is revealed about the condition, other ways to treat or prevent it may be found. Participation in research is important and helps to improve dementia care and support for people with dementia, plus their carers and families. You can read about ongoing dementia researchon the Alzheimers Research UK website. You can also ask your local memory clinic about projects taking place. The National Institute for Health and Care Excellence (NICE) has advised that there isnt evidence to support the use of the following to prevent dementia: statins hormone replacement therapy when chemicals are taken to replace those that your body no longer produces vitamin E found in a variety of foods, such as olive oil, nuts and seeds non-steroidal anti-inflammatory drugs (NSAIDs)

Anal cancer

Anal cancer- Illnesses and conditions Cancer Cancer types in adults Anal cancer Anal cancer Anal cancer is a rare type of cancer that affects the very end of the large bowel. Symptoms of anal cancer The symptoms of anal cancer are often similar to more common and less serious conditions affecting the anus, such as piles (haemorrhoids) and anal fissures (small tears or sores). Symptoms of anal cancer can include: bleeding from the bottom (rectal bleeding) itching and pain around the anus small lumps around the anus a discharge of mucus from the anus loss of bowel control (bowel incontinence) However, some people with anal cancer dont have any symptoms. Speak to your GP if you develop any of the above symptoms. While theyre unlikely to be caused by anal cancer, its best to get them checked out. Diagnosing anal cancer Your GP will usually ask about your symptoms and carry out some examinations. They may feel your tummy and carry out a rectal examination. This involves your doctor inserting a gloved finger into yourbottom so they canfeel any abnormalities. Your GP will refer youto hospital if they think further tests are necessary. TheNational Institute for Health and Care Excellence (NICE) recommends in its 2015 guidelines that GPs should consider referring someone with an unexplained anal lumporanal ulcer. The person should receive an appointment within 2 weeks. If youre referred tohospital, a number of different tests may be carried out to check for anal cancer and rule out other conditions. Some of the tests you may have include a: sigmoidoscopy where a thin, flexible tube with a small camera and light is inserted into your bottom to check for any abnormalities proctoscopy where the inside of your rectum is examined using a hollow tube-like instrument (proctoscope) with a light on the end biopsy where a small tissue sample is removed from your anus during a sigmoidoscopy or proctoscopy so it can be examined in a laboratory under a microscope If these tests suggest you have anal cancer, you may have some scans to check whether the cancer has spread. Once these are complete, your doctors will be able to stage the cancer. This means giving it a score to describe how large it is and how far it has spread. You can read more about the stages of anal cancer on theCancer Research UK website. How anal cancer is treated If youre diagnosed with anal cancer, youll be cared for by a multidisciplinary team. This is a team of different specialists who work together to provide the best treatment and care. The main treatments used for anal cancer are: chemoradiation a combination of chemotherapy and radiotherapy surgery to remove a tumour or a larger section of bowel In cases where the cancer has spread and cant be cured, chemotherapy alone may be considered to help relieve symptoms. This is known as palliative care . Chemoradiation Chemoradiation is a treatment that combines chemotherapy (cancer-killing medication) and radiotherapy (whereradiationis used to kill cancer cells). Its currently the most effective treatment for anal cancer. You dont usually need to stay in hospital when youre having chemoradiation. Chemotherapy for anal cancer is usually given in 2 cycles, each lasting 4 to 5 days, with a 4-week gap between the cycles. In many cases, part of the chemotherapy is delivered through a small tube called a peripherally inserted central catheter (PICC) in your arm, which can stay in place until yourtreatment has finished. The tube means you dont need to stay inhospital during each of the cycles of chemotherapy. However, youll be attached to a small plastic pump, which you take home with you. A few hospitals now offer tablet chemotherapy for anal cancer, which avoids the need for the pump and PICC. Read more about how chemotherapy is carried out Radiotherapy is usually given in short sessions, once a day from Monday to Friday, with a break at weekends. This is usually carried out for 5 to 6 weeks. To prepare for radiotherapy, additional scans will be required. Read more about how radiotherapy is carried out Both chemotherapy and radiotherapy often cause significant side effects, including: tiredness sore skin around the anus sore skin around the penis and scrotum in men or vulva in women hair loss limited hair loss from the head, but total loss from the pubic area feeling sick diarrhoea These side effects are usually temporary, but theres also a risk of longer-term problems, such as infertility . If youre concerned about the potential side effects of treatment, you should discuss this with your care team before treatment begins. Other possible long-term side effects can include: bowel control problems long-term (chronic)diarrhoea erectile dysfunction vaginal pain when having sex dry and itchy skin around the groin and anus bleeding from the anus, rectum, vagina or bladder Tell your doctor if you develop any of these symptoms so they can be investigated and treated. Surgery Surgery is a less common treatment optionfor anal cancer. Its usually only considered if the tumour is small and can be easilyremoved, or if chemoradiation hasnt worked. If the tumour is very small and clearly defined,it may be cut out during a procedure called a local excision. This is a relatively simple procedure, carried out under general anaesthetic , that usually only requires astay in hospital of a few days. If chemoradiation has been unsuccessful or the cancer has returned after treatment, a more complex operation called an abdominoperineal resection may be recommended. As with a local excision, this operation is carried out under general anaesthetic. Anabdominoperineal resection involves removing your anus, rectum, part of the colon, some surrounding muscle tissue, and sometimes some of the surrounding lymph nodes (small glands that form part of the immune system) to reduce the risk of the cancer returning. Youll usually need to stay in hospital for up to 10 days after this type of surgery. During the operation,apermanent colostomy will also be formed to allow you to pass stools. This is where asection of the large intestine is diverted through an opening made in the abdomen called a stoma. The stoma is attached to a special pouch that will collect your stools after the operation. Before and after the operation, youll see a specialist nurse who can offer support and advice to help you adapt to life with a colostomy. Adjusting to life with a colostomy can be challenging, but most people become accustomed to it over time. Read more about living with a colostomy Follow-up After your course of treatment ends, youll need to haveregular follow-up appointments to monitor your recovery and check for any signs of the cancer returning. To start with, these appointments will be every few weeks or months, but theyll graduallybecome less frequent over time. What causes anal cancer? The exact cause of anal cancer is unknown, although a number of factors can increase your risk of developing the condition. These include: infection with human papilloma virus (HPV) a common and usually harmless group of viruses spread through sexual contact, which can affect the moist membranes lining your body having anal sex or lots ofsexual partners possibly because this increases your risk ofdeveloping HPV having a history of cervical , vaginal or vulval cancer smoking having a weakened immune system for example, if you have HIV Your risk of developing anal cancer increases as you get older, with half of all cases diagnosed in people aged 65 or over. The condition is also slightly more common in women than men. Further informationabout anal cancer Cancer Research UK: anal cancer Macmillan: anal cancer

Anaphylaxis

Anaphylaxis - Illnesses & conditions Immune system Anaphylaxis Anaphylaxis About anaphylaxis Causes of anaphylaxis Treating anaphylaxis Preventing anaphylaxis About anaphylaxis Anaphylaxis is a severe, potentially life-threatening allergic reaction that can develop rapidly. It is also known as anaphylactic shock. Signs of anaphylaxis include: itchy skin or a raised, red skin rash swollen eyes, lips, hands and feet feeling lightheaded or faint swelling of the mouth, throat or tongue, which can cause breathing and swallowing difficulties wheezing abdominal pain, nausea and vomiting collapse and unconsciousness What to do Anaphylaxis should always be treated as a medical emergency. If available, an injection of a medicine called adrenalineshould be given as soon as possible. Some people with a previous history of anaphylaxis will have an auto-injector of adrenaline. This should be injected into their outer thigh muscle and held in place for 5 to 10 seconds. Instructions for how to use these auto-injectors can be found on the side of each device. You should call 999 for an ambulance whether adrenaline has been given or not. If after 5 to 10 minutes the person still feels unwell, a second injection should be given. This should be given in the opposite thigh. A second dose may also be needed if the person improves and then becomes unwell again. The person should lie flat, with their legs raised on a chair or a low table. If they are having difficulty breathing, they should sit up to make breathing easier. If the person is unconscious, you should move themto therecovery position on their side, supported by one leg and one arm, with the head tilted back and the chin lifted. If the persons breathing or heart stops, cardiopulmonary resuscitation (CPR) should be performed. Further treatment will be carried out in hospital. Read more about treating anaphylaxis . Causes and triggers Anaphylaxis is the result of your bodys immune system overreacting to a harmless substance, such as food. Substances that trigger allergic reactions are known as allergens. Anaphylaxis usually develops within minutes of contact with an allergen, but sometimes the reaction can happen up to 4hours later. The most widely reported triggers of anaphylaxis are: insect stings particularly wasp and bee stings peanuts and tree nuts other types of foodssuch as milk and seafood certain medicinessuch as antibiotics Read more about the causes of anaphylaxis . Preventing further episodes If you know what has triggered anaphylaxis, its important to take steps to avoid exposure to similar triggers. You should be referred to a specialist allergy clinic to either find out your allergy triggers or, if you already know what causes it, for further assessment and advice about how to avoid allergens in the future. You may be given two adrenaline auto-injectors to use during any future episodes of anaphylaxis. Read more about preventing anaphylaxis . Who is affected? Anaphylaxis is not common, but people of all ages can be affected. People with other allergic conditions, such as asthma or the allergic skin condition atopic eczema , are most at risk of developing anaphylaxis. Although the condition is life threatening, deaths are rare. There are around 20 deaths in the UK each year. With prompt and proper treatment, most people make a full recovery. Causes of anaphylaxis Anaphylaxis is caused by a problem with the immune system, which is the bodys natural defence against illness and infection. In the case of anaphylaxis, your immune system overreacts to a harmless substance and releases a number of different chemicals, such as histamine, to deal with the mistaken threat. Triggers Some of the more common triggers for anaphylaxis are shown below. Insect stings Most cases of anaphylaxis are caused by wasp and bee stings, although potentially any insect bite or sting can cause anaphylaxis. Its estimated around1 in 100 people will experience an allergic reaction after a wasp or bee sting, but only a small number of these people will go on to develop severe anaphylaxis. Foods More than half of all cases of food-related anaphylaxis are caused by peanuts. Other foods known to trigger anaphylaxis include: nuts such as walnuts, cashew nuts, almonds, brazil nuts and hazelnuts milk fish and shellfish eggs some types of fruit such as bananas, kiwi fruit, grapes and strawberries Medicines Medicines known to trigger anaphylaxis in a small amount of people include: antibiotics particularly penicillin-like antibiotics general anaesthetic muscle-relaxant medicines used during surgery non-steroidal anti-inflammatory drugs (NSAIDs) a type of painkiller that includes ibuprofen andaspirin People sensitive to these types of medicines will usually develop anaphylaxis as soon as they begin a course of treatment, although they may have safely received them in the past. The risk of anaphylaxis using these types of medicines is very small, so in most cases the benefits of treatment outweigh the potential risk. For example, the risk of developing anaphylaxis is around: 1 in 1,480after taking a NSAID-type painkiller 1 in 5,000 after taking penicillin 1 in 10,000 after being given a general anaesthetic Contrast agents Contrast agents are a group of special dyes used in some medical tests to help certain areas of your body show up better on scans such as X-rays . For example, a contrast agent injected into a blood vessel will help show up any problems in the vessel, such as a blockage, on the X-ray. This is known as angiography . The risk of developing anaphylaxis after being injected with a contrast agent is thought to be less than1 in 10,000. Rubber latex Less than 1 in 100 people in the population has anatural rubber latex allergy. Healthcare, hair, beauty, catering and motor industry workers are more likely to have a latex allergy. Those with a history of hayfever, asthma, eczema, and certain medical conditions, like spina bifida, are more likely to be affected. Idiopathic anaphylaxis Sometimes, despite extensive testing, no trigger can be found for anaphylaxis, and the cause remains unknown. This is known as idiopathic anaphylaxis. Treating anaphylaxis If you think somebody is experiencing symptoms of anaphylaxis, you should use an adrenaline injector if one is available. Dial 999 immediately afterwards. Call 999 straight away if an adrenaline injector is not available. If you can see a potential trigger, such as a wasp or bee sting stuck in their skin, carefully remove it. Adrenaline injections Adrenaline causes the blood vessels to become narrower, which raises your blood pressure and reduces swelling. It also causes the airways to open, relieving breathing difficulties. An adrenaline injection should be given as soon as a serious reaction is suspected. The signs of suspected anaphylaxis are: problems breathing feeling faint or dizzy loss of consciousness The injectioncan be done by the person with anaphylaxis, but sometimes if its a young child or someone who is unconscious, for example another person may need to do it. Before attempting the injection, make sure you know what to do. You should read all of the instructions carefully when you, or the person you are responsible for, are first prescribed the injector. After injecting, the syringe should be held in place for 5 to 10 seconds. Injections can be given through clothing. After injecting the adrenaline, you should immediately dial 999 for an ambulance, even if the person is starting to feel better. Most people should experience a rapid improvement in symptoms once the adrenaline has been used. If theres no improvement after 5 to 10 minutes, you should inject a second dose of adrenaline, if one is available. This should be injected into the opposite thigh. Read Medicines and Healthcare products Regulatory Agency (MHRA) 2014guidelines on how to use an adrenaline auto-injector (PDF, 188kb) . Positioning and resuscitation In most cases, the person should lie flat, with their legs raised on a chair or a low table, to help maintain bloodflow to the head and heart. Pregnant women should lie down on their left side to avoid putting too much pressure on the large vein that leads to the heart. If the person is conscious but having trouble breathing, they should sit up to make breathing easier. If the person is unconscious, check thattheir airways are open and clear, and also check their breathing. Then put them in the recovery position to make sure they dont choke on their vomit. Place the person on their side, making sure they are supported by one leg and one arm. Open the airway by tilting the head and lifting the chin. If the persons breathing or heart stops, cardiopulmonary resuscitation (CPR) should be performed. Admission to hospital Even if adrenaline is given, the person will need to go to hospital for observation usually for6 to 12 hours as symptoms can occasionally return during this period. While in hospital, an oxygen mask can be used to help breathing, and fluids given by an intravenous drip directly into a vein can help increase blood pressure. As well as adrenaline, additional medications such asantihistamines and corticosteroids can be used to help relieve symptoms. Blood tests may also be carried out while youre in hospital to confirm anaphylaxis. You should be able to leave hospital when the symptoms are under control and its thought they will not return quickly. This may be after a few hours, but you may have to stay in hospital for a few days if the symptoms were severe. You may be asked to take antihistamines and corticosteroid tablets 2to 3days after leaving hospital to help stop your symptoms returning. You will probably be asked to attend a follow-up appointment so you can be given advice about how you can avoid further episodes of anaphylaxis. An adrenaline auto-injector may be given to you for emergency use between leaving hospital and attending the follow-up appointment. Read more about preventing anaphylaxis . Preventing anaphylaxis If you have anaphylaxis, you should be offered advice and medication to help prevent further episodes. Allergy clinic You should be referred to a specialist allergy clinic for tests to find out what caused the anaphylaxis. Knowing what allergen triggered the allergic reaction can help you avoid further episodes of anaphylaxis. Some of the tests commonly used to determine allergies include: a skin prick test your skin is pricked with a tiny amount of a suspected allergen to see if it reacts by becoming red, raised and itchy a blood test a sample of your blood is taken to test its reaction to a suspected allergen Read more about diagnosing allergies . Adrenaline auto-injectors You may be prescribed an adrenaline auto-injector if youve had a previous episode of anaphylaxis and theres a risk of you having another episode in the future. There are 3types of auto-injector: EpiPen Jext Emerade Each type is slightly different, and you should make sure you know how to use your auto-injector correctly. You can also ask for a trainer kit so you can practise giving yourself or your child injections. The following points are important: Carry your auto-injector(s) at all times there should be no exceptions. It may also be recommended that you get an emergency card or bracelet with full details of your allergy and doctors contact details to alert others. Extremes of heat can make adrenaline less effective, so dont leave your auto-injector inthe fridge or your cars glove compartment. Check the expiry date regularly. An out-of-date injector will offer limited protection. The manufacturers offer a reminder service, where you can be contacted near the expiry date. Check the information leaflet that comes with your medicine for more information. If your child has an auto-injector, they will need to change over to an adult dose once they reach 30kg (approximately4.5 stone). Dont delay injecting yourself if you think you may be experiencing the beginning of anaphylaxis, even if your initial symptoms are mild. Its better to use adrenaline early and then find out it was a false alarm than delay treatment until youre sure you are experiencing severe anaphylaxis. Avoid triggers If a trigger has been identified as causing your episode of anaphylaxis, you will need to take steps to avoid it in the future. Food You can reduce the chances of being exposed to a food allergen by: checking food labels letting staff at a restaurant know what youre allergic to, so its not included in your meal remembering that some types of food may contain small traces of potential allergens for example, some sauces contain wheat and peanuts Seeour page on living with a food allergy for more information. Insect stings You can reduce your risk of being stung by an insect by taking basic precautions, such as: moving away from wasps, hornets or bees slowly without panicking dont wave your arms around or swat at them using an insect repellent if you spend time outdoors, particularly in the summer Some specialist allergy centres also offer special treatment to help desensitise you to insect stings if you are at a particularly high risk of a further sting for example, if you area beekeeper or gardener. Read more about preventing insect stings . Medicines If youre allergic to certain types of medicines, there are normally alternatives that can be safely used. For example, if youre allergic to: penicillin you can normally safely take a different group of antibiotics known asmacrolides non-steroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen and aspirin you can normally safely take paracetamol , but read the ingredients of things like colds medicines carefully to make sure they dont contain NSAIDs one type of general anaesthetic others are available, or it may be possible to perform surgery using a local anaesthetic or anepidural injection angiotensin-converting enzyme (ACE) inhibitors alternative blood pressure medications, such as calcium channel blockers, can be used Always tell any healthcare professional about medicine allergies you have, as they may not be aware of them. Contrast agents There may be times when its necessary to use contrast agents for example, if you had bleeding inside your brain even if this places you at risk of anaphylaxis. In such circumstances, you can be given injections ofantihistamines and corticosteroids before the contrast agents, which may help prevent symptoms occurring or at least make them less severe.

Angina

Angina- Illnesses and conditions Heart and blood vessels Conditions Angina Angina About angina Treating angina About angina Angina is chest pain which occurs when the blood supply to the heart becomes restricted because of narrowing or blockages in the blood vessels around the heart. Symptoms of angina The main symptom of angina is chest pain. This can: feel like a dull pain, ache, heavy or tight feeling in your chest spread to your arms, neck, jaw or back be triggered by physical exertion Angina itself is not life threatening, but prolonged chest pain can be a symptom of a heart attack. Phone 999 immediately if: You or someone else has symptoms like: central chest pain or discomfort in the chest that doesnt go away it may feel like pressure, tightness or squeezing pain that radiates down the left arm, or both arms, or to the neck, jaw, back or stomach unconsciousness seizures or fitting difficulty breathing (snoring or rasping) chest pain alongside breathlessness, nausea and sweating Speak to your GP if you: do not have a diagnosis of angina and experience chest pain on exercise that eases after a few minutes of resting have an angina diagnosis and your symptoms are becoming more frequent or occur at rest If your GP is closed, phone 111. Diagnosing angina To diagnose angina, you will be assessed and you may need to have several tests. You will also be asked some questions about: the symptoms you experienced if there were any triggers for the pain your familys medical history lifestyle risk factors (like smoking, for example) Tests for angina You might also be given some tests to determine if you already have heart disease or youre at risk of it. measuring your weight measuring blood pressure taking blood to check cholesterol levels, diabetes or anaemia If its thought that you have angina, you might be referred to the hospital for some more tests. These might include: electrocardiogram (ECG) measures the rhythms and electrical activity of the heart exercise tolerance test (ETT) measures the activity of the heart during exercise myocardial perfusion scan (MPS or MYoview) measures how well blood is reaching the heart coronary angiography shows whether your coronary arteries are narrow and how severe any blockages are blood tests help to identify increased enzyme levels (troponin) which are released when the heart is damaged Types of angina The 2 main types of angina are stable angina and unstable angina. Stable angina is more common. Attacks are more likely to have a trigger (like physical activity or stress). Symptoms of stable angina usually only last for a few minutes after exercise or stress. They can improve with rest and by taking a medication called Glyceryl trinitrate (GTN). Attacks of unstable angina can be unpredictable and develop without any clear triggers. They might also last longer and continue even when resting. Sometimes, when chest pain occurs suddenly, its unclear if its due to unstable angina or a heart attack. Until tests confirm the diagnosis, doctors sometimes call this Acute Coronary Syndrome (ACS). Treating angina There are various ways to treat and manage angina. Stable angina If you have stable angina you may be given medicine to: prevent and treat angina attacks reduce your risk of a heart attack Preventing and treating angina attacks Nitrates You may be given nitrates if you have stable angina. These work by relaxing the muscles in the blood vessels so that blood can pass through more easily. You might be given nitrates as: slow release tablets a fast acting spray or tablet Glyceryl trinitrate (GTN) is usually given in a fast acting spray or tablets. You should keep this with you at all times. If you experience an episode of angina you can use the spray or tablet under your tongue. The pain should then ease within a few minutes. You can repeat the dose after 5 minutes if the pain has not gone away. If the pain has still not gone 5 minutes after you take the second dose you should call an ambulance. Beta blockers Beta blockers work mainly by slowing down the heart. Calcium channel blockers Calcium channel blockers relax the arteries, increasing blood supply to the heart muscle. If you cannot have beta blockers or calcium channel blockers, you may be given another medicine. Your doctor will discuss this with you. Reducing your risk of a heart attack or stroke To reduce your risk of more serious cardiovascular problems, your doctor might give you: a low dose of aspirin to prevent blood clots statins to reduce your cholesterol (blood fats) level ACE inhibitors to reduce your blood pressure Unstable angina Worsening angina symptoms over a short period of time can be a sign of a more acute coronary syndrome and you should seek urgent medical advice by phoning 999. If you have unstable angina (where symptoms develop unpredictably), youll need certain medicines. These will prevent blood clots and reduce your risk of having a heart attack. You may be given: low-dose aspirin clopidogrel Ticagrelor Surgery may be recommended if you continue to have angina attacks despite medical treatment. It may also be recommended if tests show that youre at a high risk of having a heart attack. Surgery for angina There are 2 types of procedures that are used to treat angina. These are a: coronary artery bypass graft (CABG) percutaneous coronary intervention (PCI) The best option for you depends on your circumstances. You should discuss the different options with your doctor. Its likely that you will need to continue taking some medicines after surgery. Coronary artery bypass graft (CABG) A CABG is where a section of a blood vessel is taken from another part of the body. This is then used to re-route the flow of blood past a blocked or narrow section of artery. Percutaneous coronary intervention (PCI) PCI is where a narrowed section of artery is widened using a balloon and a tiny tube called a stent. Its also known as a coronary angioplasty.

Angioedema

Angioedema - Illnesses and conditions Skin, hair and nails Angioedema Angioedema About angioedema Symptoms of angioedema Causes of angioedema Diagnosing angioedema Treating angioedema About angioedema Angioedema is the swelling of the deeper layers of the skin, caused by a build-up of fluid. The symptoms of angioedema can affect any part of the body, butswelling usuallyaffects the: eyes lips genitals hands feet Many people with angioedema also experience urticaria (hives) . This is a raised, red and itchy rash that appears on the skin. Angioedema can cause swelling in any part of the body, including the lips. Source: https://dermnetnz.org/ Angioedema can cause swelling around the eye. Source: https://dermnetnz.org/ Why does angioedema happen? The cause of angioedema depends on the type you have. There are 4main types of angioedema: allergic angioedema the swelling is caused by an allergic reaction, such as a reaction to peanuts, and sometimes occurs in combination with anaphylaxis idiopathic angioedema there is no known cause for the swelling (although certain factors, such as stress or infection, may trigger the symptoms) drug-induced angioedema the swelling is a side effect of certain medications,most oftenangiotensin-converting enzyme (ACE) inhibitors hereditary angioedema the swelling is caused by faulty genes that are inherited from a persons parents Read more about the causes of angioedema . Who is affected Angioedema is a common condition, affecting about 10-20% of people during their life, althoughsome types are more common than others. Hereditary angioedema is rare, only affecting between 1 in 10,000and 1 in 50,000 people worldwide. Diagnosis Your doctor candiagnose angioedema by examining the affected skin anddiscussing symptoms. However, further tests, such as blood tests or allergy tests,may be required to determine the type of angioedema. Idiopathic angioedema is only diagnosed if no cause can be found. Read more about diagnosing angioedema . How is angioedema treated? Although most cases of angioedema get better without treatment after a few days, medication is often used. For cases of allergic and idiopathic angioedema, antihistamines and oral steroids (steroid tablets) can be used to relieve the swelling. Drug-induced angioedema can usually be treated byusing an alternative medication to treat whatever underlying condition you have. Although the condition cannot be cured, regular drug treatment can prevent attacks in people with hereditary angioedema. Read more about treating angioedema . Symptoms of angioedema The main sign of angioedema is swelling that develops below the skins surface. Swollen skin The swelling is caused by a collection of fluid in the deep layers of the skin. It most often affects the hands, feet, eyes, lips, or genitals. In severe cases, the inside lining of the throat and bowel can be affected (see below). The swellingusually appears suddenly, and is more severe than normal hives (nettle rash). It commonly lasts 1to 3days. There may be a prickling sensation in the affected area before swelling is visible. The swelling is not itchy and the skin may look a normal colour; however, many people with allergic or idiopathic angioedema also develop urticaria (hives) , which is red and itchy. Swelling caused by angioedema often affects the hands and feet. Source: https://dermnetnz.org/ Other symptoms As well as visible swellings, angioedema can cause other symptoms, including: a hot or painfulsensation in the swollen areas swelling of the inside of the throat, thewindpipe and the tongue, making breathing difficult swelling of the conjunctiva (the transparent layer of cells that cover the white part of the eye), which affectsvision People with hereditary angioedema may also experience: abdominal (stomach) pain caused by swelling in the stomach and bowel, which can cause nausea, vomiting and diarrhoea swelling of the bladder or urethra (the tube that connects the bladder to the genitals), which can cause bladder problems and difficulty passing urine When to seek medical advice Contact your GP if you have an episode of angioedema that does not affect your breathing and you have not previously been diagnosed with the condition. You will need to have tests to determine what type of angioedema you have. When to seek emergency medical advice Dial 999 to request an ambulance if you suspect that you, or someone you know, is experiencing anaphylaxis (a severe allergic reaction) . Tell the operator that you suspect anaphylaxis. Initial symptoms of anaphylaxis include: a feeling of tightness in the chest that leads tobreathing problems swelling of the tongue and throat If you, or the person in your care, has previously been prescribed an adrenaline auto-injector pen, you should use it while waiting for the ambulance to arrive. Causes of angioedema Angioedema is often caused by a problem with the immune system, although there are many cases where no cause can be identified. Allergic angioedema Normally, your immune system protects your body from illness and infection by attacking germs in your body. In allergic angioedema, your immune system mistakenly attacks harmless substances in your blood. Your body produces the chemical histamine, which causes the blood vessels in the area to expand, leading to swelling of the skin. Substances known to trigger allergic angioedema include: certain types of food particularly nuts, shellfish, milk and eggs some types of medicationsuch as penicillin, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen insect bites and stings particularly wasp and bee stings latex a naturally occurring rubber used to make medical gloves, balloons and condoms Idiopathic angioedema Cases of angioedema without an identifiable cause are known as idiopathic angioedema. It may be that a problem with the immune system sometimes causes it to misfire. In cases ofidiopathic angioedema, certain triggers may lead to swelling, such as: anxiety or stress minor infections hot or cold temperatures exercise Avoiding these triggers whenever possible may improve your symptoms. Drug-induced angioedema Some medications can cause angioedema. Angiotensin-converting enzyme (ACE) inhibitors, which are used to treat high blood pressure (hypertension) , are usually responsible. Its estimated that around1-5% ofpeople taking ACE inhibitors will develop drug-induced angioedema. Black people being treated with ACE inhibitors are 3to 4times more likely to develop this side effect than white people. Around 1in 4cases of drug-induced angioedema occurs during the first month of taking an ACE inhibitor. The remaining cases develop many months or even years after treatment begins. While they are useful in lowering blood pressure, ACE inhibitors can sometimes disrupt the chemical balance and trigger an episode of severe swelling. Less common causes of drug-induced angioedema include: bupropion a medication that helps people to give up smoking vaccines selective serotonin reuptake inhibitors (SSRIs) a type of antidepressant COX-II inhibitors a type of painkiller used to treat chronic pain conditions such as arthritis NSAIDs a type of painkiller, such as aspirin or ibuprofen angiotensin-2 receptor antagonists another medication used to treat high blood pressure statins used to treat people with high cholesterol levels proton pump inhibitors (PPIs) used to treat stomach ulcers Hereditary angioedema Hereditary angioedema is caused by a genetic mutation (a change in the DNA) in the C1 esterase inhibitor (C1-inh) gene. Genes are single units of genetic material that code for characteristics such as eye and hair colour. As a result of the mutated C1-inhgene, the body does not make enough C1-inhprotein. This protein plays an important role in regulating the immune system. Without enough C1-inhprotein, the immune system can misfire and trigger the symptoms of angioedema. Certainthings are thought to trigger hereditary angioedema, such as: traumaincluding surgery or infection the oral contraceptive pill pregnancy The mutated C1-inh gene is passed down through families. If you have hereditary angioedema, you have a50% chance of passing it on to your children. Diagnosing angioedema Angioedema is usually diagnosed by your doctor examining the affected skin and discussing your symptoms. It can be difficult to find the exact cause and identify which type of angioedema you have. There is no single test available, but you may have allergy tests orblood tests if a specific cause is suspected. Allergic angioedema Youre likely to be asked ifyou have recently been exposed to any allergy-causing substances, such as nuts or latex.You may also be asked whether you have a history of other allergic conditions, such as urticaria (hives) or asthma . People with an allergic condition often develop other allergic conditions. Tell your doctor about any medications you are taking, including over-the-counter medication, such as painkillers, herbal supplements and vitamins. Your GP may recommend that you keep a diary of your exposure to possible irritants or a food diary, if a food allergy is suspected. If allergic angioedema is suspected, you arelikely to be referred to a specialist allergy or immunology clinic for further testing. Tests may include: a skin prick test your skin is pricked with a tiny amount of the suspected allergen to see whether there is a reaction a blood test a sample of your blood is tested to determine whether your immune system reacts to a suspected allergen Read more about diagnosing allergies . Drug-induced angioedema If you are taking a medication known to cause drug-induced angioedema, your GP will withdraw that medication and prescribe an alternative. You should not stop taking any prescribed medication without advice from a health professional. If you dont have any further episodes of angioedema, a diagnosis of drug-induced angioedema can be made. Hereditary angioedema Hereditary angioedema can be diagnosed using a blood test to check the level of proteins regulated by the C1-inh gene. A very low level would suggest hereditary angioedema. The diagnosis and management of hereditary angioedema is highly specialised and should be carried out in a specialist immunology clinic. Idiopathic angioedema Idiopathic angioedema is usually confirmed by a diagnosis of exclusion. This means a diagnosis of idiopathic angioedema can only be made after all the above tests have been carried out and a cause has not been found. As angioedema can be associated with other medical problems such as an iron deficiency, liver diseases and problems with the thyroid gland your doctor or specialist will undertake some simple blood tests to check for these conditions. Treating angioedema Medication is the main treatment for angioedema, although many cases get better after a few days without treatment. Allergic angioedema and idiopathic angioedema are usually treated in the same way, using a combination of antihistamines and corticosteroids to help relieve the swelling. Drug-induced angioedema can usually be treated by using an alternative medication to the one causing your symptoms. If you also had symptoms of anaphylaxis during an episode of angioedema, you will probably be given an adrenaline auto-injector pen in case your symptoms return. Read more about treating anaphylaxis . Hereditary angioedema cannot be cured and does not respond to adrenaline, antihistamines or steroids, so a preventative approach is taken.A number of different medications are used to stabilise the protein levels in your blood to help prevent symptoms developing. Antihistamines Antihistamines work by blocking the effects of a protein called histamine, which is one of the chemicals responsible for causing your skin to swell. A 2-week course ofa non-sedating type of antihistamine (which does not cause drowsiness) is usually recommended these include fexofenadine and cetirizine. Cetirizine can be bought over the counter in pharmacies and supermarkets without a prescription. Antihistamines can also be given by injection at hospital or your GP surgery. If you also have urticaria (hives) and are being kept awake at night by itchy skin, your GP may prescribe an older type of antihistamineto take before going to bed. These typescause drowsiness and should help you sleep. A minority of people will still experience drowsiness after taking the newer type of antihistamines. If you find yourself feeling drowsy, you should avoid: driving drinking alcohol operating complex or heavy machinery Other side effects of the newer antihistamines include: headache dry mouth dry nose These side effects are usually short-lived and should pass quickly. Corticosteroids Corticosteroids (steroids) work by blocking many of your immune systems actions. In most cases, a 3to 5day course of steroid tablets is recommended. A steroid called prednisolone is the preferred choice. Side effects of prednisolone include: nausea abdominal (stomach) pain tiredness oral thrush a fungal infection inside your mouth dizziness If you feel dizzy after taking prednisolone, avoid driving and operating heavy machinery. These side effects should pass once you finish the course of treatment. Steroid injections may be needed for more severe cases of angioedema. These are usually administered in hospitals or at specialist clinicsby an allergy specialist or immunologist (a doctor who specialises in treating conditions that affect the immune system). Medication for hereditary angioedema The medication used to treat hereditary angioedema falls into 1of 2categories: medication used to prevent angioedema medication used to relieve symptoms Danazol Danazol is a synthetic hormone that is effective in preventing the symptoms of angioedema because it helps boost levels of the C1-inh protein. However, danazol can cause a number of unpleasant side effects if used on a long-term basis. For example, it may cause: weight gain depression disruption to the menstrual cyclesuch asirregular periods orabsent periods high blood pressure in women, changes to the body that are usually associated with mensuch as excessivebody hair growth, flattening of the chest, deepening of the voice and an increase in muscle tone liver problems Due tothese side effects, many people with hereditary angioedema are uneasy about using danazol on a long-term basis. Stanozolol is a similar medication that is slightly better tolerated. Tranexamic acid Tranexamic acid is also an alternative medication to danazol. It can be as effective as danazol, but does not cause as many side effects and is preferred for use in women. Icatibant Icatibant is a relatively new medication used to treat acute (short-lasting) episodes of swelling. It works by blocking the effects of some of the chemicals that are responsible for causing the swelling in cases of hereditary angioedema. Icatibant is given by injection under the skin, and asecond injection is often required. Common side effects of icatibant include: adverse skin reactions at the site of the injectionsuch as pain, redness, swelling or itchiness itchiness in other areas of the skin dizziness C1-inhibitors Purified C1-inhibitor concentrate is widely used to replace the missing protein in the blood. Its needed for patients undergoing surgery, to prevent attacks caused by surgical trauma. Its used to treat acute attacks and is injected directly into the vein. Many patients will keep supplies of their concentrate at home for emergency use. Icatibant and C1-inhibitor concentrate will be prescribed by the specialist immunology unit caring for the patient with hereditary angioedema.

Ankylosing spondylitis

Ankylosing spondylitis (AS) - Illnesses and conditions Muscle, bone and joints Conditions Ankylosing spondylitis Ankylosing spondylitis About ankylosing spondylitis Symptoms of ankylosing spondylitis Causes of ankylosing spondylitis Diagnosing ankylosing spondylitis Treating ankylosing spondylitis Complications of ankylosing spondylitis About ankylosing spondylitis Ankylosing spondylitis (AS) is a long-term (chronic) condition in which the spine and other areas of the body become inflamed. Thesymptoms of AS can vary but usually involve: back pain and stiffness that improves with exercise and isnt relieved by rest pain and swelling in other parts of the body, such as the hips, knees and ribs fatigue (extreme tiredness) These symptoms tend to develop gradually, usually over several months or years, and may come and go over time. In some people, the condition gets better with time, but for others it can get slowly worse. Read more about the symptoms of ankylosing spondylitis When to seek medical advice You should see your GP if you have persistent symptoms of AS. If your GP thinks you may have the condition, theyshould refer you to a rheumatologist (a specialist in conditions affecting muscles and joints) for further tests and any necessary treatment. Read more about diagnosing ankylosing spondylitis . What causes ankylosing spondylitis? In AS, various areas of the spine and other joints become inflamed. As well as causingpain, stiffness and swelling, this inflammation can damage affected areas of the body over time, and in some cases can lead tosome of the individual bones of the spine fusing (joining together). This fusing of the spine is known as ankylosis. It is not known what causes the condition, but there is thought to be a link with a particular gene known as HLA-B27. Read more about the causes of ankylosing spondylitis . Who is affected AS tends to first develop in teenagers and young adults. Most cases first start in people aged 20-30, with only a minority of cases first affecting adults over 45. AS is around three times more common in men than in women. There are around 200,000 people in the UK who have been diagnosed with the condition. How ankylosing spondylitis is treated There is no cure for AS and it is not possible to reverse the damage caused by the condition. However, treatment is available to relieve the symptoms and help prevent or delay its progression. In most cases, treatment will involve a combination of: exercises carried out individually or in groups to reduce pain and stiffness physiotherapy where physical methods, such as massage and manipulation, are used to improve comfort and spinal flexibility medication to help relieve pain and reduce inflammation such aspainkillers anda type of medicine calledanti-TNF medication Surgery is sometimes needed to repair significantly damaged joints or correct severe bends in the spine, but this is uncommon. Read more about treatingankylosing spondylitis . Outlook The outlook for AS is highly variable. For some people, the condition improves after an initial period of inflammation, whereas for others the condition can get progressively worse over time. Around 70-90% of people with ASremain fully independent or minimally disabled in the long term. However,some people eventually become severely disabled due to the bones in their spine fusing in a fixed position and damage to other joints, such as the hips or knees. With modern treatments, AS doesnt normally affect life expectancy significantly, although the condition is associated with an increased risk of other potentially life-threateningproblems. For example, AS can lead to osteoporosis (weakening of the bones), spinal fractures and cardiovascular disease (a group of conditions affecting the heartand blood vessels). Readmore about the complications of ankylosing spondylitis . Information about you If you have AS, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register . Symptoms of ankylosing spondylitis The symptoms of ankylosing spondylitis (AS) can vary from person to person, but usually develop slowly, over several months or years. ASusually first starts to developduringlater teenage years or early adulthood. The symptoms maycome and go, and improve or get worse over many years. Main symptoms The main symptoms ofAS are described below, although you may not develop all of these if you have the condition. Back pain and stiffness Back painand stiffness are usually the main symptoms of AS.You may find: thepain gets better with exercise but doesnt improve, or gets worse, with rest the pain and stiffness is worse in the morning and at night you may wake up regularly during the night because of the pain you have pain inthe area around yourbuttocks Arthritis As well as causing symptoms in your back and spine, AS canalso cause inflammation of the joints ( arthritis ) in other parts of your body, such as your hips and knees. The main symptoms associated with arthritis are: pain on moving the affected joint tenderness when the affected joint is examined swelling and warmth in the affected area Enthesitis Enthesitis is painful inflammation where a bone is joined to a tendon (a tough cord of tissue that connects muscles to bones) or a ligament (a band of tissue that connects bones to bones). Common sites for enthesitis are: at the top of the shin bone behind the heel (Achilles tendon) under the heel wherethe ribs join to the breast bone If your ribs are affected, you may experience chest pain, and you may find it difficult to expand your chest when breathing deeply. Fatigue Fatigue is a common symptom of untreated AS. It can make you feel tired and lacking in energy. When to seek medical advice You should see your GP if you have persistent symptoms of AS. If your GP thinks you may have the condition, they should refer you to a rheumatologist (a specialist in conditions affecting muscles and joints) for further tests and any necessary treatment. Read more about diagnosing ankylosing spondylitis . Causes of ankylosing spondylitis In ankylosing spondylitis (AS), several parts of the lower spine become inflamed, including the vertebrae (bones in the spine) and spinal joints. Over time, this can damage the spine and lead to the growth of new bone, which in some cases can cause parts of the spine to join up (fuse) and lose flexibility. This is known as ankylosis. It is not known exactly what causes AS, but in many cases there seems tobe a link with a particular gene known as HLA-B27. HLA-B27 gene Research has shown that more than 9 out of 10 peoplewith AS carry a particular gene known as human leukocyte antigen B27 (HLA-B27). Having this gene does not necessarily meanyou will develop AS. It is estimated that 8 in every 100 people in the general population have the HLA-B27 gene, but most do not have AS. It is thought that having this gene may make you more vulnerable to developing AS, and the condition is triggered by one or more environmental factors although it is not known what these are. Testing for this gene may be carried out if AS is suspected. However, this testis not a very reliable method of diagnosing the condition because some people can have the HLA-B27 gene but not have ankylosing spondylitis. Read about how ankylosing spondylitis is diagnosed . Can ankylosing spondylitis be inherited? AScan run in families, and the HLA-B27 gene can be inherited from another family member. If youhaveAS and tests have shown you carry the HLA-B27 gene, the chance ofany children you have developing the condition is less than 20%. If you have AS but dont carry the HLA-B27 gene,the chance of any children you have developing the condition is less than 10%. If you have a close relative who has AS, such as a parent or a sibling (brother or sister), you are three times more likely to develop the condition compared with someone who does not have a relative with the condition. Diagnosing ankylosing spondylitis Ankylosing spondylitis (AS) can be difficult to diagnose because the condition develops slowly and there is no definitive test to confirm a diagnosis. The first thing you should do if you think you have AS is to see your GP. They will ask about your symptoms, including what symptoms you are experiencing, when they started and how long you have had them. Back pain associated withAS can bequite distinctive. For example, it usually doesnt improve with rest and may wake you up during the night. Blood tests If your GP suspects AS, they may arrange blood tests to check for signs of inflammation in your body.Inflammation in your spine and joints is one of the main symptoms of the condition. If yourresultssuggest you do have inflammation, youwill be referred to a rheumatologist for further tests. A rheumatologist is a specialist in conditions that affect muscles and joints. Further tests Your rheumatologist will carry out imaging tests to examine the appearance of your spine and pelvis, as well as further blood tests. These are described below. X-rays An X-ray of your lower back can showdamage to the joints at the base of your spine (the sacroiliac joints) andnew bone forming between the vertebrae (bones in your spine), which are common signs of advanced AS. MRI scan A magnetic resonance imaging (MRI) scan may highlight changes in your sacroiliac joints that might not show up on an X-ray. It may also show any inflammation of ligaments in the spinal region. Ultrasound scan An ultrasound scan can pick up inflammation of the tissues (tendons and ligaments) attached to your bones. Genetic testing A genetic blood testmay sometimesbe carried out to see if you carry theHLA-B27 gene, which is found in most people with AS. This can contribute towards a diagnosis of AS, but it is not entirely reliable as not everyone withthe conditionhas this gene, and some people have the gene without ever developing AS. Confirming ankylosing spondylitis Although scans can sometimes show spinal inflammation and fusing of the spine (ankylosis), damage to the spine cannot always be picked up in the early stages of AS. This is whydiagnosis is often difficult. In many cases, confirming a diagnosis is a long process that can take years. A diagnosis of AS canusuallybe confirmed if an X-ray shows sacroiliitis (inflammation of the sacroiliac joints) and you have at least one of the following: at least three months of lower back pain that gets better with exercise and doesnt improve with rest limited movement in your lumbar spine (lower back) limited chest expansion compared to what is expected for your age and sex If you have all three of these features but do not have sacroiliitis or if you only have sacroiliitis you will be diagnosed with probable ankylosing spondylitis. Treating ankylosing spondylitis There is no cure for ankylosing spondylitis (AS), but treatment is available to help relieve the symptoms. Treatment can also help delay or prevent the process of the spine fusing (joining up) and stiffening. In most cases, treatment will involve a combination of exercise, physiotherapy and medication, which are described below. Physiotherapy and exercise Keeping active can improve your posture and range of spinal movement, along with preventing your spine from becoming stiff and painful. As well as keeping active, physiotherapy is a key part of treating AS. A physiotherapist (a healthcare professional trained in using physical methods of treatment) can advise about the most effective exercises and draw up an exercise programme that suits you. Types of physiotherapy recommended for AS include: a group exercise programme where you exercise with others an individual exercise programme you are given exercises to do by yourself massage your muscles and other soft tissues are manipulated to relieve pain and improve movement (the bones of the spine should never be manipulated as this can cause injury in people with AS) hydrotherapy exercise in water (usually a warm, shallow swimming pool or a special hydrotherapy bath); thebuoyancy ofthe water helps make movement easierby supporting you, and the warmth can relax your muscles Some people prefer to swim or play sport to keep flexible. This is usually fine, although some daily stretching and exercise is also important. If youre ever in doubt, speak to your physiotherapist or rheumatologist before taking up a new form of sport or exercise. The National Ankylosing Spondylitis Society (NASS) provides detailed information about different types of exercise to help you manage your condition. Painkillers You may need painkillers to manage your condition while you are being referred to a rheumatologist. The rheumatologist may continue prescribing painkillers, although not everyone needs them all the time. Non-steroidal anti-inflammatory drugs (NSAIDs) The first type of painkiller usually prescribed is a non-steroidal anti-inflammatory drug (NSAID) . As well as helping to ease pain, NSAIDs can help relieve swelling (inflammation) in your joints. Examples of NSAIDs include ibuprofen , naproxen and diclofenac. When prescribing NSAIDs, your GP or rheumatologist will try to find the one that suits you, and the lowest possible dose that relieves your symptoms. Your dose will be monitored and reviewed as necessary. Paracetamol If NSAIDs are unsuitable for you, an alternative painkiller, such as paracetamol , may be recommended. Paracetamol rarely causes side effects and can be used in women who are pregnant or breastfeeding. However, paracetamol may not be suitable for people with liver problems or those dependent on alcohol. Codeine If necessary, as well as paracetamol, you may also be prescribed a stronger type of painkiller called codeine. Codeine can cause side effects includingfeeling sick, vomiting, constipation and drowsiness. Anti-TNF medication If your symptoms cannot be controlled using painkillers or exercising and stretching, anti-TNF (tumour necrosis factor) medication may be recommended. TNF is a chemical produced by cells when tissue is inflamed. Anti-TNF medications are given by injection and work by preventing the effects of TNF, as well as reducing inflammation in your joints caused by ankylosing spondylitis. Examples of anti-TNF medication include adalimumab, etanercept and golimumab. These are relatively new treatments for AS, and their long-term effects are unknown. However, they have been used for longer in people with rheumatoid arthritis ,and this is providing clearer information about their long-term safety. If your rheumatologist recommends using anti-TNF medication, the decision about whether they are right for you must be discussed carefully and your progress will be closely monitored. This is because anti-TNF medication can interfere with the immune system (the bodys natural defence system), increasing your risk of developing potentially serious infections. NICE guidelines The National Institute for Health and Care Excellence (NICE) has produced guidance about the use ofanti-TNF medication for AS. NICE states that adalimumab, etanercept and golimumab may only be used if: your diagnosis of ankylosing spondylitis has been confirmed your level of pain is assessed twice (using a simple scale that you fill in) 12 weeks apart and confirms your condition has not improved your Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is tested twice, 12 weeks apart, and confirms your conditionhas not improved BASDAI is a set of measures devised by experts to evaluate your condition, by asking a number of questions about your symptoms treatment with two or more NSAIDs for four weeks at the highest possible dose has not controlled your symptoms After 12 weeks of treatment with anti-TNF medication, your pain score and BASDAI will be tested again to see whether they have improved enough to make continuing treatment worthwhile. If they have, treatment will continue and you will be tested every 12 weeks. If there is not enough improvement after 12 weeks, you will be testedagain at a later dateor the treatment will be stopped. Corticosteroids Corticosteroids have a powerful anti-inflammatory effect and can be taken as tablets or injections by people with AS. If a particular joint is inflamed, corticosteroids can be injected directly into the joint. After the injection, you will need to rest the joint for up to 48 hours. It is usually considered wise to have a corticosteroid injection up to three times in one year, with at least three months between injections in the same joint. This is because corticosteroids injections can cause a number of side effects, such as: infection in response to the injection the skin around the injection may change colour (depigmentation) the surrounding tissue may waste away a tendon (cord of tissue that connects muscles to bones) near the joint may rupture (burst) Corticosteroids may also calm down painful swollen joints when taken as tablets. Disease-modifying anti-rheumatic drugs (DMARDs) Disease-modifying anti-rheumatic drugs (DMARDs) are an alternative type of medication often used to treat other types of arthritis. DMARDs may be prescribed for AS, although they are only beneficial in treating pain and inflammation in joints in areas of the body other than the spine. Two DMARDs sometimes used to treat inflammation of joints other than the spine include sulfasalazine and methotrexate. Surgery Most people with AS will not need surgery. However, in cases where a joint has become severely damaged,joint replacement surgery may be recommended to improve pain and movement in the affect joint. For example, if thehip joints are affected, a hip replacement may be carried out. In rare cases, corrective surgery may be neededif the spine becomes badly bent. Follow-up As the symptoms ofAS develop slowly and tend to come and go, you will need to see your rheumatologist or GP for regular check-ups. They will make sure your treatment is working properly and may carry out physical assessments to assess how your condition is progressing. This may involve further sets of the same blood tests or X-rays you had at the time of your diagnosis. Any complications of ankylosing spondylitis that arise will be treated as they develop. Complications of ankylosing spondylitis Ankylosing spondylitis (AS) is a complex condition that can affect many parts of your body. It can cause complications in your day-to-day life and lead to additional health conditions. Some complications associated with AS are outlined below. Reduced flexibility Although most people with AS remain fully independent or minimally disabled in the long term, around4 in every 10 people with the condition will eventually have severely restricted movement in their spine. This usually only affects the lower back and isthe result of the bones in the spine fusing (joining up). Fusing of the spine can make it difficult to move your back and can mean yourposture becomes fixed in one position,although it doesntlead to severe disability in most cases. In rare cases, surgery may be recommended to correct severe bends in the spine. Joint damage AS can cause joints such as the hips and knees to become inflamed.This can damagethe affected joints over time, making them painful and difficult to move. If a joint becomes particularly damaged, you may need surgery to replace it with an artificial one. Iritis Iritis, also known as anterior uveitis, is a condition sometimes associated with AS where the front part of the eye becomes red and swollen. It usually only affects one eye, rather than both. If you have iritis, your eye may become red, painful and sensitive to light (photophobia). Your vision may also become blurred or cloudy. You should visit your GP as soon as possible if you have AS and think you may have developed iritis, as the condition can cause the loss of some or all of your vision if not treated promptly. If your GP thinks you have iritis, they will refer you urgently to an ophthalmologist (a medical doctor who specialises in eye problems) for treatment. Iritis can usually be treated with corticosteroid eye drops. Osteoporosis and spinal fractures Osteoporosis is where the bones become weak and brittle. In AS, osteoporosis can develop in the spine and can increase your risk of fracturing the bones in your backbone.The longer you have the condition, the more this risk increases. If you do develop osteoporosis, you will usually need to take medication to help strengthen your bones. There are a number of medications that can be used to treat osteoporosis, which can be taken by mouth (orally) as tablets or given by injection. Read moreabout treating osteoporosis . Cardiovascular disease If you have AS, you may also have an increased risk of developing cardiovascular disease (CVD) .CVD is a general term that describes a disease of the heart or blood vessels, such as heart disease and stroke . Due to this increased risk, it is important to take steps to minimise your chances of developingCVD. Your rheumatologist (a specialist in treating muscle and joint conditions) can advise about lifestyle changes you should make to minimise your risk of developing a CVD. These changes may include: stopping smoking if you smoke losing weight if you are overweight or obese taking regular exercise 150 minutes of exercise per week can greatly increase your health making changes to your diet to keep other conditions you may have under control such as diabetes or high blood pressure You may also be prescribed medication to reduce your blood pressure or blood cholesterol level. Cauda equina syndrome Cauda equina syndrome is a very rare complication of AS that occurs when nerves at the bottom of your spine become compressed (compacted). Cauda equina syndrome causes: pain or numbness in your lower back and buttocks weakness in your legs which can affect your ability to walk urinary incontinence orbowel incontinence (when you cannot control your bladder or bowels) See your GP as soon as possible if you have AS and you develop any of these symptoms. Amyloidosis In very rare cases, it is possible to develop a condition calledamyloidosis as a complication of AS. Amyloid is a protein produced by cells in your bone marrow (the spongy material found in the centres of some hollow bones). Amyloidosis is a condition where amyloid builds up in organs such as your heart, kidneys and liver. Amyloidosis can cause a wide range of symptoms, includingfatigue, weight loss, fluid retention (oedema), shortness of breath and numbness or tingling in the hands and feet. Problems with employment Over time,AScan increasingly affect your ability to work. Some people with the condition may beunable to work at all and othersmay need changes to their working life, such as working part-time, working from homeor avoiding physically demanding work. When at work, it is important to maintain a good posture when sitting or standing for long periods of time. You should get up, stretch and move around regularly. This could mean adjusting your work station or ensuring you take regular breaks.

Anorexia nervosa

Anorexia nervosa - Illnesses and conditions Mental health Anorexia nervosa Anorexia nervosa Anorexia nervosa is an eating disorder. Its a serious, potentially life-threatening, mental health condition. People who have anorexia are very anxious about their weight and body shape. They try to keep their weight as low as possible by strictly controlling what they eat. Many people with anorexia will also exercise excessively. They may also use other methods to try to control their weight, like using laxatives , vomiting after eating, and taking stimulant drugs. Symptoms of anorexia Signs and symptoms of anorexia include: fear of being fat or gaining weight problems with self-esteem and body image when it comes to food and weight restricting food intake keeping your body weight low, to the point its unhealthy Restricting your food intake means your body isnt getting enough energy or nutrition. This can lead to other physical symptoms. Other signs of anorexia Eating too little for a long time can cause physical symptoms, like: fine downy hair (lanugo) growing on the body more hair on the face pubic hair becoming sparse and thin slow or irregular heartbeat People with anorexia may also: have pain in their abdomen (tummy) feel bloated or constipated have swelling in their feet, hands or face feel very tired have low blood pressure ( hypotension ) feel cold or have a low body temperature feel light-headed or dizzy In children with anorexia, puberty and the associated growth spurt may be delayed. They may gain less weight than expected for someone going through puberty. They might be shorter than other people of the same age. If you get periods and you have anorexia, your periods may stop. Anorexia can also lead to infertility, for both men and women. Getting help for anorexia Speak to your GP if you think you have: an eating problem anorexia Beat has more information about treatment for anorexia Helping someone else with anorexia If someone close to you is showing signs of anorexia, you can offer help and support. You could try talking to them about how they feel, and encourage them to think about getting help. Try not to put pressure on them or be critical of them, as this could make things worse. You could also offer to help by going with the person to see their GP. If youd like to get some advice on how to help, a healthcare professional, such as your own GP, can provide information on: how to help the person recognise that they have a problem the treatments available how you can support them during their treatment You could also get help from a support group for people who have loved ones with eating disorders. Beat has more information about how to support someone with anorexia Diagnosing anorexia When making a diagnosis, your GP will probably ask questions about your weight and eating habits. For example, they might: ask if youve lost a lot of weight recently or quite quickly ask how you feel about your weight, and if youre concerned about it ask if you make yourself vomit regularly check if you have periods, whether your periods have stopped and if so, for how long check your weight check your pulse and blood pressure do a blood test Its important to answer these questions honestly. Your GP isnt trying to judge you. They just need to accurately assess your symptoms. Referral to a specialist If your GP thinks you may have anorexia, theyll refer you to a specialist in eating disorders for a more detailed assessment. Your GP sometimes carries out this assessment. Treatment for anorexia Treatment for anorexia usually involves a combination of: talking therapy , and supervised weight gain Its important to start treatment as early as possible to reduce the risk of serious complications. Treatment for anorexia is slightly different for adults and those under 18 years old. Complications of anorexia If someone has anorexia for a long time, it can lead to severe complications and health problems. These can sometimes be permanent. People with anorexia have an increased risk of: poor circulation and cardiovascular problems heart conditions, like coronary heart disease and irregular heartbeat (arrhythmia) health problems caused by malnutrition a lack of vitamins and minerals Anorexia can cause an imbalance of minerals in the blood, like potassium, calcium and sodium. These minerals help keep you healthy. When theres an imbalance, it can cause symptoms like: tiredness weakness dehydration fits irregular heartbeat (arrhythmia) muscle spasms confusion Health conditions Other conditions that can be caused by anorexia and malnutrition can include: low blood pressure ( hypotension ) anaemia dental problems, like tooth decay caused by regular vomiting low blood sugar levels ( hypoglycaemia ) acute kidney (renal) failure liver damage heart failure osteoporosis (fragile bones) and loss of muscle strength, particularly in women and girls loss of sex drive (libido) and impotency in men Misuse of laxatives can damage the bowels and cause permanent constipation. Anorexia and pregnancy Anorexia can lead to irregular menstrual cycles (periods), or cause your periods to stop altogether. This doesnt mean anorexia makes you infertile. If you have anorexia, even if your periods are irregular or have stopped, you should continue to use birth control if you arent planning a pregnancy. If you have anorexia and are trying to become pregnant, you should discuss this with your GP and care team. Anorexia during pregnancy can increase the risk of complications, like: miscarriage giving birth early (premature birth) having a baby with a low birth weight Youre also likely to need extra care and support during pregnancy if you have previously had anorexia and recovered from it.

Anxiety

Anxiety - Illnesses and conditions Mental health Anxiety Anxiety Anxiety is a feeling of unease, like worry or fear, that can be mild or severe. Generalised anxiety disorder GAD is a long-term condition. It causes you to feel anxious about a wide range of issues, rather than 1 specific event. People with GAD feel anxious most days. They often struggle to remember the last time they felt relaxed. As soon as 1 anxious thought is resolved, another may appear about a different issue. Speak to your GP if anxiety is: affecting your daily life causing you distress Your GP will ask you about your symptoms and your worries, fears and emotions. Everyone has feelings of anxiety at some point in their life. For example, you may feel worried and anxious about sitting an exam, or having a job interview. During times like these, feeling anxious can be perfectly normal. But some people find it hard to control their worries. Their feelings of anxiety are more constant and often affect their daily lives. Anxiety is the main symptom of several conditions, including: panic disorder phobias post-traumatic stress disorder (PTSD) social anxiety disorder (social phobia) The information on this page is about a specific condition called generalised anxiety disorder (GAD). Symptoms of generalised anxiety disorder GAD can cause a change in your behaviour and the way you think and feel about things. It can also cause physical changes. This results in symptoms like: restlessness a sense of dread feeling constantly on edge difficulty concentrating irritability dizziness tiredness a noticeably strong, fast or irregular heartbeat ( palpitations ) muscle aches and tension trembling or shaking dry mouth excessive sweating shortness of breath stomach ache feeling sick headache pins and needles difficulty falling or staying asleep ( insomnia ) Your symptoms may cause you to withdraw from social contact to avoid feelings of worry and dread. You may also find going to work difficult and stressful and may take time off sick. These actions can make you worry even more about yourself and increase your lack of self-esteem. Anxiety triggers If youre anxious as a result of a specific phobia or because of panic disorder , youll usually know what the cause is. For example, if you have claustrophobia (a fear of enclosed spaces), you know that being confined in a small space will trigger your anxiety. However, if you have GAD, it may not always be clear what youre feeling anxious about. Not knowing what triggers your anxiety can intensify it. You may start to worry that therell be no solution. Causes of generalised anxiety disorder The exact cause of GAD is not fully understood. Its likely that a combination of several factors plays a role, like: overactivity in areas of the brain involved in emotions and behaviour an imbalance of the brain chemicals serotonin and noradrenaline, which are involved in the control and regulation of mood the genes you inherit from your parents youre estimated to be 5 times more likely to develop GAD if a close relative has it having a history of stressful or traumatic experiences, like domestic violence, child abuse or bullying having a painful long-term health condition, like arthritis having a history of drug or alcohol misuse However, many people develop GAD for no apparent reason. Treating generalised anxiety disorder GAD can have a significant effect on your daily life. There are several different treatments are available that can help. These include: talking therapies like cognitive behavioural therapy (CBT) medication like a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs) There are also many things you can do yourself to help reduce your anxiety, like: trying a self-help course exercising regularly stopping smoking cutting down on alcohol drinking less caffeine With treatment, many people are able to control their levels of anxiety. However, some treatments may need to be continued for a long time. There may be periods where your symptoms worsen. Self help for anxiety Our mental health self-help guides are based on Cognitive Behavioural Therapy (CBT) . Theyve proven highly successful in helping people with anxiety and other mental health issues. Try the anxiety self help guide Daylight Daylight is a digital programme to improve anxiety based on Cognitive Behavioural Therapy (CBT). Its clinically proven to help people improve their anxiety symptoms by using it for just a few minutes each day. You can use Daylight via the app for iOS and Android devices. To access this course, you need to provide the first half of your postcode and your email address. Sign up for Daylight Contact support groups Support groups can give you useful advice about how to effectively manage your anxiety. Theyre also a good way to meet other people with similar experiences. Examples of support groups you may find useful include: Anxiety UK Mind Rethink Mental Illness Support groups can often arrange face-to-face meetings, where you can talk about your feelings with other people. Many support groups also provide support and guidance over the phone or in writing. Ask your GP about local support groups for anxiety in your area. Or search our support service directory for mental health information and support services near you. Referral to a specialist If treatments youve tried arent helping, you may want to discuss with your GP whether you should be referred to a mental health specialist. Youll usually be referred to your community mental health team. These teams include a range of specialists, including: psychiatrists psychiatric nurses clinical psychologists occupational therapists social workers A mental health specialist from your local team will carry out a reassessment of your condition. Theyll ask you about your previous treatment and how effective you found it. Your specialist will then be able to devise a treatment plan for you. As part of this plan, you may be offered a treatment youve not tried before. Or you may be offered a combination of a psychological treatment with medication.

Anxiety disorders in children

Anxiety disorders in children - Illnesses and conditions Mental health Anxiety disorders in children Anxiety disorders in children Its normal for children to feel worried or anxious from time to time, like when theyre starting school or nursery, or moving to a new area. Anxiety is a feeling of unease, like worry or fear. Its an understandable reaction in children to change or a stressful event. But for some children, anxiety affects their behaviour and thoughts on a daily basis. This can interfere with their school, home and social life. If your child is anxious for a period of time and its impacting on day to day life you may need to speak to a healthcare professional to help support your child. For example, if they feel they cannot go to school or see their friends anymore. So how do you know when your childs anxiety has reached this stage? What are the signs of anxiety in children? Anxiety can make a child feel scared, panicky, embarrassed or ashamed. Some of the signs to look out for in your child are: finding it hard to concentrate not sleeping, or waking in the night not eating properly quickly getting angry or irritable, and being out of control during outbursts constantly worrying or having negative thoughts feeling tense and fidgety, or using the toilet often always crying being clingy all the time (when other children are ok) complaining of tummy aches and feeling unwell being withdrawn and not wanting to do things they used to enjoy Your child may not be old enough to recognise why theyre feeling this way. The reason for the anxiety (if there is one) will differ depending on the age of the child. Separation anxiety is common in younger children. Older children and teenagers tend to worry more about school performance, relationships or health. What types of anxiety do children and teenagers experience? The common types of anxiety in children and teenagers are : A fear or phobia about something specific Young children are commonly afraid of things like the dark or imaginary things like monsters. This is a normal part of growing up, but has the potential to become a phobia (a type of anxiety disorder) when the fear becomes overwhelming and affects your childs day-to-day life. Read about phobias Feeling anxious for most of the time for no apparent reason Its normal for children to frequently have fears and worries. Some anxious children may develop a condition called generalised anxiety disorder when they get older. Generalised anxiety disorder causes you to feel anxious about a wide range of situations and issues, rather than one specific event. Its a feeling of constant fear or dread all the time that makes doing daily tasks hard because of feelings of anxiety. People affected by it feel anxious most days and often struggle to remember the last time they felt relaxed. Separation anxiety Separation anxiety means a child worrying about not being with their parent or regular carer. Its common in young children, and normally develops at about 6 months of age. It can make settling into nursery or school or with a child minder very difficult. Separation anxiety in older children may be a sign that theyre feeling insecure about something. They could be reacting to changes at home or at school, for example. Social anxiety Social anxiety is not wanting to go out in public, see friends or take part in activities. Social shyness is perfectly normal for some children and teenagers. However it becomes a problem social anxiety disorder when everyday activities like shopping or speaking on the phone cause intense, overwhelming fear. Children affected by it tend to fear doing or saying something they think will be humiliating. Social anxiety disorder tends to affect older children whove gone through puberty. School-based anxiety Some children become anxious about going to school. This could also be about schoolwork, friendships or bullying, especially if theyre changing school or moving up a level. They may not always share these worries with you, and instead they may say they have a tummy ache or are feeling sick. One of the signs is crying or seeming tired in the morning. This may be a problem that needs tackling if it is significantly affecting their daily life. Less common anxiety disorders Post-traumatic stress disorder and obsessive compulsive disorder are other anxiety disorders that can occasionally affect children, but are usually seen in adults. When is anxiety a disorder that needs treating? You should seek help for your childs anxiety if: you feel its not getting better or is getting worse, and efforts to tackle it yourself have not worked you think its slowing down their development or having a significant effect on their schooling or relationships it happens very frequently or they feel anxious all the time its making them feel physically unwell a lot of the time like feeling sick or having constant headaches your child becomes very withdrawn and is anxious about doing things they used to enjoy How serious can it be? Long-term anxiety can severely interfere with a childs personal development, family life and schooling. Anxiety disorders that start in childhood often persist into the teenage years and early adulthood. Teenagers with an anxiety disorder can also: experience clinical depression feel hopeless misuse drugs What can I do to help my child? If a child is experiencing anxiety, theres plenty parents and carers can do to help. First, its important to listen to your child about their anxiety or worries. YoungMinds has advice and resources for parents. YoungScot has advice and support for young people. Where should I go for help? You can talk to your GP or someone at your childs school like the school nurse. You might want to do this on your own or with your child, or your child might be able to have an appointment without you. The healthcare professional should listen to your concerns and offer some advice about what to do next. Your child may be referred to the local child and adolescent mental health service (CAMHS). CAMHS staff are trained to help young people with a wide range of problems. Professionals who work in CAMHS services include: psychologists psychiatrists nurses occupational therapists physiotherapists and other specially trained professionals They should offer help and support to parents and carers as well as the child. More about CAMHS Youth counselling services If your child doesnt want to see a doctor, they may be able to get help from a local youth counselling service. Youth counselling services are specially set up for young people to talk about whats worrying them, and get advice. For more information, search Scotlands Service Directory for mental health and wellbeing services in your area. Counselling may also be available in your local school. Telephone or online help Telephone helplines or online services can be helpful for children and young people. They might feel its easier to talk to someone who doesnt know them. YoungScot has information about support organisations. YoungMinds has information about where to get support. How do you treat anxiety disorders? The type of treatment offered will depend on what is causing your childs anxiety. It can be helpful for your child to talk in confidence about whats worrying them to a trained person, especially as its someone they dont know. If your child is being seen at CAMHS, they might see a child and adolescent psychotherapist or a clinical psychologist. If theyre at a youth counselling service, it might be a trained youth counsellor or psychotherapist. These sessions can help them work out what is making them anxious and how they can work through the situation. Psychological therapies Psychological therapies can really help with anxiety. Theyre evidence based talking treatments, like cognitive behavioural therapy, that are proven to help. Cognitive behavioural therapy (CBT) is a talking therapy that can help your child manage their problems by changing the way they think and behave. Its been proven to help with anxiety and is commonly offered to young people who are anxious. Your child will work with the psychological therapist to find ways to change the way they think. Theyll help your child to find strategies for coping in situations that make them anxious. The psychological therapies matrix describes the most helpful talking therapies for anxiety. What is psychological therapy? Medication If your childs anxiety problem has not got better, your doctor may talk to you about trying medication. A type of antidepressant , called a selective serotonin reuptake inhibitor (SSRI), may help your child feel calmer and differently about things. Antidepressants usually take around 2 to 4 weeks to work properly, so you or your child may not notice the difference immediately. Its natural to be concerned about side effects. Your child should be aware of any possible adverse effects and should tell you or their doctor if they happen. Why are some children affected and others not? Some children are simply born more nervous and anxious and less able to cope with stress than other children. Sometimes traumatic life events like an illness, or an accident, can cause anxiety. This can happen even if your child was previously confident by nature before. A childs anxious personality may be partly determined by the genes theyve inherited from their parents. Parents of anxious children may recognise the signs and remember feeling and behaving the same when they were younger. Life events Some children can also develop anxiety after a series of difficult life events. They may be able to cope with one of these events, but several difficult events together, or a traumatic single event, may be too much for them to cope with. Examples are: frequently moving house and school it can be hard to settle when youre always expecting change divorce or separation of parents death of a close relative or friend becoming seriously ill or injured in an accident having someone in the family who is ill or disabled school-related issues like homework or exams, or bullying or friendship problems becoming involved in crime being abused or neglected Medical conditions Children with certain conditions such as attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorders may experience anxiety as part of the symptoms of their condition. This is because of differences in the way their brain functions.

Appendicitis

Appendicitis- Illnesses and conditions Stomach, liver and gastrointestinal tract Appendicitis Appendicitis About appendicitis Symptoms of appendicitis Diagnosing appendicitis Treating appendicitis Complications of appendicitis About appendicitis Appendicitis is a painful swelling of the appendix. The appendix is a small, thin pouch about 5 to 10cm (2 to 4 inches) long. Its connected to the large intestine, where stools (faeces) are formed. Nobody knows exactly why we have an appendix, but removing it isnt harmful. Appendicitis typically starts with a pain in the middle of your tummy (abdomen) that may come and go. Within hours, the pain travels to the lower right-hand side, where the appendix usually lies, and becomes constant and severe. Pressing on this area, coughing, or walking may all make the pain worse. You may lose your appetite, feel sick, and occasionally experience diarrhoea . Read more about the symptoms of appendicitis . When to get medical help If youre experiencing abdominal pain thats gradually getting worse, contact your GP or localout-of-hours service immediately. If these options arent available, phone NHS 24s 111 service for advice. You should phone 999 for an ambulance if you have sudden pain that continues to get worse and spreads across your abdomen. These are signs your appendix may have burst, which can lead to potentially life-threatening complications. Read more about: diagnosing appendicitis complications of appendicitis How appendicitis is treated In most cases of appendicitis, the appendix needs to be surgically removed as soon as possible. Removal of the appendix, known as an appendectomy or appendicectomy, is one of the most common operations in the UK and its success rate is excellent. The operation is most commonly performed as keyhole surgery (laparoscopy), which involves making several small cuts in your abdomen, through which special surgical instruments are inserted. Open surgery, where a larger, single cut is made in the abdomen, is usually carried out if the appendix has burst or access is more difficult. Most people make a full recovery from an appendectomy in a couple of weeks, although strenuous activities may need to be avoided for up to 6weeks after open surgery. Read moreabout treating appendicitis . What causes appendicitis? Its not exactly clear what the causes of appendicitis are. Most cases are thought to occur when somethingblocks the entrance of the appendix. For example, a blockage may be formed by a small piece offaeces or an upperrespiratory tract infectioncould lead toa swollen lymph node within the wall of the bowel. This obstruction leads to the development of inflammation and swelling. The pressure caused by the swelling can then lead to the appendix bursting. As the causes arent fully understood, theres no guaranteed way of preventing appendicitis. Whos affected? Appendicitis is a common condition. Its estimated around1 in every 13 people develop it at some point in their life. Appendicitis can develop at any age, but its most common in young people aged from 10 to 20 years old. Symptoms of appendicitis Appendicitis typically starts with a pain in the middle of your tummy (abdomen) that may come and go. Within hours, the pain travels to your lower right-hand side, where the appendix is usually located, and becomes constant and severe. Pressing on this area, coughing, or walking may all make the pain worse. If you have appendicitis, you may also have other symptoms, including: feeling sick (nausea) being sick loss of appetite diarrhoea a high temperature (fever) and a flushed face When to get medical help If youre experiencingabdominal pain thats gradually getting worse, contact your GP or localout-of-hours service immediately. If these options arent available, phone NHS 24 111 Service for advice. Appendicitis can easily be confused with something else, such as: gastroenteritis severe irritable bowel syndrome (IBS) constipation bladder or urine infections Crohns disease pelvic infection In young women, these symptoms can sometimes have a gynaecological cause, such as an ectopic pregnancy or menstrual pain. However, any condition that causes constant stomach pain requires urgent medical attention. You should phone 999 for an ambulance if you get a pain that suddenly becomes worse and spreads across your abdomen. These are signs your appendix may have burst. If the appendix bursts, it can causeperitonitis, a potentially serious infection of the inner lining of the abdomen. Read more about the complications of appendicitis . Diagnosing appendicitis Appendicitis can be tricky to diagnose unless you have the typical symptoms, which are only present in about half of all cases. Also, some peoples appendixes may be located in a slightly different part of their body, such as: the pelvis behind the large intestine around the small bowel near the right lower part of the liver Some people develop pain similar to appendicitis, but its caused by something else, such as: gastroenteritis severe irritable bowel syndrome (IBS) constipation a bladder or urine infection Your GP will ask about your symptoms, examine your abdomen, and see if the pain gets worse when pressure is applied to the appendix area (your lower right-hand side). If your symptoms are typical of appendicitis, this is normally enough for your GP to make a confident diagnosis. Inthis case, youll immediately be referred to hospital for treatment. Further tests If your symptoms arent typical, further tests may be required in hospital to confirm the diagnosis and rule out other conditions. Further tests may involve: a blood test to look for signs of infection a pregnancy testfor women a urine test to rule out other conditions, such as a bladder infection an ultrasound scan to see if the appendix is swollen a computerised tomography (CT) scan It can sometimes taketime to get test results. Your surgeon may recommend a laparoscopy to inspect your appendix and pelvic organs if the diagnosis is still uncertain. Youll usuallybe advised to have your appendix removed if appendicitis is suspected, rather than run the risk of it bursting. This means some people will have their appendix removed even though its eventually found to be normal. In some cases where a diagnosis is not certain, a doctor may recommend waiting up to 24 hours to see if your symptoms improve, stay the same, or get worse. If your doctor suspects your appendix has burst, youll be sent to hospital immediately for treatment. Read more about treating appendicitis . Treating appendicitis If you have appendicitis, your appendix usually needs to be removed as soon as possible. This operation is known as an appendectomy or appendicectomy. Surgery is usuallyalso recommended if theres a chance you have appendicitis but its not been possible to make a clear diagnosis. This is because its considered safer to remove the appendix than run the risk of the appendix bursting. In humans, the appendix doesnt perform any important function and having it removed doesnt cause any long-term problems. The procedure Appendectomies are carried out under general anaesthetic using either a keyhole or open technique. Keyhole surgery Keyhole surgery (laparoscopy) is usually the preferred method of removing the appendix because the recovery tends to be quicker than with open surgery. This operation involves making 3or 4small cuts (incisions) in your tummy (abdomen). Special instruments are then inserted, including: a tube that gas is pumped throughto inflate your abdomen this allows the surgeon to see your appendix more clearly and gives them more room to work a laparoscope a small tube containing a light source and a camera, which relays images of the inside of the abdomen to a television monitor small surgical tools used to remove the appendix Once the appendix has been removed, the incisions will usually be closed with dissolvablestitches.Regular stitchesmay also be used, which need to be removed at your GP surgery 7 to 10 days later. Open surgery In some circumstances, keyhole surgery isnt recommended and open surgery is performed instead. These include: when the appendix has already burst and formed a lump called an appendix mass when the surgeon isnt very experienced in laparoscopic removal people who have previously had open abdominal surgery In these cases, the operation involves making a single larger cut in the lower right-hand side of your abdomen to remove the appendix. When theres widespread peritonitisinfection of the inner lining of the abdomenits sometimes necessary to operate through a long cut along the middle of the abdomen in a procedure called a laparotomy. As with keyhole surgery, the incisionis closed using either dissolvable stitches or regular stitchesthat need to be removed at a later date. After both types of surgery, the removed appendix is routinely sent to a laboratory to check there are no signs of cancer. This is a precautionary measure, although its rare for a serious problem to be found. Recovery One of the main advantages of keyhole surgery is the recovery time tends to be short and most people can leave hospital a few days after the operation. If the appendix is operated upon promptly, most patients can go home within 24 hours. With open or complicated surgery for example, if you have peritonitis it maytake up toa week before youre well enough to go home. For the first few days after the operation youre likely to experience some pain and bruising. This improves over time, but you can take painkillers if necessary. If you had keyhole surgery, you may experience pain in the tip of your shoulder for about a week. This is caused by the gas that was pumped into the abdomen during the operation. You may also experience some short-term constipation . You can help reduce this by not taking codeine painkillers, eating plenty of fibre, andstaying well hydrated. Your GP can prescribe medication if the problem is particularly troublesome. Before leaving hospital, youll be advised about caring for your wound and what activities you should avoid. In most cases, you can return to normal activities in a couple of weeks, although more strenuous activities may need to be avoided for 4to 6weeks after open surgery. When to seek medical advice While you recover, its important to keep an eye out for signs of any problems. Contact the hospital unit where the appendectomy was performed or your GP for advice if you notice: increasing pain and swelling you start vomiting repeatedly a high temperature (fever) any discharge coming from the wound the wound is hot to touch These symptoms could be a sign of infection. Risks Appendectomies are one of the most commonly performed operations in the UK, and serious or long-term complications are rare. However, like all types of surgery, there are some risks. These include: antibiotics may be given before, during, or after the operation to minimise the risk of serious infections bleeding under the skin that causes a firm swelling (haematoma) this usually gets better on its own, but you should see your GP if youre concerned scarring both surgical techniques will leave some scarring where the incisions were made a collection of pus (abscess) in rare cases, an infection caused by the appendix bursting can lead to an abscess after surgery hernia at the site of the open incision or any of the incisions used in the laparoscopic approach The use of general anaesthetic also carries some risks, such as the risk of an allergic reaction or inhaling stomach contents, leading to pneumonia . However, serious complications like this are very rare. Alternatives to emergency surgery In some cases, appendicitis can lead to the development of a lump on the appendix called an appendix mass. This lump, consisting of appendix and fatty tissue, is an attempt by the body to deal with the problem and heal itself. If an appendix mass is found during an examination, your doctors may decide its not necessary to operate immediately. Instead, youll be given a course of antibiotics and an appointment will be made for an appendectomy a few weeks later, when the mass has settled. Another possible alternative to immediate surgery is the use of antibiotics to treat appendicitis. However, studies have looked into whether antibiotics could be an alternative to surgery and as yet there isnt enough clear evidence to suggest this is the case. Complications of appendicitis If appendicitis isnt treated, the appendix can burst and cause potentially life-threatening infections. Phone 999 for an ambulance if you have abdominal (tummy) pain that suddenly gets much worse and spreads across your abdomen. These are signs your appendix may have burst. Peritonitis If your appendix bursts, it releases bacteria into other parts of the body. This can cause a condition called peritonitis if the infection spreads to the peritoneum, the thin layer of tissue that lines the inside of the abdomen. Symptoms of peritonitis can include: severe continuous abdominal pain feeling sick or being sick a high temperature (fever) a rapid heartbeat shortness of breath with rapid breathing swelling of the abdomen If peritonitis isnt treated immediately, it can cause long-term problems and may even be fatal. Treatment for peritonitis usually involves antibiotics and the surgical removal of the appendix (appendectomy). Abscesses Sometimes anabscess forms around a burst appendix. This is a painful collection of pus that occurs as a result of the bodys attempt to fight the infection. It can also occur as a complication of surgery to remove the appendix in about 1 in 500 cases. Abscesses can sometimes be treated using antibiotics, but in the vast majority of cases the pus needs to be drained from the abscess. This can be carried out under ultrasound or computerised tomography (CT) guidance using local anaesthetic and a needle inserted through the skin, followed by theplacement of a drain. If an abscess is found during surgery, the area is carefully washed out and a course of antibiotics is given.

Arterial thrombosis

Arterial thrombosis - Illnesses & conditions- Illnesses and conditions Heart and blood vessels Conditions Arterial thrombosis Arterial thrombosis About arterial thrombosis Symptoms of arterial thrombosis Causes of arterial thrombosis Diagnosing arterial thrombosis Treating arterial thrombosis Preventing arterial thrombosis About arterial thrombosis Arterial thrombosis is a blood clot that develops in an artery. Its dangerous as it can obstruct or stop the flow of blood to major organs, such as the heart or brain. If a blood clot narrows one or more of the arteries leading to the heart, muscle pain known as angina can occur. If a blood clot blocks the arteries leading to part of the heart muscle, it will cause a heart attack. If it blocks an artery in the brain, it will cause a stroke . Symptoms therefore depend on where the blood clot has formed. Find out more about the symptoms of arterial thrombosis Whos at risk of arterial thrombosis? Most cases of arterial thrombosis are caused when a process called atherosclerosisdamages an artery. Fatty deposits build up on the walls of the arteries and cause them to harden and narrow. Find out more about the causes and risk factors for developing arterial thrombosis Treating arterial thrombosis There are two main types of treatment for arterial thrombosis. Medication Medication can help dissolve clots and restore the flow of the blood to the brain or heart. Surgery Surgery involves a surgeon accessing the affected artery. They will either: unblock it re-route the blood flow via another blood vessel graft the blood vessel to travel around, or past, the section thats blocked Find out more about the treatment of arterial thrombosis Preventing arterial thrombosis If youve had a blood clot in an artery, you may need to take medication to prevent it from happening again. Its also vital that you live a healthy lifestyle. This includes: stopping smoking (if you smoke) doing some physical activity reducing the amount of salt and saturated fat that you eat Find out more about preventing arterial thrombosis Symptoms of arterial thrombosis Depending on where the clot is in your body, a bloodclot in an artery (arterial thrombosis) can cause: angina heart attack stroke peripheral vascular disease Find out about each of these below. Heart attack A heart attackcan happen when a blood clot completely blocks an artery that pumps blood to your heart muscle. You may experience: a crushing central chest pain or mild chest discomfort shortness of breath a clammy, sweaty and grey complexion dizziness nausea and vomiting If you suspect you or someone you know is having a heart attack, dial 999 immediately. Its important that you dont wait and do treat these symptoms as an emergency. Find out more about the symptoms of a heart attack Stroke Arterial thrombosis can cause a stroke if a blood clot is blocking an artery that supplies blood to your brain. The symptoms of a stroke can come on suddenly and may include: numbness or weakness down one side, ranging in severity from weakness in your hand to complete paralysis of the whole side of your body weakness in your face, which can make you drool saliva dizziness difficulty talking and understanding what others are saying problems with balance and co-ordination difficulty swallowing If you suspect that you or someone else is having a stroke, dial 999 immediately. Its important that you dont wait and do treat these symptoms as an emergency. Further information on a stroke Peripheral vascular disease If you have a narrowing of an artery in one or both of your legs (peripheral vascular disease) you may: be more susceptible to developing a clot have pain when exercising, usually in the lower half of your legs have pain that may affect both legs, but develops in one leg before the other have pale, cold skin and numbness in one of your legs Peripheral vascular disease can also cause other problems such as impotence ( erectile dysfunction ). If you have any of these symptoms, its important to talk to your GP. If one of your legs is a very different colour from the other, and you have other symptoms, you should treat this as an emergency and call 999 . Causes of arterial thrombosis Arterial thrombosis occurs when a blood clot forms within an artery, slowing or stopping the flow of blood. How it happens Your blood contains cells called platelets and proteins (clotting factors). Together they make up the blood-clotting mechanism. When a blood vessel is cut, the platelets and clotting factors in your blood mesh together to form a solid clot at the site of the wound. This clot acts as a plug to stop the wound from bleeding. Normally, the blood-clotting mechanism is triggered when a blood vessel is damaged and bleeds, such as when you cut yourself. However, the blood may sometimes begin to clot even when a blood vessel has not been damaged. If this happens, a blood clot can form within a vein or artery (thrombosis). What causes it to happen Most cases of arterial thrombosis are caused when an artery is damaged byatherosclerosis. Fatty deposits build up on the walls of the arteries and cause them to harden and narrow. The risk factors for a blood clot in an artery include: eating a high-fat diet smoking alcohol misuse obesity lack of exercise diabetes (both type 1 diabetes and type 2 diabetes ) high blood pressure (hypertension) Diagnosing arterial thrombosis The tests used to diagnose blood clots in the arteries (arterial thrombosis) will depend on what medical condition the blood clot has triggered. Electrocardiogram (ECG) Suspected cases of unstable angina and heart attacks are diagnosed using an electrocardiogram (ECG). Every time your heart beats, it produces tiny electrical signals that will show on paper. This allows your doctor to see how well your heart is functioning or if there are any areas not receiving blood as in a heart attack. Find out more about having an ECG Blood test Blood may also be taken to measure levels of a protein called troponin. This is released when the heart muscle is damaged by a heart attack. Find out more about blood tests Scans Suspected cases of stroke are diagnosed by producing a scan of the brain using a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan . Treating arterial thrombosis There are two main types of treatment for a blood clot that develops in an artery (arterial thrombosis): medication surgery Medication Medication can help dissolve clots and restore the flow of the blood to the brain or heart. Surgery You may need a heart procedure if the blood clot is in an artery that supplies blood to your heart. Coronary angioplasty A coronary angioplasty is the most common type of procedure for a heart attack. A hollow metal tube called a stent is inserted to widen the artery and stop it from blocking again. Find out more about having a coronary angioplasty Coronary artery bypass graft (CABG) Occasionally, a coronary artery bypass graft (CABG) may be carried out after a heart attack. A blood vessel that is taken from another part of the body is used to bypass where the blockage is. Find out more about having a CABG Carotid endarterectomy Another type of surgery for arterial thrombosis is called carotid endarterectomy, which you may have if you have had a blood clot in an artery in your neck (causing a stroke). The surgeon makes a cut in your neck to open up the artery and remove the fatty deposits. Preventing arterial thrombosis Its not possible to prevent blood clots altogether, but there are a number of ways to reduce the risks of developing a blood clot in an artery. Medication If youve had blood clot in an artery before, you might need to take medication to prevent it from happening again. Medication can include: statins used to lower your blood cholesterol levels anticoagulant medicines- such as warfarin antiplatelet medicines such as low-dose aspirin or angiotensin-converting enzyme (ACE) inhibitors (used to treat high blood pressure) Lifestyle In addition to medication, its vital that you look after your health and take steps to improve your lifestyle. Most cases of arterial thrombosis are associated with atherosclerosis(the furring up of your arteries with fatty deposits). This can lead to a blood clot in an artery and cause a heart attack or stroke. Making healthy changes to your lifestyle can greatly reduce the effects of this condition, and others such a heart disease. Things you could do include: stopping smoking (if you smoke) reduce your alcohol intake to recommended limits reduce salt intake eat at least 5 portions of fruit and vegetables and 2 portions of fish per week (1 oily) do a minimum of 30 minutes of moderate exercise such as walking or cycling at least 5 times a week

Arthritis

Arthritis Illnesses and conditions Muscle, bone and joints Conditions Arthritis Arthritis About arthritis Living with arthritis About arthritis Arthritis is a common condition that causes pain and inflammation in a joint. In the UK, around 10 million people have arthritis. It affects peopleof all ages, including children (see below). Types of arthritis The two most common types of arthritis are: osteoarthritis rheumatoid arthritis Osteoarthritis Osteoarthritis is the most common type of arthritis in the UK, affecting around 8 million people. It most often develops inadults who are in their late 40s or older. Its also more common in women andpeople with a family history ofthe condition.However, it can occur at any age as a result of an injury or be associated with otherjoint-related conditions, such as gout or rheumatoid arthritis. Osteoarthritis initially affects the smooth cartilage lining of the joint. This makes movement more difficult than usual, leading to pain and stiffness. Once the cartilage lining starts to roughen and thin out, the tendons and ligaments have to work harder. This can cause swelling and the formation of bony spurs, called osteophytes. Severe loss of cartilage can lead to bone rubbing on bone, altering the shape of the joint and forcing the bones out of their normal position. The most commonly affected jointsare those in the: hands spine knees hips Rheumatoid arthritis In the UK, rheumatoid arthritis affects more than 400,000 people. It often starts when a person is between 40 and 50 years old. Women are three times more likely to be affected than men. Rheumatoid and osteoarthritis are two different conditions. Rheumatoid arthritis occurs when the bodys immune system targets affected joints, which leads to pain and swelling. The outer covering (synovium) of the joint is the first place affected. This can then spread across the joint, leading to further swelling and a change in the joints shape. Thismay cause thebone and cartilage to break down. People with rheumatoid arthritis can also develop problems with other tissues and organs in their body. Other types of arthritis and related conditions Ankylosing spondylitis a long-term inflammatorycondition that mainly affects the bones, muscles and ligaments of the spine, leading to stiffness and joints fusing together.Other problems can include the swelling of tendons, eyes and large joints. Cervical spondylosis also known as degenerative osteoarthritis, cervical spondylitis affects the joints and bones in the neck, which can lead to pain and stiffness. Fibromyalgia causes pain in the bodys muscles, ligaments and tendons. Lupus an autoimmune condition that can affect many different organs and the bodys tissues. Gout a type of arthritis caused by too much uric acid in the body. This can be left in joints (usually affecting the big toe) but can develop in any joint. It causes intense pain, rednessand swelling. Psoriatic arthritis an inflammatory joint condition that can affect people with psoriasis . Enteropathic arthritis a form of chronic, inflammatory arthritis associated with inflammatory bowel disease (IBD), the two best-known types being ulcerative colitis and Crohns disease . About one infive people with Crohns or ulcerative colitis will develop enteropathic arthritis. The most common areas affected by inflammation arethe peripheral (limb) joints and the spine. Reactive arthritis this can cause inflammation of the joints, eyes and urethra (the tube that urine passes through).It develops shortly after an infection of the bowel, genital tract or, less frequently, after a throat infection. Secondary arthritis a type of arthritis that can develop after a joint injury and sometimes occurs many years afterwards. Polymyalgia rheumatica a condition that almost always affects people over 50 years of age, where the immune system causes muscle pain andstiffness, usually across the shoulders and tops of the legs. It can also causejoint inflammation. Symptoms of arthritis Thesymptoms of arthritis you experience will vary depending on the type you have. This is why its important to have an accurate diagnosis if you have: joint pain, tenderness and stiffness inflammation in and around the joints restricted movement of thejoints warm, red skin over the affected joint weakness andmuscle wasting Arthritis and children Arthritis is often associated with older people, butit can alsoaffect children. In the UK, about 15,000 children and young people are affected by arthritis. Most types of childhood arthritis are known as juvenile idiopathic arthritis (JIA). JIA causes pain andinflammation in one or more joints for at least six weeks. Although the exact cause of JIA isunknown, the symptoms often improve as a child gets older, meaning they can lead a normal life. The main types of JIA are discussed below. Arthritis Research UK has more information about the different types of juvenile idiopathic arthritis . Oligo-articular JIA Oligo-articular JIA is the most common type of JIA. It affects fewer than five joints in the bodymost commonly in the knees, ankles and wrists. Oligo-articular JIA has good recovery rates and long-term effects are rare. However, theres a risk that childrenwith the condition may develop eye problems, so regulareyetests with an ophthalmologist (eye care specialist) are recommended. Polyarticular JIA (polyarthritis) Polyarticular JIA, or polyarthritis, affects five or more joints. It can develop at any age during childhood. The symptoms of polyarticular JIA are similar to the symptoms of adult rheumatoid arthritis . The condition is often accompanied by a rash and a high temperature of 38C (100.4F) or above. Systemic onset JIA Systemic onset JIA begins with symptoms such as a fever, rash, lethargy (a lack of energy) and enlarged glands. Later on, joints canbecome swollen and inflamed. Like polyarticular JIA, systemic onset JIA can affect children of any age. Enthesitis-related arthritis Enthesitis-related arthritis is a type of juvenile arthritis that affects older boys or teenagers. It can cause pain in the soles of the feet and around the knee and hip joints, where the ligaments attach to the bone. Treating arthritis Theres no cure for arthritis, but there are many treatments that can help slow down the condition. For osteoarthritis, medications are often prescribed, including: painkillers non-steroidal anti-inflammatory drugs (NSAIDs) corticosteroids In severe cases, the following surgical procedures may be recommended: arthroplasty (joint replacement) arthodesis (joint fusion) osteotomy (where abone is cut and re-aligned) Treatment forrheumatoid arthritis aimsto slow down the conditions progress and minimise joint inflammation or swelling. This isto try and prevent damage to the joints. Recommended treatments include: analgesics (painkillers) disease modifying anti-rheumatic drugs (DMARDs)a combination of treatments is often recommended physiotherapy regular exercise Read moreabout how rheumatoid arthritisis treated . Living with arthritis Living with arthritis isnt easy and carrying out simple, everyday tasks can often be painful and difficult. However, there are many things you can do to make sure you live a healthy lifestyle.A range of services and benefits are also available. Work Many people with arthritis want to continue working for many reasons, including betterfinancial security and higher self-esteem. Better treatment options have helped to ensure that many people return to work after being diagnosed with arthritis.This is particularly the case if arthritis is diagnosed and treated at an early stage. You may find work challenging, but your employer should help you with the training and support you need. Help is also available if your arthritis is so severe that youre unable to work. Find out more about the Personal Independence Payment (formerly known as the Disability Living Allowance). Healthy eating Its very important to eat ahealthy, balanceddiet if you have arthritis. Eating healthily will give you all the nutrients you need and help you maintain a healthy weight. Your diet should consist of a variety of foods from all5 foodgroups. These are: fruit and vegetables starchy foods like bread, rice, potatoes and pasta meat, fish,eggs and beans milk and dairy foods foods containing fat and sugar Further informationabout how to have a healthy, balanced diet . Weight If youre overweight, losing weight can really help you cope with arthritis. Too much weight places excess pressure on the joints in your hips, knees, ankles and feet, leading to increased pain and mobility problems. Further informationabouthow you can lose weight. Exercise If your arthritis is painful, you may not feel like exercising. However, being active can help reduce and prevent pain. Regular exercisecan also: improve your range of movement and joint mobility increase muscle strength reduce stiffness boost your energy As long as you do the right type and level of exercise for your condition, your arthritis wont get any worse. Combined with a healthy, balanced diet (see above), regular exercise willhelp you lose weight and place less strain on your joints. Your GP can advise about the type and level of exercise thats right for you. Versus Arthritis also has further information about exercising with arthritis . Joint care If you have arthritis, its important to look after your joints so theres no further damage. For example, try to reduce the stress on your joints while carrying out everyday tasks like moving and lifting. Sometips for protecting your joints,particularly if you have arthritis, include: use larger, stronger joints as levers for example,take the pressure of opening a heavy door on your shoulder rather than on your hand use several joints to spread the weight of an object for example, use both hands to carry your shopping or distribute the weight evenly in a shoulder bag or rucksack dont grip too tightly grip as looselyas possible or use a padded handleto widen your grip Its also important toavoid sitting in the same position for long periods of time and to take regular breaks so you can move around. At home If you have arthritis, carrying out tasks around the home can be a challenge. However, making some practical changes to your home and changing the way you work should make things easier. Practical tips that could help include: keeping things in easyreach using a hand rail to help you get up and down the stairs using long-handled tools to pick things up or to clean fitting levers totaps to make them easier to turn using electric kitchen equipment,like tin openers, when preparing food Versus Arthritis has further information and tips for living with arthritis . Occupational therapy An occupational therapist can help if you have severearthritis thats affecting your ability to move around your home and carry out everyday tasks,like cooking and cleaning. They can advise about equipment you may need to help you live independently. Depending on the exact nature of your condition, your GP may be able to refer you to an NHS occupational therapist. However, you may need to access this type of therapy through your local council. Find your local council Further information about occupational therapy . Telecare Self-Check online tool Visit the Telecare Self-Check online tool to find the right support for you in your area. This easy to use online tool allows you to find helpful information on telecare services that could help you live independently at home for longer.

Asbestosis

Asbestosis - Illnesses and conditions Lungs and airways Asbestosis Asbestosis About asbestosis Causes of asbestosis Diagnosing asbestosis Treating asbestosis Preventing asbestosis About asbestosis Asbestosis is a chronic (long-term) lung condition caused by prolonged exposure to asbestos. Asbestos is a general term for a group of minerals made of microscopic fibres. In the past, it was widely used in construction. Asbestos canbe very dangerous.It does not present a health risk if it is undisturbed, but if material containing asbestosis chipped, drilled, broken or allowed to deteriorate,it can release a fine dust that contains asbestos fibres. When the dust is breathed in, the asbestos fibres enter the lungs and can gradually damagethem over time. For asbestosis to develop, prolonged exposure to relatively high numbers of the fibres is necessary.However, it is not the only factor, as many people avoid getting asbestosis, despite heavy exposure. Read more about the causes of asbestosis . Symptoms of asbestosis Breathing in asbestos fibres may eventually scar the lungs of some people, which can lead to a number of symptoms, including: shortness of breath this may only occur after physicalactivity at first, but itcan eventually become a more constant problem a persistent cough wheezing fatigue (extreme tiredness) chest pain in more advanced cases,clubbed (swollen) fingertips Nowadays, most people who are diagnosed with asbestosis were exposed many years ago, before there were effective controls on exposure to asbestos fibres in the workplace. See your GP if you have the above symptoms and you think you may have been exposed to asbestos in the past. Read more about diagnosing asbestosis . Treating asbestosis There is no cure for asbestosis once it has developed, because it is not possible to reverse the damage to the lungs. One of themost important things someone with the condition can do is to stop smoking ,if they smoke. This is becausethe symptomsare morelikely to get worse in people who smoke, andsmoking also increases the risk of lung cancer in people with asbestosis. If necessary, treatments such as oxygen therapycan improve the quality of life of someone with asbestosis. Read more about treating asbestosis . Outlook The outlook for asbestosis can vary significantly, depending on the extent of damage to the lungs and whether any other conditions are present. Asbestosis can get worse over time and severe cases can place a significant strain on a persons health and shorten their life expectancy,but in many cases the condition progresses very slowly or not at all. However, people with asbestosis have a higher risk of developing other serious and potentially life-threatening conditions, such as: pleural disease where the membrane covering the lungs (pleura) becomes thicker, which can further contribute to breathlessness and chest discomfort mesothelioma a type of cancer that affects the membrane that covers the lungs, heart and gut lung cancer Overall, more people with asbestosis die as a result of one of the cancers mentioned above, or from natural causes, than from asbestosis itself. Compensation If you have been diagnosed with asbestosis, you may be able to claim compensation. This can be done through: industrial injuries disablement benefit this isa weekly benefit that may be paid to people with asbestosis who were exposed to asbestos while in employment (but not self-employed) a civil claim for compensation through the courts you will need to obtain legal advice about how to do this a claim for a lump compensation sum under thePneumoconiosis etc. (Workers Compensation) Act 1979 if you have asbestosis, or you are the dependant of someone who has died from the condition, andyou havent been able to get compensation through the courts because the employer who exposed you (or the person on whose behalf you are claiming) has ceased trading Read more about industrial injuries disablement benefit on the GOV.UK website . Preventing asbestosis There are three main types of asbestos that were used in construction. Two of these called crocidolite and amosite were banned in 1985 (although voluntary bans came into force earlier than this) and the use of the third type (chrysotile) was widely banned in 1999. However, despite these strict regulations having been in place for a number of years, large amounts of asbestos are still found in many older buildings. Its thereforeimportant to take precautions to reduce your risk of inhaling asbestos fibres if you live or work in a building that may contain asbestos. If you are concerned that your house may contain asbestos,you can seek advice from an environmental health officer at your local authority or council. Do not attempt to remove any materials that you think may contain asbestos yourself. If your job meansyou could potentially be exposed to asbestos fibres, make sure you are fully aware of what you can do to reduce your risk. Do notattempt to remove any asbestos you come across, unless you have been trained in how to do this safely. Read about preventing asbestosis . Who is affected Asbestosis is a relatively rare condition, because it takes a considerable degree of asbestos exposure to cause it, and regulations to restrict exposure have been in place for many years. However, in 2011 there were 178 deaths directly caused by asbestosis and 429 where the condition was thought to have played a role. 980 new cases were assessed for industrial injuries disablement benefit during 2012. Causes of asbestosis Asbestosis is caused by breathing in asbestos fibres. People working in certain trades are more likely to have been exposed to asbestos in the past. What is asbestos? Asbestos is a general termfor a group of minerals made of microscopic fibres.Materials containing asbestos used to be widely used in construction, because they are strong, durable and fire-resistant. There were three main types of asbestos in commercial use: crocidolite (blue asbestos) amosite (brown asbestos) chrysotile (white asbestos) All these types of asbestos are hazardous if a material containing them becomes damaged and the fibres are released into the air. No crocidolite was imported into the UK after 1970, and both amosite and crocidolite were banned in 1985 (although voluntary bans on the industrial use of both these materials came into force earlier than this). Chrysotile was not banned until 1999. This means that, although asbestos is no longer used, materials containing asbestos are still found in many older buildings. How asbestos fibres affect the lungs When you inhale a foreign body, such as a dust particle, cells in the lungs called macrophagesusually hunt and break the particle down before it gets into your lung tissues and bloodstream. However, asbestos fibres are too difficult for the macrophages to break down. In an attempt to break down the fibres, the macrophages release substances that are intended to destroy the fibres, but actually cause the tiny air sacs in your lungs (alveoli) to become damaged and permanently scarred over time. This scarring is what is known as asbestosis. Alveoli are crucial in transferring oxygen from the air into your bloodstream and removing carbon dioxide from your bloodstream. If they become damaged and scarred, these processes will be affected, resulting in symptoms such as breathlessness. For asbestosis to develop, prolonged exposure usually over many years to relatively high numbers ofasbestosis fibres is necessary. Occupations associated with asbestos exposure The use of asbestos increased significantly after World War II. Itpeaked during the 1970s, before declining during the 1980s and 1990s. You may have been exposed to asbestos if you worked in an industry such as building or construction, where asbestos was used during this time period. Occupations particularly associated with exposure to asbestos during this periodinclude: insulation workers boilermakers plumbers, pipefitters and steamfitters shipyard workers sheet metal workers plasterers chemical technicians heating, air-conditioning and refrigeration mechanics Now that asbestos isno longer used,those most at risk of being exposed to asbestos fibres include people whose jobs put them at risk of damaging any asbestos remaining in older buildings, such as caretakers,electricians and demolition workers. The Health and Safety Executive (HSE) website has further information about when you are most likely to be at risk of asbestos exposure. Diagnosing asbestosis When diagnosing asbestosis, your GP will first ask about your symptoms and listen to your lungs with a stethoscope (a medical instrument used to listen to the heart and lungs). If your lungs have been affected by asbestos, they will usually make a crackling noise when you breathe in. Your GP will also ask about your work history, particularlyabout periods when you may have been exposed to asbestos, how long you may have been exposed, and whether you were issued with any safety equipment, such as a face mask, when you were working. Referral to a specialist Ifasbestosis issuspected,youwill be referred to a specialist in lung diseases for tests to confirm any lung scarring. These may include: a chest X-ray to detect abnormalities in the structure of your lungs that could be caused by asbestosis a computerised tomography (CT) scan of the lungs which produces more detailed images ofthe lungs and the membrane covering the lungs and can help identify less obvious abnormalities lung function tests to assess the impact of damage of the lungs, determine how much air your lungs can hold and assesshow well oxygen crosses the membrane of the lungs into your bloodstream Before confirming a diagnosis of asbestosis, the chest specialist will also consider and rule out other possible causes of lung inflammation and scarring, such as rheumatoid arthritis . Treating asbestosis There is no cure for asbestosis, as the damage to the lungs is irreversible. However, you can take steps to reduce your symptoms and improve your quality of life. Not smoking If you have been diagnosed with asbestosis and you smoke, its very important to stop as soon as possible. Smoking can make your symptoms ofbreathlessness worse and significantly increase your risk of developing lung cancer at a later stage. Speak to your GP for help with giving up smoking. They can advise about nicotine replacement therapies and prescription medicines thatcan greatly increase your chances of quitting successfully. Your GP can alsoput you in touch with local support groups in your area. You can also phone Quit Your Way Scotlandon 0800 84 84 84 to get more help and advice about quitting smoking. Read more about stopping smoking . Vaccinations If you have asbestosis, your lungs will be more vulnerable to infection. Its recommended that you have theinfluenza (flu) vaccination to protect against flu , and the pneumococcal vaccination to protect you from the bacteria that can cause serious conditions, such as pneumonia . Your GPcan arrange for you to have these vaccinations. You will need the flu vaccine every year to ensure you stay protected. Most people only require one dose of the pneumococcal vaccine, although additional booster shots may be recommended if your general health is poor. Long-term oxygen therapy If you have severe asbestosis, your body may not be getting allthe oxygen it needs to function properly. Oxygen therapy may be recommendedif you have low levels of oxygen in your blood. Oxygen therapyis supplied through a machine called an oxygen concentrator, which purifies oxygen from the air in the room and produces a more oxygen-rich supply of air. This oxygen-rich air is breathed in through a mask or a small, soft plastic tubeplaced just inside your nostrils (nasal cannula). You may be given a small, portable oxygen tank and mask, to be used when youre out of the house. This is known as ambulatory oxygen. Its very important not to smoke when you are using an oxygen concentrator. This is because high concentrations of oxygenare highly flammable, and a lit cigarette or flame could cause a fire or an explosion. Medication Most people with asbestosis will not benefit from any specific medication for the condition, unless you have another condition also affecting the lungs,such as chronic obstructive pulmonary disease (COPD) . More severe cases may benefitfrom medicines, such as small doses ofmorphine to reduce breathlessness and a cough . Serious side effects are uncommon, because the dose is so small. The most common problem is constipation ,and a laxative will usually be given at the same time to help you pass stools. Preventing asbestosis Although asbestos is no longer widely used in the UK, its still important to take precautions to reduce your risk of exposure, because its still found in many old buildings. Strict regulations were introduced in 1970 to regulate the use of asbestos in the workplace. However, the import, supply and use of brown (amosite) and blue (crocidolite) asbestos was not banned in the UK until 1985. White asbestos (chrysotile) was banned in 1999, except for a small number of specialist uses of the material. This means that buildings that were built or refurbished before the year 2000 could still contain asbestos. Asbestos in your home If you are concerned that your house may contain asbestos, you can seek advice from an environmental health officer at your local authority or council. In these circumstances, it may be best to leave any asbestos-containing materialswhere they are especially if they are in good condition and unlikely to get damaged. You should check the condition of the materials from time to time to make sure they havent been damaged or started to deteriorate. Slightly damaged asbestos-containing materials can sometimes be repaired by sealing or enclosing them. However, this should only be done by someone with the necessary training. Any badly-damaged asbestos material that cannot be protected should be removed by someone who is appropriately trained. Your local environmental health officer can advise you about this. If you are planning any home improvements, repairs or maintenance, and you intend to bring in any additional workers or contractors, you should inform them of any asbestos materials in your home before they start work. This will help reduce the risks of anyasbestos-containing materialbeing disturbed. You can search for who to contact about asbestos in your home on the GOV.UK website. Asbestos in your workplace If your job doesnt directly put you at risk of asbestos exposure, but you are concerned about asbestos in your workplace, speak to the building duty holder about what they are doing to monitor and manage the situation. A duty holder is someone who is responsible for maintaining and repairing non-domestic premises. If any asbestos-containing materials in your workplace are assessed as being in good condition, and not in a position where they are likely to be damaged, they will usually be left in place and monitored. However,asbestos-containing materials that are in a poor condition orare likely to be damaged during the normal use of the building should be sealed, enclosed or removed as appropriate. Working with asbestos If your job means that you could potentially be exposed to asbestos fibres, make sure the appropriate precautions are taken before and during any work you do. The Health and Safety Executive (HSE) has drawn up the following checklist for employers,managers and traders to go through before carrying out work on a building that may contain asbestos: Identify whether asbestos is present and determine its type and condition this may mean checking with the building manager or having the area surveyed. Carry out a risk assessment to determine whether its possible to carry out the work, while avoiding the risk of asbestos exposure completely. Decide if the work needs to be carried out by a licensed contractor the removal of certain types of asbestos-containing material will need to be done by a contractor holding a licence from the HSE. If the work is not licensable, decide if the work needs to be notified somejobs requirethe relevant enforcing authority to be notified of what you are doing Ensure that those carrying out the work are suitably trained any worker who may disturb asbestos during their daily work needs to receive appropriate training, so that they can protect themselves and others. Steps that may help reduce your exposure to asbestos during your work include wearing protective equipment (such as a suitable face mask),cleaning up as you go (using avacuum cleaner or wet rags, rather than sweeping) and not using power tools whenever possible. Want to know more? The HSE website has more information about: managing and working with asbestos dos and donts when working with asbestos task sheetsoutlininghow to carry out non-licensed work with asbestos You may also find it useful to read theControl of Asbestos Regulations (2012), which outline the measures that should be in place to reduce the risk of asbestos exposure. Read the full Control of Asbestos Regulations 2012 (PDF, 143 KB) .

Asthma

Asthma - Illnesses and conditions Lungs and airways Asthma Asthma About asthma Symptoms of asthma Causes of asthma Diagnosing asthma Treating asthma Living with asthma About asthma Asthma is a common long-term condition that can cause coughing, wheezing, chest tightness and breathlessness. The severity of these symptoms varies from person to person. Asthma can be controlled well in most people most of the time, although some people may have more persistent problems. Occasionally, asthma symptoms can get gradually or suddenly worse. This is known as an asthma attack, although doctors sometimes use the term exacerbation. Severeattacks may require hospital treatment and can be life threatening, although this is unusual. Read more about the symptoms of asthma and diagnosing asthma What causes asthma? Asthma is caused by inflammation of the small tubes, called bronchi, which carry air in and out of the lungs. If you have asthma, the bronchi will be inflamed and more sensitive than normal. When you come into contact with something that irritates your lungs known as a trigger your airways become narrow, the muscles around them tighten, and there is an increase in the production of sticky mucus (phlegm). Common asthma triggers include: house dust mites animal fur pollen cigarettesmoke exercise viral infections Asthma may also be triggered by substances (allergens or chemicals) inhaled while at work. Speak to your GP if you think your symptoms are worse at work and get better on holiday. The reason why some people develop asthma is not fully understood, although it is known that you are more likely to develop it if you have a family history of the condition. Asthma can develop at any age,including in young children and elderly people. Read more about the causes of asthma Who is affected? In the UK, around 5.4 million people are currently receiving treatment for asthma. Thats the equivalent of 1 in every 12 adults and1 in every 11 children. Asthma in adults is more common in women than men. Howasthma is treated While there is no cure for asthma, there are a number of treatments that can help control the condition. Treatment is based on two important goals, which are: relieving symptoms preventing future symptoms and attacks For most people, this will involve the occasional or, more commonly, daily use of medications, usually taken using an inhaler. However, identifying and avoiding possible triggers is also important. You should have a personal asthma action plan agreed with your doctor or nurse that includes information about the medicines you need to take, how to recognise when your symptoms are getting worse, and what steps to take when they do so. Read more about treating asthma and living with asthma Outlook For many people, asthma is a long-term condition particularly if it first develops in adulthood. Asthma symptoms are usually controllable and reversible with treatment, although some people withlong-lasting asthma maydevelop permanent narrowing of their airways and more persistent problems. For children diagnosed with asthma, the condition may disappear or improve during the teenage years, although it can return later in life. Moderate or severe childhood asthma is more likely to persist or return later on. Symptoms of asthma The symptoms of asthma can range from mild to severe. Most people will only experience occasional symptoms, although a few people will have problems most of the time. The main symptoms of asthma are: wheezing (a whistling sound when you breathe) shortness of breath a tight chest which may feel likea band is tightening aroundit coughing These symptoms are often worse at night and early in the morning, particularly if the condition is not well controlled. They may also develop or become worse in response to a certain trigger, such as exercise or exposure to an allergen. Read our page on the causes of asthma for more information about potential triggers. Speak to your GP if you think you or your child may have asthma. You should also talk to your doctor or asthma nurse if you have been diagnosed with asthma and you are finding it difficult to control the symptoms. Asthma attacks When asthma symptoms get significantly worse, it is known as an asthma attack or acute asthma exacerbation. Asthma attacks often develop slowly, sometimes taking a couple of days or more to become serious, although some people with asthma are prone to sudden, unexpected severe attacks. It is important to recognise attacks early and take appropriate action. During an asthma attack, the symptoms described above may get worse and if youre already on treatment your inhaler medication may not workas well as it normally does. You might be monitoring your asthma using a device called a peak flow meter, and theremay be a drop in your peak expiratory flow. Read about diagnosing asthma for more information. Signs of a particularly severe asthma attack can include: your reliever inhaler (which is usually blue) is not helping symptoms as much as usual, or at all wheezing, coughing and chest tightness becoming severe and constant being too breathless to eat, speak or sleep breathing faster a rapid heartbeat feeling drowsy, exhausted or dizzy your lips or fingersturning blue (cyanosis) Phone 999 to seek immediate help if you or someone else has symptoms of a severe asthma attack. Causes of asthma Its not clear exactly what causes asthma, although it is likely to be a combination of factors. Some of these may be genetic. However, a number of environmental factors are thought toplay a role in the development of asthma. These include air pollution, chlorine in swimming pools and modern hygiene standards (known as the hygiene hypothesis). There is currently not enough evidence to be certain whether any of these can cause asthma, although a variety of environmental irritants, such as dust, cold air and smoke, may make it worse. Who is at risk? Although the cause of asthma is unknown, a number of things that can increase your chances of developing the condition have been identified. These include: a family history of asthma or other related allergic conditions (known as atopic conditions) such as eczema, food allergy or hay fever havinganother atopic condition having bronchiolitis (a common childhood lung infection) as a child childhood exposure to tobacco smoke, particularly if your mother also smoked during pregnancy being born prematurely, especially if you needed a ventilator to support your breathing after birth having a low birth weight as a result of restricted growth within the womb Some people may also be at risk of developing asthma through their job. Asthma triggers In people with asthma, the small tubes (bronchi) that carry air in and out of the lungs become inflamed and more sensitive than normal. This means that when you come into contact with something that irritates your lungs (a trigger), your airways become narrow, the muscles around them tighten, and there is an increase in the production of sticky mucus (phlegm). Asthma symptoms can have a range of triggers, such as: respiratory tract infections particularly infections affecting the upper airways, such as colds and the flu allergens including pollen, dust mites, animal fur or feathers airborne irritants including cigarette smoke, chemical fumes and atmospheric pollution medicines particularly the class of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs) , which includes aspirin and ibuprofen , and beta-blockers sometimes given for high blood pressure or some types of heart disease emotions including stress or laughing foods containing sulphites naturally occurring substances found in some food and drinks, such as concentrated fruit juice, jam, prawns and many processed or pre-cooked meals weather conditions includinga sudden change in temperature, cold air, windy days, thunderstorms, poor air quality and hot, humid days indoor conditions including mould or damp, house dust mites and chemicals in carpets and flooring materials exercise food allergies including allergies to nuts or other food items Once you know your asthma triggers, youmay be able tohelp control your condition by tryingto avoid them. Further information Asthma UK: asthma triggers A-Z Occupational asthma In some cases, asthma isassociated with substancesyou may be exposed toat work. This is known as occupational asthma. Some of the most commonly reportedcauses of occupational asthma include exposure to: isocyanates (chemicals often found in spray paint) flour and grain dust colophony (a substanceoften found in solder fumes) latex animals wood dust You may be at an increased risk of developing occupational asthma if you are regularly exposed to substances such as these throughyour work. Occupations that are commonly associated with the condition include paint sprayers, bakers and pastry makers, nurses, chemical workers, animal handlers, welders, food processing workers and timber workers. Further information Asthma UK:occupational asthma Health and Safety Executive: asthma Diagnosing asthma If you have typical asthma symptoms, your GP will often be able to make a diagnosis. Theywill want to know whenthe symptoms happen and how often, and if you have noticed anything that might trigger them. Your GP may also ask whetheryou have any allergic (atopic) conditions such as eczema and hay fever , which often occur alongside asthma. A number of tests can be carried out to confirm the diagnosis. These are described below. In children, asthma can be difficult to diagnose because many other conditions can cause similar symptoms in infants. The tests outlined below are also not always suitable forchildren. Your GP therefore may sometimes suggestthat your child usesan asthma inhaler as a trial treatment. If this helps improve your childs symptoms, it is likelythey have asthma. Spirometry A breathing test calledspirometry will often be carried out to assess how well your lungs work. This involves taking a deep breath and exhaling as fast as you can through a mouthpiece attached to a machine called a spirometer. The spirometer takes two measurements the volume of air you can breathe out in the first second of exhalation (the forced expiratory volume in one second, or FEV1) and the total amount of air you breathe out (the forced vital capacity or FVC). You may be asked to breathe into the spirometer a few times to get an accurate reading. The readings are then compared with average measurements for people your age, sex and height, which can show if your airways are obstructed. Sometimes an initial set of measurements is taken, and you arethen given a medicine to open up your airways (a reliever inhaler) to see if this improves your breathing when another reading is taken. This is known as reversibility testing, and it can be useful in distinguishing asthma from other lung conditions, such as chronic obstructive pulmonary disease (COPD) . Peak expiratory flow test A small hand-held device known as a peak flow meter can be used to measure how fast you can blow air out of your lungs in one breath. This is your peak expiratory flow (PEF) and the test is usually called a peak flow test. This test requires a bit of practise to get it right, so your GP or nurse will show you how to do it and may suggest you take the best of two or three readings. You may be given a peak flow meter to take home and a diary to record measurements of your peak flow over a period of weeks. This is because asthma is variable and your lung function may change throughout the day. Your diary may also have a space to record your symptoms. This helps to diagnose asthma and, once diagnosed, will help you recognise when your asthma is getting worse and aid decisions about what action to take. To help diagnose asthma that may be related to your work (occupational asthma), your GP may ask you to take measurements of your peak expiratory flow both at work and when you are away from work. Your GP may then refer you to a specialist to confirm the diagnosis. Other tests Some people may also need anumber of more specialised tests. The tests may confirm the diagnosis of asthma or help diagnose a different condition. This will help you and your doctor to plan your treatment. Airways responsiveness This test is sometimes used to diagnose asthma when the diagnosis is not clear from the more simple tests discussed above. It measures how your airways react when they come into contact with a trigger. You will be asked to breathe in a medication that deliberately irritates or constricts your airways slightly if you have asthma, causing a small decrease in your FEV1 measured using spirometry and possibly triggering mild asthma symptoms. If you do not have asthma, your airways will not respond to this stimulus. The test often involves inhaling progressively increasing amounts of the medication at intervals, with spirometry measurement of FEV1 in between to see if it falls below a certain threshold. In some cases, however, exercise may be used as a trigger. Testing airway inflammation It may also be useful in some cases to carry out tests to check for inflammation in your airways. This can be done in two main ways: amucus sample the doctor may take a sample of mucus (phlegm)so it can be tested for signs ofinflammation in the airways nitric oxide concentration as you breathe out, the level of nitric oxide in your breath is measured using a special machine;a high level of nitric oxide can be a sign of airway inflammation Allergy tests Skin testing or a blood test can be used to confirm whether your asthma is associated with specific allergies,such asdust mites, pollen or foods. Tests can also be carried out to see if you are allergic or sensitive to certain substances known to cause occupational asthma. Read more about diagnosing allergies Treating asthma Reliever inhalers Reliever inhalersusually blueare taken to relieve asthma symptoms quickly. The inhaler usually contains a medicine called a short-acting beta2-agonist, which works by relaxing the muscles surrounding the narrowed airways. This allows the airways to open wider, making it easier to breathe again. Reliever inhalers do not reduce the inflammation in the airways, so they do not make asthma better in the long term they are intended only for the relief of symptoms. Examples of reliever medicines include salbutamol and terbutaline. They are generally safe medicines with few side effects, unless overused. However, they should rarely, if ever, be necessary if asthma is well controlled, and anyone needing to use them three or more times a week should have their treatment reviewed. Everyone with asthma should be given a reliever inhaler, also known simply as a reliever. Read further information: Asthma UK: relievers Preventer inhalers Preventer inhalersusually brown, red or orangework over time to reduce the amount of inflammation and sensitivity of the airways, and reduce the chances of asthma attacks occurring. They must be used regularly (typically twice or occasionally once daily) and indefinitely to keep asthma under control. You will need to use the preventer inhaler daily for some time before you gain the full benefit. You may still occasionally need the blue reliever inhaler to relieve yoursymptoms, but your treatment should be reviewedif you continue to need them often. The preventer inhaler usually contains a medicine called an inhaled corticosteroid. Examples of preventer medicines include beclometasone, budesonide, fluticasone, ciclesonide and mometasone. Preventer treatment should be taken regularly if you have anything more than occasional symptoms from your asthma, and certainly if you feel the need to use a reliever inhaler more than twice a week. Some inhaled corticosteroids can occasionally cause a mild fungal infection (oral thrush) in the mouth and throat, so make sure you rinse your mouth thoroughly after inhaling a dose. The use of a spacer device also reduces this risk. Smoking can reduce the effects of preventer inhalers. Read further information: Asthma UK:preventer inhalers Other treatments and add-on therapy Long-acting reliever inhalers If your asthma does not respond to initial treatment, the dose of preventer inhaler you take may be increased in agreement with your healthcare team. If this does not control your asthma symptoms, you may be given an inhaler containing a medicine called a long-acting reliever (long-acting bronchodilator/long-acting beta2-agonist, or LABA) to take as well. These work in the same way as short-acting relievers. Although they take slightly longer to work, their effects can last for up to 12 hours. This means that taking them regularly twice a day provides 24-hour cover. Regular use of long-acting relievers can also help reduce the dosage of preventer medication needed to control asthma. Examples of long-acting relievers include formoterol and salmeterol, and recently vilanterol, which may last up to 24 hours. However, like short-acting relievers, long-acting relievers do not reduce the inflammation in the airways. If they are taken without a preventer, this may allow the condition to get worse while masking the symptoms, increasing the chance of a sudden and potentially life-threatening severe asthma attack. You should therefore always use a long-acting reliever inhaler in combination with a preventer inhaler, and never by itself. In view of this, most long-acting relievers are prescribed in a combination inhaler, which contains both an inhaled steroid (as a preventer) and a long-acting bronchodilator in the one device. Examples of combination inhalers include Seretide, Symbicort, Fostair, Flutiform and Relvar. These are usually (but not always) purple, red and white, or maroon. Other preventer medicines If regular efficient administration of treatment with a preventer and a long-acting reliever still fails to control asthma symptoms, additional medicines may be tried. Two possible alternatives include: leukotriene receptor antagonists tablets that block part of the chemical reaction involved in the swelling (inflammation) of the airways theophyllines tablets that help widen the airways by relaxing the muscles around them, and are also relatively weak anti-inflammatory agents Oral steroids If your asthma is still not under control, you may be prescribed regular steroid tablets. This treatment is usually monitored by a respiratory specialist (an asthma specialist). Oral steroids are powerful anti-inflammatory preventers, which are generally used in two ways: to regain control of asthma when it is temporarily upsetfor example, by a lapse in regular medication or an unexpected chest infection; in these cases, they are typically given for one or two weeks, then stopped when long-term control of asthma remains a problem, despite maximal dosages of inhaled and other medicationsin these cases, oral steroids may be given for prolonged periods, or even indefinitely, while maintaining maximum treatment with inhalers asthis maximises the chance of being able to stop the oral steroids again in the future Long-term use of oral steroids has serious possibleside effects, so they are only used once other treatment options have been tried, and after discussing the risks and benefits with your healthcare team. Omalizumab (Xolair) Omalizumab, also known as Xolair, is the first of a new category of medication that binds to one of the proteins involved in the immune response and reduces its level in the blood. This lowers the chance of an immune reaction happening and causing an asthma attack. It is licensed for use in adults and children over six years of age with asthma. The National Institute for Heath and Care Excellence (NICE) recommends that omalizumab can be used in people with allergy-related asthma whoneed continuous or frequent treatment with oral corticosteroids. Omalizumab is given as an injection every two to four weeks. It should only be prescribed in a specialist centre. If omalizumab does not control asthma symptoms within 16 weeks, the treatment should be stopped. Read further information: Asthma UK:other treatments and add-on therapies Asthma UK:steroid tablets NICE: omalizumab for severe persistent allergic asthma Bronchial thermoplasty Bronchial thermoplasty is a relatively new procedurethat can be usedin some cases of severe asthma. It worksby destroying some of the muscles surrounding the airways in the lungs, which canreduce their ability to narrow the airways. The procedure is carried out either with sedation or under general anaesthetic . A bronchoscope (a long, flexible tube) containing a probe is inserted into the lungs through the mouth or noseso it touches the airways. The probe then uses controlled heat to damage the muscles around the airways. Three treatment sessions are usually needed, with at leastthree weeks between each session. There is some evidence to showthis procedure may reduce asthma attacks and improve the quality of life of someone with severe asthma. However, the long-term risks and benefits are not yet fully understood. There is a small risk it will trigger an asthma attack, which sometimes requires hospital admission. You should discuss this procedure fully with your clinician if the treatment is offered. Read further information: NICE:bronchial thermoplasty for severe asthma Side effects of treatments Side effects of relievers and preventers Relievers are a safe and effective medicine, and havefew side effects as long as they are not used too much. The main side effects include a mild shaking of the hands (tremors), headaches and muscle cramps. These usually only happen with high doses of reliever inhaler and usually only last for a few minutes. Preventers arevery safe at usual doses, although they can cause a range of side effects at high doses, especially with long-term use. The main side effect of preventer inhalers is a fungal infection of the mouth or throat (oral candidiasis) . You may also develop a hoarse voice and sore throat . Using a spacer can help prevent these side effects, as can rinsing your mouth or cleaning your teeth afterusingyour preventer inhaler. Your doctor or nurse will discuss with you the need to balance control of your asthma with the risk of side effects, and how to keepside effects to a minimum. Side effects of add-on therapy Long-acting relievers may cause similar side effects to short-acting relievers. You should be monitored at the beginning of your treatment and reviewed regularly. If you find there is no benefit to using the long-acting reliever, it should be stopped. Theophylline tablets have been known to cause side effects in some people, including nausea, vomiting, tremors and noticeable heartbeats (palpitations). These can usually be avoided by adjusting the dose according to periodic measurement of the theophylline concentration in the blood. Side effects of leukotriene receptor agonists can include tummy (abdominal) pain and headaches. Side effects of steroid tablets Oral steroids carry a risk if they are taken for more than three months or if they are taken frequently (more than three or four courses of steroids a year). Side effects can include: osteoporosis (fragile bones) high blood pressure (hypertension) diabetes increased appetite, leading to weight gain cataracts andglaucoma (eye disorders) thinning of the skin easy bruising muscle weakness With the exception of increased appetite, which is very commonly experienced by people taking oral steroids, most of these unwanted effects are uncommon. However, it is a good idea to keep an eye out for them regularly, especially side effects that are not immediately obvious, such as high blood pressure, thinning of the bones, diabetes and glaucoma. You will need regular appointments to check for these. Read further information: Asthma UK:side effects of asthma medicines Asthma attacks Apersonal asthma action plan will help you recognise the initial symptoms of an asthma attack, know how to respond, and when to seek medical attention. In most cases, the following actions will be recommended: Take one to two puffs of your reliever inhaler (usually blue) immediately. Sit down and try to take slow, steady breaths. If you do not start to feel better, take two puffs of your reliever inhaler (one puff at a time) every two minutes(you can take up to 10 puffs)this is easier using a spacer, if you have one. If you do not feel better after taking your inhaler as above or if you are worried at any time, phone 999. If an ambulance does not arrive within 10 minutes and you are still feeling unwell, repeat step three. If your symptoms improve and you do not need to phone 999, you still need to see a doctor or asthma nurse within 24 hours. If you are admitted to hospital, you will be given a combination of oxygen, reliever and preventer medicines to bring your asthma under control. Your personal asthma action plan will need to be reviewed after an asthma attack, so reasons for the attack can be identified and avoided in future. Read further information: Asthma UK: what to do in an asthma attack Personal asthma action plan As part of your initial assessment, you should be encouraged to draw up a personal asthma action plan with your GP or asthma nurse. If youve been admitted to hospital because of an asthma attack, you should be offered an action plan (or the opportunity to review an existing action plan) before you go home. The action plan should include information about your asthma medicines, and will help you recognise when your symptoms are getting worse and what steps to take. You should also be given information about what to do if you have an asthma attack. Your personal asthma action plan should be reviewed with your GP or asthma nurse at least once a year, or more frequently if your symptoms are severe. As part of your asthma plan, you may be given a peak flow meter . This will give you another way of monitoring your asthma, rather than relying only on symptoms, so you can recognise deterioration earlier and take appropriate steps. Read further information: Asthma UK: personal asthma action plan What is good asthma care? Your doctor or nurse will tailor your asthma treatment to your symptoms. Sometimes you may need to be on higher levels of medication than at others. You should be offered: care at your GP surgery provided by doctors and nurses trained in asthma management full information about your condition and how to control it involvement in making decisions about your treatment regular checks to ensure your asthma is under control and your treatment is right for you (this should be at least once a year) a written personal asthma action plan agreed with your doctor or nurse It is also important that your GP or pharmacist teaches you how to properly use your inhaler, as this is an important part of good asthma care. Occupational asthma If it is possible you have asthma associated with your job (occupational asthma), you will be referred to a respiratory specialist to confirm the diagnosis. If your employer has an occupational health service, they should also be informed, along with your health and safety officer. Your employer has a responsibility to protect you from the causes of occupational asthma. It maysometimes be possible to substitute or remove the substance triggering your occupational asthma from your workplace, to redeploy youto another role within the company, or to wear protective breathing equipment. However, you may need to consider changing your job or relocating away from your work environment, ideally within 12 months of your symptoms developing. Some people with occupational asthma may be entitled to Industrial Injuries Disablement Benefit. Read further information: Asthma UK: occupational asthma GOV.UK: Industrial Injuries Disablement Benefit Health and Safety Executive: asthma Complementary therapies A number of complementary therapies have been suggested for the treatment of asthma, including: breathing exercises traditional Chinese herbal medicine acupuncture ionisersdevices that use an electric current to charge (ionise) molecules of air manual therapiessuch as chiropractic hypnosis homoeopathy dietary supplements However, there is little evidence that any of these treatments, other than breathing exercises, are effective. There is some evidence that breathing exercisescan improve symptoms and reduce the need for reliever medicines in some people. These includebreathing exercises taught by a physiotherapist, yoga and the Buteyko method (a technique involving slowed, controlled breathing). Read further information: Asthma UK: complementary therapies Living with asthma With the right treatment and management, asthma shouldnt restrict your daily life (including your sleep) in any way. You should work with your healthcare professionals and strive to achieve this goal. You should also be confident about how to recognise when your asthma is getting out of control, and what to do if it does. Sleeping Asthma symptoms are often worse at night. This means you might wake up some nights coughing or with a tight chest. If your child has asthma, poor sleep can affect their behaviour and concentration, as well as their ability to learn. Effectively controlling asthma with the treatment your doctor or nurse recommends will reduce the symptoms, so you or your childshould sleep better. Read about living with insomnia for more tips on getting better sleep. Exercise Very occasionally, people with asthma develop symptoms only during exercise. However, usually this is a sign that your asthma could be better controlled generally. If you or your child have asthma symptoms during or after exercise, speak to your doctor or asthma nurse. It is likely they will review your general symptoms and personal asthma plan to make surethe conditionis under control. Your doctor or asthma nurse may also advise that: you make sure the people you are exercising with know you have asthma you increase your fitness levels gradually you always have your reliever inhaler (usually blue) with you when you exercise you use your reliever inhaler immediately before you warm up you ensure that you always warm up and down thoroughly if you have symptoms while you are exercising, stop what youre doing, take your reliever inhaler and wait until you feel better before starting again Read about health and fitness for more information on simple ways to exercise. Diet Most people with asthma can eat a normal, healthy diet. Occasionally, people with asthma may have food-based allergic triggers and will need to avoid foods such as cows milk, eggs, fish, shellfish, yeast products, nuts, and some food colourings and preservatives. However, this is uncommon. Read more about eating well Read further information: Asthma UK: exercise Asthma UK: diet and food Know your triggers Its important to identify possible asthma triggers by making a note of any worsening symptoms or by using yourpeak flow meter during exposure to certain situations. Read our page on the causes of asthma for more information about potential triggers. Some triggers, such as air pollution, illnesses and certain weather conditions, can be hard to avoid. However, it may be possible to avoid other triggers, such as dust mites, fungal spores, pet fur and certain medications that trigger your symptoms. Make sure your healthcare team knows about and investigates triggers for your symptoms that you may have noticed yourself. Read further information: Allergy prevention Asthma UK: asthma triggers A-Z Complications of asthma Quality of life Badly controlled asthma can have an adverse effect on your quality of life. The condition can result in: fatigue (extreme tiredness) underperformance or absence from work or school psychological problems including stress, anxiety and depression disruption of your work and leisure because of unexpected visits to your GP or hospital in children, delays in growth or

puberty Children may also feel excluded from their school friends if they cannot take part in games

sports and social activities. Respiratory complications In rare cases

Atopic eczema

Atopic eczema - Illnesses and conditions Skin, hair and nails Atopic eczema Atopic eczema About atopic eczema Symptoms of atopic eczema Causes of atopic eczema Diagnosing atopic eczema Treating atopic eczema Complications of atopic eczema About atopic eczema Atopic eczema, also known as atopic dermatitis, is the most common form of eczema. It mainly affects children, but can also affect adults. Eczema is a condition that causes the skin to become itchy, red, dry and cracked. It is a long-term (chronic) condition in most people, although it can improve over time, especially in children. Atopic eczemacan affect any part of the body,but the most common areas to be affected are: backs or fronts ofthe knees outside or inside of the elbows around the neck hands cheeks scalp People with atopic eczema usuallyhave periods when symptoms are less noticeable, as well as periods when symptoms become more severe (flare-ups). Read more about the symptoms of atopic eczema and diagnosing atopic eczema . Atopic eczema causes itchy, red, dry and cracked skin. Source: https://dermnetnz.org/ What causes atopic eczema? The exact cause of atopic eczema is unknown, but its clear its not down to one single thing. It often occurs in people who get allergies atopic means sensitivity to allergens. Itcan run in families, and oftendevelops alongside other conditions, such as asthma and hay fever . The symptoms of atopic eczemaoften have certaintriggers, such assoaps, detergents, stress and the weather.Sometimes food allergies can play a part, especially in young children with severe eczema. Readmore about the causes of atopic eczema . Treating atopic eczema There is currently no cure for atopic eczema, but treatment canhelp relieve the symptoms and many cases improve over time. However, severe eczema often has a significant impact on daily life and may be difficult tocope with physically and mentally. There is also an increased risk of skin infections. Many different treatments can be used to control symptoms and manage eczema, including: self care techniques,such as reducing scratching and avoiding triggers emollients(moisturising treatments)used on a daily basis for dry skin topical corticosteroids used to reduce swelling, redness and itching during flare-ups When to get professional advice Pharmacy First Scotland: Atopic eczema treatment from your pharmacy If you have atopic eczema or symptoms of atopic eczema you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotlands Service Directory. Search for a pharmacy near you Atopic eczema isnt usually serious and can be treated by a pharmacist. Your pharmacist may recommend that you contact your GP practice if required. Read more about treatingatopic eczema and the complications of atopic eczema . Who is affected? About 1in 5children in the UK has atopic eczema. In 8 out of 10 cases, the condition develops before a child reaches the age of 5. Many children develop it before their first birthday. Atopic eczema can improve significantly, or even clear completely, in some children as they get older. About half of all cases improve a lot by the time a child reaches 11 years, and around two-thirds improveby the age of 16. However, the condition can continue into adulthood and can sometimes develop for the first time in adults. Symptoms of atopic eczema Atopic eczema causes areas of skin to become itchy, dry, cracked, sore and red. There will usually be periods where the symptoms improve, followed by periods where they get worse (flare-ups). Flare-ups may occur as often as 2or 3times a month. Atopic eczema can occur all over the body, but is most common on the hands (especially fingers), the insides of the elbows or backs of the knees, and the face and scalp in children. The face is more commonly involved in adults. The severity of atopic eczema can vary a lot from person to person. People with mild eczema may only have small areas of dry skin that are occasionally itchy. In more severe cases, atopic eczema can cause widespread red, inflamed skin all over the body and constant itching. Scratching can disrupt your sleep, make your skin bleed, and cause secondary infections. It can also make itching worse, and a cycle of itching and regular scratching may develop. This can lead to sleepless nights and difficulty concentrating at school or work. Areas of skin affected by eczema may also turn temporarily darker or lighter after the condition has improved. This is more noticeable in people with darker skin. Its nota result ofscarring or a side effect of steroid creams, but more of a footprint of old inflammationand will eventually return to its normal colour. Atopic eczema often occurs on the insides of the elbows. Source: https://dermnetnz.org/ Atopic eczema can occur on the face. Source: https://dermnetnz.org/ Signs of an infection Occasionally, areas of skin affected by atopic eczema can become infected. Signs of an infection can include: your eczema getting a lot worse fluid oozing from the skin a yellow crust on the skin surface or small yellowish-white spots appearing in the eczema the skin becoming swollen and sore a high temperature (fever) and generally feeling unwell See your doctor as soon as possible if you think your or your childs skin may have become infected. Read more about infections and other complications of atopic eczema . Causes of atopic eczema Atopic eczema is likely to be caused by a combination of things. People with atopic eczema often have very dry skin because their skin is unable to retainmuch moisture. This dryness may makethe skin more likely to react to certain triggers, causing it to become red and itchy. You may be born with an increased likelihood of developing atopic eczema because of the genes you inherit from your parents. Research has shown children who have 1or both parents with atopic eczema, or who have other siblings with eczema, are more likely to develop it themselves. Atopic eczema is not infectious, so it cannot be passed on through close contact. Eczema triggers There are a number of things that may trigger your eczema symptoms. These can vary from person to person. Commontriggers include: irritants such assoaps and detergents, including shampoo, washing up liquidand bubble bath environmental factors or allergens such as cold and dry weather, dampness, and more specific things such as house dust mites, pet fur, pollen and moulds food allergies such as allergies tocows milk, eggs, peanuts, soya or wheat certainmaterials worn next to the skin such as wool and synthetic fabrics hormonal changes women may find their symptoms get worse in the days before their period or during pregnancy skin infections Some people also report their symptoms get worse when the air is dry or dusty, or when they are stressed,sweaty, or too hot or too cold. If you are diagnosed with atopic eczema, your pharmacist or GP will work with you to try to identify any triggers for your symptoms. Read more about diagnosing atopic eczema . Diagnosing atopic eczema Your GP will usually be able to diagnose atopic eczema by looking at your skin and asking questions about your symptoms. These questions may include asking: whether the rash is itchy and where it appears when the symptoms first began whether it comes and goes over time whether there is a history of atopic eczema in your family whether you have any other conditions, such as allergies or asthma You should tell your pharmacist or GP if your condition is affecting your quality of life for example, if youhave difficulty sleeping because of itching, oryour eczema limits your everydayactivities. Checklist for diagnosing atopic eczema Typically, to be diagnosed with atopic eczema you should have had an itchy skin condition in the last 12 months and 3or more of the following: visibly irritated red skin in the creases of your skin, such as the insides of your elbows or behind your knees (or on the cheeks, outsides of elbows, or fronts of the knees in children aged 18 months or under) at the time of examination by a health professional a history of skin irritation occurring in the same areas mentioned above generally dry skin in the last 12 months a history of asthma or hay fever children under 4must have an immediate relative, such as a parent, brother or sister, who has one of these conditions the condition started before the age of 2(this does not apply to children under the age of 4) Establishing triggers Your pharmacist should work with you to establish if any triggers make your eczema worse. You may be asked about your diet and lifestyle to see if something obvious may be contributing to your symptoms. For example, you may have noticed some soaps or shampoos make the eczema worse. You may also be asked to keep a food diary to try to determine whether a specific food makes your symptoms worse. A food diary involves writing down everything you eat and making a record of any eczema flare-ups you have. Your pharmacist can then use the diary to see if there is a pattern between your symptoms and what you eat. Allergy tests are not usually needed to identify triggers, although they are sometimes helpful in identifying food allergies that may be triggering symptoms in young children or in those where a food allergy is suspected. Read more about triggers and causes of atopic eczema . Treating atopic eczema There is no cure for atopic eczema, but treatments can ease the symptoms. Many children find their symptoms naturally improve as they get older. The main treatments for atopic eczema are: emollients(moisturisers) used every day to stop the skin becoming dry topical corticosteroids creams and ointments used to reduce swelling and redness during flare-ups Other treatments include topical pimecrolimus or tacrolimus for eczema in sensitive sites not responding to simpler treatment,antihistamines for severe itching, bandages or special body suits to allow the body to heal underneath, or more powerful treatments offered by a dermatologist (skin specialist). The various treatments foratopic eczema are outlined below. Self care As well as the treatments mentioned above, there are thingsyou cando yourself to help easeyour symptoms and prevent further problems. Try to reduce the damage from scratching Eczema is often itchy and it can be very tempting to scratch the affected areas of skin. But scratching usually damages the skin, which can itself cause more eczema to occur. The skin eventually thickens into leathery areas as a result of chronic scratching. Deep scratching also causes bleeding and increases the risk of your skin becoming infected or scarred. Try to reduce scratching whenever possible. You could try gently rubbing your skin with your fingers instead. If your baby has atopic eczema, anti-scratch mittens may stop them scratching their skin. Keep your nails short and clean to minimise damage to the skin from unintentional scratching. Keep your skin covered with light clothing to reduce damage from habitual scratching. Avoid triggers Your pharmacist will work with you toestablish what mighttrigger the eczema flare-ups, althoughit may get better or worse for no obvious reason. Once you knowyour triggers, you can try to avoid them.For example: if certain fabrics irritate your skin, avoid wearing these and stick to soft, fine-weave clothing or natural materials such as cotton if heat aggravates your eczema, keep the rooms in your home cool, especially the bedroom avoid using soaps or detergents that may affect your skin use soap substitutes instead Althoughsome people with eczema are allergic to house dust mites, trying to rid your home of them isnt recommendedas it can be difficult and there is no clear evidence that it helps. Read more about preventing allergies . Dietary changes Some foods, such as eggs and cows milk, can trigger eczema symptoms. However, you should not make significant changes to your diet without first speaking to your pharmacist or GP. It may not be healthy to cut these foods from your diet, especially in young children who need the calcium, calories and protein from these foods. If your GP suspects you have a food allergy , you may be referred to a dietitian (a specialist in diet and nutrition), who can help work out a way to avoid the food youre allergic to while ensuring you still get all the nutrition you need. Alternatively, you may be referred to a hospital specialist such as an immunologist, dermatologist or paediatrician. If you are breastfeeding a baby with atopic eczema, get medical advice before making any changes to your regular diet. Emollients Emollients are moisturising treatments applied directly to the skin to reduce water loss and cover it with a protective film. They are often used to help manage dry or scaly skin conditions such as atopic eczema. In addition to making the skin feel less dry, they may also have a mild anti-inflammatory role, and can help reduce the number of flare-ups you have. Choosing anemollient Several different emollients are available. You may need to try a few to find one that works for you. You may also be advised to use a mix of emollients, such as: an ointment for very dry skin a cream or lotion for less dry skin an emollient to use instead of soap an emollient to add to bath water or use in the shower one emollient to use on your face and hands, and a different one to use on your body The difference between lotions, creams and ointments is the amount of oil they contain. Ointments contain the most oil so they can be quite greasy, but are the most effective at keeping moisture in the skin. Lotions contain the least amount of oil so are not greasy, but can be less effective. Creams are somewhere in between. If you have been using a particular emollient for some time, it may eventually become less effective or may start to irritate your skin. If this is the case, your pharmacist will be able to recommend another product that suits you better. The best emollient is the one you feel happy using every day. How to use emollients Use your emollient all the time, even if you are not experiencing symptoms. Many people find it helpful to keep separate supplies of emollients at work or school, or a tub in the bathroom and one in a living area. To apply the emollient: use a large amount dont rub it in smooth it into the skin in the same direction the hair grows instead after a bath or shower, gently pat the skin dry andapply the emollient while the skin is still moist to keep the moisture in You should use an emollient at least twice a day if you can, or more often if you have very dry skin. During a flare-up, apply generous amounts of emollient more frequently, but remember to treat inflamed skin with a topical corticosteroidas emollients usedon their ownare not enough to control it. Dont put your fingers into an emollient pot use a spoon or pump dispenser instead, as this reduces the risk of infection. And never share your emollient with other people. Topical corticosteroids If your skin is sore and inflamed, your pharmacist may recommend a topical corticosteroid (applied directly to your skin), which can reduce the inflammation within a few days. Topical corticosteroids can be prescribed in different strengths, depending on the severity of your atopic eczema and the areas of skin affected. They can be very mild (such as hydrocortisone), moderate (such as clobetasone butyrate), or even stronger (such as mometasone). If you need to use corticosteroids frequently, see your GP regularly so they can check the treatment is working effectively and you are using the right amount. How to use topical corticosteroids Dont be afraid to apply the treatment to affected areas to control your eczema. Unless instructed otherwise by your doctor, follow the directions on the patient information leaflet that comes with your medication. This will give details of how much to apply. Most people will only have to apply it once a day as there is no evidence there is any benefit to applying it more often. When using a topical corticosteroid: apply your emollient first and ideally wait around 30 minutes until the emollient has soaked into your skin, or apply the corticosteroid at a different time of day (such as at night) apply the recommended amount of the topical corticosteroid to the affected area continue to use it until 48 hours after the flare-up has cleared so the inflammation under the skin surface is treated Occasionally, your doctor may suggest using a topical corticosteroid less frequently, but over a longer period of time. This is designedto help prevent flare-ups. This is sometimes called weekend treatment, where a person who has already gained control of their eczema uses the topical corticosteroid every weekend on the trouble sites to prevent them becoming active again. Side effects Topical corticosteroids may cause a mild stinging sensation for less than a minute as you apply them. In rare cases, they may also cause: thinning of the skin especially if the strong steroids are used in the wrong places, such as the face, for too long (for example, several weeks) changes in skin colour usually, skinlightening after many months of using very strong steroids, but most lighteningafter eczema is a footprint of old inflammation and nothing to do with treatments acne (spots) especially when used on the face in teenagers increased hair growth Most of these side effects will improve once treatment stops. Generally, using a strong topical corticosteroid for many months,using them in sensitive areas such as theface, armpits or groin, or using a large amount will increase your risk of side effects. For this reason, you should be prescribed the weakest effective treatment to control your symptoms. Antihistamines Antihistamines are a type of medicine that blocks the effects of a substance in the blood called histamine. Theycan help relieve the itching associated with atopic eczema. They can eitherbe sedating, which cause drowsiness,ornon-sedating. If you have severe itching, your pharmacist may suggest tryinga non-sedating antihistamine. If itching during a flare-up affects your sleep, your pharmacist may suggest taking a sedatingantihistamine. Sedatingantihistamines can cause drowsiness into the following day, so it may be helpful to let your childs school know they may not be as alert as normal. Bandages and wet wraps In some cases, your GP may prescribe special medicated bandages, clothing or wet wraps to wear over areas of skin affected by eczema. These can either be used over emollients or with topical corticosteroids to prevent scratching, allow the skin underneath to heal, and stop the skin drying out. Corticosteroid tablets Corticosteroid tablets are rarely used to treat atopic eczema nowadays, but may occasionally be prescribed for short periods of 5to 7days to help bring particularly severe flare-ups under control. Longer courses of treatment are generally avoided because of the risk of potentially serious side effects. If your GP thinks your condition may be severe enough to benefit from repeated or prolonged treatment with corticosteroid tablets, they will probably refer you to a specialist. Seeing a specialist In some cases, your GP may refer you to a specialist in treating skin conditions (dermatologist). You may be referred if your GP is not sure what type of eczema you have, normal treatment is not your eczema, your eczema is affecting your daily life, or its not clear what is causing it. A dermatologist may be able to offer the following: a thorough review of your existing treatment to make sure you are using enough of the right things at the right times topical calcineurin inhibitors creams and ointments that suppress your immune system, such aspimecrolimus and tacrolimus very strong topical corticosteroids bandages or wet wraps phototherapy ultraviolet (UV) light that reduces inflammation immunosuppressant tablets to suppress your immune system, such as azathioprine, ciclosporin and methotrexate alitretinoin medicine to treat severe eczema affecting the hands in adults A dermatologist may also offer additional support to help you use your treatments correctly, such as demonstrations from nurse specialists, and they may be able to refer you for psychological support if you feel youneed it. Complications of atopic eczema People with atopic eczema can sometimes develop further physical and psychological problems. Bacterial skin infections As atopic eczema can cause your skin to become cracked and broken, there is a risk of the skin becoming infected with bacteria. The risk is higher if you scratch your eczema or do not use your treatments correctly. Signs of a bacterial infection can include: fluid oozing from the skin a yellow crust on the skin surface small yellowish-white spots appearing in the eczema the skin becoming swollen and sore a high temperature (fever) and generally feeling unwell Your normal symptoms may also get rapidly worse and your eczema may not respond to your regular treatments. You should see your doctor as soon as possible if you think your or your childs skin may have become infected. They will usually prescribe antibiotic tablets, capsules or cream to treat the infection, as well as making sure the skin inflammation that led to the infection is well controlled. Speak to your pharmacist or GP if these dont help or your symptoms get worse. Once your infection has cleared, your GP should prescribe new supplies of any creams and ointments youre using to avoid contamination. Old treatments should be disposed of. Viral skin infections Its also possible for eczema to become infected with the herpes simplex virus, which normally causes cold sores . This can develop into a serious condition called eczema herpeticum. Symptoms of eczema herpeticum include: areas of painful eczema that quickly get worse groups of fluid-filled blisters that break open and leave small, shallow open sores on the skin a high temperature and generally feeling unwell, in some cases Contact yourdoctor immediately if you think you or your child may have eczema herpeticum. If you cannot contact your GP, call NHS 111 or go to your nearest hospital. If you are diagnosed witheczema herpeticum, you will be given an antiviral medication called aciclovir. Psychological effects As well as affecting you physically, atopic eczema may also affect you psychologically. Preschool children with atopic eczema may be more likely to have behavioural problems such as hyperactivity than children who do not have the condition. They are also more likely to be more dependent on their parents. Bullying Schoolchildren may experience teasing or bullying if they have atopic eczema. Any kind of bullying can betraumatic and difficult for a child to deal with. Your child maybecome quiet and withdrawn. Explain the situation to your childs teacher and encourage your child to tell you how they are feeling. The National Eczema Society provides information about regional support groups , where you may be able to meet other people living with atopic eczema. Problems sleeping Sleep-related problems are common among people with eczema. A lack of sleep may affect mood and behaviour. It may also make it more difficult to concentrate at school or work. If your child has problems sleepingbecause of theireczema,they may fall behind with their schoolwork. Itmight helpto lettheir teacher know about their condition so it can be taken into consideration. During a severeeczema flare-up, your child may need time off from school. This may also affect their ability to keep up with their studies. Self-confidence Atopic eczema can affect the self-confidence of both adults and children. Children may find it particularly difficult to deal with their condition, which maylead tothem having a poor self-image. If your child is severely lacking in confidence, it may affect their ability to develop social skills. Support and encouragement will help boost your childs self-confidence and give them a more positive attitude about their appearance. Speak to your GP if you are concerned your childs eczema is severely affecting their confidence. They may benefit from specialist psychological support.

Atrial fibrillation

Atrial fibrillation - Illnesses & conditions Heart and blood vessels Conditions Atrial fibrillation Atrial fibrillation About atrial fibrillation Symptoms of atrial fibrillation Causes of atrial fibrillation Diagnosing atrial fibrillation Treating atrial fibrillation Complications of atrial fibrillation About atrial fibrillation Atrial fibrillation (AF)is a condition that causes an irregular heart rate. Most commonly, the heart rate will be unusually fast with this condition;butit is possible for the heart rate to be within accepted limitsor slower and still be in atrial fibrillation. You can measure your heart rate by feeling the pulse in your wrist or neck. A normal heart rate, when you are resting, should be between 60 and 100 beats a minute. In atrial fibrillation, it may be over 140 beats a minute. How is atrial fibrillation defined? Atrial fibrillation is defined in various ways, depending on how it affects you: paroxysmal atrial fibrillation this comes and goes, usually stopping within 48 hours without any treatment. persistent atrial fibrillation this lasts for longer than seven days, or less when it is treated. longstanding persistent atrial fibrillation this means you have had continuous atrial fibrillation for a year or longer. permanent atrial fibrillation this is when atrial fibrillation is present all the time and no more attempts to restore normal heart rhythm will be made What happens in atrial fibrillation? When the heart beats normally, its muscular walls contract (tighten and squeeze) to force blood out and around the body. They then relax, so the heart can fill with blood again. This process is repeated every time the heart beats. Atrial fibrillation occurs when abnormal electrical impulses suddenly start firing in the atria (upper chambers of the heart). These impulses override the hearts natural pacemaker, which can no longer control the rhythm of the heart. The atria contract randomly and sometimes so fast that the heart muscle cannot relax properly between contractions. This reduces the hearts efficiency and performance and causes a highly irregular pulse rate. What are the symptoms of atrial fibrillation? Atrial fibrillation can lead to a number of problems, including: dizziness feeling faint shortness of breath fast and irregular heartbeat (palpitations) feeling very tired Some people with atrial fibrillation have no symptoms and are completely unaware that their heart rate is irregular. Find out more about the symptoms of atrial fibrillation Why does atrial fibrillation happen and how common is it? Atrial fibrillation is the most common heart rhythm disturbance and affects up to 800,000 people in the UK. The cause of atrial fibrillation is not fully understood, but it tends to occur in certain groups of people and may be triggered by certain situations, such as drinking excessive amounts of alcohol or smoking. The condition can affect adults of any age or gender but: is more common the older you get affects about 10% of people over 75 more common in men than women Atrial fibrillation is more likely to occur in people with other conditions, like: high blood pressure diabetes coronary heart disease Find out more about the causesof atrial fibrillation and how its diagnosed What is the outlook with atrial fibrillation? Atrial fibrillation is generally not life threatening, many people live normal healthy lives with this condition, but it can be uncomfortable and often needs treatment. This condition increases your risk by about fourto five times of having a transient ischaemic attack (TIA) or stroke . This is because when the atria in the heart do not contract properly there is a risk ofblood clot formation. Clots from the atria may break off and go to other parts of the body. A blood clot passing up to the arteries supplying the brain may cause a stroke. For this reason, treatment may involve medication to control the heart rate or rhythm, and medication to prevent clots from forming in the blood. Find out how to treatatrial fibrillation and possible complicationsof having AF Symptoms of atrial fibrillation The most obvious symptom of atrial fibrillation (AF)is palpitations caused by a fast and irregular heartbeat. A normal heart rate, when you are resting, should be between 60 and 100 beats a minute. In atrial fibrillation, it may be over 140 beats a minute. If you notice an irregular heartbeat and/or have chest pain, see your doctor immediately. How to check your heart rate You can check your heart rate by pressing gently on the pulse in your wrist or neck. Other symptoms As well as a fast and irregular heartbeat, you may also experience: tiredness (inability to carry out normal exercise for you) breathlessness dizziness feeling faint palpitations chest discomfort or pain Some people have no symptoms Some people with atrial fibrillation have no symptoms and it is only discovered during routine tests or investigations for another condition. Causes of atrial fibrillation The exact cause of atrial fibrillation (AF) is unknown, but it becomes more common with age and affects certain groups of people more than others. People with other heart conditions Atrial fibrillation is common in people with other heart conditions, such as: high blood pressure coronary heart disease heart valve disease congenital heart disease(heart defects at birth) heart failure (from any cause) People with other medical conditions Atrial fibrillation isalso associated with other medical conditions such as: hyperthyroidism (overactive thyroid gland) heavy alcohol consumption pneumonia chronic obstructive pulmonary disease pulmonary embolism(a blockage in a blood vessel in your lungs) Cause is unknown Not everyone with atrial fibrillation falls into one of the above groups. Sometimes the cause can be idiopathic (no known cause) and can affect extremely athletic people. Triggers Sometimes there is a trigger to an episode of atrial fibrillation, including: drinking excessive amounts of alcohol, particularly binge drinking being overweight taking illegal drugs, particularly amphetamines or cocaine smoking heightened emotional stress Diagnosing atrial fibrillation Feeling your pulse to check if you have an irregular heartbeat can give a strong indication of whether you have atrial fibrillation (AF). However,a complete diagnosis requires a full medical investigation. If you notice your heartbeat is irregular and/or you have chest pain, see your GP straight away. If your GP thinks you have atrial fibrillation after assessing your symptoms, you will be asked to have an electrocardiogram (ECG) and referred to a heart specialist, known as a cardiologist. Electrocardiogram (ECG) An ECG is a test that records the rhythm and electrical activity of your heart. Small stickers called electrodes are attached to your arms, legs and chest and connected by wires to an ECG machine. Every time your heart beats, it produces tiny electrical signals. An ECG machine traces these signals on paper. An ECG is usually carried out in a hospital or GP surgery. It takes about five minutes and is painless. If you have the test during an episode of atrial fibrillation, the ECG will record your abnormal heart rate. This will confirm the diagnosis of atrial fibrillation and rule out other conditions. However, it may be difficult to capture an episode, as the irregular rhythm may come and go, therefore, to capture this your GP or cardiologist, may ask you to wear a small, portable ECG recorder for a longer period of time away from the hospital or GP surgery. Find out more about having an ECG Echocardiogram (Echo) An echocardiogram, sometimes called an echo, is an ultrasound scan of the heart. It can help identify any other heart problems and assess the structure and function of your heart and valves. Find out more about having an echocardiogram Chest X-ray A chest X-ray may be performed and will identify any lung problems that may have caused the atrial fibrillation. Blood tests Blood tests can also be useful in the diagnosis of atrial fibrillation. They may showanaemia, which could be complicating the situation, problems with kidney function or hyperthyroidism (overactive thyroid gland). Treating atrial fibrillation The treatment of atrial fibrillation (AF)varies from person to person and depends on: the type of atrial fibrillation symptoms treatment of any underlying cause age overall health Some people may be treated by their GP, whereas others may be referred to a cardiologist. Finding an underlying cause The first step is to try to find out the cause of the atrial fibrillation. If a cause is found, treatment for this may be enough. For example,medication to correct hyperthyroidism (an overactive thyroid gland) may cure atrial fibrillation. If there is no underlying cause found If no underlying cause of the atrial fibrillation can be found, the treatment options are: medicines to control atrial fibrillation restoring a normal heart rhythm medicines to reduce the risk of a stroke cardioversion (a controlled electrical shock to reset the heart rhythm) catheter ablation having a pacemaker fitted You can find out more about each of these below. Medicines to control atrial fibrillation Medicines called anti-arrhythmics can control atrial fibrillation by: restoring a normal heart rhythm controlling the rate at which the heart beats The choice of anti-arrhythmic medicine depends on: the type of atrial fibrillation any other medical conditions you have side effects of the medicine chosen how well the atrial fibrillation responds. Some people with atrial fibrillation may need more than one anti-arrhythmic medicine to control it. Restoring a normal heart rhythm There are a number of drugs that can be used to try to restore a normal heart. The best option for you will be decided by your cardiologist and /or GP. Commonly, these drugs include: flecainide beta-blockers amiodarone Dronedarone may also be used for certain people. It is important you know what side effects to look out for if taking such medication and seek medical advice if you experience any of them. To find out about side effects, read the patient information leaflet that comes with your medicine for more details. Medicines to reduce the risk of a stroke The way the heart beats in atrial fibrillation means that there is a risk of blood clots forming in the heart chambers. If these get into the bloodstream, they can cause a stroke (our complications of atrial fibrillation section has more information on this). Your doctor will assess your risk to minimise your chance of a stroke. They will consider your age and whether you have a history of any of the following: stroke orblood clots heart valve problems heart failure high blood pressure diabetes heart disease You will be classed as having a high, moderate or low risk of a stroke and will be given medication according to your risk. Depending on your level of risk, you may be prescribed warfarin . Anticoagulants Anticoagulants help to reduce the risk of stroke in patients with atrial fibrillation. Newer anticoagulants like apixaban, dabigatran, edoxaban and rivoroxaban are now more commonly used than warfarin. They do not require dose changes and continuous blood test monitoring. Warfarin may still be used in patients who cant be treated with a newer anticoagulant, or in those patients with other conditions where treatment with warfarin is preferred. Cardioversion Cardioversion may be tried in some people with atrial fibrillation. The heart is given a controlled electric shock to try to restore a normal rhythm. The procedure normally takes place in hospital with heavy sedation or anaesthetic and careful monitoring. In people who have had atrial fibrillation for more than two days, cardioversion is associated with an increased risk of clot formation. If this is the case, warfarin is given for three to four weeks before cardioversion and for at least four weeks afterwards to minimise the chance of having a stroke. If the cardioversion is successful, warfarin may be stopped. However, some people may need to continue with warfarin if there is a high chance of their atrial fibrillation returning and they have a moderate to high risk of a stroke. Catheter ablation Catheter ablation is a procedure that very carefully interrupts abnormal electrical circuits. It is an option if medication has not been effective or tolerated. Catheters (thin, soft wires) are guided through one of your veins into your heart where they record electrical activity. When the source of the abnormality is found, an energy source (such as high-frequency radiowaves that generate heat) is transmitted through one of the catheters to destroy the tissue. This procedure commonly takes two to three hours, so it may be done under general anaesthetic , where you are put to sleep. Find out more about catheter ablation for atrial fibrillation on the Arrhythmia Alliance website Having a pacemaker fitted A pacemaker is a small, battery-operated device that is implanted in your chest, just below your collarbone. It will not cure, reverse or actively treat your atrial fibrillation. A pacemaker provides beats where your heart is not supplying its own. If your heart beatis very slow the pacemaker will override this and pace at a set rate.If there are significant pauses between your heart beats beats, the pacemaker will supply a beat, acting as a safety net. Having a pacemaker fitted is usually a minor surgical procedure performed under a local anaesthetic (where the area is numbed). Complications of atrial fibrillation When the upper chambers of the heart, called the atria, do not pump efficiently then there is a risk of blood clots forming. These blood clots may move into the lower chambers of the heart, called the ventricles, and get pumped into the blood supply to the lungs or the general blood circulation. Stroke Clots in the general circulation can block arteries in the brain, causing a stroke . The risk of a stroke in people with atrial fibrillation (AF)is four to five times greater than the general population. However, the risk depends on a number of factors, including age, whether you have high blood pressure, heart failure, diabetes and a previous history of blood clots. Heart failure If your atrial fibrillation is persistent, it may start to weaken your heart muscle. In extreme cases, it can lead to heart failure , where your heart cannot pump blood around your body as efficiently as before.

Attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) - Illnesses and conditions Mental health Attention deficit hyperactivity disorder (ADHD) Attention deficit hyperactivity disorder (ADHD) Attention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms that include: difficulty concentrating and paying attention hyperactivity impulsiveness Symptoms of ADHD in children and teenagers Symptoms of ADHD tend to be noticed at an early age. They may become more noticeable when a childs circumstances change, like when they start school. The main symptoms of ADHD in children and teenagers are: Inattentiveness The main signs of inattentiveness are: having a short attention span being easily distracted making careless mistakes appearing forgetful losing things being unable to stick at tedious or time-consuming tasks appearing to be unable to listen to or carry out instructions constantly changing activity or task having difficulty organising tasks Hyperactivity and impulsiveness The main signs of hyperactivity and impulsiveness are: being unable to sit still, especially in quiet surroundings constantly fidgeting being unable to concentrate on tasks excessive physical movement excessive talking being unable to wait their turn acting without thinking interrupting conversations little or no sense of danger Symptoms of ADHD in adults If youre an adult with ADHD, you may find that: you get easily distracted and find it hard to notice details, particularly with things you find boring its hard to listen to other people you may find yourself finishing their sentences for them or interrupting them its hard to follow instructions you find it hard to organise yourself you start a lot of things without ever finishing them you find it hard to wait you fidget and cant sit still when theres nothing much going on youre forgetful and tend to lose or misplace things you easily get irritable, impatient or frustrated and lose your temper quickly you feel restless or edgy, have difficulty turning your thoughts off you find stress hard to handle you tend to do things on the spur of the moment, without thinking, which gets you into trouble Some people with ADHD have problems with inattentiveness, but not with hyperactivity or impulsiveness. This form of ADHD is also known as attention deficit disorder (ADD). ADD can sometimes go unnoticed because the symptoms may be less obvious. Related conditions Some people might have other conditions alongside ADHD. Related conditions in children and teenagers with ADHD Some children may also have signs of other problems or conditions alongside ADHD, like: anxiety disorder oppositional defiant disorder (ODD) this involves negative and disruptive behaviour, particularly towards figures of authority conduct disorder this often involves antisocial behaviour, like stealing and harming people or animals depression sleep problems autistic spectrum disorder (ASD) epilepsy Tourettes syndrome learning difficulties, like dyslexia The symptoms of ADHD can improve with age. Although many adults diagnosed with the condition at a young age continue to experience problems. Related conditions in adults with ADHD ADHD in adults can occur alongside several related problems or conditions. One of the most common conditions is depression. Other conditions that adults may have alongside ADHD include: personality disorders bipolar disorder obsessive-compulsive disorder (OCD) ADHD can also cause problems like difficulties with relationships and social interaction. Causes of ADHD The exact cause of ADHD isnt fully understood. A combination of the following factors might be responsible: Genetics ADHD tends to run in families. The genes you you inherit from your parents are a factor in developing the condition. The way ADHD is inherited is complex and isnt thought to be related to a single gene. Brain function and structure Research has identified some possible differences in the brains of people with ADHD. Some studies involving brain scans have suggested that certain areas of the brain may be a different size in people with ADHD. Other studies have suggested that people with ADHD may have a chemical imbalance in the brain. Or that some chemicals may not work properly. Groups at risk Certain people are also believed to be more at risk of ADHD, including people: who were born prematurely (before the 37th week of pregnancy) or with a low birthweight with epilepsy with brain damage which happened either in the womb or after a severe head injury later in life Diagnosing ADHD Speak to your GP if you think that you or your child may have ADHD. If youre worried about your child, it may help to speak to their teachers before seeing your GP. This means you can find out if they have any concerns about your childs behaviour. Your GP cant formally diagnose ADHD. They can discuss your concerns with you and refer you for a specialist assessment, if necessary. Treating ADHD Treatment for ADHD can help relieve the symptoms. ADHD can be treated using medication or therapy. A combination of both is often best. Treatment is usually arranged by a specialist, like a paediatrician or psychiatrist. Treatment of ADHD might include: Medication Medication might help you or your child concentrate better, be less impulsive and feel calmer. Therapy You might be offered therapy. This might be: psychoeducation behaviour therapy parent training education programmes cognitive behavioural therapy social skills training There are other treatments that involve altering your diet or taking supplements.

Autistic spectrum disorder (ASD)

Autism spectrum disorder (ASD) - Illnesses and conditions Brain, nerves and spinal cord Autism spectrum disorder (ASD) Autism spectrum disorder (ASD) About autism Characteristics of autism Diagnosing autism Living with autism Facts and myths about autism About autism Autism spectrum disorder (ASD), usually called autism, is something youre born with. Autism means that the way you think about and experience the world is different to most people. This means you can behave differently to most people, and have different strengths and difficulties. For example, some autism characteristics (things you think, feel and do) can make it hard to express yourself in social situations, but you may also be particularly knowledgeable and passionate about topics that interest you. Read more about characteristics of autism here Autism is highly variable the word spectrum refers to how autism is experienced differently by different people. Autism is considered a spectrum because its different for every autistic person some autistic people might need more support than others to live the lives they want to lead. The way autism affects you can change as you grow and develop, and experience different environments. Read more about support here Talking about autism Many people who have been diagnosed with autism prefer using the term autistic to describe themselves this is known as identity-first language (for example, Im autistic). They consider autism to be part of their identity, not a condition to be treated. For a long time people used the term person on the autism spectrum, known as person-first language (for example, Im on the autism spectrum), and some people still prefer this. In this guide, well mostly use the term autistic. If in doubt, you can always ask an autistic person what term theyd prefer. In the past, autism was broken down into several different diagnoses, including: Aspergers Syndrome autistic disorder Kanners Syndrome childhood autism atypical autism Pervasive Development Disorder Not Otherwise Specified (PDD-NOS) Because these diagnoses all had the characteristics of autism, they were removed and replaced with autism spectrum disorder (ASD), or autism for short. People also use the term autism spectrum condition (ASC). Learn more about autism from autistic people How common is autism? At least 1 in 100 people in Scotland are autistic. Currently, between 1 in 3 and 1 in 4 people diagnosed with autism are assigned female at birth (AFAB). Read more about autism and gender Autism is always present from birth, but it might not be recognised or diagnosed until adulthood. Early intervention, in the form of support for their individual needs, can be helpful for autistic children. Even if you arent diagnosed until adulthood, getting a diagnosis can be very helpful for identifying your strengths and the things you struggle with, and finding support. Read more about characteristics of autism Characteristics of autism Every autistic person is different and has different experiences. However, there are some characteristics that are common in autistic people. The way these characteristics show themselves can change with age, and also with the situation youre in. For example: the way you use language and talk might be different to most people you may use facial expressions, tone of voice, and gestures (hand and body movements) differently to most people making and maintaining friendships might be difficult for you you may be good at seeing patterns or solutions, and be good at seeing solutions to problems that other people might not you might have set ways of doing things, and find it difficult to do them differently autistic people are often very good at understanding and working with structured systems, for example languages, music, and computers you may have good attention to detail, and be good at spotting mistakes you might be passionately interested in certain things, and as a result learn a large amount about them in a short time these interests can change throughout your life you might avoid or seek out certain sensations, like loud noises or specific textures, more than most people, and experience them more strongly there might be some foods you particularly enjoy and eat a lot of, and others that you cant be around due to their texture or smell when working on projects, you might find it difficult to think about the project as a whole you may do a great job on your part of a group project, but struggle to imagine how it fits in with everyone elses part while autistic people can be good at paying attention to detail, you might find it difficult to leave out details that are accurate but not needed when talking to people or working on projects autistic people can be very determined and driven, and keep going with tasks or problems when other people may give up you might find youre always determined to make sure things are perfect, and sometimes forget to eat or sleep if youre working on something it can be difficult for autistic people to work in groups where there isnt clear communication about what theyre expected to do There are a number of other possible signs that a healthcare professional will look for when assessing if someone is autistic. Read more about diagnosing autism here Autism and gender At the moment, men and those assigned male at birth are diagnosed with autism more often than women and those assigned female at birth. As more healthcare professionals now know what characteristics to look for, its becoming more common for women and those assigned female at birth to receive an autism diagnosis. However, recognising autism can take longer for women and those assigned female at birth. This is because the characteristics healthcare professionals look for are the same for everyone, but women and those assigned female at birth can often show these in slightly different ways. For example, theyre more likely to mask autism hiding autism characteristics and copying what other people without autism do in order to fit into groups. This can make it harder to recognise that they might be autistic, and to receive a diagnosis. Autism and environment Some environments can be very difficult for autistic people, due to the way they experience and interact with the world. Every autistic person finds different things difficult, but common examples are: social situations with no timetable or clear rules on things like who speaks when for example, parties and nights out busy environments like concerts, supermarkets, and school playgrounds, where there might be a lot of different loud noises at once Many environments allow autistic people to feel more comfortable and be themselves. When autistic people are in an environment with people who understand their individual needs and characteristics, theyre likely to: feel more relaxed perform better at tasks find it easier to learn use less time and energy trying to fit in with their environment Because every autistic person is different, it can take time to understand how you experience different environments. It may also take time to find the environments that suit your needs, and to learn which ones to avoid. If theres an autistic person in your life, its important to ask them what theyd prefer and if theres anything you can do to make a new environment more comfortable for them. If youre the parent or caregiver of an autistic child, you can ask how they felt in situations, or look for signs that theyre uncomfortable during or after being in different environments. Autistic children are often able to communicate best with those closest to them about what they enjoy and dont enjoy. Read more about finding the right environment Diagnosing autism The signs of autism can be different depending on the person and how old they are. Because autism is present from birth, it can usually be diagnosed in childhood. However, it may only be recognised later in life. Understanding of autism has grown over time, so more people are now being diagnosed when theyre older if the signs werent recognised when they were children. These are signs of autism that health professionals look for when making a diagnosis, but an autistic person may not have all of these signs. For example, delayed speech (learning to speak later than most children), or a child not speaking at all, can be a sign of autism. However, many autistic children talk at the same age a child without autism would. Its also possible that these signs are there, but they arent caused by autism. If you think you or your child might be autistic, talk to your GP or health visitor. Signs of autism in children The signs of autism can change as children grow babies and toddlers show different signs of autism than children aged 4 and older. Babies and toddlers Signs of autism in babies and toddlers can include a number of things that affect different parts of their life and behaviour. Talking and showing emotions Autistic babies and toddlers might: start talking later than most children seem less aware of others around them for example, they might not respond to their name being called make repetitive movements when excited or upset for example flapping their hands, rocking back and forth, or making the same noise repeatedly Autistic babies and toddlers might not: smile back when you smile at them point to show when they want something point to show you something they find interesting share when theyre feeling happy for example, they might be having fun playing, but they might not turn around and smile at you Playing Autistic babies and toddlers might: spend a long time setting up toys in a certain way, and set them up the same way every time enjoy lining toys up in order, or watching parts of them move Autistic babies and toddlers might not: seem interested in playing with other children their age seem to use their toys to make up stories or pretend they might also start pretend play at a later age than most children Sensory (sights, smells, sounds, touch, and tastes) Autistic babies and toddlers might: react strongly to sounds, smells, touch, tastes, or things they can see for example, if they like the way a stuffed toy feels, they want to spend a lot of time stroking the toy become upset if given something to eat or drink thats new to them eat a limited range of foods Children aged 4 and up As children grow and experience different environments, such as nursery and school, the characteristics of autism can appear differently. Communicating Autistic children might: speak differently to most children for example, they might use an unusual accent, talk slowly or quickly compared to others, speak in a flat tone that doesnt change, or use a sing-song voice use longer or more complicated words than most children, even in relaxed situations struggle to ask other people questions about themselves find it hard to keep a conversation going Relationships Autistic children might: show a great deal of enthusiasm for talking about subjects that interest them, but experience significant difficulty when talking about other peoples interests find it difficult to make and keep friends want to play with other children, but find it hard to ask if they can join in have 1 or 2 good friends that they spend a lot of time with spend free time, such as school break times, by themselves find it hard to tell the difference between someone being friendly or joking and someone trying to bully them or hurt their feelings get on better with adults than other children their age get on better with children who are younger or older than them spend time with a group of children, but find it hard to join in with other childrens play, and so spend a lot of time on the edge of the group have friends at school, but show little to no interest in seeing them outside of school Different situations and routine Autistic children might: accidentally make social mistakes, for example correcting a teacher about classroom rules find some social situations, like parties or busy places, overwhelming and difficult to cope with be passive around other children or adults, agreeing to everything and doing everything people ask often tell others what to do, including while playing struggle with social situations with no timetable or clear rules, such as free play or school break times find it difficult to cope with changes to their routine, especially if the change is unexpected for example, having a different teacher for a day or having plans change due to bad weather Sensory (sights, smells, sounds, touch, and tastes) Autistic children might: react strongly to sounds, smells, touch, tastes, or things they can see for example, being unable to cope with seams in their socks or the noises in supermarkets find certain sounds, smells, feelings or tastes particularly calming or enjoyable for example, coloured lights or being tucked tightly into bed make repetitive movements when excited or upset for example flapping their hands, rocking back and forth, or making the same noise repeatedly Signs of autism in teenagers and adults The characteristics of autism can affect you differently as you get older you may also recognise some of the signs of autism in children in yourself as an adult. Many people are diagnosed with autism as teenagers or adults based on noticing that they think and behave differently from most other people. Signs of autism in teenagers As you age and experience different environments, you might notice different signs of autism. Communicating As an autistic teenager, you might: find it hard to be understood in conversations, find it hard to work out when to talk in conversations you might never get to say what you want to say, or find yourself talking over other people find it easier to communicate with other autistic people be able to talk for a long time about the subjects that particularly interest you show a great deal of enthusiasm for talking about subjects that interest you, but experience significant difficulty when trying to talk about other peoples interests be able to answer other peoples questions, but struggle to know what questions to ask or how to answer when someone tells you something about themselves find other people say you use a lot of long words, or use longer or more complicated words than most people often use the same phrases when youre talking struggle with hidden meanings when other people are talking to you it might be difficult for you to understand a hint, or notice when someone is flirting with you find people can take the wrong meaning from your words or behaviour for example, if you make a lot of eye contact, they might think youre flirting with them Behaviour and different situations As an autistic teenager, you might: find eye contact uncomfortable, or struggle to know how much eye contact to use do well when youre in your routine, but find it difficult when routines change changes might make you feel anxious, make it hard to concentrate, or mean you have to work harder on things itd normally be easy to do struggle to imagine things that you havent experienced before for example, if youre going to a party for the first time, it might be hard for you to imagine what will happen and what youll be expected to do find yourself making social mistakes without realising why for example, during conversations you might not realise there are things other people would rather not talk about, or dont think are important to talk about Learning and hobbies As an autistic teenager, you might: have a lot of knowledge on particular topics, and spend a lot of time learning about them and telling others about them have a hobby you feel very passionate about and spend a lot of time on find it hard to start a new activity but get very focused on it once you get started you might be able to focus on it better than most people find it difficult to stop doing an activity youre very focused on, even if you need to move on to something else you might forget to eat or sleep Emotions and relationships As an autistic teenager, you might: spend a lot of time being careful to avoid making social mistakes, or trying to make sure you dont accidentally hurt anyones feelings find that other people struggle to understand your feelings from your face or tone of voice find that your friends are often older or younger than you find that your friends tend to be autistic people have to ask people to explain idioms (phrases that say one thing, when theyre actually talking about something else), for example: well cross that bridge when we come to it, which means well talk about that problem later have a clear idea of right and wrong, and strong views on issues that are important to you you might struggle to understand exceptions to rules, or grey areas find a lot of people dont understand your sense of humour, and you might not understand why their jokes are funny be trusting, and find people can often take advantage of you find it hard to work out when someone is being unkind Sensory (sights, smells, sounds, touch, and tastes) As an autistic teenager, you might: have a strong negative reaction to sounds, smells, sights, and things you can touch for example, being unable to wear certain types of clothing or find it overwhelming being in places with a lot of different noises, like gyms have a strong positive reaction to sounds, smells, sights, and things you can touch for example, enjoying flashing, multi-coloured lights in nightclubs or how loud the music is at a concert seek out certain sounds, smells, feelings or tastes because you find them particularly calming for example, coloured lights or soft clothing and blankets find making repetitive movements (often with your hands, fingers or legs) or sounds calming or enjoyable Signs of autism in adults As you age and experience different environments, life events, and circumstances, you might notice different signs of autism. You might also have developed coping strategies for environments you find difficult, changing the way you manage them. Work and education As an autistic adult, you might: find it more difficult than most people to communicate in interviews for example, talking about your skills which can make it hard to get a job find it more difficult than most people to keep a job you may be good at your work, but it might be hard to have good relationships with colleagues and managers have a lot of knowledge or feel very passionate about a subject thats useful for your work or studies find it difficult or frustrating when rules or ways of doing things dont make sense to you find it more difficult than most people would to work on a project or task that has unclear instructions for how to complete it Relationships and being social As an autistic adult, you might: find socialising hard work when others seem to have a lot of energy after meeting a group of friends, for example, you might feel exhausted have had relationships with friends or partners end because you couldnt understand how each other thought, behaved, and communicated find dating challenging prefer to be alone during breaks at work find it difficult to make small talk meaning conversation about day-to-day things such as the weather or understand the reasons for making small talk enjoy spending time with other people, but find activities that dont have clear rules or a schedule for example, going to parties or nightclubs difficult because you arent sure what to do prefer meeting up with people to do structured activities, like cooking or taking part in a shared hobby or interest Hobbies and skills As an autistic adult, you might: have a lot of detailed knowledge about a particular topic or hobby and feel very passionate about it find that the hobbies or topics youre particularly passionate about have changed several times in your life Communication and emotions As an autistic adult, you might: find other people often misunderstand you, or seem upset by things you say even if you dont mean to upset them find it hard to understand why people around you see a situation one way, and not the way you understand it find change more difficult than most people do things that disrupt your daily routine, like changes to your job or going on holiday, can make you feel stressed and anxious Sensory (sights, smells, sounds, touch, and tastes) As an autistic adult, you might: have a strong negative reaction to sounds, smells, sights, and things you can touch for example, being unable to wear certain types of clothing or find it overwhelming being in places with a lot of different noises, like busy buses or trains have a strong positive reaction to sounds, smells, sights, and things you can touch for example, enjoying lying under a weighted blanket, or the loudness of the music at a concert seek out certain sounds, smells, feelings or tastes because you find them particularly calming for example, coloured lights or soft clothing and blankets find making repetitive movements (often with your hands, fingers or legs) or sounds calming or enjoyable Autistic traits and diagnosis Autistic traits meaning things that autistic people often do, think, and feel are often shared by people who dont have autism too. This doesnt mean that everyone is a little bit autistic, or that autistic people dont need support. To be diagnosed with autism, a person has to have a lot of autistic traits from birth, and those traits need to have a big effect on their life. In order to be diagnosed with autism, those traits must cause what a healthcare professional would call clinically significant difficulties in their day-to-day life. This means that they have difficulties with day-to-day life due to their autistic traits and need to use their own ways of overcoming those difficulties, or the people in their life need to help them to overcome them, or both. Being in a supportive environment makes a big difference to an autistic persons wellbeing and quality of life. Learn more about how autism is diagnosed Other health conditions People who have these conditions can be more likely to also have autism: developmental disorders such as Attention Deficit Hyperactivity Disorder (ADHD) or learning disability muscular dystrophy Downs syndrome cerebral palsy epilepsy neurofibromatosis a number of genetic conditions that cause tumours to grow along the nerves (the main types are neurofibromatosis type 1 and neurofibromatosis type 2) rare genetic conditions, including fragile X syndrome, tuberous sclerosis and Rett syndrome Causes of autism The exact cause of autism is unknown, but researchers think its at least partly genetic that autism can run in the family. However, autism can also develop when theres no family history. Theres no way to predict whether a child will be autistic, even if one or both of their parents are autistic. More research is being done to find out which genes cause autism its thought to be caused by more than one. Living with autism Like everyone else, autistic people can be happy and healthy in the right environment however, the right environment for an autistic person can be different to the right environment for a non-autistic person. Autism doesnt mean that a person will need additional support to work, have relationships, or enjoy hobbies. However, many autistic people do need additional understanding or support to overcome the challenges caused by having autistic characteristics in a society where most people dont have them. Therapies for autistic people Theres no cure for autism, and most autistic people wouldnt want to be cured even if it was possible. Many autistic people feel autism is part of their identity, and not something to be cured or treated. Related conditions Because of the difficulties they can experience, autistic people may need treatment or support for other conditions, including: low mood anxiety sleep problems Psychological therapies like cognitive behavioural therapy (CBT) are often used to treat depression, anxiety, and sleep problems, both in people who have autism and people who dont. Psychological therapies can help to manage conditions linked with autism, like anxiety, but psychological therapies arent a treatment for autism itself. Therapy techniques might need to be adapted to work for an autistic person. Challenges in daily living Depending on whats offered by your NHS board and local organisations, there are therapies to help overcome the challenges that autistic people can experience. Possible therapies include: help with communicating, both for autistic people and the people in their lives groups for autistic people to share experiences and advice sensory assessments and support with an occupational therapist to help find ways of managing and improving your environment and how you experience the world training courses for loved ones, to help them understand autism and offer the best possible support Finding the right therapies Interventions that aim to train out behaviours (like repetitive movements, for example) or force autistic people to behave like non-autistic people are unethical and often harmful. However, many autistic people can benefit from support in learning skills to overcome some of the difficulties they experience this is different to forcing someone to change their behaviour. For example, an autistic adult might want to learn extra social skills to improve their relationships at work, or a therapist may work with a child and parent to help them to develop their communication skills. These therapies dont aim to change a persons autism, but to give them skills they can use. If youre an autistic adult, the decision to have therapies for things like social skills should be yours. If you have an autistic child, any therapy they have should be with the aim of meeting their needs. Learn about avoiding harmful and unhelpful therapies for autism Autism and your environment Sometimes, when a situation is too much to cope with due to sensory input (things you see, hear, feel, smell or taste), or being asked to do things that cause stress or distress, an autistic person can become overwhelmed. Meltdowns and shutdowns When an autistic person becomes overwhelmed and isnt able to use or benefit from their coping strategies, they might have meltdowns or shutdowns. Its important, for parents of autistic children in particular, to be aware that a meltdown isnt a tantrum. A tantrum is something that a child can control, and tantrums often happen because a child wants something. A meltdown or shutdown isnt something an autistic person can control, and its caused by being overwhelmed. During a meltdown, an autistic person might try to make themselves feel less overwhelmed. This can include doing things like: trying to get away from people for example by running away or hiding trying to get people away from them for example by shouting, screaming, hitting, or acting aggressively During a shutdown, an autistic person might try to block everything out for example by not responding to anything or anyone around them. Read more about meltdowns Challenging behaviour Like everyone else, autistic people can display challenging behaviour if theyre in the wrong environment. While it can be challenging for the people around them, this behaviour is often a result of distress or frustration, particularly if an autistic person has difficulty with communicating. Behaviour that challenges others is usually a way for someone to get their needs met when they dont have any other way to do so. Its not bad behaviour, or intended to cause harm. This kind of behaviour is most common in children, or people who find it hard to communicate their needs for example, people with a learning disability. If youre autistic, effective communication about your needs, and finding ways to have those needs met, can be helpful in reducing the distress that can lead to behaviour that challenges. If someone in your life is autistic, or youre the parent or caregiver of an autistic child, finding the right strategies for supporting their needs is important and helpful, and can be done if theres effective support for everyone involved. Behaviour that challenges can also be caused by: trying to meet sensory needs for example, wanting to do something because it feels nice, like rubbing soaps and creams all over themselves and the walls wanting something for example, being hungry or wanting to play with a toy needing assistance or attention for example, because theyre bored or want help with a project at school trying to escape an environment or the people around them, but doing so in a way that can be dangerous or harmful, such as running into the road Behaviour that people can find challenging includes: being destructive breaking things, for example being disruptive making noise in class or throwing things, for example self-harm aggression Help is available for anyone experiencing distress that might result in behaviour that challenges. Finding support can help you identify the reasons behind this behaviour and find other ways of communicating and meeting needs. Contact your GP or the healthcare professional who usually supports you for advice. Getting the right environment Environment is important to quality of life for autistic people. There are ways you can adapt (change) and improve your environment to make it as comfortable and supportive as possible for you or your child. The social model of disability is a way of looking at the world that treats the difficulties people with disabilities have as being caused by barriers in society, rather than just the disabilities themselves. These barriers can be physical for example, buildings not having accessible toilets. Barriers can also be caused by peoples attitudes for example, many people will assume someone is lying because they dont make eye contact while talking. The social model of disability can be a helpful way of considering the difficulties someone faces, and how to adapt their environment so it works for them. Learn more about the social model of disability Autism is covered by the Equality Act (2010), which means that schools and employers are required to make reasonable adjustments to ensure autistic people are comfortable in their environment and able to learn or work. Learn more about the Equality Act (2010) Common changes to an environment that can help autistic people include: sensory changes for example, being given a quiet space to work, being able to use sensory toys like fidget spinners, or being allowed to make noises while working communication changes for example, using email or apps to communicate, using very clear language, allowing additional time to ask questions, or using visual communication such as photos or pictures as well as written words routine keeping to a regular routine and giving warning of any changes as far in advance as possible Every autistic person is likely to benefit from different changes the best way to find the right ones is to ask an autistic person, or in the case of a child, their parents or caregivers. Learn more about autism from autistic people Facts and myths about autism There are many incorrect beliefs about autism, particularly the causes of autism or the best ways to overcome the challenges often faced by autistic people. Causes These things do not cause autism: bad parenting vaccines, or any ingredients in vaccines trauma or distress at a young age diet infections Fake treatments Theres no cure for autism, but many people incorrectly believe there are ways to cure it, or to change the way autistic people experience and interact with the world. Some fake treatments are dangerous even the ones that arent dangerous are unethical, and none of them are helpful. Harmful and dangerous fake treatments include: any treatment that aims to train out autistic behaviour like forcing someone to stop making repetitive movements any treatment that aims to train autistic people to do things that cause them distress

Bacterial vaginosis

Bacterial vaginosis- Illnesses and conditions Sexual and reproductive Bacterial vaginosis Bacterial vaginosis Bacterial vaginosis is not a sexually transmitted infection. Its an imbalance of the usual bacteria found in the vagina. Symptoms of bacterial vaginosis Often there are no symptoms of bacterial vaginosis. Some women may notice a change in the normal discharge from the vagina. This discharge will usually be white or grey, thin or watery and have a strong, unpleasant fishy smell. This can be more noticeable during and after sex, and during periods. Bacterial vaginosis does not usually cause itching or irritation. What to do if you think you may have bacterial vaginosis Check if you could be triggering it with toiletries . Consider over the counter treatments from your pharmacy . Contact your GP practice for an appointment or book an appointment at your local sexual health service . What does a bacterial vaginosis test involve? Sometimes treatment is given based on symptoms without the need for an examination or test. Sometimes a diagnosis can be made straightaway because of how the discharge looks. Sometimes the sample will be sent to a lab for testing. You are more likely to need a test if you have frequent episodes of discharge. Your nurse or doctor may perform an internal examination to check your vagina for signs of bacterial vaginosis. They may use a swab to collect a sample of the discharge from your vagina. A swab looks a bit like a cotton bud and collecting a sample only takes a few minutes. Its not painful, but it may be a little uncomfortable for a moment. If your nurse or doctor suspects you are at risk of an STI they may do more tests. Treatment for bacterial vaginosis Bacterial vaginosis is treated with antibiotics. Antibiotics must be prescribed by a doctor or nurse. You may be given an antibiotic cream or gel to use in your vagina, instead of antibiotic tablets by mouth. While youre there, make sure you tell the doctor or nurse if you: are pregnant think you might be pregnant are breastfeeding These may affect the type of treatment youre given. You can still have sex while being treated for bacterial vaginosis as its not sexually transmitted. However antibiotics and creams can affect condoms and other forms of contraception. Speak to your doctor or pharmacist who can give you further information. Partners do not usually need treatment. Non-antibiotic treatment is also available to buy in pharmacies . What causes bacterial vaginosis? Bacteria called lactobacilli naturally live in your vagina and stop other bacteria from growing there. Sometimes the balance of these bacteria changes. If this happens you can develop bacterial vaginosis. Bacterial vaginosis cant be passed on. But its more common in sexually active people. Other things that may increase the risk of getting it include: having a new sexual partner having multiple sexual partners smoking using scented soaps or perfumed bubble bath putting antiseptic liquids in the bath douching (washing or cleaning out the vagina with water or other fluids) using vaginal washes or deodorant using strong detergents to wash your underwear receiving oral sex How to prevent bacterial vaginosis The causes of bacterial vaginosis are not fully understood, so it may not be possible to completely prevent it. However, you may be able to lower your risk of developing it by following our genital washing advice .

Benign prostate enlargement

Benign prostate enlargement - Illnesses & conditions Kidneys, bladder and prostate Benign prostate enlargement Benign prostate enlargement About benign prostate enlargement Symptoms of benign prostate enlargement Causes of benign prostate enlargement Diagnosing benign prostate enlargement Treating benign prostate enlargement Complications of benign prostate enlargement About benign prostate enlargement Benign prostate enlargement (BPE), also known as benign prostatic hyperplasia (BPH), is a condition that affects older men and anyone with a prostate. Its particularly common in men and anyone with a prostate over 50 years of age and isnt usually a serious threat to health. Prostate gland The prostate is a small gland, located in the pelvis, between the penis and bladder. Its involved in the production of semen. The prostate produces a thick, white fluid thats made into a thinnerliquid by a protein called prostate-specific antigen (PSA). The liquid is then mixed with sperm, produced by the testicles, to create semen. If the prostate becomes enlarged, it can place pressure on the bladder and urethra (the tube through which urine passes). This canaffect how you pass urine and may cause: difficulty starting urination a frequent need to urinate difficulty fully emptying the bladder In some men and anyone with a prostate, the symptoms are mild and dont require treatment. In others, the symptoms can be very troublesome and have a major impact on a persons quality of life. Read more about the symptoms of benign prostate enlargement Many people worry that having an enlarged prostate means they have an increased risk of developing prostate cancer .This isnt the case. The risk of prostate cancer is no greater for people with an enlarged prostate than it is for those without anenlarged prostate. What causes benign prostate enlargement? The cause of prostate enlargement is unknown, but most experts agree that its linked to hormonal changes that occur as a man gets older. Read more about the causes of benign prostate enlargement How is benign prostate enlargement diagnosed? If your GP suspects that you have an enlarged prostate, youll be asked to complete a questionnaire to assess your symptoms. Each question has 5 possible answers that carry a score, and your overall score indicates the severity of your symptoms. Your GP will also want to rule out other conditions that cause similar symptoms to prostate enlargement. You may have a number of standard tests, such as urine tests, plus some more specific tests, such as ablood test that measures PSA. Read more about diagnosing benign prostate enlargement Treating benign prostate enlargement Treatment for an enlarged prostate is determined by the severity of your symptoms. If you have mild to moderatesymptoms, you wont receive any immediate medical treatment, but youll have regular check-ups to carefully monitor your prostate. Youll probably also be advised to makelifestyle changes, such as limiting your caffeine and alcohol intake, and exercising regularly ,to see if they improve your symptoms. As well aslifestyle changes, medication is usually recommended to treat moderate to severe symptoms of benign prostate enlargement.Finasteride and dutasteride are medicationsthat are commonly used. They block the effects of a hormone called dihydrotestosterone (DHT) on the prostate gland, which can reduce the size of the prostate and improve associated symptoms. Alpha blockers may also be prescribed. They help to relax your bladder muscles, making it easier to pass urine. Tamsulosin and alfuzosin are two alpha blockers commonly used to treat benign prostate enlargement. Surgery is usually only recommended for moderate to severe symptoms of benign prostate enlargement that have failed to respond to medication. Read more about treating benign prostate enlargement Complications of benign prostate enlargement Benign prostate enlargement can sometimes lead to complications such as a urinary tract infection (UTI) or acute urinary retention. Serious complications are rare. Read more about the complications of benign prostate enlargement How common is benign prostate enlargement? Benign prostate enlargement is a condition associated with ageing and is common in men and anyone with a prostate over 50 years of age. Symptoms of benign prostate enlargement The symptoms of benign prostate enlargement are caused by the enlarged prostate placing pressure on the bladder and urethra (which carries urine from the bladder to the penis). This can affect urination in a number of ways. For example, it can: make it difficult for you to start urinating weaken theflow of urine or cause stopping and starting cause you to strain to pass urine cause you to need to urinatefrequently cause you to wake up frequently during the night to urinate cause a sudden urge to urinate, which can result in urinary incontinence if you cant find a toilet quickly enough cause you to not be able to empty your bladder fully cause blood in the urine (haematuria) In the later stages, benign prostate enlargement can cause urine retention and other complications such asbladder stones,bladder infections and kidney damage. When to seek medical advice Seeyour GP if you notice any problems with, or changes to,your usual pattern of urination. Even if the symptoms are mild, they could be caused by a condition that needs to be investigated. Anyblood in the urine must be investigated by your GP to rule out other more serious conditions. Causes of benign prostate enlargement The exact cause of benign prostate enlargement is unknown, but research suggests that hormones probably play an important role in the conditions development. Hormones are powerful chemicals that can have a wide range of effects on the cells of the body. One theory is that as some men and anyone with a prostate gets older, the levels of a type of hormone called dihydrotestosterone (DHT) increases, which may stimulate the growth of the prostate. Another theory suggests that two hormones, testosterone and oestrogen, play a role. Younger men and anyone with a prostate produce high levels of testosterone and much smaller levels of oestrogen. But as they get older, levels of testosterone decrease, which means they then have a higher proportion of oestrogen in their body. Its been suggested that the relative increase in oestrogen may stimulate prostate growth. Risk factors Research has shown that rates of benign prostate enlargement are higher among men and anyone with a prostate with high blood pressure and diabetes . However, both diabetes and high blood pressure are associated with the natural ageing process, so there may not be a direct connection between the three conditions. Diagnosing benign prostate enlargement To find out whether your prostate gland is enlarged, youll need to have a few tests. Some tests will be carried out by your GP and others will be carried out by a urologist (a doctor who specialises in urinary problems). First, your GP will ask about your symptoms. If it seems that you have symptoms of benign prostate enlargement , the next stage is to calculate yourInternational Prostate Symptom Score (IPSS). International Prostate Symptom Score (IPSS) Youll be asked to completeaquestionnaireto assess your symptoms. Each question has5 possible answers that carry a score, andyour overall scoreis used to assess the severity of your symptoms. The checklist includes the following questions. Over the past month, how often: have you had the sensation of not completely emptying your bladder after urinating? have you had to urinate again less than 2 hours after finishing urinating? have you found that you stopped and started again when urinating? have you found it difficult to postpone urination? have you had a weak stream of urine? have you had to push or strain to begin urinating during the course of one night? haveyou had toget up during the night to urinate? After your GP has assessed the severity your symptoms, theyll aim to ruleout other conditionswith similar symptoms using certain tests. Ruling out other conditions Thesymptoms of benign prostate enlargement are similar to those of other conditions, including prostate cancer . Therefore, your GP will need to be completely sure that your symptoms arent caused by cancer. Urine tests A urine test can be used to check whether your symptoms are caused by an infection in your urinary system, such as a kidney infection or bladder infection. Rectal examination You may needarectal examination to check whether you might have prostate cancer. Prostate cancer can cause the prostate gland to become hard and bumpy. Your GP will put on a glove and lubricate one of their fingers, before gently pushing this finger into your bottom and up into your rectum. As the rectum is close to the prostate gland, theyll be able to check whether the surface of the gland has changed. The procedure will feel a little uncomfortable, but it isnt usually painful. Prostate cancer doesnt always cause changes to the prostate gland, so you may need to have some more specialised tests to rule it out. You will probably be referred to a urologist for these tests. Prostate-specific antigen (PSA) test A blood test can be used to measure the amount of the PSA protein thats produced by the prostate. A raised PSA level indicates enlargement of the prostate, and a significantly raised level may indicate prostate cancer. However, as with a rectal examination, a PSA test cant provide a definitive diagnosis of prostate cancer. Transrectal ultrasound (TRUS) A TRUS is a type of ultrasound scan specifically designed to study the prostate and the surrounding area. An ultrasound probe is placed into your rectum and uses soundwaves to build a detailed image of your prostate. This type of scan measures the size of your prostate and can be used to either confirm or rule out a diagnosis of prostate cancer. Computer tomographic (CT) urogram A CT urogram is used to study the urinary tract (the bladder and the tubes through which urine passes, also known as the ureter and urethra). A CT urogram can be used to check for blockages in your urinary system that could be causing your symptoms, such as a kidney stone or bladder stone. It can also be used to detect any damage in the urinary tract. During a CT urogram, youll be injected with a harmless radioactive dye, which will be visible on X-rays . After 30-60 minutes, the dye should have passed into your urinary tract and a series of X-rays will be taken. In some cases, you may be asked to pass urine before the final X-ray is taken. Voiding charts A voiding chart is a urination diary, which you may be asked to keep for 24 hours. Youll be asked to record how often you urinate, as well as details about how you urinate for example, whether your urination is stopping and starting, or whether its difficult to start urinating. A voiding chart is a good way of finding out more information about your symptoms and can be used to determine the type of treatment that would be most effective in controlling your symptoms. Uroflowmetry Uroflowmetry measures the pressure of your bladder and how well your bladder works when you urinate. Youll be given a local anaesthetic and a small flexible tube (catheter) will be inserted into your urethra and moved up into your bladder. Water will then be injected through the catheter and into your bladder. A computer connected to the catheter measures the pressure inside your bladder and can assess how well your bladder is working. As with voiding charts, uroflowmetry is a good way of determining what type of treatment will help to control your symptoms. Treating benign prostate enlargement The treatment for an enlarged prostate gland will depend on how severe your symptoms are. The 3 main treatments are: lifestyle changes medication surgery If your symptoms are mild to moderate, you may not receive any immediate medical treatment, but youll have regular check-ups to carefully monitor your prostate gland. This is often referred to as watchful waiting. You may also be advised to make lifestylechanges to see whether they improve your symptoms. Lifestyle changes If your prostate gland is enlarged, you may be advised to: avoid drinking any liquids for 1 to 2 hours before going to bed this will reduce your chances of waking up during the night to pass urine (nocturia) experiment with the time you take prescribed medication for example, taking itat 7pm may help prevent nocturia stop drinking alcohol and caffeine, or limit your consumption of them these drinkscan irritate your bladder and make your symptoms worse exercise regularly research shows moderate exercise, such as walking for 30 to 60 minutes a day, can improve symptoms, although its unclear exactly why this is the case join a patient support group your doctor should be able to recommend one, whichmay help you manage mild symptoms without the need for medication Bladder training Bladder training is an exercise programme that aims to increase the time between urination and the amount of urine your bladder can hold. Youll be given a target, such as waiting at least 2 hours between each time you urinate. Its a good idea to use a bladder training chart, which allows you to record each time you pass urine and the volume of urine passed youll need a plastic jug to measure this. Your doctor should give you a chart to take home. Youll also be taught a number of exercises, such as breathing, relaxation and muscle exercises, to help take your mind off the need to urinate. Over time your target time will be increased, and at the end of the programme you should find that youre able to go for longer without urinating. Bladder training should only be carried out under medical supervision. Medication Medication, in combination with the lifestyle changes above, is usually recommended to treat moderate to severe symptoms of benign prostate enlargement. Finasteride or dutasteride Finasterideanddutasteride are widely used to treat benign prostate enlargement. They block the effects of a hormone called dihydrotestosterone (DHT) on the prostate gland, which can reduce the size of the prostate and improve your associated symptoms. Find out about the causes of prostate enlargement If youre prescribed one of these medications, you may experience an immediate improvement in symptoms. However, youll need to take it for at least six months to get the maximum benefit, and your doctor will need to monitor you every year. Use condoms if youre sexually activeboth finasteride and dutasteride can have an adverse effect on your sperm. If you get a woman pregnant, theres a risk the baby could develop birth defects. Other possible side effects can alsoinclude impotence and little or nosperm when you ejaculate. In many cases, these side effects will improve as your body gets used to the medication. See your GP if the side effects are troubling you. Alpha blockers Alpha blockers help relax the muscles of your bladder, making it easier to pass urine. You may be prescribed alpha blockers as your primary treatment or in combination with finasteride. Tamsulosinandalfuzosin are 2 alpha blockers commonly used to treat benign prostate enlargement. Side effects of tamsulosin and alfuzosin are uncommon and usually mild. They include: dizziness headaches weakness little or no sperm when you ejaculate You should only begin taking alpha blockers over a restful weekend when youre not planning to drive, as theres a risk they could cause low blood pressure (hypotension) and fainting. Generally, if you experience dizziness while taking this medication, avoid driving or operating heavy machinery until its passed. Surgery Surgery is usually only recommended for moderate to severe symptoms of benign prostate enlargementthat have failed to respond to medication. Various procedures can be used to reduce the pressure on your bladder. Transurethral resection of the prostate (TURP) Transurethral resection of the prostate (TURP)involves inserting a small instrument called a resectoscope into your urethra, thetube that carries urine from the bladder to the penis. A wire loop heated by an electric currentis used to remove excess tissue from your prostate. TURP is carried out using either a general anaesthetic , where youre asleep, or a spinal anaesthetic, where youre awake, but the lower half of your body is numbed. The procedure can take up to an hour, depending on how much tissue needs to be removed. Most people are well enough to leave hospital 2 to 3 days after the operation. Aftersurgery, youll be unable to urinate normally at firstbecause of your swollen urethra. A thin tube called acatheter will be inserted into your urethra and up into your bladder to allow urine to drain away. This will usually be removed 24 to 48 hours after surgery. A common complication of TURP is youll no longer produce semen when you ejaculate. This is known as retrograde ejaculation. It causes sperm to go into your bladder rather than out of your penis during ejaculation. However, youll still experience the physical pleasure associated with ejaculation (the climax). Bladder neck incision(TUIP) Bladder neck incisioninvolves widening the urethra so it is easier to pass urine. It is also known astransurethral incision of the prostate (TUIP). Like TURP, the surgeon will insert a resectoscope into your urethra. The resectoscope has a heated wire loop at the end and is used to make small cuts (incisions) in the muscle where the prostate meets the bladder. This type of surgery relaxes the opening to the bladder, helping urine flow out of it. As with TURP, TUIPis carried out under a spinal or general anaesthetic. After surgery, you may not be able to urinate and a catheter may be needed to empty your bladder. Like TURP, youll only need to use a catheter for a short time until youre able to urinate normally. Theres less of a risk of retrograde ejaculation with TUIP compared with TURP, although it can sometimes still occur. Holmium laser enucleation of the prostate(HoLEP) Holmium laser enucleation of the prostate (HoLEP) is similar to a TURP. Excess prostate tissue is removed using an instrument inserted through the urethra. However, it usesa laser, rather than a wire loop. There are some advantages to using this technique rather than a TURP, but also some disadvantages. If you have been offered a HoLEP, you may want to ask your surgeon to explain why this was chosen for you, and the risks and benefits comparedwith TURP. Insertion of prostatic urethral lift implants The insertion of prostatic urethral lift implants is a new surgical procedure that can help relieve urinary symptoms. The procedure can be carried out underlocal anaesthesia or general anaesthesia. It involves inserting tiny implants through the urethra.The implants are then positioned to hold the enlarged prostate away from the urethra so it isnt blocked. One of the big advantagesof prostatic urethral lift implants compared with TURPand TUIP is a reduced risk to your sexual function there is less chance of erectile dysfunction and ejaculation problems. Theres also less tissue injury, which means your recovery will be quicker and you wont need to stay in hospital as long. However, prostatic urethral lift implantsare unlikely to provide permanent symptom relief in all cases. And as its a new procedure, the long-term outcomes are unknown and availability may be limited. Read more about the use of prostatic urethral lift implants to relieve symptoms ofprostateenlargement. Transurethral vaporisation of the prostate (TUVP) Transurethral vaporisation of the prostate (TUVP)is similar to a TURP, but parts of the prostate are destroyed (vaporised) rather than cut away. Studies have shown that TUVP is as effective as TURP at improving symptoms. But some men and anyone with a prostate may need more treatment in the future. Greenlight laser surgery (PVP) A laser can sometimes be used to destroy the prostate tissue. This particular form of TUVP is called photoselective vaporisation of the prostate (PVP), or Greenlight laser surgery. A thin, flexible instrument called a cytoscope is inserted into the urethra. A laser fibre is then passed through thecytoscope to destroy the excess prostate tissue that is blocking the urine flow. The procedure is recommended for thosewho dont have a high risk of developing complications from treatment, such as men and anyone with a prostate who: doesnt have urinary retention doesnt have an increased risk of bleeding has a prostate smaller than 100ml In these low-risk groups,Greenlight laser surgery is thought to be as effective as TURP, but also has several benefits. These include: a shorter hospital stay the procedure is often carried out as a day case the catheter can be removed sooner recovery is quicker theres a lower risk of complications The National Institute for Health and Care Excellence (NICE) website has more information about GreenLight XPS for treating benign prostatic hyperplasia . Open prostatectomy An open prostatectomy is a procedure that may be more effective than TURP if you have severe benign prostate enlargement. However, its now rarely used, even for larger prostates,because other techniques have beendeveloped, such as HoLEP. During an open prostatectomy, anincision will be made in your tummy and the outer portion of your prostate will be removed. The procedure carries a higher risk of complications, such as erectile dysfunction and urinary incontinence . Theres also a greater chance that these complications will become permanent than if they occur after TURP. Complications of benign prostate enlargement Benign prostate enlargement can sometimes lead to complications, such as a urinary tract infection or acute urinary retention. Urinary tract infections If youre unable to empty your bladder properly, theres a risk that bacteria in your urinary system wont get flushed out and will spread through the urine to cause a urinary tract infection (UTI) . Symptoms of a UTIinclude: cloudy, bloody or bad smelling urine pain in your lower abdomen (tummy) nausea vomiting shaking and chills a high temperature of 38C (100.4F) or above UTIs can be treated with antibiotics . A single UTI isnt usually serious, but repeated UTIs can damage your kidneys and bladder. If you have a history of repeated UTIs, you may need to have surgery. Acute urinary retention Acute urinary retention (AUR) is the sudden inability to pass any urine. AUR should be treated as a medical emergency, because without prompt treatment urine may be passed back up into the kidneys, which can damage them. Symptoms of AUR include: the sudden inability to pass urine severe lower abdominal pain swelling of the bladder that you can feel with your hands Phone 999 and ask for an ambulance if you or someone you know experiences the symptoms of AUR. AUR can be treated using a thin tube (catheter) to drain the urine out of your bladder. In very serious cases, surgery may be required to empty the bladder.

Bile duct cancer (cholangiocarcinoma)

Bile duct cancer - Illnesses & conditions Cancer Cancer types in adults Bile duct cancer (cholangiocarcinoma) Bile duct cancer (cholangiocarcinoma) About bile duct cancer Symptoms of bile duct cancer Causes of bile duct cancer Diagnosing bile duct cancer Treating bile duct cancer Preventing bile duct cancer About bile duct cancer Bile duct cancer (cholangiocarcinoma) is a rare but aggressive type of cancer. The bile duct system, or biliary system, is made up of a series of tubes that begin in the liver and end in the small intestine. Bile is a fluid the digestive system uses to help break down fats and digest foods. Symptoms of bile duct cancer In most cases, there are no signs of bile duct cancer until it reaches the later stages, when symptoms caninclude: jaundice yellowing of the skin and the whites of the eyes, itchy skin, pale stools and dark-coloured urine unintentional weight loss abdominal pain Speak to your GP if you have signs of jaundice or are worried about other symptoms. While it is unlikely you have bile duct cancer, it is best to get it checked. Read more about the symptoms of bile duct cancer Why does bile duct cancer happen? The exact cause of bile duct cancer is unknown. However, some thingsmay increase your chances of developing the condition. The most commoninclude being over 65 years old or havingarare chronic liver disease called primary sclerosing cholangitis (PSC). Read more about the causes of bile duct cancer Types of bile duct cancer There are 2 main types of bile duct cancer,depending on where the cancer begins: cancer that starts in a part of the bile duct inside the liver is known as intrahepatic bile duct cancer cancer that starts in part of the bile duct outside the liver is known as extrahepatic bile duct cancer Diagnosis Cancer of the bile duct can be difficult to diagnose, so you may need several tests, including: blood tests ultrasound scans computerised tomography (CT) scans magnetic resonance imaging (MRI) scans For some of these tests, youmay need to be injected with a special dye that highlights your bile ducts. You may alsoneed a biopsy . This involves removing a small sample of tissue soit can be studied under a microscope. However, in some cases, your surgeon may prefer to remove the suspected tumour based on the results of your scans alone. Read more about diagnosing bile duct cancer How is bile duct cancer treated? Cancer of the bile ductcan usually only be cured if cancerous cells havent spread. If this is the case, some or all of the bile ductmay be removed. Only a small proportion of bile duct cancer cases are diagnosed early enough to be suitable for surgery. This isbecause symptoms usually develop at a late stage. Despite this, treatmentsuch as chemotherapy can relievethe symptoms of bile duct cancer and improve the quality of life of people in the advanced stages of the condition. Read more about treating bile duct cancer Who is affected? Most cases of bile duct cancer occur in peopleover the age of 65. The condition affects men and women almost equally. Can bile duct cancer be prevented? There are no guaranteed ways to avoid getting bile duct cancer, but you can reduce your chances of developing it. Themost effectiveways ofachieving this are reducing your alcohol intake, as cirrhosis is a risk factor,and trying to ensure that you dont become infected withhepatitis B or hepatitis C. Read more about preventing bile duct cancer Symptoms of bile duct cancer Bile duct cancer doesnt usually cause any symptoms until the flow of bile from the liver is blocked. In most cases, the condition is at an advanced stage by this time. The blockage will cause bile to move back into the blood and body tissue, resulting in symptoms such as: jaundiceyellowing of the skin and whites of the eyes, itchy skin, pale stools and dark-coloured urine unintentional weight loss abdominal pain most people feel a dull ache in the upper right-hand side of their abdomen (stomach) high temperature (fever) of 38C (100.4F) or above and shivering loss of appetite When to seek medical advice Always visit your GP if you have jaundice. While jaundice is unlikely to be caused by bile duct cancer, it could indicate an underlying problem with the liver, such as hepatitis. Causes of bile duct cancer The exact cause of bile duct cancer is unknown, although some things can increase the risk of developing the condition. Cancerbegins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means that cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour. If left untreated, cancer can grow and spread to other parts of your body, either directly or through the blood and lymphatic system. Increased risk Anumber offactors that increase the risk of developing bile duct cancer have been identified. Age Your chances of developing cancer of the bile duct increase as you get older. Most people with the condition are over 65 years old. Primary sclerosing cholangitis Primary sclerosing cholangitis (PSC) is a rare type of liver disease that causeslong-lasting (chronic) inflammation of the liver. Itusually occurs in peopleaged 30to 50. Up to 10% of people with ulcerative colitis (inflammation of the colon and rectum) also have PSC. Around 10to 20% of people with PSC will develop bile duct cancer.Your risk of developing bile duct cancer is thought to be higher if you have PSC and you smoke. Bile duct abnormalities Some people can have fluid-filled sacs (cysts) in their bile duct.These cysts are usually congenital, which meansthey are present frombirth. The most common types are choledochal cysts and Carolis disease, but both conditions are very rare. Up to 20%of people with choledochal cysts that are not removed will develop cancer of the bile duct. Biliary stones Biliary stones are similar to gallstones , except they form inside the liver rather than inside the gallbladder. Biliary stones are rare in western Europe, but are relatively common in parts of Asia, such as Japan and Taiwan. Its estimated that approximately 10% of people with biliary stones will develop bile duct cancer. Parasitic infection Liver flukes are a type of parasitic insect known to increase the risk of developing bile duct cancer. You can become infected with liver flukes by eating undercooked fish that has been contaminated with fluke eggs. Liver fluke infections are usually only a problem in Asia (especially Thailand) and Africa, where liver flukes are more widespread. Exposure to toxins Exposure to certain chemical toxins is known to increase the risk of developing bile duct cancer. For example, if you are exposed to a chemical called thorotrast, your chances of developing bile duct cancer rises. Thorotrast was widely used in radiography until it was banned during the 1960s after its dangerous properties were fully understood. Other toxins that may increase your chances of developing cancer of the bile duct include: asbestos a fire-resistant materialthat was widely used in construction and manufacturing, but is now banned in this country polychlorinated biphenyls (PCBs) a chemical that was used in manufacturing and building but, like asbestos, has now been banned Other factors The following factorsare linked with an increased risk of developing bile duct cancer, but more research is still needed: hepatitis B and hepatitis C cirrhosis (a scarred liver) as a result of drinking excessive amounts of alcohol HIV diabetes obesity smoking Diagnosing bile duct cancer Bile duct cancer can be a challenging condition to diagnose. You usually need several different tests before an accurate diagnosis can be made. Blood tests In bile duct cancer, the cancerous cells may release certainchemicals that can be detected using blood tests . These are known as tumour markers. However, tumour markers can also be caused by other conditions.A positive blood test does not necessarily mean you have bile duct cancer, and a negative blood test does not always meanyou dont. Scans A number of scans can be used to examine your bile ducts in more detail and check for lumps or other abnormalities that could be the result of cancer. These scans include: ultrasound scan high-frequency sound waves are used to build up a picture of the inside of your body computer tomography (CT) scan a series of X-rays of your liver are taken and a computer is used to assemble them into a more detailed three-dimensional image magnetic resonance imaging (MRI) scan this uses a strong magnetic field and radio waves to produce a picture of the inside of your liver Endoscopic retrograde cholangio-pancreatography (ERCP) Endoscopic retrograde cholangio-pancreatography (ERCP) allows your bile ducts show up more clearly on an X-ray scanner. A special dye is injected and the X-ray scanner is used to guide an endoscope (a small, flexible tube with a camera at the end) down your throat and into your bile duct. The endoscope can detect blockages in your bile ductthat could be the result of bile duct cancer. A short wire-mesh tube, called a stent, may also be inserted into the artery during the procedure. The stent is left in place permanently to allow blood to flow more freely. Spyglass An advanced form of ERCP is a special test called a spyglass. This involves passing a specialised endoscope into the bile duct to detect abnormalities. It also enables a biopsyto be taken. While this test can help confirm bile duct cancer in uncertain cases, it is very expensive and requires specialist training. Therefore, it is only available at a limited number of centres. Percutaneous transhepatic cholangiography (PTC) Percutaneous transhepatic cholangiography is carried out to obtain a detailed X-ray image of your bile duct. The side of your abdomen (tummy)is numbed using local anaesthetic , anda special dyethat shows up on X-rays is injected through your skin and into your liver duct. As with ECRP, a stent may be inserted during the procedure. PTC and ECRPare bothuseful ways of detecting any blockages in your bile duct that could be caused by bile duct cancer. Biopsy If scans indicatethat you may have bile duct cancer, a biopsy may becarried out to confirm a diagnosis. Duringa biopsy, a small sample of tissue is taken from the body and checked under a microscope forcancerous cells. A biopsy is usually performed while ERCP or PTC is being carried out. As well as taking bile and tissue samples from your bile duct, samples may be taken from nearby lymph nodes. This is to check whether the cancer has spread from your bile duct into your lymphatic system. Staging A widely used method of staging bile duct cancer is a number staging system. The stages are: stage 1A the cancer is contained inside the bile duct stage 1B the cancer is beginning to spread beyond the walls of the bile duct, but has not spread into the surrounding tissue or lymph nodes stage 2 the cancer has spread into nearby tissue, such as the liver, but has not spread into the lymph nodes stage 3 the cancer has spread into the lymph nodesandmajor blood vessels that supply the liver stage 4 the cancer has spread into distant organs, such as the lungs Read more about staging bile duct cancer on the Cancer Research UK website Cancer support If you are diagnosed with cancer, the Alan Morement Memorial Fund (AMMF) is currently the only dedicated UK charity that provides support for people affected by bile duct cancer. Treating bile duct cancer Most cases of bile duct cancer cannot be cured. Instead, treatment is most commonly used to relieve symptoms. Cancer treatment team Due to the rarity of bile duct cancer, you are likely to be referred to a specialist hepatobiliary unitwith experience in treating the condition. A multidisciplinary team (MDT) made up of different specialistswill help you decide on your treatment, but the final decision will be yours. Your MDTmayinclude: a liver surgeon a specialist in treating cancers of the liver a medical or clinical oncologist a specialist in the non-surgical treatment of cancer using techniques such as radiotherapy and chemotherapy a pathologist a specialist in diseased tissue a radiologist a specialist inradiological diagnosis and intervention a cancer nurse who usually acts as the first point of contact between you and the rest of the care team a gastroenterologist a specialist in the medical management of liver and biliary disease Before going to hospital to discuss your treatment options, you may want to write a list of questions to ask the specialist. For example, you may want to find out theadvantages and disadvantages of particular treatments. Your treatment plan Your recommended treatment plan will be determined by your general health and the stage the cancer has reached . In cases of stage 1 and stage2 bile duct cancer, a cure may be possible by surgically removing the affected part of the bile duct, and possibly some of the liver or gallbladder. In cases of stage 3 bile duct cancers, the chances of achieving a successful cure will depend on how many lymph nodes have been affected. A cure may be possible if only a few nodes have cancerous cells in them, or it may be possible to slow the spread of the cancer by surgically removing the lymph nodes. In cases of stage4 bile duct cancer, achieving a successful cure is highly unlikely. However, stenting, chemotherapy, radiotherapy and surgery can often be used to help relieve the symptoms. Your treatment plan may also be different if you have intrahepatic bile duct cancer, as this is usually treated in a similar way to liver cancer. Read more about treating liver cancer . A number of experimental treatments may be available as part of a clinical trial. Surgery If your MDT thinks it is possible to cure your bile duct cancer, surgery will be needed to remove any cancerous tissue. Depending on the extent of the cancer, it may be necessary to remove: the part of your bile duct that contains cancerous cells your gallbladder nearby lymph nodes a large partof your liver After surgery, it is usually possible to reconstruct what remains of the bile duct so that bile can stillflow into the intestine. Similarly, it is often possible for the liver to resume normal function after surgery because we do not need all of our liver. The liver can also regenerate itself after surgery. You may need to stay in hospital for up to two weeks or more after having bile duct cancer surgery before you are well enough to go home. Success rates of bile duct surgery depend on individual circumstances, such as whether nearby lymph nodes are free of cancer and whether it was possible to remove all of the cancerous cells during surgery. Unblocking the bile duct If your bile duct becomes blocked as a result of cancer, treatment to unblock it may be recommended. This will help resolve symptoms such as: jaundice yellowing of the skin and the whites of the eyes itchy skin abdominal (tummy) pain Unblocking the bile duct is sometimes necessary if the flow of bile back into your liver starts to affect the normal functioning of your liver. The bile duct can be unblocked by using a small tube called a stent.The stent widens the bile duct, which should help to get the bile flowing again. A stent can be inserted using either: avariation of the endoscopic retrograde cholangiopancreatography (ERCP) procedure, which uses an endoscope to guide the stent into the bile duct avariation of the percutaneous transhepatic cholangiography (PTC) procedure, which involves making a small incision (under local anaesthetic) in your abdominal wall Occasionally, an implanted stent can become blocked. If this occurs, it will need to be removed and replaced. Radiotherapy Radiotherapy is not a standard treatment for bile duct cancer, butmay help to relieve the symptoms, slow the spread of the cancer and prolong life. The types of radiotherapy are used to treat bile duct cancer: external beam radiotherapy a machine is used to target radioactive beams at your bile duct internal radiotherapy (brachytherapy) a radioactive wire is placed inside your bile duct next to the tumour Radiotherapy works by damaging the cancerous cells. However, it can also damage healthy cells and cause side effects. Side effects of radiotherapy include: nausea (feeling sick) vomiting fatigue (severe tiredness) Read more about radiotherapy Chemotherapy Chemotherapy is used in a similar way to radiotherapy to relieve the symptoms of cancer, slow down the rate it spreads and prolong life. It is sometimes used in combination with radiotherapy. Medicines used in chemotherapy can sometimes damage healthy tissue as well as cancerous tissue, and adverse side effects are common. Side effects of chemotherapy can include: nausea vomiting fatigue hair loss However, these side effects should stop once the course of treatment has finished. Chemotherapy can also weaken your immune system, making you more vulnerable to infection. Read more about chemotherapy Clinical trials and experimental treatments The treatments for bile duct cancer are not as effective as treatments for other types of cancer. Therefore, a number of clinical trials are being conducted to find better ways of treating the condition. For example, ongoing trials are looking at new combinations of chemotherapy medicines, which may helpextend the lifespan of someone with bile duct cancer. Targeted therapies Another promising field of research involves using targeted therapies to treat bile duct cancer. Targeted therapies are medicationsthat target the processes that cancerous cells need to grow and reproduce. In studies for some cancers, a medication called sorafenib has proved reasonably effective. Sorafenib works by blocking a protein that cancerous cells need to create a blood supply. However, sorafenib is not currently used as a routine treatment for bile duct cancer. As bile duct cancer is a rare condition, there is a possibility you may be invited to take part in a clinical trial lookingat the use of these types of experimental treatments. All clinical trials are carried out under strict ethical guidelines based on the principles of patient care. However, there is no guarantee that the treatment you receive during a clinical trial will be more effective, or even as effective, as existing treatments. Read more about clinical trials and clinical trials for bile duct cancer Preventing bile duct cancer There are no guaranteed ways to avoid getting bile duct cancer, although itis possible to reduce your chances of developing the condition. The 3 most effective steps to reduce your chances of developing bile duct cancer are: giving up smoking (if you smoke) drinking alcohol in moderation minimising your exposure to the hepatitis B and hepatitis C viruses Stopping smoking Not smokingis the most effective way of preventing bile duct cancer, as well as other serious health conditions, such as stroke , heart attack and lung cancer . It is particularly important tostop smoking if you have the liver condition known as primary sclerosing cholangitis (PSC). If you have PSC, smoking will significantly increase your chances of developing bile duct cancer. Your GP can adviseon how to give up smoking. They canalso recommend and prescribe suitable medication. You can get more information and advice from the Quit Your Way Scotland advice and support service. Read more about stopping smoking Alcohol If you are a heavy drinker, reducing your alcohol intake will help prevent liver damage (cirrhosis) . This may, in turn, reduce your risk of developing bile duct cancer. Reducing your alcohol consumption is particularly important if you have a pre-existing liver condition, such as PSC or hepatitis B or C. Read low-risk drinking guidelines Visit your GP if you are finding it difficult to moderate your alcohol consumption. Counselling and medication are available to help reduce the amount you drink. Read more about alcohol Hepatitis C If you regularly inject drugs, the best way to avoid getting hepatitis C is to never share any of your drug-injecting equipment with others. You should also avoid sharing any object that could be contaminated with blood, such as razors and toothbrushes. There is less risk of getting hepatitis C by having sex with someone who is infected. However, as a precaution it is best to use a barrier method of contraception, such as a condom, with a new partner. Read more about preventing hepatitis C Hepatitis B A vaccine is available that provides immunisation against hepatitis B . Vaccination would usually only be recommended for people in high-risk groups, such as: people who inject drugs or have a sexual partner who injects drugs people who change their sexual partner frequently people travelling to or from a part of the world where hepatitis B is widespread healthcare workers who may have come into contact with the virus Pregnant women are also screened for hepatitis B. If they are infected, their baby can be vaccinated shortly after birth to prevent them also becoming infected. Read more detailed information about hepatitis B vaccination The liver fluke The liver fluke is a major cause of bile duct cancer in Asia. It is a parasite which, after infection, damages the tissue of the bile duct and in some cases triggers the onset of bile duct cancer. The liver fluke is widespread in Thailand. Other countries where the liver fluke can be found include: Cambodia Laos Vietnam Infection occurs after eating raw or undercooked fish contaminated by fluke eggs. Always ensure any fish you eat is cooked thoroughly when travelling in these countries.

Binge eating

Binge eating disorder -llnesses and conditions Mental health Binge eating disorder Binge eating disorder Binge eating is an eating disorder where a person feels they have to overeat through regular binges. Symptoms of binge eating disorder The main sign of binge eating disorder is someone bingeing on a regular basis. Signs that an episode of overeating is actually a binge, include: eating much faster than normal eating until you feel uncomfortably full eating a large amount of food when youre not hungry eating alone or secretly due to being embarrassed about the amount of food youre consuming having feelings of guilt, shame or disgust afterwards If you feel like you have to purge what youve eaten after a binge to avoid gaining weight, you may have symptoms of bulimia . If binges dont happen regularly, and your weight is very low, you may have symptoms of anorexia . Treating binge eating disorder There are some treatments available for binge eating disorder. Guided self-help The main type of psychological treatment for binge eating disorder is guided self-help. Guided self-help is where you work through information and activities on your own. Youll also have regular support sessions with a professional (usually a psychologist). Cognitive behavioural therapy (CBT) Another treatment is cognitive behavioural therapy (CBT), either individually or as part of a group. CBT starts with the idea that thoughts, feelings, and behaviour are linked and affect one another. If problems in your life are causing you to binge eat, CBT helps you to reduce bingeing. It helps to identify the underlying issues so youre less likely to binge in the future. Learn more about talking therapies Antidepressants Antidepressants may be used alongside other treatments for binge eating disorder. Long term physical effects of binge eating Binge eating often leads to weight gain. Being overweight or obese can put you at risk of a number of physical health problems, some of which can be life threatening. These include: high cholesterol high blood pressure diabetes osteoarthritis some types of cancer, like breast cancer and bowel cancer If you think you might have a binge eating problem, help is available. You can get support to tackle both the physical and mental effects of binge eating. Getting help for binge eating disorder If you have eating problems or think you may have an eating disorder, its important to seek help as soon as possible. You could: talk to someone you trust, like a friend or member of your family see your GP you may find it helpful to bring someone with you for support Helping someone else If someone close to you is showing signs of an eating disorder, you can offer help and support. You could try talking to them about how they feel, and encourage them to think about getting help. Try not to put pressure on them or be critical of them, as this could make things worse. You could also offer to help by going with the person to see their GP. Your GP or a healthcare professional can give you advice on how to help someone. This includes information on: the treatments available how you can support them during their treatment Support for binge eating disorder Beat is a leading charity for people with eating disorders. They have a range of information on the help and support available for people with eating disorders, and their friends and families. Your GP and care team can recommend other helpful resources.

Bipolar disorder

Bipolar disorder Illnesses and conditions Mental health Bipolar disorder Bipolar disorder Introduction Symptoms Causes Diagnosis Treatment Living with bipolar disorder Introduction Bipolar disorder, formerly known as manic depression, is a condition that affects your moods, which can swing from one extreme to another. People withbipolar disorder have periods or episodes of: depression feeling very low and lethargic mania feeling very high and overactive (less severe mania is known as hypomania) Symptoms of bipolar disorder depend on which mood youre experiencing. Unlike simple mood swings, each extreme episode of bipolar disorder can last for several weeks (or even longer), and some people may not experience a normal mood very often. Depression You may initially be diagnosed with clinical depression before having a future manic episode (sometimes years later), after whichyou may be diagnosed withbipolar disorder . During an episode of depression, you may have overwhelming feelings of worthlessness, which can potentially lead to thoughts of suicide . If youre feeling suicidal or having severe depressive symptoms, contact your GP, care co-ordinator or local mental health emergency services as soon as possible. If you want to talk to someone confidentially, call the Samaritans, free of charge,on 116 123. You can talk to them24 hours a day,7 days a week. Alternatively, visit the Samaritans website. Mania During a manic phase of bipolar disorder, you may feel very happy and have lots of energy, ambitious plans and ideas. You may spend large amounts of money on things you cant afford and wouldnt normally want. Not feeling like eating or sleeping, talking quickly and becoming annoyed easily are also common characteristics of this phase. You may feel very creative and view the manic phase of bipolar as a positive experience. However, you may also experience symptoms of psychosis , where you see or hear things that arent there or become convinced of things that arent true. Living with bipolar disorder The high and low phases of bipolar disorder are often so extreme that they interfere with everyday life. However, there are several options for treating bipolar disorder that can make a difference. They aim to control the effects of an episode and help someone with bipolar disorder live life as normally as possible. The following treatment options are available: medication to prevent episodes of mania, hypomania (less severe mania) and depressionthese are known as mood stabilisers and are taken every day on a long-term basis medication to treat the main symptoms of depression and mania when they occur learning to recognise the triggers and signs of an episode of depression or mania psychological treatmentsuch as talking therapy, which can help you deal with depression, and provides advice about how to improve your relationships lifestyle advicesuch as doing regular exercise, planning activities you enjoy that give you a sense of achievement, as well as advice on improving your diet and getting more sleep Its thought using a combination of different treatment methods is the best way to control bipolar disorder. Help and advice for people with a long-term condition or their carersis also availablefrom charities, support groups and associations. This includes self-help and self-management advice, and learning todeal with the practical aspects of a long-term condition. Find out more about living with bipolar disorder Bipolar disorder and pregnancy Bipolar disorder, like all other mental health problems, can get worse during pregnancy. However, specialist help is available if you need it. What causes bipolar disorder? The exact cause of bipolar disorder is unknown, although its believed a number of things can trigger an episode. Extreme stress, overwhelming problems and life-changing events are thought to contribute, as well as genetic and chemical factors. Whos affected? Bipolar disorder is fairly common and one in every 100 adults will be diagnosed with the condition at some point in their life. Bipolar disorder can occur at any age, although it often develops between the ages of 15 and 19 and rarely develops after 40. Men and women from all backgrounds are equally likely todevelop bipolar disorder. The pattern of mood swings in bipolar disorder varies widely between people. For example, some people only have a couple of bipolar episodes in their lifetime andare stable in between, while others have many episodes. Symptoms Bipolar disorder is characterised by extreme mood swings. These can range from extreme highs (mania) to extreme lows (depression). Episodes of mania and depression often last for several weeks or months. Depression During a period of depression, your symptoms may include: feeling sad, hopeless or irritable most of the time lacking energy difficulty concentrating and remembering things loss of interest in everyday activities feelings of emptiness or worthlessness feelings of guilt and despair feeling pessimistic about everything self-doubt being delusional, having hallucinations and disturbed or illogical thinking lack of appetite difficulty sleeping waking up early suicidal thoughts Mania The manic phase of bipolar disorder may include: feeling very happy, elated or overjoyed talking very quickly feeling full of energy feeling self-important feeling full of great new ideas and having important plans being easily distracted being easily irritated or agitated being delusional, having hallucinations and disturbed or illogical thinking not feeling like sleeping not eating doing things that often have disastrous consequences such as spending large sums of money on expensive and sometimes unaffordable items making decisions or saying things that are out of character and that others see as being risky or harmful Patterns of depression and mania If you have bipolar disorder, you may have episodes of depression more regularly than episodes of mania, or vice versa. Between episodes of depression and mania, you may sometimes have periods where you have a normal mood. The patterns arent always the same and some people may experience: rapid cyclingwhere a person with bipolar disorder repeatedly swings from a high to low phase quickly without having a normal period in between mixed statewhere a person with bipolar disorder experiences symptoms ofdepression and mania together; for example, overactivity with a depressed mood If your mood swings last a long time but arent severe enough to be classed as bipolar disorder, you may be diagnosed with cyclothymia(a mild form of bipolar disorder). Living with bipolar disorder Bipolar disorder is a condition of extremes.A person with the condition may be unaware theyre in the manic phase. After the episode is over, they may be shocked at their behaviour. However, at the time, they may believe other peopleare being negative or unhelpful. Some people with bipolar disorder have more frequent and severe episodes than others.The extreme nature of the condition meansstaying in a job may be difficult and relationships may become strained. Theres also an increased risk of suicide . During episodes of mania and depression, someone with bipolar disorder may experience strange sensations, such as seeing, hearing or smelling things that arent there (hallucinations). They may also believe things that seem irrational to other people (delusions). These types of symptoms are known as psychosis or a psychotic episode. Read more about living with bipolar disorder Causes The exact cause of bipolar disorder is unknown. Experts believe there are a number of factors that work together to make a person more likely to develop the condition. These are thought to be a complex mix of physical, environmental and social factors. Chemical imbalance in the brain Bipolar disorder is widely believed to be the result of chemical imbalances in the brain. The chemicals responsible for controlling the brains functions are called neurotransmitters and includenoradrenaline, serotonin and dopamine. Theres some evidence that if theres an imbalance in the levels of one or more neurotransmitters, a person may develop some symptoms of bipolar disorder . For example, theres evidence that episodes of mania may occur when levels of noradrenaline are too high, and episodes of depression may be the result of noradrenaline levels becoming too low. Genetics Its also thought bipolar disorder is linked to genetics, as the condition seems to run in families. The family members of a person with the condition have an increased risk of developing it themselves. However, no single gene is responsible for bipolar disorder. Instead, a number of genetic and environmental factors are thought to act as triggers. Triggers A stressful circumstance or situation often triggers the symptoms of bipolar disorder. Examples of stressful triggers include: the breakdown of a relationship physical, sexual or emotional abuse the death of a close family member or loved one These types of life-altering events can cause episodes of depression at any time in a persons life. Bipolar disorder may also be triggered by: physical illness sleep disturbances overwhelming problems in everyday life such as problems with money, work or relationships Diagnosis If your GP thinks you may have bipolar disorder, theyll usually refer you to a psychiatrist (a medically qualified mental health specialist). If your illness puts you at risk of harming yourself, your GP will arrange an appointment immediately. Specialist assessment Youll be assessed by the psychiatrist at your appointment. Theyll ask you a few questions to determine if you have bipolar disorder.If you do, theyll decide what treatments are most suitable. During the assessment, youll be asked about your symptoms and when you first experienced them. The psychiatrist will also ask about how you feel leading up to and during an episode of mania or depression, and if you have thoughts about harming yourself. The psychiatrist will also want to know about your medical background and family history, especially whether any of your relatives have had bipolar disorder. If someone else in your family has the condition, the psychiatrist may want to talk to them. However, theyll ask for your agreement before doing so. Other tests Depending on your symptoms, you may also need tests to see whether you have a physical problem, such as an underactive thyroid or an overactive thyroid . If you have bipolar disorder, youll need to visit your GP regularly for a physical health check. Treatment Treatment for bipolar disorder aims to reduce the severity and number of episodes of depression and mania to allow as normal a life as possible. Treatment options for bipolar disorder Treatment for bipolar disorder aims to reduce the length and severity of episodes. In some cases treatment can prevent bipolar episodes. Most people with bipolar disorder can be treated using a combination of different treatments. These can include one or more of the following: medication to prevent episodes of mania, hypomania (less severe mania) and depression these are known as mood stabilisers and are taken every day on a long-term basis medication to treat the main symptoms of depression and mania when they occur learning to recognise the triggers and signs of an episode of depression or mania psychological treatment like talking therapies, which help you deal with depression and provide advice on how to improve relationships lifestyle advice such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, and advice on improving your diet and getting more sleep Read more about living with bipolar disorder . Medication Several medications are available to help stabilise mood swings. These are commonly referred to as mood stabilisers and include: lithium carbonate anticonvulsant medicines antipsychotic medicines If youre already taking medication for bipolar disorder and you develop depression, you should speak to your healthcare professional. Learning to recognise triggers If you have bipolar disorder, you can learn to recognise the warning signs of an approaching episode of mania or depression. A community mental health worker, such as a psychiatric nurse, may be able to help you identify your early signs of relapse from your history. This may mean making some changes to your treatment. Your healthcare professional can advise you on this. Psychological treatment Most people find psychological treatment helpful when used alongside medication in between episodes of mania or depression. Pregnancy You should speak to your healthcare professional if you have bipolar disorder if youre trying to conceive or become pregnant. The National Institute for Health and Care Excellence (NICE) recommends that specialist mental health services work closely with maternity services. A written plan for managing the treatment of a pregnant woman with bipolar disorder should be developed as soon as possible. The plan should be drawn up with the patient, her partner, her obstetrician (pregnancy specialist), midwife, GP and health visitor. If you become pregnant while taking medication prescribed to treat bipolar disorder, its important that you dont stop taking it until youve discussed it with your healthcare professional. If medication is prescribed for bipolar disorder after the baby is born, it may also affect a mothers decision to breastfeed her child. Your pharmacist, midwife or mental health team can give you advice based on your circumstances. Living with bipolar disorder Although its usually a long-term condition, effective treatments for bipolar disorder , combined with self-help techniques, can limit the conditions impact on your everyday life. Staying active and eating well Eating well and keeping fitare important for everyone.Exercise can also help reduce the symptoms of bipolar disorder, particularly depressive symptoms. It may also give you something tofocus onand provide aroutine, which is important for many people. A healthy diet, combined with exercise, may also help limit weight gain, which is a common side effect of medical treatments for bipolar disorder. Some treatments alsoincrease the risk of developing diabetes, or worsen the illness in people that already have it. Maintaining a healthy weight and exercising are an important way of limiting that risk. You should have a check-up at least once a year to monitor your risk of developing cardiovascular disease or diabetes . This will include recording your weight, checking your blood pressure and having any appropriate blood tests. Read more information about losing weight and improving fitness Self-care and self-management Self-care Self-care is an essential part of daily life.It involves taking responsibility for your own health and wellbeing with support from the people involved in your care. It includes: staying fit and maintaining good physical and mental health preventing illness or accidents caring more effectively for minor ailments and long-term conditions People withlong-term conditions can benefit enormously from being helpedwith self-care.They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life, and be more active and independent. Self-management programmes Self-management programmes aim to help people with bipolar disorder take an active part in their own recovery so theyre not controlled by their condition. One course run by BipolarUK aims to teach people with bipolar disorder how to manage their illness. The programme includes information about: triggers and warning signs coping strategies and self-medication support networks and action plans maintaining a healthy lifestyle drawing up an advance decision complementary therapies action plans There are other courses, such as those run by Self Management UK , for mild to moderate mental health conditions. Coursessuch asthese help people who may feel distressed and uncertain about their bipolar disorder improve their own lives. Talking about it Some people with bipolar disorder find it easy to talk to family and friends about their condition and its effects. Other people find it easier to turn to charities and support groups. Many organisations run self-help groups that can put you in touch with other people with the condition. This enables people to share helpful ideas and helps themrealise theyre not alone in feeling the way they do. These organisations also provide online support in forums and blogs. Some useful charities, support groups and associations include: Bipolar UK Carers UK Mind Rethink Samaritans SANE Talking therapies are useful for managing bipolar disorder, particularly during periods of stability. Services that can help You may be involved with many different services during treatment for bipolar disorder. Some are accessed through referral from your GP, others through your local authority. These services may include: Community mental health teams (CMHT) these provide the main part of local specialist mental health services. They offer assessment, treatment and social care to people withbipolar disorderand other mental illnesses. Early intervention teams these provide early identification and treatment for people who have the first symptoms of psychosis. Your GP may be able to refer you directly to an early intervention team. Crisis services these allow people to be treated at home, instead of in hospital, for an acute episode. These are specialist mental health teams that deal with crises that occur outside normal office hours. Acute day hospital these are an alternative to inpatient care in a hospital. You can visit every day or as often as you need. Assertive outreach teams these deliver intensive treatment and rehabilitation in the community for people with severe mental health problems, providing rapid help in a crisis. Staff often visit people at home and liaise with other services, such as your GP or social services. They can also help with practical problems, such as helping to find housing and work, or doing your shopping and cooking. Avoiding drugs and alcohol Some people with bipolar disorder use alcohol or illegal drugs to try to take away their pain and distress. Both have well-known harmful physical and social effects and are not a substitute for effective treatment and good healthcare. Some people with bipolar disorder find they can stop misusing alcohol and drugsonce theyre using effective treatment. Others may have separate but related problems of alcohol and drug abuse, which may need to be treated separately. Avoiding alcohol and illegal drugs is an important part of recovery from episodes of manic, hypomanic or depressive symptoms, and can help you gain stability. Read more about alcohol misuse Money and benefits Its important to avoid too much stress ,including work-related stress. If youre employed, you may be able to work shorter hours or in a more flexible way, particularly if job pressure triggers your symptoms. Under the Equality Act 2010 , people are protected from discrimination in the workplace and in wider society. This can include people with a diagnosis of bipolar disorder or other mental illnesses. Arange of benefitsis available to people with bipolar disorder whocant work as a result of their mental illness. The Adult Disability Payment is managed by Social Security Scotland. Depending on your circumstances, you may qualify fromnon-devolved benefits from the UK Government . Want to know more? Care Information Scotland: Money Living with or caring for someone with bipolar disorder People living with or caring for someone with bipolar disorder can have a tough time. During episodes of illness, the personalities of people with bipolar disorder may change, and they may become abusive or even violent. Sometimes social workers and the police may become involved. Relationships and family life are likely to feel the strain. If youre the Named Person (as defined by theMental Health (Scotland) Act 2015) of a person with bipolar disorder, you havecertain rights that can be used to protect the persons interests. These include requesting that the local social services authority asks an approved mental health professional to consider whether the person with bipolar disorder should be detained in hospital (also known as sectioning). You may feel at a loss if youre caring for someone with bipolar disorder. Finding a support group and talking to other peoplein a similar situation might help. If youre having relationship or marriage difficulties, you can contact specialist relationship counsellors, who can talk things through with you and your partner. Want to know more? Care Information Scotland: Support for carers Relate: Relationship advice Dealing with suicidal feelings Having suicidal thoughts is a common depressive symptom of bipolar disorder.Without treatment, these thoughts may get stronger. Some research has shown the risk of suicide for people with bipolar disorder is 15 to 20 times greater than the general population. Studies have also shown that as many as 25-50% of people with bipolar disorder attempt suicide at least once. The risk of suicide seems to be higher earlier in the illness, so early recognition and help may prevent it. If youre feeling suicidal or youre having severe depressive symptoms, contact your GP, care co-ordinator or the local mental health emergency services as soon as possible. If you cant or dont want to contact these people, contact the Samaritans on 116 123. You can call them24 hours a day, seven days a week. Alternatively, visit the Samaritans website or email [email protected] . Self-harm Self-harm(sometimes called self-injury) is often a symptom of mental health problems such as bipolar disorder. For some people, self-harm is a way of gaining control over their lives or temporarily distracting themselves from mental distress. It may not be related to suicide or attempted suicide. Want to know more? Mind: Understanding self-harm National Self Harm Network Rethink: Suicide and self-harm Samaritans Recommended communities Online communities help you talk to people, share your experiences and learn from others. The SANESupport Forumallows people to share their feelings and provide mutual support to anyone with mental health issues, as well as their friends and family. SANE Support Forum Bipolar UK, a national charity, alsoruns an online discussion forum for people with bipolar disorder, their families and carers. Bipolar UK eCommunity Source: NHS 24 - Opens in new browser window Last updated: 04 April 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Depression Other health sites Bipolar Scotland NICE: Bipolar disorder Royal College of Psychiatrists: bipolar disorder Choice and Medication: Bipolar depression Choice and Medication: Bipolar mood disorder NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852']

Bladder cancer

Bladder cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Bladder cancer Bladder cancer About bladder cancer Symptoms of bladder cancer Causes of bladder cancer Diagnosing bladder cancer Treating bladder cancer Complications of bladder cancer Preventing bladder cancer About bladder cancer Bladder cancer is where a growth of abnormal tissue, known as a tumour, develops in the bladder lining. In some cases, the tumour spreads into the surrounding muscles. The most common symptom of bladder cancer is blood in your urine, which is usually painless. If you notice blood in your urine, even if it comes and goes, you should speak to your GP, so the cause can be investigated. Read about the symptoms of bladder cancer Types of bladder cancer Once diagnosed, bladder cancer can be classified by how far it hasspread. If the cancerous cells are contained inside the lining of the bladder, doctors describe it as non-muscle-invasive bladder cancer.This is the most common type of bladder cancer, accounting for 7 out of 10 cases.Most people dont die as a resultofthis type of bladder cancer. When the cancerous cells spread beyond the lining, into the surrounding muscles of the bladder, its referred to as muscle-invasive bladder cancer.This is less common,but has a higher chanceof spreading to other parts of the body and can be fatal. If bladder cancer has spread to other parts of the body, its known as locally advanced or metastatic bladder cancer. Read more about diagnosing bladder cancer Why does bladder cancer happen? Most cases of bladder cancer appear to be caused by exposure to harmful substances, which lead to abnormal changes in the bladders cells over many years. Tobacco smoke is a common cause andits estimated that half of all cases of bladder cancer are caused by smoking. Contact with certain chemicals previouslyused in manufacturing is also known to cause bladder cancer. However, these substances have sincebeen banned. Read more about the causes of bladder cancer and preventing bladder cancer Treating bladder cancer In cases of non-muscle-invasive bladder cancer, its usually possible to remove the cancerous cells while leaving the rest of the bladder intact. This is done using a surgical technique called transurethral resection of a bladder tumour (TURBT).Thisis followed by a dose of chemotherapy medication directly into the bladder, to reduce the risk of the cancer returning. In cases with a higher risk of recurrence, a medication known as Bacillus Calmette-Gurin (BCG) may beinjected into the bladder to reduce the risk of the cancer returning. Treatment for high-risk non-muscle-invasive bladder cancer, or muscle-invasive bladder cancer may involve surgically removing the bladder in an operation known as a cystectomy. When the bladder is removed, youll need another way ofcollecting your urine. Possible options include making an opening in the abdomen so urine can be passed into an externalbag, or constructing a new bladder out of a section of bowel. This will be done at the same time as a cystectomy. If its possible to avoid removing the bladder, or if surgeryis not suitable, a course of radiotherapy and chemotherapy may be recommended. Chemotherapy may sometimes be used on its own before surgery or before being combined with radiotherapy. After treatment for all types of bladder cancer, youll have regular follow-up tests to check for signs of recurrence. Read more about treating bladder cancer Who is affected? Bladder canceris more common in older adults, with more than half of all newcases diagnosed in peopleaged 75 and over. Bladder cancer is also more common in men than in women, possibly because in the past, men were more likely to smoke and work in themanufacturing industry. Symptoms of bladder cancer Blood in your urine is the most common symptom of bladder cancer. The medical name for this is haematuriaand its usually painless. You may notice streaks of blood in your urine or the blood may turn your urine brown. The blood isnt always noticeable and it may come and go. Less common symptoms of bladder cancer include: a need to urinate on a more frequent basis sudden urges to urinate a burning sensation when passing urine If bladder cancer reaches an advanced stage and begins to spread, symptoms can include: pelvic pain bone pain unintentional weight loss swelling of the legs When to seek medical advice If you ever have blood in your urine even if it comes and goes you should speak to your GP, so the cause can be investigated. Having blood in your urine doesnt mean you definitely have bladder cancer. There are other, more common, causes including: a urinary tract infection ,such as cystitis a kidney infection kidney stones urethritis an enlarged prostate gland ,in men Causes of bladder cancer Bladder cancer is caused by changes to the cells of the bladder. Its often linked with exposure to certain chemicals, but the cause isnt always known. What is cancer? Cancer begins with a change (mutation)in the structure of the DNA in cells, whichcanaffect how they grow. This means that cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour. Increased risk Severalfactorshave been identified that can significantly increase your risk of developing bladder cancer. Smoking Smoking is the single biggest risk factor for bladder cancer. This is because tobacco contains cancer-causing (carcinogenic) chemicals. If you smoke for many years, these chemicals pass into your bloodstream and are filtered by the kidneysinto your urine. The bladder is repeatedly exposed to these harmful chemicals, as it acts as a store for urine. This can cause changes to the cells of the bladder lining, which maylead to bladder cancer. Its estimated thatjust over a thirdof all cases of bladder cancer are caused bysmoking. People who smoke may be up tofour times more likely to develop bladder cancer than non-smokers. Exposure to chemicals Exposure to certain industrial chemicals is the second biggest risk factor. Previous studies have estimated that this may account for around 25% of cases. Chemicals known to increase the risk of bladder cancer include: aniline dyes 2-Naphthylamine 4-Aminobiphenyl xenylamine benzidine o-toluidine Occupationslinked to an increased risk of bladder cancer are manufacturing jobs involving: dyes textiles rubbers paints plastics leather tanning Some non-manufacturing jobs have also been linked to an increased risk of bladder cancer. These include taxi or bus drivers, as a result of their regular exposure to the chemicals present in diesel fumes. The link between bladder cancer and these types of occupations was discovered in the 1950s and 1960s. Since then, regulations relating to exposure to cancer-causing chemicals have been made much more rigorous and many of the chemicals listed abovehave been banned. However,these chemicals are stilllinked with cases of bladder cancer now, as it can take up to30 years after initial exposure to the chemicals before the condition starts to develop. Other risk factors Otherfactors that can increase your risk of bladder cancer include: radiotherapy to treat previous cancers near the bladder, such as bowel cancer previous treatment withcertain chemotherapy medications, such ascyclophosphamide and cisplatin previous surgery to remove part of the prostate gland, during treatment for benign prostate enlargement having diabetes bladder cancer is thought to be linked to certain treatments for type 2 diabetes having a tube in your bladder (an indwelling catheter) for a long time, because you have nerve damage that has resulted in paralysis long-term or repeated urinary tract infections (UTIs) long-term bladder stones having an early menopause (before the age of 42) an untreated infection called schistosomiasis , which iscaused by a parasite thatlives in fresh waterthis is very rare in the UK How does bladder cancer spread? Bladder cancer usually begins in the cells of the bladder lining. In some cases, itmay spread into surrounding bladder muscle. If the cancer penetrates this muscle, itcan spread to other parts of the body, usually through the lymphatic system. If bladder cancer spreads to other parts of the body, such as other organs, its known as metastatic bladder cancer. Diagnosing bladder cancer If you have symptoms of bladder cancer, such as blood in your urine, you should speak to your GP. Your GP may ask about yoursymptoms,family history and whether youve been exposed to any possible causes of bladder cancer,such assmoking. In some cases, your GP may request a urine sample, soit can be tested in a laboratory for traces of blood, bacteria or abnormal cells. Your GPmay also carry out a physical examination of your rectum and vagina,as bladder cancersometimes causes a noticeable lump that presses against them. If your doctor suspectsbladder cancer,youll bereferred to a hospital for further tests. In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of bladder cancer and refer people for the right tests faster.Find out who should be referred for further tests for suspected bladder cancer . At thehospital Some hospitals havespecialist clinics for people withblood in their urine (haematuria), while others have specialist urology departments for people with urinary tract problems. Cystoscopy If youre referred to a hospital specialist and they think you might have bladder cancer, you should first be offered a cystoscopy . This procedure allows the specialist to examine the inside of your bladder by passing a cystoscope through your urethra (the tube through which you urinate).A cystoscope isathin tube with a camera and light at the end. Before having a cystoscopy,a local anaesthetic gel is applied to your urethra (the tube through which you urinate) soyou dont feel any pain.The gel alsohelps the cystoscope to pass into the urethra more easily. The procedure usually takes about 5 minutes. Imaging scans You may be offered a CT scan or an MRI scan if the specialist feels they need a more detailed picture of your bladder. An intravenous (IV) urogram may also be used to look at your whole urinary system before or after treatment for bladder cancer. During this procedure, dye is injected into your bloodstream and X-rays are used to study it as it passes through your urinary system. Transurethral resection of a bladder tumour (TURBT) If abnormalities are found in your bladder during a cystoscopy, you should be offered an operation known as TURBT. This isso any abnormal areas of tissuecan be removed and tested for cancer (a biopsy). TURBTis carried out under general anaesthetic . Sometimes, a sample of the muscle wall of your bladder is also taken to check whether the cancer has spread, but this may be a separate operation within 6 weeks of the first biopsy . You should also be offered a dose of chemotherapy after the operation. This may help to prevent the bladder cancer returning if the removed cells are found to be cancerous. See treating bladder cancer for more information about the TURBT procedure Staging and grading Once these tests have been completed, it should be possible to tell you the grade of the cancer and what stage it is. Staging is a measurement of how far the cancer has spread. Lower-stage cancers are smaller and have a better chance of successful treatment. Grading is a measurement of how likely a cancer is to spread.The grade of a cancer is usually described using a number system ranging from G1 to G3. High-grade cancers are more likely to spread than low-grade cancers. The most widely used staging system for bladder cancer is known as the TNM system, where: T stands for howfar into the bladder the tumour has grown N stands for whether the cancer has spread into nearby lymph nodes M stands for whether the cancer has spread into another part of the body (metastasis), such as the lungs T stages The T staging system is as follows: TIS or CIS (carcinoma in situ) a very early high-grade cancer confined to the innermost layer of the bladder lining Ta the cancer is just in the innermost layer of the bladder lining T1 the cancerous cells have started to grow into the connective tissue beyond the bladder lining Bladder cancer up to the T1 stage is usually called early bladder cancer or non-muscle-invasive bladder cancer. If the tumour grows larger than this, its usually called muscle-invasive bladder cancer and is categorised as: T2 the cancer has grown through the connective tissue, into the bladder muscle T3 the cancer has grown through the layer of muscles, into the surrounding layer of fat If the tumour grows larger than the T3 stage, its considered to be advanced bladder cancer and is categorised as: T4 the cancer has spread outside the bladder, into surrounding organs N stages The N staging system is as follows: N0 there are no cancerous cells in any of your lymph nodes N1 there are cancerous cells in just one of your lymph nodes in your pelvis N2 there are cancerous cells in two or more lymph nodes in your pelvis N3 there are cancerous cells in one or more of your lymph nodes (known as common iliac nodes) deep in your groin M stages There are only two options in the M system: M0 where the cancer hasnt spread to another part of the body M1 where the cancer has spread to another part of the body, such as the bones, lungs or liver The TNM system can be difficult to understand, so dont be afraid to ask your care team questions about your test results and what they mean for your treatment and outlook. Treating bladder cancer The treatment options for bladder cancer largely depend on how advanced the cancer is. Treatments usually differbetween early stage, non-muscle-invasive bladder cancer and more advanced muscle-invasive bladder cancer. Multidisciplinary teams (MDTs) All hospitals use MDTs to treat bladder cancer. These are teams of specialists that work together to make decisions about the best way to proceed with your treatment. Members of your MDT may include: a urologist a surgeon specialising in treating conditions affecting the urinary tract a clinical oncologist a specialist in chemotherapy and radiotherapy a pathologista specialist in diseased tissue a radiologist a specialist in detecting disease using imaging techniques You should be given the contact details for a clinical nurse specialist, who will be in contact with all members of your MDT.Theyll be able to answer questions and support you throughout your treatment. Deciding what treatment is best for you can be difficult. Your MDT will make recommendations, but remember that the final decision is yours. Before discussing your treatment options, you may find it useful to write a list of questions to ask your MDT. Non-muscle-invasive bladder cancer If youve been diagnosed with non-muscle-invasive bladder cancer (stages CIS, Ta and T1), your recommended treatment plan depends on the risk of the cancer returning or spreading beyond the lining of your bladder. This risk is calculated using a series of factors, including: the number of tumours present in your bladder whether the tumours are larger than 3cm (1 inch) in diameter whether youve had bladder cancer before the grade of the cancer cells These treatments are discussed in more detail below. Low-risk Low-risk non-muscle-invasive bladder cancer is treated with transurethral resection of a bladder tumour (TURBT). This procedure may be performed during your first cystoscopy when tissue samples are taken for testing (see diagnosing bladder cancer ). TURBT is carried out under general anaesthetic . The surgeon uses an instrument called a cystoscope to locate the visible tumours and cut them away from the lining of the bladder. The wounds are sealed (cauterised) using a mild electric current, and you may be given a catheter to drain any blood or debris from your bladder over the next few days. After surgery,you may be given asingle dose of chemotherapy , directly into your bladder,using a catheter. The solution is kept in your bladder for around an hour before being drained away. Most people are able to leave hospital less than 48 hours after having TURBT and are able to resume normal physical activity within 2 weeks. You should be offered follow-up appointments at 3 months and nine months to check your bladder, using a cystoscopy . If your cancer returns after 6 months and is small,you may be offered a treatment called fulguration. This involves using an electric current to destroy the cancer cells. Intermediate-risk People with intermediate-risk non-muscle-invasive bladder cancer should be offered a course of at least 6 doses of chemotherapy. The liquid is placed directly into your bladder,using a catheter, and kept there for around an hour before being drained away. You should be offered follow-up appointments at 3 months, 9 months, 18 months, then once every year.Atthese appointments, your bladder will be checked using a cystoscopy.If your cancer returns within 5 years, youll be referred back to a specialist urology team. Some residue of the chemotherapy medication may be left in your urine after treatment, which could severely irritate your skin. It helpsif you urinate while sitting down and that youre careful not to splash yourself or the toilet seat. After passing urine, wash the skin around your genitals with soap and water. If youre sexually active, its important to use a barrier method of contraception , such as a condom. This isbecause the medication may be present in your semen or vaginal fluids, which can cause irritation. You also shouldnt try to get pregnant or father a child while having chemotherapy for bladder cancer, as the medication can increase the risk of having a child with birth defects. High-risk People with high-risk non-muscle-invasive bladder cancer should be offered a second TURBT operation, within 6 weeks of the initial investigation(see diagnosing bladder cancer ). A CT scan or an MRI scan may also be required. Your urologist and clinical nurse specialistwill discussyour treatment options with you, which will either be: a course of Bacillus Calmette-Gurin (BCG) treatment using a variant of the BCG vaccine an operation to remove your bladder (cystectomy) The BCG vaccine is passed into your bladder through a catheter and left for 2 hours before being drained away. Most people require weekly treatments over a 6-week period. Common side effects ofBCG include: a frequent need to urinate pain when urinating blood in your urine (haematuria) flu-like symptoms, such as tiredness, fever and aching urinary tract infections IfBCGtreatment doesnt work, or the side effects are too strong, youll be referred back to a specialist urology team. You should be offered follow-up appointments every 3 months for the first 2 years, then every 6 months for the next 2 years, then once a year.Atthese appointments, your bladder will be checked using a cystoscopy. If you decide to have a cystectomy, your surgeon willneed tocreate an alternative way for urine to leave your body (urinary diversion). Your clinical nurse specialist can discuss your options for the procedure and how the urinary diversion will be created. Read about the complications of bladder cancer surgery for more information about urinary diversion and sexual problems after surgery. After having a cystectomy,you should be offered follow-up appointments including a CT scan at six and 12 months, andblood tests once a year. Men require an appointment to check their urethra once a year for 5 years. Muscle-invasive bladder cancer The recommended treatment plan for muscle-invasive bladder cancer depends on how far the cancer has spread. With T2 andT3 bladder cancer, treatment aims to cure the condition if possible, or at least control it for a long time. Your urologist, oncologist and clinical nurse specialistwill discussyour treatment options with you, which will either be: an operation to remove your bladder (cystectomy) see above radiotherapy with a radiosensitiser Your oncologistshould also discuss the possibility of having chemotherapy before eitherof these treatments (neoadjuvant therapy), if its suitable for you. Radiotherapy with a radiosensitiser Radiotherapy is given by a machine that beams the radiation at the bladder (external radiotherapy). Sessions are usually given on a daily basis for 5 days a week over the course of 4 to 7 weeks. Each session lasts for about 10 to 15 minutes. A radiosensitisershould also be given alongside radiotherapy for muscle-invasive bladder cancer. This is a medicine which affects the cells of a tumour, to enhance the effect of radiotherapy. It has a much smaller effect on normal tissue. As well as destroying cancerous cells, radiotherapy can also damage healthy cells, which means it can cause a number of side effects. These include: diarrhoea inflammation of the bladder (cystitis) tightening of the vagina (in women), which can make having sex painful erectile dysfunction (in men) loss of pubic hair infertility tiredness difficulty passing urine Most of these side effects should pass a few weeks after your treatment finishes, although theres a chance theyll be permanent. Having radiation directed at your pelvis usually means youll be infertile for the rest of your life.However, most people treated for bladder cancer are too old to have children, so this isnt usually a problem. After having radiotherapy for bladder cancer,you should be offered follow-up appointmentsevery 3 months for the first 2 years, then every 6 months for the next 2 years, and every year after that.Atthese appointments, your bladder will be checked using a cystoscopy. You may also be offered CT scans of your abdomen, pelvis and chest after 6 months, 1 year and 2 years. A CT scan of your urinary tract may be offered every year for 5 years. Surgery or radiotherapy? Your MDT may recommend a specific treatmentbecause ofyour individual circumstances. For example, someone with a small bladder ormany existing urinary symptoms is better suited to surgery. Someone who has a single bladder tumour with normal bladder function is better suited for treatments that preserve the bladder. However, your input is also important, so you should discuss which treatment is best for you with your MDT. There are pros and cons of both surgery and radiotherapy. The pros of having a radical cystectomy include: treatment is carried out in one go you wont need regular cystoscopies after treatment, although other less invasive testsmay be needed The cons of having a radical cystectomy include: it can take up to 3 months to fully recover a risk of general surgical complications, such as pain, infection and bleeding a risk of complications from the use ofgeneral anaesthetic an alternative way of passing urine out of your body needs to be created, which may involve an external bag a high risk of erectile dysfunction in men (estimated at around 90%)as a result of nerve damage after surgery, some women may find sex uncomfortable, as their vagina may be smaller a small chance of a fatal complication, such as a heart attack , stroke or deep vein thrombosis (DVT) The pros of having radiotherapy include: theres no need to have surgery, which is often an important consideration for people in poor health your bladder function may not be affected, as your bladder isnt removed theres less chance of causing erectile dysfunction (around 30%) The cons of having radiotherapy include: youll require regular sessions of radiotherapy for 4 to 7 weeks short-term side effects are common,such as diarrhoea, tiredness and inflammation of the bladder (cystitis) a small chanceof permanently damaging the bladder, which could lead to problems urinating women may experience a narrowed vagina, making sex difficult and uncomfortable Chemotherapy In some cases,chemotherapy may be used during treatment for muscle-invasive bladder cancer. Instead of medication being put directly into your bladder, its put into a vein in your arm. This is called intravenous chemotherapy and can be used: before radiotherapy and surgery to shrink the size of any tumours in combination with radiotherapy before surgery (chemoradiation) to slow the spread of incurable advanced bladder cancer (palliative chemotherapy) There isnt enough evidence to say whether chemotherapy is an effective treatment when its given after surgery to prevent the cancer returning. Its usually only used this way as part of a clinical trial .See clinical trials for bladder cancer for more information. Chemotherapy is usually given over a few consecutive days at first. Youll then have a few weeks off to allow your body to recover before the treatment begins again. This cycle will be repeated for a few months. As the chemotherapy medication is being injected into your blood, youll experience a wider range of side effects than if you were having chemotherapy directly into the bladder. These side effects should stop after the treatment has finished. Chemotherapy weakens your immune system, making you more vulnerable to infection. Its important to report any symptoms of a potential infection, such as a high temperature, persistent cough or reddening of the skin, to your MDT. Avoid close contact with people who are known to have an infection. Otherside effects of chemotherapy can include: nausea vomiting hair loss lack of appetite tiredness Locally advanced or metastatic bladder cancer The recommended treatment plan forlocally advanced or metastatic bladder cancerdepends on how far the cancer has spread. Your oncologist should discuss your treatment options with you, which may include: a course of chemotherapy treatments to relieve cancer symptoms Chemotherapy If you receive a course of chemotherapy, youll be given a combination of drugs to help relieve the side effects of treatment. Treatment may be stopped if chemotherapy isnt helping, or a second course may be offered. Relieving cancer symptoms You may be offered treatment to relieve any cancer symptoms. This may include: radiotherapy to treat painful urination, blood in urine, frequently needing to urinate or pain in your pelvic area treatment to drain your kidneys, if they become blocked and cause lower back pain Palliative care If your cancer is at an advanced stage and cant be cured, your MDT should discuss how the cancer will progress and which treatments are available to ease the symptoms. You can be referred to a palliative care team, who can provide support and practical help, including pain relief. Read more about end of life care Complications of bladder cancer A diagnosis of bladder cancer, and some treatments for the condition, can have a significant impact on your life. Emotional impact The emotional impact of living with bladder cancer can be huge. Many people report experiencing a kind of rollercoaster effect. For example, you may feel down at receiving a diagnosis,up whenthe canceris removed, and down again as you try to come to terms with the after-effects of your treatment. This type of emotional disruption can sometimes trigger feelings of depression . Signs that you may be depressed include: having continuous feelingsof sadnessor hopelessness no longer taking pleasure in the things you enjoy Contact your GP for advice if you think you may be depressed. Theres a range of relatively successful treatments for depression, including antidepressant medication andtherapies such as cognitive behavioural therapy (CBT). Read more about coping with cancer Urinary diversion Ifyour bladder is removed, an alternative way of passing urine out of yourbody will be created during the operation. This is called urinary diversion. There are various types of urinary diversion, which are described below. In some cases, you may be able to make a choice based on your personal preferences. However, certain treatment options will not be suitable for everyone. Your multidisciplinary team (MDT) can provide information on the most suitable options for you. Urostomy A urostomy iscarried out during a radical cystectomy. A small section ofthe small bowel isremoved andconnected to your ureters (the 2 tubes that normally carry urine out of the kidneys). The surgeonthen creates a small hole in the surface of your abdomen and the open end of the removed bowel is placed in this hole, creating an opening known as a stoma. Aspecial waterproofbagis placed over the stoma to collect urine. Astoma nurse will teach you how to care for your stoma, and how and when to change the bag. Continent urinary diversion Continent urinary diversion is similar to a urostomy, butwithout an external bag. Instead, a section of your bowelis used to create a pouch inside your body that stores urine. The ureters are connected to the pouch and the pouch is connected to an opening in the abdominal wall.A valve in the opening (stoma) prevents urine leaking out. The pouch is emptied using athin, flexible tube(catheter). Most people need to empty their pouch about 4 or 5 times a day. Bladder reconstruction In some cases it may be possible to create a new bladder, known as a neobladder. This involves removing a section of your bowel and reconstructing it into a balloon-like sac, before connecting it to your urethra (the tube that carries urine out of the body) at one end and your ureters at the other end. However, bladder reconstruction isnt suitable for everyone. Youll be taught how to empty your neobladder by relaxing the muscles in your pelvis, whiletightening the muscles in your abdomen at the same time. Your neobladder wont contain the same types of nerve endings as a real bladder, so you wont get the distinctive sensation that tells you to pass urine. Some people experience a feeling of fullness inside their abdomen, while others have reported they feel like they need to pass wind. Because ofthe loss of normal nerve function, most people with a neobladder experience some episodes of urinary incontinence , which usually occurs during the night, while theyre asleep. You may find it useful to empty your neobladder at set times during the day, including before you go to bed, to help prevent incontinence. Sexual problems Erectile dysfunction Contact yourMDT if you lose the ability to obtain or maintain an erection after a radical cystectomy. It may be possible for you to be treated with a type of medicine known as phosphodiesterase type 5 inhibitors (PDE5). PDE5s work by increasing the blood supply to your penis. PDE5s are sometimes combined witha device called a vacuum pump, which consists of acylinder connected to a pump. The penis is placed inside the cylinder and the air is pumped out. This creates a vacuum that causes blood toflow into the penis. A rubber ring is then placed around the base of the penis, which allows an erection to be maintained for around 30 minutes. Read more about treating erectile dysfunction Narrowing of the vagina Both radiotherapy and cystectomy can cause a womans vagina to become shortened and narrowed, which can make penetrative sex painful or difficult. There are 2 main treatment options available if you have a narrowed vagina. The first is to apply hormonal cream to the area, which should help to increase moisture inside your vagina. The second is to use vaginal dilators. These areplastic cone-shaped devices of various sizesthat are designed to gently stretchyour vagina and make it more supple. Its usually recommended that youusedilatorsfor a 5 to10-minute period every day, starting with the dilator that fits in easiest first andgradually increasing the size, as your vagina stretches over the following weeks. Many women find this an embarrassing issue to discuss, but the use of dilators is a well-recognised treatment for narrowing of the vagina. Your specialist cancer nurse should be able to provide more information and advice. You may find that themore often you have penetrative sex, the less painful it becomes. However, it may be several months before you feel emotionally ready to be intimate with a sexual partner. The Macmillan Cancer Support website has information and a video about cancer and sexuality Preventing bladder cancer Its not always possible to prevent bladder cancer, but some risk factors have been identified, which may increase your risk of developing the condition. Stopping smoking If you smoke, giving up is the best way to reduce your risk of developing bladder cancer and preventing it from recurring. If you decide to stop smoking, youcould contact the Quit Your Way .

Smoking and Bladder Cancer

every day). The specially trained helpline staff willoffer you free expert advice and encouragement. If youre committed to giving up smoking butdont want to be referred to a stop smoking service your GP should be able to prescribe medical treatment to help with any withdrawal symptoms you may experience after giving up. For more information and advice about giving up smoking have a browse through stop smoking treatments and the stop smoking home page . Workplace safety Your risk of bladder cancer could be increased if your job involves exposure to certain chemicals. Occupations linked to an increased risk of bladder cancer are manufacturing jobs involving: rubber dyes textiles plastic leather tanning diesel fumes Nowadays there are rigorous safety protocols in place designed to minimise your risk of exposure andchemicals known to increase the risk of bladder cancer have been banned. If youre uncertain about what these protocols involve talk to your line manager or health and safety representative. If youre concerned that your employer may be disregarding recommendations about workplace safety you should contact the Health and Safety Executive for advice. Diet Theres some evidence to suggest that a diet high in fruit and vegetables and low in fat can help to prevent bladder cancer. Even though this evidence is limited its a good idea to follow this type of healthy diet as it can help to prevent other types of cancer such as bowel cancer as well as serious health conditions including high blood pressure (hypertension) stroke and heart disease . A low-fat high-fibre diet is recommended including plenty of fresh fruit and vegetables (5 portions a day) and whole grains. Limit the amount of salt you eat to no more than 6g (0.2oz) a day (1 teaspoon) because too much can increase your blood pressure. You should try to avoid foods that contain saturated fat as itcan increase your cholesterol levels. Foods high in saturated fat include: meat pies sausages and fatty cuts of meat butter ghee (a type of butter often used in Indian cooking) lard cream hard cheese cakes and biscuits foods that contain coconut or palm oil However a balanced diet should include a small amount of unsaturated fat becausethis will actually help to control your cholesterol levels. Foodshigh in unsaturated fat include: oily fish avocados nuts and seeds sunflower rapeseed olive and vegetable oils Read more about healthy eating Source: NHS 24 - Opens in new browser window Last updated: 13 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Radiotherapy Chemotherapy Other health sites Cancer Research UK: Bladder cancer Macmillan Cancer Support: Bladder cancer Penny Brohn UK Fight Bladder Cancer: What is bladder cancer? Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852']"

Blood poisoning (sepsis)

Sepsis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Blood and lymph Sepsis Sepsis About sepsis Symptoms of sepsis Treating sepsis About sepsis Phone 999 immediately or go to A&E if: You or someone else has symptoms like: loss of consciousness severe breathlessness a high temperature (fever) or low body temperature a change in mental state like confusion or disorientation slurred speech cold, clammy and pale or mottled skin a fast heartbeat fast breathing chills and shivering severe muscle pain feeling dizzy or faint nausea and vomiting diarrhoea What is sepsis? Sepsis is a serious complication of an infection. Without quick treatment, sepsis can lead to multiple organ failure and death. What causes a sepsis infection? The immune system usually keeps an infection limited to one place. This is called a localised infection. To do this, the body produces white blood cells. White blood cells travel to an infection site to destroy the germs causing the infection. This triggers tissue swelling, known as inflammation. This helps to fight the infection and prevent it from spreading. However, an infection can spread to other parts of the body if the immune system is weak or an infection is severe. Widespread inflammation can damage tissue and interfere with blood flow. When blood flow is interrupted, blood pressure can drop dangerously low. This stops oxygen from reaching the organs and tissues. Sources of infection Sepsis can be triggered by an infection in any part of the body. The most common sites of infection that lead to sepsis are the: lungs urinary tract tummy (abdomen) pelvis However, sometimes the specific infection and source of sepsis cant be identified. Infections linked to sepsis appendicitis infection in the appendix cellulitis a skin infection that can be caused by an intravenous catheter thats been inserted through the skin to give fluids or medication cholangitis an infection of the bile duct cholecystitis an infection of the gallbladder encephalitis an infection of the brain and nervous system endocarditis a heart infection flu only in some cases meningitis an infection of the brain and nervous system peritonitis an infection of the thin layer of tissue that lines the abdomen pneumonia a lung infection post-surgery infections osteomyelitis a bone infection urinary tract infection an infection of the bladder, urethra or kidneys Tests to diagnose sepsis Sepsis is often diagnosed by testing your: temperature heart rate breathing rate blood Other tests can help determine the type of infection, where its located and which parts of the body have been affected. These include: urine or stool samples a wound culture where a small sample of tissue, skin or fluid is taken from the affected area for testing respiratory secretion testing taking a sample of saliva, phlegm or mucus blood pressure tests imaging studies like an X-ray , ultrasound scan or computerised tomography (CT) scan Whos at risk of sepsis? Anyone can develop sepsis after an injury or minor infection. However, some people are more vulnerable, including people who: are very young are very old are pregnant have had a urinary catheter fitted have a long term health condition like diabetes have recently had surgery are genetically prone to infections are already in hospital with a serious illness have to stay in hospital for a long time have wounds or injuries as a result of an accident have a medical condition that weakens the immune system like HIV or leukaemia are receiving medical treatment that weakens the immune system like chemotherapy or long-term steroids are on mechanical ventilation where a machine is used to help you breathe Recovering from sepsis Some people make a full recovery from sepsis fairly quickly. The amount of time it takes to fully recover from sepsis varies depending on: the severity of the sepsis the persons overall health how much time was spent in hospital whether treatment was needed in an intensive care unit (ICU) Long term effects of sepsis Some people with sepsis will experience long-term physical and psychological problems. This is known as post-sepsis syndrome. Symptoms of post-sepsis syndrome include: feeling lethargic or excessively tired muscle weakness swollen limbs joint pain chest pain breathlessness Symptoms of sepsis Sepsis can cause a variety of symptoms. Sepsis symptoms in children under 5 Temperature over 38C (babies under 3 months) over 39C (babies aged 3 to 6 months) below 36C check 3 times in a 10-minute period a high temperature in a child who cant be encouraged to show interest in anything Breathing difficulty breathing this looks like hard work grunting with every breath struggling to speak more than a few words at once (for older children who normally talk) breathing that obviously pauses Eating and drinking no interest in feeding (child under 1 month) not drinking for more than 8 hours (when awake) black, green or bloody vomit Body a soft spot on a babys head that bulges sunken eyes a baby thats floppy a child that cant be encouraged to show interest in anything weak, whining or continuous crying in a younger child confusion in an older child irritableness unresponsive stiffness in the neck, especially when trying to look up or down not had a wee or wet nappy for 12 hours Go to A&E or call 999 if your child: is very lethargic or difficult to wake feels abnormally cold to touch is breathing very fast has a rash that does not fade when you press it has a fit or convulsion Trust your instincts and phone 111 if your childs symptoms are getting worse or they are sicker than youd expect (even if their temperature falls). Sepsis symptoms in older children and adults Early symptoms of sepsis may include: a high temperature (fever) or low body temperature chills and shivering a fast heartbeat fast breathing Symptoms of severe sepsis or septic shock In some cases, symptoms of more severe sepsis or septic shock (when your blood pressure drops to a dangerously low level) develop. These can include: feeling dizzy or faint a change in mental state like confusion or disorientation diarrhoea nausea and vomiting slurred speech severe muscle pain severe breathlessness less urine production than normal for example, not urinating for a day cold, clammy and pale or mottled skin loss of consciousness Phone 999 or go to A&E if: youve recently had an infection or injury and you have possible signs of sepsis you think you or someone in your care has severe sepsis or septic shock Dont be afraid to ask the healthcare professional is this sepsis?. Treating sepsis Treatment for sepsis varies, depending on the: area affected cause of the infection organs affected extent of any damage If you have the early signs of sepsis, youll usually be referred to hospital. Youll then be given a diagnosis and treatment. Emergency treatment Youll need emergency treatment, or treatment in an intensive care unit (ICU), if: the sepsis is severe you develop septic shock when your blood pressure drops to a dangerously low level ICUs can support body functions like breathing that are affected by sepsis. This allows the medical staff to focus on treating the infection. Sepsis is treatable if its identified and treated quickly. In most cases it leads to full recovery with no lasting problems. Antibiotics The main treatment for sepsis, severe sepsis or septic shock is antibiotics . These will be given directly into a vein (intravenously). Ideally, antibiotic treatment should start within an hour of diagnosis. Intravenous antibiotics are usually replaced by tablets after 2 to 4 days. You may have to take them for 7 to 10 days or longer, depending on the severity of your condition. Types of antibiotics If sepsis is suspected, broad-spectrum antibiotics are given first. This is because there wont be time to wait until a specific type of infection has been identified. Broad-spectrum antibiotics work against a wide range of known infectious bacteria. They usually cure most common infections. Once a specific bacterium has been identified, a more focused antibiotic can be used. Viral infections If the sepsis is caused by a virus, antibiotics wont work. However, it would be too dangerous to delay treatment to find out the specific cause. This means antibiotics are usually given anyway. With a viral infection, youll need to wait until your immune system starts to tackle it. However, antiviral medication may be given in some cases. Intravenous fluids If you have sepsis, your body needs more fluid to prevent dehydration and kidney failure. If you have severe sepsis or septic shock, youll usually be given fluids intravenously for the first 24 to 48 hours. Its important that the doctors know how much urine your kidneys are making when you have sepsis. This helps them spot signs of kidney failure. If youre admitted with severe sepsis or septic shock, youll usually be given a catheter . This is inserted into your bladder to monitor your urine output. Oxygen Your bodys oxygen demand goes up if you have sepsis. If youre admitted to hospital with sepsis and the level of oxygen in your blood is low, youll usually be given oxygen. This is given through a mask or tubes in your nostrils. Treating the source of infection If a source of the infection can be identified, like an abscess or infected wound, this will also need to be treated. For example, any pus may need to be drained away. In more serious cases, surgery may be needed to remove the infected tissue and repair any damage. Increasing blood pressure Medications called vasopressors are used if you have low blood pressure caused by sepsis. Vasopressors are normally given intravenously while youre in an ICU. Extra fluids may also be given intravenously to help increase blood pressure. Other treatments You may require additional treatments like: corticosteroids insulin medication a blood transfusion mechanical ventilation where a machine is used to help you breathe dialysis where a machine filters your blood to copy the function of your kidneys These treatments are mostly used in ICUs. Source: NHS 24 - Opens in new browser window Last updated: 16 August 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Antibiotics Other health sites UK Sepsis Trust Nice: Sepsis: recognition, diagnosis and early management Sepsis Research NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852']

Bone cancer

Bone cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Bone cancer Bone cancer About bone cancer Symptoms of bone cancer Causes of bone cancer Diagnosing bone cancer Treating bone cancer About bone cancer Primary bone cancer is a rare type of cancer that begins in the bones. This is a separate condition from secondary bone cancer, which is cancer that spreads to the bones after developing in another part of the body. These pages only refer to primary bone cancer. The Macmillan Cancer Support website has more information about secondary bone cancer . Signs and symptoms of bone cancer Bone cancer can affect any bone, but most cases develop in the long bones of the legs or upper arms. The main symptoms include: persistent bone pain that gets worse over time and continues into the night swelling and redness (inflammation)over a bone, which can make movement difficult ifthe affectedbone is near a joint a noticeable lump over a bone a weak bone that breaks (fractures) more easily than normal If you or your child are experiencing persistent, severe or worseningbone pain, visit your GP. While its highly unlikely to be the result of bone cancer, it does require further investigation. Read more about the symptoms of bone cancer Types of bone cancer Some of the main types of bone cancer are: osteosarcoma the most common type, which mostly affects children andyoung adults under 20 Ewing sarcoma which most commonly affects people aged between 10and 20 chondrosarcoma which tends to affect adults aged over 40 Young people can be affected becausethe rapid growth spurts that occur duringpubertymay make bone tumours develop. These types of bone canceraffect different types ofcell. The treatment and outlook will depend on the type of bone cancer you have. What causes bone cancer? In most cases, its not known why a person develops bone cancer. Youre more at riskof developing it if you: have had previous exposure toradiationduring radiotherapy have a condition known as Pagets disease of the bone however, only a very small number of people with Pagets disease will actually develop bone cancer have a rare genetic condition calledLi-Fraumeni syndromepeople with this condition have a faulty version of a gene that normally helps stop the growth of cancerous cells Read more about the causes of bone cancer How bone cancer is treated Treatment for bone cancer depends on the type of bone cancer you have and how far it has spread. Most people have a combination of: surgery to remove the section of cancerous bone its often possible to reconstruct or replace the bone thats been removed,but amputation is sometimes necessary chemotherapy treatmentwith powerful cancer-killing medication radiotherapy whereradiation is used to destroy cancerous cells In some cases ofosteosarcoma,a medication called mifamurtide may alsobe recommended. Read more about treating bone cancer Outlook The outlook for bone cancer depends onfactors such asyour age, the type of bone cancer you have, how far the cancer has spread (the stage), and how likely it is to spread further (the grade). Generally, bone cancer is much easier to cure in otherwise healthy people whose cancer hasnt spread. Symptoms of bone cancer Bone pain is the most common symptom of bone cancer. Some people experience other symptoms as well. Bone pain Pain caused by bone cancer usually begins with a feeling of tenderness in the affected bone. Thisgradually progresses to a persistent ache or ache that comes and goes, which continues at night and when resting. Any bone can be affected, although bone cancer most often develops in the long bones of the legs or upper arms. Thepain can sometimes bewrongly mistaken for arthritis in adults and growing painsin children and teenagers. Other symptoms Some peoplealso experience swelling and redness (inflammation) ornotice a lump on or around the affected bone. If the bone is near a joint, the swelling may make it difficult to use the joint. In some cases, the cancer can weaken a bone, causing it to break (fracture) easilyafter a minor injury or fall . Less common symptoms can include: a high temperature (fever) of 38C (100.4F) or above unexplained weight loss sweating, particularlyat night When to seek medical advice Speak to your GP if you or your child experiences persistent, severe or worsening bone pain, or if youre worried about any symptoms. While its highly unlikely that your symptoms are caused by cancer, its best to be sure by getting a proper diagnosis. Read more about diagnosing bone cancer Causes of bone cancer Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour. The exact reason why this happens is often not known, but certain things can increase your chance of developing the condition, including: previous radiotherapy treatment otherbone conditions, such as Pagets disease of the bone rare genetic conditions, such asLi-Fraumeni syndrome a history ofcertainotherconditions, including retinoblastomaand umbilical hernia Radiotherapy treatment Previous exposure to high doses of radiationduring radiotherapy may cause cancerous changes in your bone cells at a later stage, although this risk is thought to be small. Bone conditions Some non-cancerous (benign) conditions affecting the bones may increase your chances of developing bone cancer, although the risk is still small. In particular, a condition called Pagets disease of the bonecan increase the risk of bone cancer in people over 50to 60 years of age. Rarer conditions that cause tumours to grow in your bones, such as Olliers disease, can also increase your risk of bone cancer. Genetic conditions A rare genetic condition calledLi-Fraumeni syndrome can increase your risk of developing bone cancer, as well as several other types of cancer. People with this condition have a faulty version of a gene that usually helps stop the growth of tumours in the body. Other conditions People who had a rare type of eye cancer called retinoblastomaas a child may be more likely to develop bone cancer, because the same inherited faulty gene can be responsible for both conditions. Research has also found that babies born with an umbilical herniaare three times more likely to develop a type of bone cancer called Ewing sarcoma,although the risk is stillvery small. Diagnosing bone cancer If youre experiencing bone pain, your GP will ask about your symptoms and examine the affected area, before deciding whether you need to have any further tests. They will look for any swelling or lumps, and ask if you haveproblems moving the affected area. They may ask about the type of pain you experience whether its constant or comes and goes, and whether anything makes it worse. After being examined, you may bereferred for an X-ray of the affected area to look for any problems in the bones. If the X-ray shows abnormal areas, youll be referred toan orthopaedic surgeon (a specialist in bone conditions) or bone cancer specialistfor a further assessment. X-rays An X-rayis a procedure where radiation is used toproduce images of the inside of the body. Its a particularly effective way of looking at bones. X-rays can often detect damage to the bones caused by cancer, or new bone thats growing because of cancer.They can also determine whether your symptoms arecaused bysomething else, such as a brokenbone (fracture). Ifan X-ray suggests you may have bone cancer, you should be referred to a specialist centre with expertise in diagnosing and treating the condition. As bone cancer israre,there are asmall number of specialist centres, so you may have to travel outside your local area for advice and treatment. Biopsy The most definitive way of diagnosing bone cancer is to take a sample of affected bone and send it to a laboratory for testing. This is known as a biopsy . A biopsy can determine exactly what type of bone cancer you have and what grade it is (see below). A biopsy can becarried outin two ways: A core needle biopsy isperformed under anaesthetic (depending on where the bone is located, this could be a local anaesthetic or general anaesthetic ).A thin needle is inserted into the bone and used to remove a sample of tissue. An open biopsy isperformed under a general anaesthetic. The surgeon makes an incision in the affected bone to remove a sample of tissue. You may need to have an open biopsy if the results of a core needle biopsy are inconclusive. Further tests If the results of the biopsy confirm or suggest bone cancer, its likely youll have further tests to assess how far the cancer has spread. These tests are described below. MRI scan A magnetic resonance imaging (MRI) scan uses a strong magnetic field and radio waves to produce detailed pictures of the bones and soft tissues. An MRI scan is an effective way of assessing the size and spread of any cancerous tumour in or around the bones. CT scan A computerised tomography (CT) scan involves taking a series of X-rays and using a computer to reassemble them into a detailed three-dimensional (3D) image of your body. CT scans are often used to check if the cancer has spread to your lungs. Chest X-rays may also be taken for this purpose. Bone scans A bone scan cangive more detailed information about the inside of your bones than an X-ray. During a bone scan,a small amount of radioactive material is injected into your veins. Abnormal areas of bone will absorb the material at a faster rate than normal bone and will show up as hot spots on the scan. Bone marrow biopsy If you have a type of bone cancer called Ewing sarcoma , you may have a test called a bonemarrow biopsy to check if the cancer has spread to the bone marrow (the tissue inside your bones). During the test,a needle is inserted into your bone to remove a sample of your bone marrow. This may be done under either local or general anaesthetic. Staging and grading Once these tests have been completed, it should be possible to tell you what stage and grade the bone cancer is. Staging is a description of how far a cancer has spread and grading is a description of how quickly the cancer is likely to spread in the future. A widely used staging system for bone cancer inthe UKuses 3 main stages: stage 1 the cancer is low-grade and has not spread beyond the bone stage 2 the cancer has still not spread beyond the bone, but is a high-grade stage 3 the cancer has spread into other parts of the body, such as the lungs Most cases of stage 1 bone cancer and some stage 2 bone cancers have a goodchance of being cured. Unfortunately, stage 3 bone cancer is more difficult to cure, although treatment can relieve symptoms and slow the spread of the cancer. Coping with a diagnosis Being toldyou have bone cancer can be a distressing and frightening experience. Receiving that type of news can be upsetting at any age, but can be particularly difficult if you are still in your teenage years, orif youre a parent of a child who has just been toldthey have bone cancer. These types of feelings can cause considerable stress and anxiety, which in some cases can trigger depression . If you think you may be depressed,your GP may be a good person to talk to about support and possiblytreatment. You may also find it useful to contact the Bone Cancer Research Trust , which is the UKs leading charity for people affected by bone cancer, if you need more information. If youre a teenager you may want to contact the Teenage Cancer Trust , which is a charity for teenagers and young adults affected by cancer. Read more about coping with a cancer diagnosis Treating bone cancer Treatment for bone cancer depends on the type of bone cancer you have, how far it has spread and your general health. The main treatments are surgery, chemotherapy and radiotherapy. Your treatment plan Your treatment should be managed by a specialist centre with experience in treating bone cancer, where youll be cared for by a team of different healthcare professionals known as a multi-disciplinary team (MDT). Members of the MDT will include an orthopaedic surgeon (a surgeon who specialises in bone and joint surgery), a clinical oncologist (a specialist in the non-surgical treatment of cancer) and a specialist cancer nurse, among others. Your MDT will recommend what they think is the best treatment for you, but the final decision will be yours. Your recommended treatment plan may include a combination of: surgery to remove the section of cancerous bone its often possible to reconstruct or replace the bone thats been removed, although amputation is occasionally necessary chemotherapy treatmentwith powerful cancer-killing medication radiotherapy whereradiation is used to destroy cancerous cells In some cases, a medication called mifamurtide may be recommended as well. Surgery Surgery to remove the cancerous area of bone is an important part of treatment for bone cancer, although its often combined with the other treatments mentioned below. Nowadays, its usually possible to avoid removing an affected body part completely (known as limb-sparing surgery), although up to 1 in every 10 people may need to have a limb permanently removed (amputation). Limb-sparing surgery Limb-sparing surgery is usually possible when the cancer has not spread beyond the bone, and the bone can be reconstructed. The most common type of limb-sparing surgery involves removing the section of affected bone and some of the surrounding tissue (in case any cancerous cells have spread into the tissue). The removed section of bonemay then bereplaced with a metal implant called a prosthesis or a piece of bone from elsewhere in your body (bone graft). If the cancer is near a joint, such as the knee, it may bepossible to remove the joint and replace it with an artificial one. Read more about knee joint replacement and hip joint replacement. Amputation Amputationmay be necessary if limb-sparing surgery is not possible or has not worked well. For example, it may be necessary if: the cancer has spread beyond the bone into major blood vessels or nerves you developed an infection after limb-sparing surgery and the prosthesis or bone graft had to be removed the cancer has developed in a part of the body where limb-sparing surgery is not technically possible, such as the ankle Your care team will understand the shock and fear that you, or your child, may be feeling if an amputation is needed and should be able to provide you withcounselling and other support. In some cases, your care team may be able to introduce you to someone who has already had an amputation. After an amputation, most people use an artificial limb to replace the limb thats removed. These limbs are now very advanced and convenient to use. For example, people with an artificial leg are often able to walk, run and play sport, and have an excellent quality of life. Recovering from surgery After limb-sparing surgery or an amputation, youll need help to return to normal life. This is known as rehabilitation. Rehabilitation will usually involve physiotherapysessions, where you carry out exercises to help regain proper function in the treated body part, and occupational therapy , where youre taught skills to help you cope with day-to-day activities. After an amputation, you may be referred to a local limb centre for advice, support and rehabilitation treatment.Read more about living with an amputation . Chemotherapy There are 4 ways chemotherapy can be used to treat bone cancer. It can be used: before surgery, to shrink the tumour and make surgery easier in combination with radiotherapy before surgery (chemoradiation) this approach works particularly well in the treatment of Ewing sarcoma after surgery, to prevent the cancer returning to control symptoms in cases where a cure is not possible (known as palliative chemotherapy) Chemotherapy for bone cancer involves taking a combination of different medications that are usually delivered via a drip into your vein, or into a line inserted into a bigger blood vessel. Thetreatment isusually given in cycles. A cycle involves taking the chemotherapy medication for several days, then having a break for a few weeks to allow your body to recover from the effects of the treatment. The number of cyclesyouneed will depend on the type and grade of your bone cancer. Side effects Chemotherapy can damage healthy cells as well as cancerous cells, which means it often causes a number of side effects. Common side effects of chemotherapy include: nauseaand vomiting diarrhoea mouth ulcers tiredness increased risk of catching infections temporary hair loss infertility Most side effects associated with chemotherapy should resolve once your treatment has finished. However, there is a riskyou will be permanently infertile. Your care team will provide more detailed information about the specific risk to your fertility. Read more about the side effects of chemotherapy Radiotherapy As with chemotherapy, radiotherapy can be used before and after surgery to treat bone cancer, or used to control the symptoms and slow the spread of cancer when a cure is not possible. Radiotherapy for bone cancer involves beams of radiation being directed at the cancerous section of bone by an external machine. This is normally given in daily sessions, 5 days a week, with each session lasting a few minutes. The whole course of treatment will usually last a few weeks. Side effects The radiation youre exposed to during radiotherapy will mostly be focused on the cancerous cells, but healthy cells nearby can also be damaged. This can lead toside effects such as: reddening and irritation of the skin (this can feel much like sunburn) joint pain in the part of the body that is being treated feeling sick hair loss in the body part being treated tiredness These side effects will pass once the radiotherapy has been completed, although feelings of tiredness may persist for several weeks. Read more about the side effects of radiotherapy Mifamurtide For people with a type of bone cancer called osteosarcoma, a medication called mifamurtide may be used alongside other treatments. Mifamurtide is an immune macrophage stimulant. This means it works by encouraging the immune system to produce specialised cellsthat kill cancerous cells. Its normally recommended for young people withhigh-grade osteosarcomas and is givenafter surgery, in combination with chemotherapy, to help prevent the cancer returning. Mifamurtide is slowly pumped into one of your veins over the course of an hour (known as infusion). The recommended course of treatment is usually twice a week for 12 weeks, and then once a week for a further 24 weeks. Side effects Mifamurtide can cause a wide range of side effects. These can include: nausea and vomiting diarrhoea or constipation headache dizziness loss of appetite tiredness and weakness Its unclear whether its safe to take mifamurtide during pregnancy, so as a precaution its importanttouse an effective method of contraception if youre a sexually active woman. You will need to tell your MDT as soon as possible if youthink yourepregnant, and you should avoid breastfeeding while taking mifamurtide. Follow-up Once your treatment has finished, youll need to attend regular follow-up appointments to checkthe cancer hasnt returned. Youll be asked to attend frequent appointments in the first two years after treatment has finished possibly every 3 months.These willbecome less frequent as the years go on. Contact your specialist or GP if you develop symptoms of bone cancer again and think the cancer may have come back. Source: NHS 24 - Opens in new browser window Last updated: 13 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Ewing sarcoma Radiotherapy Chemotherapy Other health sites Bone Cancer Research Trust Cancer Research UK: Bone cancer Teenage cancer trust Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852']

Bone cancer: Teenagers and young adults

Bone cancer: Teenagers and young adults | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in teenagers and young adults Bone cancer: Teenagers and young adults Bone cancer: Teenagers and young adults Introduction The bones Tests for bone cancer Treating bone cancer Life after treatment for bone cancer Introduction This section about bone cancer is for teenagers and young adults. There are different types of bone cancer, and most of this information applies to all types. If you have a rare type of bone cancer and want to know more, you could talk to Macmillan . If youre looking for information about bone cancer in people of all ages, read our general bone cancer section. Types of bone cancer There are different types of bone cancer. The2 most common bone cancers to affect teenagers are osteosarcoma and Ewing sarcoma. Osteosarcoma Osteosarcomas are most likely to affect bones in the leg, especially around the knee joint, but they can affect any bone. Ewing sarcoma Ewing sarcoma can affect any bone, but its most common in the pelvis (which is made up of the tail bone and the2 hip bones), or in leg bones. Ewing sarcoma can sometimes start outside the bone in the soft tissue. This is called soft tissue Ewing sarcoma, and is treated in the same way. Sarcoma is the name for a cancer that starts in any connective tissue, such as muscle, fat or cartilage. In this information we sometimes use the term bone tumour. This means the same as bone cancer. Causes The cause of bone cancer is unknown. Because its more common in young people, doctors think that it may be linked to the changes that happen when bones are growing. There is lots of ongoing research into the possible causes. People often think a knock or injury might have caused bone cancer, but theres no evidence for this. Remember that nothing youve done has caused the cancer. Signs and symptoms of bone cancer Bone cancer symptoms vary, and not everyone will feel the same. Many symptoms are similar to everyday aches and pains, so they can be mistaken for other things, like strains, sports injuries or growing pains. The main symptoms are: painor tenderness this may start as an ache that doesnt go away and may be made worse by exercise or feel worse at night swelling around the affected area of bone swelling may not show up until the tumour is quite large and it isnt always possible to see or feel a lump if the affected bone is deep inside the body reduced movement if the bone tumour is near a joint (like an elbow or knee), it can make it harder to move the joint; if its in a leg bone, it may cause a limp; if its in the backbone (spine), it may press on nerves and cause tingling and numbness in the legs or arms abroken bone a bone may break suddenly, or after only a minor fall or accident if the bone has been weakened by cancer. There might also be other symptoms including: tiredness ahigh temperature loss of appetite weight loss If you have any of these symptoms, or you are worried that you may have a bone tumour, you should get it checked by your GP. They can talk to you about your symptoms, and arrange tests if they feel theyre needed. Remember most people with these symptoms wont have bone cancer. The bones Knowing what your bones do might help you understand what bone cancer is. Bones are like human scaffolding. They help keepyou upright. The human skeleton is made up of more than 200 bones of different shapes and sizes. Bones do lots of important things: they work with joints and connective tissue so thatyou can move around they protect parts of the body from injury for example, the ribs protect the heart and lungs they store calcium some bones contain bone marrow, which make blood cells Joints Joints help bones fit together so that we can move freely. There are different types of joint. Some work as levers, like the finger joint. Others are ball-and-socket joints, such as the hip joint. There are different types of connective tissue that help bones move: ligaments are tough cords of tissue that attach bones to each other cartilage is a slippery material that covers the ends of bones to stop them rubbing together muscles are made of tough, stretchy tissueand give strength tendons are strong cords of tissue that attach muscles to bones We also have more information about: symptoms of bone cancer having tests for bone cancer treatment for bone cancer life after bone cancer If youre looking for information about bone cancer in people of all ages, read our general bone cancer section. Tests for bone cancer There are some tests you might have when you visit your GP or at the hospital. The tests will help the doctors see whether you have bone cancer. Visiting your GP If you think you might have some of the symptoms of bone cancer , you should speak to your GP. Your GP will talk to you about your symptoms, examine you and usually arrange some tests, such as X-rays and blood tests. There may be a number of reasons why youre feeling unwell, so it can be difficult to diagnose the problem straight away. If your GP cant find the cause, you may be referred to a specialist at the hospital. At the hospital The hospital youre referred to will depend on the results of the tests. You may go straight to a doctor specialising in bone cancer, or you might see doctors with more general experience first. The hospital doctor will examine you and arrange for some of the following tests: X-rays bone scans biopsies MRI and/or CT scans If youre diagnosed with bone cancer and not already seeing a specialist bone doctor, youll be referred to one. Further tests If the tests show you have bone cancer, you might need a few more tests to check how your body is working in general: blood tests tests to check your heart is healthy chest X-rays to check your lungs are healthy tests to check your kidneys are healthy you may need to give a sample ofpee (urine) to be tested This may seem like a lot of tests, but theyll help the doctors plan the best treatment for you. Having tests and waiting for the results can be an anxious time. Talking about how you feel and getting support from family, friends, your specialist nurse or your doctor can help. We have more information about: the bones symptoms of bone cancer treatment for bone cancer life after bone cancer If youre looking for information about bone cancer in people of all ages, read our general bone cancer section. Treating bone cancer The information on this page is about Ewing sarcoma and osteosarcoma. If you have a different type of bone cancer and want to know more, you can talk to Macmillan . The3 main treatments for bone cancer are chemotherapy , surgery and radiotherapy . Most people have a combination of these. Your doctors will plan your treatment based on: the type of bone cancer you have where the cancer is the stage of the cancer (this means whether it has spread outside the bone) how fast-growing the cancer is If you have any questions about your treatment, ask your doctor or nurse. Theyll be happy to help you understand whats involved. You may be offered the opportunity to take part in a clinical research trial. These trials help doctors find new and better treatments for people with bone cancer. If your doctor thinks you are suitable for a clinical trial, theyll discuss this with you. In this information we sometimes use the term bone tumour. This means the same as bone cancer. Chemotherapy Chemotherapy is when youre given anti-cancer drugs to destroy the cancer cells. Its an important treatment for bone tumours. It helps shrink the tumour before surgery or radiotherapy, and it can kill cells that have spread outside the bone. After your surgery or radiotherapy, youll usually have more chemotherapy. Chemotherapy for bone cancer is given into a vein, usually through a central line, a port or a PICC line. Youll have chemotherapy over a few days and then youll have some time off to give your body a chance to recover from any side effects. The days you have the chemotherapy and the rest period afterwards is called a cycle. Most people have several cycles of chemotherapy. Youll probably need to stay in hospital for some of the time during chemotherapy. The type of chemotherapy you have depends on whether the tumour is an Ewing sarcoma or an osteosarcoma. Chemotherapy for Ewing sarcoma For Ewing sarcoma, the drugs most often used first are vincristine, ifosfamide, doxorubicin and etoposide. Giving these drugs together is called VIDE. Youll usually have6 cycles of VIDE. After your chemotherapy you may have surgery, or, if the tumour cant be removed with an operation, youll have radiotherapy. Some people have both surgery and radiotherapy. The team looking after you will decide on the best combination for you. If you have surgery, youll have more chemotherapy afterwards to help stop the tumour coming back or spreading to other parts of the body. At the moment, there is a clinical trial called Euro-Ewing 2012 that is comparing different combinations of chemotherapy treatments before and after surgery for people with Ewing sarcomas. You can talk to your specialist doctor about whether you could take part in this trial. Chemotherapy for osteosarcoma Osteosarcoma is usually treated with3 chemotherapy drugs called methotrexate, doxorubicin (Adriamycin) and cisplatin. Giving these drugs together is called MAP. You will usually have6 cycles of chemotherapy in total. Each cycle takes about5 weeks. After the first2 cycles, youll have surgery to remove the cancer. If the cancer has spread, you may also need to have surgery on another part of your body. For example, if osteosarcoma spreads outside of the main tumour, it usually spreads to the lungs. If the cancer has spread to your lungs, you may need a second operation to remove the cancer in your lungs. If you have bone cancer thats spread, your doctors will talk to you about what will happen next. After surgery, youll have4 more cycles of MAP chemotherapy. You may also be given a new treatment called mifamurtide (Mepact), which helps your body kill tumour cells.Your doctor will tell you if you can have this drug as well as your chemotherapy. Side effects Different chemotherapy drugs cause different side effects. Some people have just a few side effects and others have more. Its hard to know how its going to be for you. Most side effects are temporary and gradually disappear once treatment stops. The most common are a sore mouth, hair loss , tiredness, sickness and being more at risk of getting an infection. The most common side effect of mifamurtide is having a high temperature or feeling cold and shivery for a few hours after its given. Surgery The surgery you have will depend on the type of bone cancer you have and where it is in the body. Your surgeon will aim to remove all of the cancer, while trying to keep as much function in the limb as possible. Limb-sparing surgery Most people with bone cancer have an operation called limb-sparing surgery. This means the surgeon removes the cancer without having to remove the arm or leg its in. Youll have all the tumour taken away from your limb, including any bone and muscle affected by the tumour. Its usually possible to remove the affected part of the bone and replace it with a custom-made metal fitting (endoprosthesis) or with a bone from another part of the body (bone graft). If the cancer affects a bone in or near a joint, the whole joint can often be replaced with an artificial one.In some cases, the surgeon can remove the affected bone without replacing it with anything and without it affecting the way you move. Before the operation If youve had chemotherapy, youll need2 or3 weeks to recover before you can have your operation. Doctors will make sure that youre well enough to have the operation. If youve lost weight or been off your food, you might need to build yourself up a bit before the operation. The hospital dietitian can help you do this. Youll probably see a physiotherapist, wholl give you exercises to strengthen your muscles. You may like to see the replacement part or endoprosthesis (often just called a prosthesis) that will be put in during your operation. If you would like to see it, your surgeon or key worker can usually arrange this. After the operation Youll have a bandage or splint on your limb to keep it supported and let it heal. Youll probably have a tube, called a drain, coming out of your wound. This stops fluid building up in your wound. A nurse will take it out after about 3 to 4 days. You wont feel like eating or drinking much for a few hours after your operation, so youll be given fluids into a vein. This is called a drip. Youll probably feel a bit sore to begin with, but youll be given strong painkillers to help. Its important to tell the nurses if you need extra pain relief. The pain usually starts to get better within 2 or 3 days. As time goes on, youll need fewer painkillers and will start to feel a lot more comfortable. Once youre home, you should start to feel a bit better and stronger every day. But if you do have any problems, its important to tell your doctor or nurse right away, so they can deal with them quickly. After your operation, you will need to do lots of physiotherapy to help you make the best possible recovery. This can feel like hard work but is really important. Your physiotherapist will tell you what exercises to do, and help you to do them regularly. If you notice any new redness, pain or swelling in the limb thats been operated on, its very important to get in touch with your doctor right away. You might have an infection that needs treatment, so youll need to see the surgeon who did your operation without delay. Theres more information about the long-term effects of limb-sparing surgery in our section on living with and after bone cancer . Amputation Sometimes the only way to get rid of the bone cancer affecting an arm or a leg is to remove the limb. This is called an amputation. Its only done if there is no alternative. This is usually needed if the cancer has spread from the bone and has grown around nearby blood vessels. These need to be removed along with the cancer. Some people choose to have an amputation rather than limb-sparing surgery. You should be given a chance to discuss the advantages and disadvantages of both types of surgery with your team. An amputation may also need to be done if theres an infection in the bone that doesnt go away with treatment, or if the cancer comes back in the bone. Every person and every tumour is different, so you might meet other people with the same type of tumour, who are having slightly different surgery. Your specialist will talk to you about your operation and make sure you understand whats involved. Before the operation Your doctor will talk things through with you so that you fully understand whats involved. Losing a limb can feel very scary and it might help to talk to your specialist nurse, key worker or a counsellor about your feelings. It might also help to talk to someone whos had an amputation your nurse or doctor can arrange this. Its really important to get support at this tough time. After the operation Youll have bandages or a plaster cast on the area thats been operated on. Therell be a tube, called a drain, coming from the wound. This stops fluid building up. A nurse will usually take it out after 3 or 4 days. Youll also have a drip to give you fluid into a vein in your arm until you feel like eating and drinking again. Youll probably feel a bit sore after your op, especially for the first 2 or 4 days, but youll be given strong painkillers to help with this. Its important to tell the nurses if you need extra pain relief. As time goes on, youll need fewer painkillers and will start to feel a lot more comfortable. You may have pain that feels like its coming from the part of the limb thats been removed. This is known as phantom pain. Let your doctor or nurse know if you have this. There are medicines that can help ease it or take it away. It usually gets better and goes away in time. A physiotherapist will visit you a day or so after your operation. Theyll show you exercises to keep your muscles strong and flexible. If youve had an arm removed, youll be able to get up and move around once youve recovered from the anaesthetic and dont feel too sore. If youve had a leg removed, the physiotherapist will show you how to move around in bed and get from your bed to a chair. Youll probably be moving around with crutches or in a wheelchair within a few days. Once youre up and about, youll go to the hospital gym for physiotherapy. This is a big part of your recovery. Your physiotherapist will give you more exercises to do as your wound heals and you get stronger. Itll take a few months for your limb to heal to its final shape after the operation, so you wont be fitted with your permanent prosthesis until this happens. In the meantime, youll be given a temporary prosthesis and learn how to use it in physiotherapy. You should be able to go home about2 weeks after your operation. Theres more information about the long-term effects of amputation in our section on living with and after bone cancer . Radiotherapy Radiotherapy treats cancer by using high-energy X-rays to destroy cancer cells. Radiotherapy is mainly used to treat Ewing sarcoma. You may have radiotherapy after your chemotherapy, or before or after having surgery. If you have osteosarcoma, youre less likely to have radiotherapy treatment. But you might have it if an operation to remove the cancer isnt possible. Occasionally, people with osteosarcoma have radiotherapy after surgery to remove their cancer. Radiotherapy is generally given every weekday (Monday to Friday) for5 weeks. Each treatment takes a few minutes. Side effects Radiotherapy isnt painful, but it can cause other side effects. After a few treatments you may begin to feel tired, and your skin may go red or get darker and feel sore or itchy around the area thats being treated. This gets better once your radiotherapy treatment is over. Other side effects depend on which part of your body is being treated. Having radiotherapy around a joint can make it feel stiff, but physiotherapy can help. We also have more information about: symptoms of bone cancer having tests for bone cancer life after bone cancer the bones If youre looking for information about bone cancer in people of all ages, read our general bone cancer section. Life after treatment for bone cancer This information is about life after having surgery for bone cancer . Life after limb-sparing surgery The long-term effects of limb-sparing surgery depend on which part of your body is affected and what kind of operation you have. The best person to ask about this is your surgeon. After limb-sparing surgery, the limb might not work as well as it used to. Physiotherapy is an important part of your recovery. Youll be given exercises to do to help you get your limb working as well as possible. These can be hard work, but its important to keep going with them. Knee joint replacement If youve had a knee joint replacement, youll be able to walk and swim, but your doctor might advise you not to play high-impact sports like hockey, football, tennis or rugby. These activities could damage or loosen the new joint. Its usuallyOK to run a short distance, for example for a bus. But running or jogging regularly wears out the new joint, so its best to avoid this. If your knee joint wears out or loosens, you might need to have it replaced after a few years. Hip joint replacements After a hip joint replacement, you should be able to do most of your usual activities, but youll probably be advised to avoid running and high-impact sports. Shoulder replacement If youve had a shoulder replacement, youll be able to move your arm below shoulder height the same as before, but you might not be able to lift your arm above your shoulder. Bone graft If youve had an implant put into your limb while youre still growing, youll need to have it lengthened as your leg or arm grows. Some types of implant can be lengthened without an operation, but with others youll need surgery. Your specialist or key worker can tell you what kind of implant you have. Life after amputation After amputation, you usually have an artificial limb fitted. This is called a prosthesis. There are artificial limbs designed to let you do all types of physical activities, including walking, swimming, running, cycling and playing sports. Different types of prosthesis let you do different things. Some people have one for wearing day-to-day, and an extra one specially designed for something like swimming or doing athletics. How will I feel? Things may be tough as you get used to living with the changes in your body, but help is available. You might have lots of different emotions. You might be tearful, angry, fed up or sad at times. You might feel like youve lost all your confidence and that youll never be able to live a normal life or be in a relationship. These feelings are normal, and its important to get support to help you cope with them. You could talk to: your specialist nurse or key worker family or friends a counsellor, which can be arranged by your nurses other young people in a similar situation Other peoples reactions can be hard to cope with too. You might be worried about what your friends think or how theyre going to treat you. The thought of going back to school, college or work can be scary. Even people in your family who you are close to might not know what to say or do. Others might say things that sound stupid or seem hurtful. Try to choose a couple of really close relatives or friends who you can talk to if things get you down. You might find it useful to talk to someone outside your close circle, like your specialist nurse, key worker or counsellor. Most people find it helps to talk about how theyre feeling or whats on their mind. Follow-up When you finish your treatment, your doctor will talk to you about what happens next. They will explain some of the long-term risks that bone cancer and its treatment could have for you. They will make arrangements to see you in a clinic to see how you are getting on. We have more info about: the bones symptoms of bone cancer having tests for bone cancer treatment for bone cancer If youre looking for information about bone cancer in people of all ages, read our general bone cancer section. Source: Macmillan - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852']

Bowel cancer

Bowel cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Bowel cancer Bowel cancer About bowel cancer Signs and symptoms of bowel cancer Causes of bowel cancer Diagnosing bowel cancer Treating bowel cancer Living with bowel cancer Preventing bowel cancer About bowel cancer Bowel cancer is a general term for cancer that begins in the large bowel. Depending on where the cancer starts, bowel cancer is sometimes called colon or rectal cancer. Cancer can sometimes start in the small bowel (small intestine), but small bowel cancer is much rarer than large bowel cancer. Bowel cancer is one of the most common types of cancer diagnosed in the UK. Signs and symptoms The 3 main symptoms of bowel cancer are blood in the stools (faeces), changes in bowel habit such as more frequent, looser stools and abdominal (tummy) pain . However, these symptoms are very common and most people with them do not have bowel cancer. For example, blood in the stools is more often caused by haemorrhoids (piles), and a change in bowel habit or abdominal pain is usuallythe result ofsomething you have eaten. As almost 9out of 10 people with bowel cancer are over the age of 60, these symptoms are more important as people get older. They are also more significant when they persist despite simple treatments. Most people who are eventually diagnosed with bowel cancer have one of the following combinations ofsymptoms: a persistent change in bowel habit that causes them to go to the toilet more often and pass looser stools, usually together with blood on or in their stools a persistent change in bowel habit without blood in their stools, but with abdominal pain blood in the stools without other haemorrhoid symptoms, such as soreness, discomfort, pain, itching or a lump hanging down outside the back passage abdominal pain, discomfort or bloating always provoked by eating, sometimes resulting in a reduction in the amount of food eaten and weight loss The symptoms of bowel cancer can be subtle and dont necessarily make you feel ill. When to seek medical advice Read about the symptoms ofbowel cancer , and when you should see your GP to discuss whether any tests are necessary. Your doctor will probably carry out a simple examination of your tummy and bottom to make sure you have no lumps. They may alsoarrange for a simple blood test to check foriron deficiency anaemia. This can indicate whether there is any bleeding from your bowel that you havent been aware of. In some cases, your doctor may decide it is best for you to have a simple test in hospital to make sure there is no serious cause for your symptoms. Make sure you return to your doctor if your symptoms persist or keep coming back after stopping treatment, regardless of their severity or your age. Read more about diagnosing bowel cancer Whos at risk? Its not known exactly what causes bowel cancer, but there are a number of things that can increase your risk. These include: age almost9 in 10 cases of bowel cancer occur in people aged 60 or over diet a diet high in red or processed meats and low in fibre can increase your risk weight bowel cancer is more common in people who are overweight or obese exercise being inactive increases the risk of getting bowel cancer alcohol and smoking a high alcohol intake and smoking may increase your chances of getting bowel cancer family history having a close relative (mother or father, brother or sister) who developed bowel cancerunder the age of50 puts you at a greater lifetime risk of developing the condition Some people have an increased risk of bowel cancer because they have another condition that affects their bowel, such as severe ulcerative colitis or Crohns disease , over a long period of time. Read more about the causes of bowel cancer and preventing bowel cancer Bowel cancer screening Bowel screening is offered to men and women aged 50 to 74 across Scotland to help find bowel cancer early when it can often be cured. Bowel screening involves taking a simple test at home every 2 years. The test looks for hidden blood in your poo, as this could mean a higher chance of bowel cancer. Read more about screening for bowel cancer Treatment Bowel cancer can be treated using a combination of different treatments, depending on where the cancer is in your bowel and how far it has spread. The main treatments are: surgery the cancerous section of bowel is removed; it is the most effective way of curing bowel cancer, and is all that many people need chemotherapy where medication is used to kill cancer cells radiotherapy where radiation is used to kill cancer cells biological treatments a newer type of medication that increases the effectiveness of chemotherapy and prevents the cancer spreading As with most types of cancer, the chances of a complete cure depends on how farithas advanced by the time it is diagnosed. Read more about how bowel cancer is treated and living with bowel cancer Signs and symptoms of bowel cancer The 3 main symptoms of bowel cancer are blood in the stools (faeces), a change in bowel habit, such as more frequent, looser stools, and abdominal (tummy) pain . However, these symptoms are very common. Blood in the stools is usually caused by haemorrhoids (piles), and a change in bowel habit or abdominal pain is often the result ofsomething you have eaten. In the UK, an estimated 7 million people have blood in the stools each year. Even more people have temporary changes in their bowel habits and abdominal pain. Most people with these symptoms do not have bowel cancer. As the vast majority of people with bowel cancer are over the age of 60, these symptoms are more important as people get older.These symptomsare also more significant when they persist in spite of simple treatments. Most patients with bowel cancer present with one of the following symptom combinations: a persistent change in bowel habit, causing them to go to the toilet more often and pass looser stools, usually together with blood on or in their stools a persistent change in bowel habit without blood in their stools, but with abdominal pain blood in the stools without other haemorrhoid symptoms, such as soreness, discomfort, pain, itching, or a lump hanging down outside the back passage abdominal pain, discomfort or bloating always provoked by eating, sometimes resulting in a reduction in the amount of food eaten and weight loss The symptoms of bowel cancer can be subtle and dont necessarily make you feel ill. When to seek medical advice Read about the symptoms ofbowel cancer , and when you should see your GP to discuss whether any tests are necessary. Your doctor will probably perform a simple examination of your tummy and bottom to make sure you have no lumps, as well asa simple blood test to check for iron deficiency anaemia . This can indicate whether there is any bleeding from your bowel you havent been aware of. In some cases, your doctor may decide it is best to have a simple test in hospital to make sure there is no serious cause for your symptoms. Make sure you return to your doctor if your symptoms persist or keep coming back after stopping treatment, regardless of their severity or your age. Read more about diagnosing bowel cancer Bowel obstruction In some cases, bowel cancer can stop digestive waste passing through the bowel. This is known as a bowel obstruction. Symptoms of a bowel obstruction can include: severe abdominal pain, which may initially come and go not being able to pass stools when you go to the toilet noticeable swelling or bloating of the tummy vomiting A bowel obstruction is a medical emergency. If you suspect your bowel is obstructed, you should see your GP quickly. If this isnt possible, go to the accident and emergency (A&E) department of your nearest hospital. Read further information: Beating Bowel Cancer: symptoms Bowel Cancer UK: symptoms of bowel cancer Cancer Research UK: bowel cancer symptoms Causes of bowel cancer Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour. Most cases of bowel cancer first develop inside clumps of cells on the inner lining of the bowel. These clumps are known as polyps . However, if you develop polyps, it does not necessarily mean you will get bowel cancer. Exactly what causes cancer to develop inside the bowel is still unknown. However, research has shown several factors may make you more likely to develop it. Age Your chances of developing bowel cancer increase as you get older. Almost9 out of 10 cases of bowel cancer in the UK are diagnosed in people over the age of 60. Family history Having a family history of bowel cancer can increase your risk of developing the condition yourself, particularly if a close relative (mother, father, brother or sister) was diagnosed with bowel cancer below the age of 50. If you are particularly concerned that your familys medical history may mean you are at an increased risk of developing bowel cancer, it may help to speak to your GP. If necessary, your GP can refer you to a genetics specialist, who can offer more advice about your level of risk and recommend any necessary tests to periodically check for the condition. Diet A large body of evidence suggests a diet high in red and processed meat can increase your risk of developing bowel cancer. For this reason, the Department of Health advises people who eat more than 90g (cooked weight) a day of red and processed meat cut down to 70g a day. Read more about red meat and bowel cancer risk There is also evidence thatsuggests a diet high in fibre could help reduce your bowel cancer risk. Read more about eating good food and a healthy diet Smoking People who smoke cigarettes are more likely to develop bowel cancer, other types of cancer, and other serious conditions, such as heart disease . Read more about stopping smoking Alcohol Drinking alcohol has been shown to be associated with an increased risk of bowel cancer, particularly if you regularly drink large amounts. Read about alcohol for information and tips on cutting down Obesity Being overweight or obese is linked to an increased risk of bowel cancer, particularly in men. If you are overweight or obese, losing weight may help lower your chances of developing the condition. Inactivity People who are physically inactive have a higher risk of developing bowel cancer. You can help reduce your risk of bowel and other cancers by being physically active every day. Read more about health and fitness Digestive disorders Some conditions affecting the bowel may put you at a higher risk of developing bowel cancer. For example, bowel cancer is more common in people who have had severe Crohns disease or ulcerative colitis for many years. If you have one of these conditions, you will usually have regular check-ups to look for signs of bowel cancer from about 10 years after your symptoms first develop. Check-ups will involve examining your bowel with a colonoscopea long, narrow flexible tubethat containsa small camerathat is inserted into your rectum. The frequency of the colonoscopy examinations will increase the longer you live with the condition, and will also depend on factors such as how severe your ulcerative colitis is and if you have a family history of bowel cancer. Genetic conditions There are two rare inherited conditions that can lead to bowel cancer. They are: familial adenomatous polyposis (FAP) a condition that triggers the growth of non-cancerous polyps inside the bowel hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome an inherited gene fault (mutation) that increases your bowel cancer risk Although the polyps caused by FAP are non-cancerous, there is a high risk that, over time, at least one will turn cancerous. Most people with FAP will have bowel cancer by the time they are 50. As people with FAP have such a high risk of getting bowel cancer, they are often advised by their doctor to have their large bowel removed before they reach the age of 25. Families affected can find support and advice from FAP registries such as The Polyposis Registry provided by St Marks Hospital, London. Removing the bowel as a precautionary measure is also usually recommended in people with HNPCC because the risk of developing bowel cancer is so high. Read further information: Bowel Cancer UK: Risk factors Bowel Cancer UK: Diet Diagnosing bowel cancer When you first see your GP, they will ask about your symptoms and whether you have a family history of bowel cancer. They will then usually carry out a simple examination of your abdomen (tummy) and your bottom, known as a digital rectal examination (DRE). This is a useful way of checking whether there are any lumps in your tummy or back passage. The tests can be uncomfortable, and most people find an examination of the back passage a little embarrassing, but they take less than a minute. If your symptoms suggest you may have bowel cancer or the diagnosis is uncertain, you will be referred to your local hospital initially for a simple examination called a flexible sigmoidoscopy. In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of bowel cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected bowel cancer, read the NICE 2015 guidelines on suspected cancer: recognition and referral . Flexible sigmoidoscopy A flexible sigmoidoscopy is an examination of your rectum and some of your large bowel using a device called a sigmoidoscope. A sigmoidoscope is a long, thin, flexible tube attached to a very small camera and light. It is inserted into your rectum and up into your bowel. The camera relays images to a monitor, and can also be used to take biopsies , where a small tissue sample is removed for further analysis. It is better for your lower bowel to be as empty as possible when sigmoidoscopy is performed, so you may be asked to carry out an enema a simple procedure to flush your bowels at home beforehand. This should be used at least two hours before you leave home for your appointment. A sigmoidoscopy can feel uncomfortable, but it only takes a few minutes and most people go home straight after the examination. More detailed tests Most people with bowel cancer can be diagnosed by flexible sigmoidoscopy. However, some cancers can only be diagnosed by a more extensive examination of the colon. The two tests used for this are colonoscopy and computerised tomography (CT) colonography. Colonoscopy A colonoscopy is an examination of your entire large bowel using a device called a colonoscope, which is like a sigmoidoscope but a bit longer. Your bowel needs to be empty when a colonoscopy is performed, so you will be advised to eat a special diet for a few days beforehand and take a laxative (medication to help empty your bowel) on the morning of the examination. You will be given a sedative to help you relax during the test, after which the doctor will insert the colonoscope into your rectum and move it along the length of your large bowel. This is not usually painful, but can feel uncomfortable. The camera relays images to a monitor, which allows the doctor to check for any abnormal areas within the rectum or bowel that could be the result of cancer. As with a sigmoidoscopy, a biopsy may also be performed during the test. A colonoscopy usually takes aboutan hour to complete, and most people can go home once they have recovered from the effects of the sedative. After the procedure, you will probably feel drowsy for a while, so you will need to arrange for someone to accompany you home. It is best for elderly people to have someone with them for 24 hours after the test. You will be advised not to drive for 24 hours. In a small number of people, it may not be possible to pass the colonoscope completely around the bowel, and it is then necessary to have CT colonography. Find out more about whata colonoscopy involves CT colonography CT colonography, also known as a virtual colonoscopy, involves using a computerised tomography (CT) scanner to produce three-dimensional images of the large bowel and rectum. During the procedure, gas is used to inflate the bowel using a thin, flexible tube placed in your rectum. CT scans are then taken from a number of different angles. As with a colonoscopy, you may need to have a special diet for a few days and take a laxative before the test to ensure your bowels are empty when the test is carried out. This test can help identify potentially cancerous areas in people who are not suitable for a colonoscopybecause ofother medical reasons. A CT colonography is a less invasive test than a colonoscopy, but you may still need to have colonoscopy or flexible sigmoidoscopy at a later stage so any abnormal areas can be removed or biopsied. Read further information: Bowel Cancer UK: Diagnosis Cancer Research UK:Getting diagnosed Macmillan Cancer Support:Symptoms of bowel cancer Further tests If a diagnosis of bowel cancer is confirmed, further testing is usually carried out to check if the cancer has spread from the bowel to other parts of the body.These tests also help your doctors decide on the most effective treatment for you. These tests can include a: CT scan of your abdomen and chest this will check if the rest of your bowel is healthy and whether the cancer has spread to the liver or lungs magnetic resonance imaging (MRI) scan this can provide a detailed image of the surrounding organs in people with cancer in the rectum Staging and grading Once the above examinations and tests have been completed, it should be possible to determine the stage and grade of your cancer. Staging refers to how far your cancer has advanced. Grading relates to how aggressive your cancer isand howlikely it isto spread. This is important, as it helps your treatment team choose the best way of curing or controlling the cancer. A number of different staging systems are used by doctors. stage 1 the cancer is still contained within the lining of the bowel or rectum stage 2 the cancer has spread beyond the layer of muscle surrounding the bowel and may have penetrated the surface covering the bowel or nearby organs stage 3 the cancer has spread into nearby lymph nodes stage 4 the cancer has spread beyond the bowel into another part of the body, such as the liver There are 3 grades of bowel cancer: grade 1 a cancer that grows slowly and has a low chance of spreading beyond the bowel grade 2 a cancer that grows moderately and has a medium chance of spreading beyond the bowel grade 3 a cancer that grows rapidly and has a high chance of spreading beyond the bowel If you are not sure what stage or grade of cancer you have, ask your doctor. Treating bowel cancer Ifcolon cancer is at a very early stage, it may be possible to remove just a small piece of the lining of the colon wall. This is known as local excision. If the cancer spreads intomuscles surrounding the colon, it will usually be necessary to remove an entire section of your colon.This is known as a colectomy. There are 2 ways a colectomy can be performed: an open colectomy where the surgeon makes a large cut (incision) in your abdomen and removes a section of your colon a laparoscopic (keyhole) colectomy where the surgeon makes a number of small incisions in your abdomen and uses special instruments guided by a camera to remove a section of colon During surgery, nearby lymph nodes are also removed. It is usual to join the ends of the bowel together after bowel cancer surgery, but very occasionally this is not possible and a stoma is needed. Both open and laparoscopic colectomies are thought to be equally effective at removing cancer and have similar risks of complications. However, laparoscopic colectomies have the advantage of a faster recovery time and less postoperative pain. It is becoming the routine way of doing most of these operations. Laparoscopic colectomies should be available in all hospitals that carry out bowel cancer surgery, although not all surgeons perform this type of surgery. Discuss your options with your surgeon to see if this method can be used. Surgery for rectal cancer There are a number of different types of operation that can be carried out to treat rectal cancer, depending on how far the cancer has spread. Some of the main techniques used are described below: Local resection If you have a very small, early-stage rectal cancer, your surgeon may be able to remove it in an operation called a local resection (transanal resection). The surgeon puts an endoscope in through your back passage and removes the cancer from the wall of the rectum. Total mesenteric excision In many cases, however, a local resection is not possible. Instead, a larger area of the rectum will need to be removed. This area willinclude a border of rectal tissue free of cancer cells, as well as fatty tissuefrom around the bowel(the mesentery). This type of operation is known as total mesenteric excision (TME). Removing the mesentery can help ensure all the cancerous cells are removed, which can lower the risk of the cancer recurring at a later stage. Depending on where in your rectum the cancer is located, one of two main TME operations may be carried out. Low anterior resection Low anterior resection is a procedure used to treat cases where the cancer is in the upper section of your rectum. The surgeon will make an incision in your abdomen and remove the upper section of your rectum, as well as some surrounding tissue to make sure any lymph glands containing cancer cells are also removed. They will then attach your colon to the lowest part of your rectum or upper part of the anal canal. Sometimes they turn the end of the colon into an internal pouch to replace the rectum. You will probably require a temporary stomato give the joined section of bowel time to heal. Abdominoperineal resection Abdominoperineal resection is used to treat cases where the cancer is in the lowest section of your rectum. In this case, it will be necessary to remove the whole of your rectum and surrounding muscles to reduce the risk of the cancer regrowing in the same area. This involves removing and closing the anus and removing its sphincter muscles, so there is no option except to have a permanent stoma after the operation. Bowel cancer surgeons always do their best to avoid giving people permanent stomas wherever possible. Stoma surgery Where a section of the bowel is removed and the remaining bowel joined, the surgeon may sometimes decide to divert your stool away from the join to allow it to heal. The stool is temporarily diverted by bringing a loop of bowel out through the abdominal wall and attaching it to the skin this is called a stoma. A bag is worn over the stoma to collect the stool. When the stoma is made from the small bowel (ileum) it is called an ileostomy , and when it is made from thelarge bowel (colon) it is called a colostomy . A specialist nurse, known as a stoma care nurse, can advise you on the best site for a stomaprior to surgery. The nurse will take into account factors such as your body shape and lifestyle, although this may not be possible where surgery is performed in an emergency. Inthe first few daysafter surgery, the stoma care nurse will advise on the care necessary to look after the stoma and the type of bag suitable. Once the join in the bowel has safely healed, which can take several weeks, the stoma can be closedduring further surgery. In some people, for various reasons, rejoining the bowel may not be possible or may lead to problems controlling bowel function, and the stoma may become permanent. Before having surgery, the care team will advise you about whether it may be necessary to form an ileostomy or colostomy, and the likelihood of this being temporary or permanent. There are patient support groups available that provide support for patients who have just had or are about to have a stoma. You canget moredetails fromyour stoma care nurse, or visit the groupsonline for further information. Ileostomy and Internal Pouch Support Group provides a unique visiting service for anyone wishing to speak with someone who has been through similar surgery Learn more about coping with a stoma after bowel cancer Side effects of surgery Bowel cancer operations carry many of the same risks as other major operations, including bleeding, infection, developing blood clots, or heart or breathing problems. The operations all carry a number of risks specific to the procedure. One risk is that the joined-up section of bowel may not heal properly and leak inside your abdomen. This is usually only a risk in the first few days after the operation. Another risk is for people having rectal cancer surgery. The nerves that control urinationand sexual function are very close to the rectum, and sometimessurgery to remove rectal cancer can damage these nerves. After rectal cancer surgery, most people need to go to the toilet to open their bowels more often than before, althoughthis usually settles down within a few months of the operation. Radiotherapy There are 2 main ways radiotherapy can be used to treat bowel cancer. It can be given before surgery to shrink rectal cancers and increase the chances of complete removal, or be used to control symptoms and slow the spread of cancer in advanced cases (palliative radiotherapy). Radiotherapy given before surgery for rectal cancer can be performed in 2 ways: external radiotherapy where a machine is used to beam high-energy waves at your rectum to kill cancerous cells internal radiotherapy (brachytherapy) where a radioactive tube is inserted into your anus and placed next to the cancer to shrink it External radiotherapy is usually given daily, 5 days a week, with a break at the weekend. Depending on the size of your tumour, you may need 1 to 5 weeks of treatment. Each session of radiotherapy is short and will only last for 10 to 15 minutes. Internal radiotherapy can usually be performed in one session before surgery is carried out a few weeks later. Palliative radiotherapy is usually given in short daily sessions, with a course ranging from 2 to 3 days, up to 10 days. Short-term side effects of radiotherapy can include: feeling sick fatigue diarrhoea burning and irritation of the skin around the rectum and pelvisthis looks and feels like sunburn a frequent need to urinate a burning sensation when passing urine These side effects should pass once the course of radiotherapy has finished. Tell your care team if the side effects of treatment become particularly troublesome. Additional treatments are often available to help you cope with the side effectsbetter. Long-term side effects of radiotherapy can include: a more frequent need to pass urine or stools blood in your urine and stools infertility erectile dysfunction If you want to have children, it may be possible to store a sample of your sperm or eggs before treatment begins so they can be used in fertility treatments in the future. Chemotherapy There are 3 ways chemotherapy can be used to treat bowel cancer: before surgeryused in combination with radiotherapyto shrink the tumour after surgeryto reduce the risk of the cancer recurring palliative chemotherapy to slow the spread of advanced bowel cancer and help control symptoms Chemotherapy for bowel cancer usually involves taking a combination of medications that kill cancer cells. They can be given as a tablet (oral chemotherapy), through a drip in your arm (intravenous chemotherapy), or as a combination of both. Treatment is given in courses (cycles) that are 2 to 3 weeks long each, depending on the stage or grade of your cancer. A single session of intravenous chemotherapy can last from several hours to several days. Most people having oral chemotherapy take tablets over the course of two weeks before having a break from treatment for another week. A course of chemotherapy can last up to 6 months, depending on how well you respond to the treatment. In some cases, it can be given in smaller doses over longer periods of time (maintenance chemotherapy). Side effects of chemotherapy can include: fatigue feeling sick vomiting diarrhoea mouth ulcers hair loss with certain treatment regimens, but this is generally uncommon in the treatment of bowel cancer a sensation of numbness, tingling or burning in your hands, feet and neck These side effects should gradually pass once your treatment has finished. It usually takes a few months for your hair to grow back if you experience hair loss. Chemotherapy can also weaken your immune system, making you more vulnerable to infection. Inform your care team or GP as soon as possible if you experience possible signs of an infection, including high temperature (fever) or a sudden feeling of being generally unwell. Medications used in chemotherapy can cause temporary damage to mens sperm and womens eggs. This means that for women who become pregnant or for men who father a child, there is a risk to the unborn babys health. Itis thereforerecommended you use a reliable method of contraception while having chemotherapy treatment and for a period after your treatment has finished. Find out more about chemotherapy Biological treatments Biological treatments, including cetuximab, bevacizumab and panitumumab, are a newer type of medication also known as monoclonal antibodies. Monoclonal antibodies are antibodies that have been genetically engineered in a laboratory. They target special proteins found on the surface of cancer cells, known as epidermal growth factor receptors (EGFR). As EGFRs help the cancer grow, targeting these proteins can help shrink tumours, and improve the effect and outcome of chemotherapy. Biological treatments are therefore usually used in combination with chemotherapy when the cancer has spread beyond the bowel (metastatic bowel cancer). These treatments are not available to everyone with bowel cancer. The National Institute for Health and Care Excellence (NICE) has specific criteriathat need to be met before these can be prescribed. Cetuximab is only available on the NHS when: surgery to remove the cancer in the colon or rectum has been carried out or is possible bowel cancer has spread to the liver and cannot be removed surgically a person is fit enough to undergo surgery to remove the cancer from the liver if this becomes possible after treatment with cetuximab Cetuximab, bevacizumab and panitumumab are available on the NHS through a government scheme called theCancer Drugs Fund. All these medications are also available privately, but are very expensive. Further information isavailable from: Macmillan Cancer Support:Targeted therapies and immunotherapies for bowel cancer Bowel Cancer UK: Surgery Cancer Research UK: Treatment Bowel Cancer UK:Radiotherapy Macmillan Cancer Support:Radiotherapy Living with bowel cancer Talk to others Your GP or nurse may be able to reassure you if you have questions, or you may find it helpful to talk to a trained counsellor, psychologist or specialist telephone helpline operator. Your GP surgery will have information on these. Some people find it helpful to talk to others with bowel cancer at a local support group or through an internet chat room. Beating Bowel Cancer offers support services to people with bowel cancer. They run anurse advisory line on 08450 719 301 or 020 8973 0011 available 9am to 5.30pm Monday to Thursday, and 9am to 4pm on Fridays. You can also email a nurse at [email protected] . The organisation also runs a national patient-to-patient network called Bowel Cancer Voicesfor people affected by bowel cancer and their relatives. Find more support from Bowel Cancer UK and cancer support groups Your emotions Having cancer cancause a range of emotions. These may include shock, anxiety, relief, sadness and depression. Different peopledeal with serious problems in different ways. It is hard to predict how knowing you have cancer will affect you. However, you and your loved ones may find it helpful toknow aboutthe feelings that people diagnosed with cancer have reported. Read aboutthe emotional effects of cancer Recovering from surgery Surgeons and anaesthetists have found using an enhanced recovery programme after bowel cancer surgery helps patients recover more quickly. Most hospitals now use this programme.It involves giving you more informationabout what to expectbefore the operation, avoiding giving you strong laxatives to clean the bowel

Bowel Cancer

before surgery and in some cases giving you a sugary drinktwo hours before the operation to give you energy. During and after the operation the anaesthetist controls the amount of IV fluid you need very carefully and after the operation you will be given painkillers that allow you to get up and out of bed by the next day. Most people will be able to eat a light diet the day after their operation. To reduce the risk ofblood clots in the legs (deep vein thrombosis) you may be given special compression stockings that help prevent blood clots or a regular injection with a blood-thinning medication calledheparin until you are fully mobile. A nurse or physiotherapist will help you get out of bed and regain your strength so you can go home within a few days. With the enhanced recovery programme most people are well enough to go home within a week of their operation. The timing depends on when you and the doctors and nurses looking after you agree you are well enough to go home. You will be asked to return to hospital a few weeks after your treatment has finished so tests can be carried out to check for any remaining signs of cancer. You may also need routine check-ups for the next few years to look out for signs of the cancer recurring. Diet after bowel surgery If you have had part of your colon removed it is likely your stools (faeces) will be looserone of the functions of the colon is to absorb water from stools. This may mean you need to go to the toilet more often to pass loose stools. Inform your care team if this becomes a problem as medication is available to help control it. You may find some foods upset your bowels particularly during the first few months after your operation. Different foods can upset different people. Food and drink known to cause problems include: fruit and vegetables that are high in fibre such as beans cabbages apples and bananas fizzy drinks such as cola and beer You may find it useful to keep a food diary to record the effects of different foods on your bowel. Contact your care team if you find you are having continual problems with your bowels as a result of your diet or you are finding it difficult to maintain a healthy diet. You may need to be referred to a dietitian for further advice. Read more about diet after treatment. Living with a stoma If you need a temporary or permanent stoma with an external bag or pouch you may feel worried about how you look and how others will react to you. Information and advice about living with a stoma including stoma care stoma products and stoma-friendly dietsis available on the ileostomy and colostomy topics. For thosewho want further information about living with a stoma there are patient support groupsthat provide support for people who may have had or are due to have a stoma. You canget moredetailsfrom your stoma care nurse or visit support groups online for further information. The Ileostomy and Internal Pouch Support Group organisation provide a unique visiting service for anyone wishing to speak with someone who has been through similar surgery. Sex and bowel cancer Having cancer andreceiving treatment may affect how you feel about relationships and sex. Although most people are able to enjoy a normal sex life after bowel cancer treatment you may feel self-conscious or uncomfortableif you havea stoma. Talking about how you feel with your partner may help you both support each other. Or you may feelyoud like to talk to someone else about your feelings. Your doctor or nurse will be able to help. Find more information on body image and intimate relations Financial concerns A diagnosis of cancer can cause money problems because you are unable to work or someone you are close to has to stop working to look after you. There is financial support available for carers and yourself if you have to stay off work for a while or stop work because of your illness. Visit Macmillan for information on your finances . The following organisations could also offer helpor information: GOV.UK: benefits Money Advice Service Dealing with dying If you are told there is nothing more that can be done to treat your bowel cancer your GP will still provide you with support and pain relief. This is called palliative care. Support is also available for your family and friends. Find out more about end of life care Visit the following organisations for further support: Macmillan Cancer Support:Looking after someone with cancer Macmillan Cancer Support:End of life Marie Curie Cancer Care Preventing bowel cancer There are some things that increase your risk of bowel cancer that you cant change such as your family history or your age. However there are several waysyou canlower your chances of developing the condition. Diet It may help prevent bowel cancer if you eat: less cured and processed meat such as bacon sausages and ham less red meat and more fish more fibre from cereals beans fruit and vegetables The Department of Health advises people who eat more than 90g (cooked weight) of red and processed meat a day to cut down to 70g to help reduce their bowel cancer risk. Read more about red meat and bowel cancer risk and eating good food and a healthy diet Exercise Regular exercise can lower the risk of developing bowel and other cancers. Its recommended adults exercise for at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity such as cycling or fast walking every week. Read more about keeping active Healthy weight Being overweight or obese increases your chances of developing bowel cancer so you should try to maintain a healthy weight if you want to lower your risk. You can find out if you are a healthy weightby usingthe BMI chart Changes to your diet and an increase in yourphysical activity will help keep your weight under control. Readmore about losing weight Stop smoking If you smoke stopping can reduce your risk of developing bowel and other cancers. Quit Your Way Scotland is an advice and support service for anyone trying to stop smoking in Scotland. To speak with an advisor phone 0800 84 84 84from8am to 10pm every day. Calls are free from landlines and mobiles. Your GP or pharmacist can alsoprovide help support and advice if you want to give up smoking. Read more about stopping smoking Cut down on alcohol Drinking alcohol has been linked to an increased risk of developing bowel cancer so you may be able to reduce your risk by cutting down on the amount of alcohol you drink. If you drink most weeks to reduce your risk of harming your health: men and women are advised not to regularly drink more than 14 units a week spread your drinking over 3 days or more if you drink as much as 14 units a week Read more about alcohol units and get tips on cutting down Bowel cancer screening Although screening cannot stop you getting bowel cancer it can allow the condition to be detected at an earlier stage when it is much easier to treat. As well as making lifestyle changes and keeping an eye out for possible symptoms of bowel cancer taking part in bowel cancer screening when it is offered can help reduce your chances of dying from the condition. Bowel screening is offered to men and women aged 50 to 74 across Scotland. If youre 75 or over you can still take a bowel screening test every 2 years. However youll need to request a new test kit each time. Read more about bowel cancer screening

Bowel incontinence

Bowel incontinence | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Bowel incontinence Bowel incontinence About bowel incontinence Causes of bowel incontinence Diagnosing bowel incontinence Treating bowel incontinence About bowel incontinence Bowel incontinence is an inability to control bowel movements, resulting in involuntary soiling. Its also sometimes known as faecal incontinence. The experience of bowel incontinence can vary from person to person. Some people feel a sudden need to go to the toilet but are unable to reach a toilet in time. This is known as urge bowel incontinence. Other people experience no sensation before soiling themselves, known as passive incontinence or passive soiling, or there might be slight soiling when passing wind. Some people experience incontinence on a daily basis, whereas for others it only happens from time to time. Its thought 1in 10 people will be affected by it at some point in their life. It can affect people of any age, although its more common in elderly people. Its also more common in women than men. Why bowel incontinence happens Bowel incontinence isa symptom of an underlying problem or medical condition. Many cases are caused by diarrhoea , constipation , or weakening of the muscle that controls the opening of the anus. It can also be caused by long-term conditions such as diabetes , multiple sclerosis and dementia . Read more about the causes of bowel incontinence . Seeking advice and treatment Bowel incontinence can be upsetting and hard to cope with, but treatment is effective and a cure is often possible, so make sure you see your GP. Its important to remember that: bowel incontinence isnt something to be ashamed of its simply a medical problem thats no different fromdiabetes or asthma it can be treated theres a wide range of successful treatments bowel incontinence isnt a normal part of ageing it wont usually go away on its own most people need treatment for the condition If you dont want to see your GP, you can usually make an appointment at your local NHS continence service without a referral. These clinics are staffed by specialist nurses who can offer useful advice about incontinence. Read more about diagnosing bowel incontinence . How bowel incontinence is treated In many cases, with the right treatment, a person can maintain normal bowel function throughout their life. Treatment will often depend on the cause and how severe it is, but possible options include: lifestyle and dietary changes to relieve constipation or diarrhoea exercise programmes to strengthen the muscles that control thebowel medication to control diarrhoea and constipation surgery, of which there are a number of different options Incontinence products , such as anal plugs and disposable pads, can be used until your symptoms are better controlled. Even ifit isnt possible tocure yourbowel incontinence, symptomsshouldimprove significantly. Read more about treating bowel incontinence . Causes of bowel incontinence Bowel incontinence is usually caused by a physical problem with the parts of the body that control the bowel. Themost common problems are: problems with the rectum the rectum is unable to retain poo properly until its time to go to the toilet problems with the sphincter muscles the muscles at the bottom of the rectum dont work properly nerve damage the nerve signals sent from the rectum dont reach the brain These problems are explained in more detail below. Its important to discuss any bowel problems with your GP as theres a small chance they could be a sign of a more serious condition, such as bowel cancer . Problems with the rectum Constipation Constipation is a leading cause of bowel incontinence. In cases of severe constipation, a large, solid stool can become stuck in the rectum. This is known as faecal impaction. The stool then begins to stretch the muscles of the rectum, weakening them. Watery stools can leak around the stool and out of the bottom, causing bowel incontinence. This is called overflow incontinence andhappens most commonly in elderly people. Repeated straining caused by constipation or faecal impaction can also lead to rectal prolapse, when part of your lower intestine falls out of place and protrudes from your bottom. Rectal prolapse may also lead to bowel incontinence. Diarrhoea Its difficult for the rectum to hold liquid stools (diarrhoea), so people with diarrhoea (particularly recurring diarrhoea) can develop bowel incontinence. Conditions that can cause recurring diarrhoea include: Crohns disease inflammation of the digestive system irritable bowel syndrome a condition that causes a range of digestive problems, such as diarrhoea and bloating ulcerative colitis inflammation of the large bowel These conditions can also cause scarring of the rectum, which can lead to bowel incontinence. Haemorrhoids Haemorrhoids (piles) are enlarged blood vessels inside or around the bottom (the rectum and anus). Symptoms include discomfort, itching, bleeding or a lump hanging down outside of the anus. In severe cases, haemorrhoids may lead to bowel incontinence. Problems with the sphincter muscles The sphincter muscles at the bottom of the rectum control the bowel. Bowel incontinence happens if these muscles become weakened or damaged. Childbirth is a common cause of damage to the sphincter muscles and a leading cause of bowel incontinence. During a vaginal birth, the sphincter muscles can become stretched and damaged, particularly as a result of a forceps delivery. Other causes include a large baby, the baby being born with the back of their head facing the mothers back (occipitoposterior position) and a long labour. Sphincter muscles can also become damaged through injury, or damage from bowel or rectal surgery. Nerve damage Bowel incontinence can also be caused by a problem with the nerves connecting the brain and the rectum. A nerve problem can mean your body is unaware of stools in your rectum, and may make it difficult for you to control your sphincter muscles. Damage to these nerves is related to a number of conditions, including: diabetes multiple sclerosis (a condition of the central nervous system) stroke spina bifida (birth defects that affect the development of the spine and nervous system) An injury to these nerves, such as a spinal injury, can also lead to bowel incontinence. Other health conditions In some cases, bowel incontinence may result from a health condition such as dementia or a severe learning disability that causes the person to lose bowel control. A physical disability can also make it difficult to get to the toilet in time. Diagnosing bowel incontinence Your GP will begin by asking you about the pattern of your symptoms and other related issues, such as your diet. You may find this embarrassing, but its important to answer as honestly and fully as you can tomake sureyou receive the most suitable treatment. Let your doctor know about: any changes in your bowel habitslasting for more than a few weeks rectal bleeding stomach pains anychanges toyour diet any medication youre taking Your GP will usually carry out a physical examination. Theyll look at your anus and the surrounding area to check for damage and carry outa rectal examination,insertinga gloved finger into your bottom. A rectal examinationwill show whether constipation is the cause, and check forany tumours in your rectum. Your GP may ask you to squeeze your rectum around their finger to assess how well the muscles in your anus are working. Depending on the results, your GP may refer you for further tests. Further tests Endoscopy (sigmoidoscopy) During anendoscopy, the inside of your rectum (and in some cases your lower bowel) is examined using a long, thin flexible tube with a light and video camera at the end (endoscope). Images can alsobe taken of the inside of your body. The endoscopechecks whether theres any obstruction, damage or inflammation in your rectum. Anendoscopy isnt painful, butit can feel uncomfortable, so you may be given a sedative to relax you. Anal manometry Anal manometry helps to assess how well the muscles and nerves in and around your rectum are working. The test uses a device that looks like a small thermometer with a balloon attached to the end.Its inserted into your rectum and the balloon is inflated. It may feel unusual, but its not uncomfortable or painful. The device is attached to a machine, which measures pressure readings taken from the balloon. Youll be asked to squeeze, relax and push your rectum muscles at certain times. You may also be asked to push the balloon out of your rectum in the same way you push out a stool. The pressure-measuring machine gives an idea of how well your muscles are working. If the balloon is inflated to a relatively large size but you dont feel any sensation of fullness, it may mean there are problems with the nerves in your rectum. Ultrasound An ultrasound scan can be used to create a detailed picture of the inside of your anus. Ultrasound scans are particularly useful in detecting underlying damage to the sphincter muscles. Defecography Defecography is a test used to studyhow youpass stools. It can also be useful in detecting signs of obstruction or prolapse that havent been discovered during a rectal examination. During this test, a liquid called barium is placed into your rectum. The barium helps make it easier tohighlight problems using an X-ray . Once the barium is in place, youll be asked to pass stools in the usual way while scans are taken. This test is occasionally carried out using a magnetic resonance imaging (MRI) scanner instead of an X-ray. Treating bowel incontinence Treatment for bowel incontinence depends on underlying cause and the pattern of your symptoms. Trying the least intrusive treatments first, such as dietary changes and exercise programmes, is often recommended. Medication and surgery are usually only considered if other treatments havent worked. Continence products You may find it helpful to use continence products until your bowel incontinence is better controlled. Most continence products are available for free on the NHS. Anal plugs are one way to prevent involuntary soiling. An anal plug is made of foam and designed to be inserted into your bottom. However, they can be uncomfortable and theyre not really a long term solution. If the plug comes into contact with moisture from the bowel, it expands and prevents leakage or soiling. Anal plugs can be worn for up to 12 hours, after which time they are removed using an attached string. Disposable body pads are contoured pads that soak up liquid stools and protect your skin. They can be used in cases of mild bowel incontinence. Single-use silicone inserts, which form a seal around the rectum until your next bowel movement, are also being investigated as a treatment option for moderate to severe bowel incontinence. Your local NHS continence service can offer help and advice about continence products, and you dont usually need a referral from your GP to make an appointment. These clinics are staffed by nurses who specialise in continence treatment. When youre out Wear trousers or skirts that are easy to undo and have elasticated waistbands rather than buttons. Disability Rights UK offers access to 9,000 disabled toilets around the UK with a Radar NKS key .The key costs 4.50 and is only sold to people who require use of toilet facilities due to a disability or health condition. Dietary changes Bowel incontinence associated with diarrhoea or constipation can often be controlled by making changes to your diet. It may be beneficialto keep a food diary to record the effect of your diet on your symptoms. Diarrhoea The National Institute for Health and Care Excellence (NICE) has published dietary advice for managing diarrhoea in cases of irritable bowel syndrome. These guidelines can also be applied to people with diarrhoea associated with bowel incontinence. The advice from NICE includes the following: limit fibre intake from wholegrain breads, bran, cereals, nuts and seeds (except golden linseeds) avoid skin, pips and pith from fruit and vegetables limit fresh and dried fruit to 3portions a day andfruit juice to 1small glass a day (make up the recommended 5a day with vegetables) limit how often you have fizzy drinksand drinks containing caffeine avoid foods high in fat, such as chips, fast foods and burgers Constipation A high-fibre diet is usually recommended for most people with constipation-associated bowel incontinence. Your GP can tell you if a high-fibre diet is suitable for you. Fibre can soften stools, making them easier to pass. Foods that are high in fibre include: fruit and vegetables beans wholegrain rice wholewheat pasta wholemeal bread seeds, nuts and oats Drink plenty of fluids because this can help to soften your stools and make them easier to pass. Pelvic floor muscle training Pelvic floor muscle training is a type of exercise programme used to treat cases of bowel incontinence caused by weakness in the pelvic floor muscles. A therapist, usually a physiotherapist or specialist nurse, will teach you a range of exercises. The goal of pelvic floor muscle training is to strengthen any muscles that may have been stretched and weakened. Youll probably be required to carry out the exercises 3times a day, for 6to 8weeks. After this time, you should notice an improvement in your symptoms. Exercises to try Check with your health professional before trying these at home. First, pretend youre trying to hold in a bowel movement. You should feel the muscles around your anus tighten. Next, sit, stand, or lie in a comfortable position with your legs slightly apart. Squeezeyour pelvic floormuscles for as long as you can, then relax. Repeat 5times. Squeeze the muscles as hard as you can, then relax. Repeat 5times. Squeeze the muscles quickly, then relax. Repeat 5times. If you find these exercisestoo difficult, try fewer repetitions at first and build them up. If they get too easy, try doing more repetitions. You can do the exercises without anyone knowing about them, so they should be easy to fit into your daily routine. Bowel retraining Bowel retraining is a type of treatment for people with reduced sensation in their rectum as a result of nerve damage, or for those who have recurring episodes of constipation. There are 3goals in bowel retraining: to improve the consistency of your stools to establish a regular time for you to empty your bowels to find ways of stimulating your bowels to empty themselves Changes to your diet usually improve stool consistency (see above). Establishing a regular time to empty your bowels meansfinding the most convenient time when you cango to the toilet without being rushed. Ways to stimulate bowel movements can differ from person to person. Some people find a hot drink and meal can help. Others may need to stimulate their anus using their finger. Biofeedback Biofeedback is a type of bowel retraining exercise that involves placing a small electric probe into your bottom. The sensor relays detailed information about the movement and pressure of the muscles in your rectum to an attached computer. Youre then asked to perform a series of exercises designed to improve your bowel function. The sensor checks that youare performing the exercises in the right way. Medication Medication can be used to help treat soft or loose stools or constipation associated with bowel incontinence. Loperamideis amedicine widelyused to treat diarrhoea. It works by slowing down the movement of stools through the digestive system, allowing more water to be absorbed from the stools. Loperamide can be prescribed in low doses to be taken regularly over a long period of time. Laxatives are used to treat constipation. Theyre a type of medicine that helps you to pass stools. Bulk-forming laxatives are usually recommended.These help your stools to retain fluid. This means theyre less likely to dry out, which can lead to faecal impaction. Enemas or rectal irrigation Rectal irrigation or enemasare used when bowel incontinence is caused by faecal impaction and other treatments have failed to remove the impacted stool from the rectum. These procedures involvea small tube that is placed into your anus. A special solution is then used to wash out your rectum. Surgery Surgery is usually only recommended after all other treatment options have been tried. The main surgical treatments used on the NHS are sphincteroplasty and sacral nerve stimulation. Other treatments such as tibial nerve stimulation, endoscopic heat therapy and artificial sphincter surgery can also be used, but their availability on the NHS is limited. An operation called a colostomy is more widely available on the NHS, but its only used if other treatments are unsuccessful. Sphincteroplasty A sphincteroplasty is an operation to repair damaged sphincter muscles. The surgeon removes some of the muscle tissue and the muscle edges are overlapped and sewn back together. This provides extra support to the muscles, which makes them stronger. Sacral nerve stimulation Sacral nerve stimulation is a treatment used for people with weakened sphincter muscles. Electrodes are inserted under the skin in the lower back and connected to a pulse generator. The generator releases pulses of electricity that stimulate the sacral nerves, which causesthe sphincter and pelvic floor muscles to work more effectively. Atfirst, the pulse generator is located outside your body. If the treatment is effective, the pulse generator will be implanted deep under the skin in your back. The most commonly reported complications of the procedure are infection at the site of surgery and technical problems with the pulse generator, which require additional surgery to correct. Read the NICE guidelines on Sacral nerve stimulation for faecal incontinence . Tibial nerve stimulation Tibial nerve stimulation is a fairly new treatment for bowel incontinence. A fine needle is inserted into the tibial nerve just above the ankle and an electrode is placed on the foot.A mild electric current is passed through the needle to stimulate the tibial nerve. Its not known exactly how this treatment works, but its thought to work in a similar way to sacral nerve stimulation. NICE concludes that the procedure appears to be safe, although there are still uncertainties about how well it works. Read the NICE guidelines on Treating faecal incontinence by stimulating the tibial nerve . Injectable bulking agents Bulking agents, such as collagen or silicone, can be injected into the muscles of the sphincter and rectum to strengthen them. The use of bulking agents in this way is a fairly new technique, so theres little information about their long-term effectiveness and safety. You should discuss the possible advantages and disadvantages of this type of treatment in full with your treatment team before deciding whether to proceed. Read the NICE guidelines on Treating faecal incontinence with injectable bulking agents . Endoscopic heat therapy Endoscopic radiofrequency (heat) therapy is a fairly new treatment for bowel incontinence. Heat energy is applied to the sphincter muscles through a thin probe, to encourage scarring of the tissue. This helps tighten the muscles and helps to control bowel movements. The National Institute for Health and Care Excellence (NICE)recently produced guidelines on this procedure.NICE concluded that the procedure appears to be safe, although there are still uncertainties about how well it works. As well as the uncertainties surrounding this procedure, it is also expensive. Therefore, it is usually only used on the NHS during clinical trials. Read the NICE guidelines on Treating faecal incontinence using endoscopic radiofrequency therapy . Artificial sphincter An artificial sphincter may be implanted if you have bowel incontinence caused by a problem with your sphincter muscles. This operation involves placing a circular cuff under the skin around the anus.The cuff is filled with fluid and sits tightly around the anus, keeping it closed. A tube is placed under the skin from the cuff to a control pump. Inmen, the pump is placed near the testicles, inwomen its placed near the vagina. A special balloon is placed into the tummy, and this isconnected to the control pump by tubing that runs under the skin. Thepumpis activated by pressing a button located under the skin. This drains the fluid from the cuff into the balloon, so your anus opens and youcan pass stools. When you are finished, the fluid slowly refills the cuff and the anus closes. The use of an artificial sphincter is arelatively new procedure, so there isnt much good-quality information aboutits long-term effectiveness and safety. Possible problemsinclude infection, injury during surgery and the cuff becoming dislodged. In some cases, further surgery is required to correct problems. Read the NICE guidelines on Treating faecal incontinence with an artificial sphincter inserted through a cut in the abdomen . Colostomy A colostomy is usually only recommended if other surgical treatments are unsuccessful. A colostomy is a surgical procedure in which your colon (lower bowel) is cut and brought through the wall of your stomach to create an artificial opening. Your stools can then be collected in a bag, known as a colostomy bag, which is attached to the opening. Source: NHS 24 - Opens in new browser window Last updated: 12 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions.

Bowel polyps

Bowel polyps | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Bowel polyps Bowel polyps Bowel polyps are small growths on the inner lining of the colon (large bowel) or rectum. They are common, affecting 15% to 20% of the UK population, and dont usually cause symptoms. Polyps are usually less than 1cm in size, although they can grow up to several centimetres. There are various forms: some are a tiny raised area or bulge, known asa sessile polyp somelook like a grape on a stalk, known as a pedunculated polyp some take the form of many tiny bumps clustered together Bowel polypsare not usually cancerous, althoughif theyre discovered theyll need to be removed, as some will eventually turn into cancer if left untreated. Some people just develop one polyp, while others may have a few.They tend to occur in people over the age of 60. How are they caused? Bowel polyps are caused by an abnormal production of cells. The lining of the bowel constantly renews itself, and a faulty gene can cause the cells in the bowel lining to grow more quickly. There may be a family tendency towards developing bowel polyps or bowel cancer. What are the symptoms? Most people with polyps wont be aware of them as they produce no symptoms and are often discovered by accident. However, some larger polyps can cause: a small amount of rectal bleeding(blood in your stool) mucus to be produced when you open your bowels diarrhoea or constipation abdominal pain How are they discovered? Bowel polypsare usually found as a result of a bowel investigation for another reason, such as a sigmoidoscopy (examination of the last part of the bowel) or during screening for bowel cancer . If polyps are found, a colonoscopy or CT colonographyis needed to view the whole of the large bowel and remove any polyps. How are they treated? There are several methods for treating polyps, but the most common procedure involves snaring the polypduring a colonoscopy. Snaring is like cutting the polyp off with cheese wire and is painless. Both of the above methods involve passing a flexible instrument called a colonoscope through your bottom andup into your bowel. The colonoscope has a wire with an electric current to either cauterise (burn off) or snare the polyp. In rare cases, polyps may need to be treated by surgically removing part of the bowel. This is usually only done when the polyp has some cell changes or is particularly large. After the polyp or polyps have been removed, they are sent to specialists in a laboratory, who will inform your consultant if: the polyp has been completely removed there is any risk of it regrowing there is any cancerous change in the polyp If there is a cancerous change in the polyp, you may need further treatment (depending on the degree and extent of change). Your specialist will be able to advise you on this. Outlook Some people will need further colonoscopies because polyps can recur. Polyps can sometimes run in families. This is uncommon, butmeans youll need colonoscopy checks at regular intervals. You might be asked to have repeat examinations at intervals of around 3to 5years to catch any further polyps that may develop and potentially turn into bowel cancer.

Brain stem death

Brain stem death - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Brain stem death Brain stem death Brain stem death is when a person no longer has any brain stem functions, and has permanently lost the potential for consciousness and the capacity to breathe. When this happens, a ventilator keeps the persons heart beating and oxygen circulating through their bloodstream. A person is confirmed as being dead when their brain stem function is permanently lost. Confirming death Confirming death used to be straightforward. Death was said to occur when the heart stopped beating and a person was unresponsive and no longer breathing. The lack of oxygen as a result of no blood flow, quickly led to the permanent loss of brain stem function. Confirming death is now more complex, because its possible to keep the heart beating after the brain stem has permanently stopped functioning. This can be done by keeping a person on a ventilator, which allows the body and heart to be artificially oxygenated. However, that person wont ever regain consciousness or start breathing again. Once the brain stem has permanently stopped functioning, theres no way of reversing it and the heart will eventually stop beating, even if a ventilator continues to be used. To save a persons family and friends from unnecessary suffering, once theres clear evidence that brain death has occurred, the person will be disconnected from the ventilator. The brain stem The brain stem is the lower part of the brain thats connected to the spinal cord (part of the central nervous system in the spinal column). The brain stem is responsible for regulating most of the bodys automatic functions that are essential for life. These include: breathing heartbeat blood pressure swallowing The brain stem also relays information to and from the brain to the rest of the body, so it plays an important role in the brains core functions, such as consciousness, awareness and movement. After brain death, its not possible for someone to remain conscious. How brain death occurs Brain death can occur when the blood and/or oxygen supply to the brain is stopped. This can be caused by: cardiac arrest when the heart stops beating and the brain is starved of oxygen heart attack a serious medical emergency that occurs when the blood supply to the heart is suddenly blocked stroke a serious medical emergency thathappenswhen the blood supply to the brain is blocked or interrupted blood clot a blockage in a blood vessel that disturbs or blocks the flow of blood around your body Brain death can also occur as a result of: a severe head injury a brain haemorrhage infections, such as encephalitis a brain tumour Vegetative state Theres a difference between brain death and avegetative state, which can occur after extensive brain damage. Someone in a vegetative state can show signs of wakefulness for example, they may open their eyes, but not respond to their surroundings. In rare cases, a person may demonstrate some sense of response that can be detected using a brain scan, but not be able to interact with their surroundings. However, the important difference between brain death and a vegetative state is that someone in a vegetative state still has a functioning brain stem, which means that: some form of consciousness may exist breathing unaided is usually possible theres a slim chance of recovery, because the brain stems core functions may be unaffected Aperson who is brain dead has no chance of recovery, because their body is unable to survive without artificial support. Confirming brain death Although rare, a few things can make it appear as though someone is brain dead. These include drug overdoses (particularly from barbiturates) and severehypothermia (where body temperature drops below 28C). Therefore, a number of tests are carried out to check that brain death has actually occurred, like shining a torch into both eyes to see if they react to the light. Organ and tissue donation After brain death has occurred, it may be possible for the persons organs and tissue to be used in transplantations. This can often save or improve the lives of others. Only 1% of people die in a way that makes organ donation possible. This means every opportunity for donation is very precious. Specialist nurses will discuss the possibility of donation with families. Thisll be done in a sensitive way. Theyll also check the NHS Organ Donor Register to see if the person had recorded a donation decision and share this information with the family. This lets the family know what their loved one wanted. It also means that nurses can check if this was their latest view. Further information about organ and tissue donation Diagnosing brain stem death There are a number of criteria for diagnosing brain stem death. For a diagnosis of brain stem death to be made: aperson must be unconscious and fail to respond to outside stimulation apersons heartbeat and breathing can only be maintained using a ventilator there must be clear evidence that serious brain damage has occurred and it cant be cured Ruling out other conditions Before testing for brain stem death, doctors must carry out a series of checks to ensure that the symptoms arent being caused by other factors, like: an overdose of illegal drugs, tranquillisers, poisons or other chemical agents an abnormally low body temperature (hypothermia) severe under-activity of the thyroid gland Once these factors have been ruled out, tests are carried out to confirm brain death. The diagnosis of brain death has to be made by two senior doctors. Neither of them can be involved with the hospitals transplant team. The doctors will explain the tests to you and theyll keep you informed about your loved ones condition at all times. Tests The doctors will run a series of tests. Both doctors have to agree on the results for a diagnosis of brain death to be confirmed. The tests are carried out twice to minimise any chance of error. The tests used to determine whether brain stem death has occurred are outlined below: A torch is shone into both eyes to see if they react to the light. The cornea (transparent outer layer of the eye), which is usually very sensitive, is stroked with a tissue or piece of cotton wool to see if the eyereacts. Pressure is applied to the forehead and the nose is pinched to see if theres any movement in response. Ice-cold water is inserted into each ear, which would usually cause the eyes to move. A thin, plastic tube is placed down the trachea (windpipe) to see if itprovokes gagging or coughing. The person is disconnected from the ventilator for a short period of time to see if they make any attempt to breathe on their own. Brain death will bediagnosedif a person fails to respond to all of these tests. Occasionally, a persons limbs or torso (the upper part of the body) may move, even after brain stem death has been diagnosed. These spinal reflex movements are generated by the spinal cord and dont involve the brain at all. Therefore, they wont affect the diagnosis of brain death.

Brain tumours

Brain tumours Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Brain tumours Brain tumours A brain tumour is a growth of cells in the brain that multiplies in an abnormal, uncontrollable way. It can either be cancerous (malignant) or non-cancerous (benign). Brain tumours are graded from 1 to 4 according to their behaviour, such as how fast they grow and how likely they are togrow back after treatment. benign brain tumours arelow grade (grade 1 or 2), which means they grow slowlyand are less likely to return after treatment malignant brain tumours arehigh grade (grade 3 or 4) and either start in the brain (primary tumours) or spread into the brain from elsewhere (secondary tumours); theyre more likely to grow back after treatment This page gives general information relevant to both types of brain tumour. Symptoms of a brain tumour The symptoms of a brain tumour vary depending on the exact part of the brain thats affected. Common symptoms include: severe, persistent headaches seizures (fits) persistent nausea, vomiting and drowsiness mental or behavioural changes, such as memory problems or changes in personality progressive weakness orparalysis on one side of the body, vision problems, or speech problems Sometimes, you may not have any symptoms to begin with, or they may only develop very slowly over time. When to speak to your GP Speak to your GP if youhave persistent symptoms of a brain tumour. While its unlikely to be a tumour, its best to be sure by getting a proper diagnosis. If your GP is unable to identify a more likely cause of your symptoms, they may refer you to a neurologist for further assessment and tests, such as a brain scan. Who is affected Brain tumours can affect people of any age, including children, although they tend to be more common in older adults. More than 9,000 people are diagnosed with primarybrain tumours in the UK each year, ofwhich about halfare benign and half are malignant. Many othersare diagnosedwith secondary brain tumours. The exact reason why some people develop primary brain tumours is unknown,but its thought that certain genetic conditions such asneurofibromatosis type 1and tuberous sclerosis and previous radiotherapy to the head increaseyour risk. Treatment and outlook The main treatment for most brain tumours is surgery, which aims to remove as much of the abnormal tissue as possible. Its not always possible to remove the entire tumour, so further treatment with radiotherapy and/or chemotherapy may be necessary to kill any abnormal cells left behind. For most benign tumours, treatment is oftensuccessful and a full recovery is possible, although theres sometimes a small chance the tumour could come back.Regular follow-up appointments will normally be recommended to monitor this. The outlook for malignant tumours is generally less good, although this varies depending on things such aswhere the tumour is in the brain, your age, and your general health. Unfortunately,a cure is often not possible and most tumours will return after treatment. If a tumour does come back, treatmentwill aim to relieve your symptoms and prolong life by controlling the growth of the tumour. Support and further information As well as reading the separate pages onbenign brain tumoursand malignant brain tumours, you may find the following websites useful sources of information and support: The Brain Tumour Charity Brain Tumour Research Cancer Research UK: Brain tumours Macmillan Cancer Support: Brain tumours

Brain tumours: Children

Brain tumours: Children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Brain tumours: Children Brain tumours: Children Brain tumours are the most common tumours that develop in children. Children of any age may be affected. Boys are affected slightly more often than girls. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming, but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has, and the treatments that may be used, can often help parents to cope. Your childs specialist will give you more detailed information and, if you have any questions, its important to ask the specialist doctor or nurse who knows your childs individual situation. Brain tumours A tumour in the brain can come from the brain itself (primary), or from another part of the body (secondary). This information is about primary brain tumours. Signs and symptoms Symptoms will depend on the size of the tumour, where it is and how it affects that part of the brain.Symptomsare caused by the pressure inside the head being higher than it should be. A growing tumour may push normal brain out of the way, or block the flow of fluid in the brain. Doctors call this raised intracranial pressure, and it can cause symptoms such as: headaches (often worse in the morning) vomiting (usually in the morning) or feeling sick fits (seizures) feeling very irritated or losing interest in day-to-day things eye problems, such as abnormal eye movements, blurring or double vision feeling very tired much more quickly than usual feeling extremely sleepy (drowsy) for no reason Brain tumours can also cause problems with balance and walking, weakness down one side of the body, or changes in behaviour. Some of these symptoms are common even without a brain tumour, and this can cause confusion in the early stages. The brain The brain is contained within the skull, which protects it. Between the brain and the skull, there are 3 layers of membrane called the meninges. These completely cover the brain and spinal cord and help to protect it. Between 2 of these layers is a space that contains a fluid called cerebrospinal fluid (CSF), which circulates around the brain and spinal cord. The main parts of the brain are: the cerebrum this is at the top of the head and is the largest part of the brain; itsmade up of 2 halves(hemispheres), it controls thinking, learning, memory, problem-solving, emotions and touch, and it also helps us be aware of our body position the cerebellum this is the back part of the brain, and it controls movement, balance and coordination the brain stem this connects the brain to the spinal cord and is in the lower part of the brain just above the back of the neck; it controls breathing, body temperature, heart rate and blood pressure, eye movements and swallowing What happens when a brain tumour is suspected Knowing what a test involves can make things a bit easier. The specialist doctor and nurse will explain things but dont be afraid to ask questions. Your doctor will want to hear about the problems your child has had recently, and will examine him or her properly. This will include looking into the back of your childs eyes with an ophthalmoscope to check for swelling, which can be a sign of raised pressure in the brain. Theyll usually check other things like balance, coordination, sensation and reflexes. CT or MRI scan Most children will have a CT or an MRI scan , which looks in detail at the inside of the brain. A CT scan uses X-rays . Its quick and often is the best first-line investigation, but it does not give as detailed pictures as an MRI. It uses quite a lot of X-rays, and so it is important to make sure we do not use it on too many people if it can be avoided. An MRI scan uses no X-rays, and gives more detailed pictures, but takes much longer. Machines are noisy, and often children cannot lie still long enough to get proper images. It is sometimes necessary to have an anaesthetic for this scan. Ordinary X-rays are not usually helpful for brain tumours. Blood tests These are usually done to make sure it is safe to do an operation, and can also be used to help diagnose certain types of tumour. Biopsy Its often necessary for doctors to remove a small part of the tumour ( biopsy ) to find out exactly what type of tumour it is. It means your child will need to go into hospital for an operation under general anaesthetic. The piece of tumour removed is then examined under a microscope by a specialist doctor called a pathologist. A biopsy isnt always done; it is sometimes better to remove the whole tumour in one operation. In this case, it will be a few days before the exact type of tumour is known. Sometimes, it may be safer to do the operation in two stages. Part of the tumour might be removed in the first operation and the rest a few days later. Types of brain tumours There are different types of brain tumours and they are usually named after the type of cells they develop from. The main types are astrocytoma, ependymoma, and medulloblastoma, but there are many other, less common types. Brain tumours can be either benign (non-cancerous) or malignant (cancerous). Benign brain tumours These remain in the part of the brain that they started in and do not usually spread into other areas. Sometimes it may be difficult to remove a benign tumour, because of where it is and, in this situation, other treatments may be needed. The most common tumour of this type is a low-grade astrocytoma (also called low-grade glioma). Malignant primary brain tumours These are most likely to cause problems by causing pressure and damage to the areas around them and possibly by spreading to the normal brain tissue close by. High-grade astrocytoma and ependymoma These tumours develop from the supporting cells of the brain known as glial cells, and are sometimes also called gliomas. Medulloblastomas These usually develop in the lower part of the brain, the cerebellum. They may spread to other parts of the brain or into the spinal cord, and treatment must include the whole of this. Treatment Because there are different types of brain tumours, treatment will not be the same for everyone. The doctors will look at the type of brain tumour, its size and where it is in the brain before deciding on the best treatment. These are the main treatments used to treat brain tumours. Your child may have one treatment or a combination of treatments. Surgery Usually, a neurosurgeon will operate to remove as much of the tumour as possible. Operations can be very long. Its not uncommon for these to be more than 6 or 8 hours. Sometimes, the fluid in and around the brain does not flow freely, as a result of the tumour or brain swelling. In this case, it may be necessary to place a fine tube (shunt) to drain excess fluid from the brain and into the lining of the tummy area (abdomen). You cannot see the shunt outside the body. Another way of treating this is to create another drainage route for the fluid around the obstruction (called a ventriculostomy). After the operation, your child may spend some time in an intensive care ward or high dependency unit, so the nurses and doctors can keep a very close eye on them. Once a diagnosis is known, a plan to treat any tumour left behind can be made. For benign tumours, there may be no further treatment, but for some, radiotherapy or chemotherapy will be required. Radiotherapy Radiotherapy treats cancer by using high energy radiation beams. These are exactly the same as visible light, but instead of reflecting from the surface, the energy passes inside the body, where it causes damage to tumour cells. Radiotherapy is delivered extremely carefully, using machines linked to the MRI scans of your childs brain. The process usually takes a few minutes each time, but often needs to continue for 5 or 6 weeks. Sometimes more specialised types of radiotherapy may be used. Your childs oncologist will explain more about this. Chemotherapy Chemotherapy uses drugs to get rid of cancer cells. Chemotherapy is given into the veins, and sometimes as a liquid or tablets by mouth. Treatment is often quite prolonged, with periods of time in hospital and gaps when you will be able to return home. This part of the treatment is planned by an oncologist. The specialist doctor and nurse will explain your childs treatment and answer your questions so that you understand what is involved. Other medicines your child may need to take Your child may need to take medicines for a while to reduce or control the symptoms of the brain tumour: Steroids These are medicines that reduce swelling and inflammation in the brain and can help with symptoms. Anticonvulsants These are medicines that help prevent fits, which can be a problem before or after operations on the brain. They may only be necessary for a short period, but sometimes are needed for longer. Side effects of treatment Your childs doctor and specialist nurse will explain more about what to expect. Always let them know about any side effects your child is having. Many side effects can be well controlled or made easier. Hair loss Both radiotherapy and chemotherapy can cause hair loss . Your childs hair will usually grow back again after chemotherapy, although it may not after radiotherapy. Tiredness Tiredness is very common with both treatments and may continue for weeks after chemotherapy or radiotherapy finishes. Feeling sick Radiotherapy and chemotherapy may make your child feel sick. This can usually be controlled well with anti-sickness drugs, which the oncologist will prescribe for your child. Increased risk of an infection Chemotherapy can increase the risk of infection. Itsimportant to contact the oncologist or specialist nurse straight away if your child has a temperature, any signs of infection or suddenly feels unwell. Skin changes in the treated area if your child is having radiotherapy Radiotherapy can cause a mild form of sunburn. The skin may become red, flaky or sore if your child has fair skin and may become darker and flaky if your child has dark skin. Youll be given advice on looking after the skin in the treated area. Clinical trials Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Its important to realise that a clinical trial is not an experiment, and your doctor will always offer you what is believed to be the best available treatment. Clinical trials are usually offered to explore ways of making new improvements to treatment, beyond what is already known. Specialist doctors carry out many trials for brain tumours. If appropriate, your childs medical team will talk to you about taking part in a clinical trial, and will answer any questions you have. Written information is often provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide if it is right for your child. You can also join a trial, and then withdraw if you change your mind at a later date. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care After treatment is over, your child will be seen regularly by specialists. This is to check their progress and how well theyre recovering from treatment. It is also to check that they dont have any long-term problems from treatment. You can contact your childs specialist doctor or nurse at any time if you have any worries about their health. Long-term side effects Sometimes treatments may cause possible long-term side effects that may develop later. Your childs oncologist or specialist nurse will explain the possible risk of any long-term effects in your childs situation. Children are monitored for any long-term problems following treatment so that they can be picked up and managed early on. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience of cancer. The Parents Guide discusses these further and talks about how you can support your child.

Brain tumours: Teenagers and young adults

Brain tumours: Teenagers and young adults | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in teenagers and young adults Brain tumours: Teenagers and young adults Brain tumours: Teenagers and young adults The brain and brain tumours Symptoms and causes of brain tumours Having tests for brain tumours Treating brain tumours The brain and brain tumours This section is for teenagers and young adults. Its about the brain and different types of brain tumour. Any illness to do with your brain can be scary. Understanding a bit more about how the brain works might help. The brain The brain and the spinal cord make up the central nervous system (CNS). The brain is the control centre which coordinates most body functions. It is inside the skull, which protects it. The spinal cord is made up of nerves that run down the spine. It passes messages between the brain and the rest of the body. The brain and the spinal cord are covered by 3 thin layers of tissue called the meninges. Between2 of these layers is a fluid called cerebrospinal fluid (CSF). The meninges and CSF help to protect the brain and spinal cord. The main parts of the brain are the: cerebrum cerebellum brain stem pituitary gland Cerebrum This is at the top of the head and is the largest part of the brain. Its made up of2 halves called hemispheres. It controls thinking, learning, memory, problem solving, emotions, and touch. It also makes us aware of our body position. Cerebellum This is at the back of the head, near the middle. It controls movement, balance and coordination. Brain stem This connects the brain to the spinal cord. Its in the lower part of the brain, just above the back of the neck. It controls breathing, body temperature, heart rate, blood pressure, eye movements and swallowing. Pituitary gland This is in the middle of the brain. It makes hormones that control things such as growth, metabolism, periods, and sperm production. Types of brain tumour There are different types of brain tumour. They are usually named after the type of cells they develop from. Brain tumours can be either benign (non-cancerous) or malignant (cancerous). This information is about both types. Benign brain tumours often press on the brain but dont usually spread into surrounding tissue. They are also less likely to spread around the brain and spinal cord. If they can be removed with an operation they may not cause any more problems. Sometimes its difficult to remove a benign tumour because of where it is in the brain. In this case, you might need treatment with chemotherapy or radiotherapy. Some benign tumours can cause long-lasting changes. This can be because they increase the pressure inside the brain, or because they press on important areas of the brain. Malignant brain tumours can spread from where they started into surrounding brain tissue, causing pressure and problems in those parts of the brain. They can also spread through the cerebrospinal fluid (CSF) into other parts of the brain or the spinal cord. This information is about tumours that start in the brain, which are called primary brain tumours. Sometimes cancers that start in other parts of the body can spread to the brain. These are known as secondary brain tumours. The types of brain tumour most likely to affect teenagers and young adults are: pituitary tumours gliomas medulloblastomas germ cell tumours Gliomas These start in cells called glial cells. There are different types of glioma, but the ones that affect younger people are usually astrocytomas, oligodendrogliomas and ependymomas. These types of tumour can develop in the brain or in the spinal cord. Astrocytomasand oligodendrogliomas These are the most common type of glioma. Astrocytomas develop from a star-shaped cell called an astrocyte. Oligodendrogliomas look like a fried egg. Sometimes tumours are a mix of both cells. These are called oligoastrocytomas. Doctors group them by how quickly they grow (known as the grade of the tumour). They can tell the grade from how the cells look under a microscope. Ependymomas These are a rarer type of glioma. They develop from the spinal cord, and from cells that line the fluid-filled spaces (ventricles) in the brain. These tumours can spread toother parts of the brain and spine through the CSF. Pituitary tumours These are usually benign tumours that grow in the pituitary gland. They are mostly grouped into pituitary adenomas and craniopharyngiomas. Some cause too many or too few hormones to be produced in the body. They very rarely spread. Medulloblastomas These usually start in the cerebellum, at the back of the brain. Sometimes they can spread through the CSF, or very rarely to other parts of the body. They start from cells that havent properly developed yet, and are sometimes called primitive neuroectodermal tumours (PNET). Germ cell tumours of the brain This type of tumour is rare. They develop from very early cells called germ cells, which have the potential to grow into any type of tissue. Although germ cell tumours often develop in the ovaries in girls or the testicles in boys, they can also start in other parts of the body, including the brain. They may be non-cancerous or cancerous. They are called by different names depending on what the cells look like under a microscope. We also have more information about: symptoms of brain tumours having tests for brain tumours treatment for brain tumours If youre looking for information about brain tumours in people of all ages, read our general brain tumours section. We also have information about brain tumours in children . Symptoms and causes of brain tumours This section on brain tumours is for teenagers and young adults. Signs and symptoms The symptoms of a brain tumour depend on the size of the tumour and where it is. The tumour can: cause fits affect the messages sent by that part of the brain to other parts of the body cause raised intracranial pressure theres only a certain amount of space in the skull for the brain and as a tumour grows, there can be a rise in pressure in or around the brain Common symptoms of raised intracranial pressure are: headaches, which are often worse in the morning vomiting (usually in the morning) or feeling sick fits (seizures) feeling very irritated or losing interest in day-to-daythings like friends, school or going out problems with your eyes, such as blurring or seeing double feeling more sleepy or drowsy than usual changes in your balance and walking, or weakness down one side of the body problems with speech personality changes Theres often a simple explanation for many of these symptoms. But if you have any of these or if youre worried, its important to speak to your GP straight away. Causes The cause of most brain tumours is unknown. Research is looking into this all the time. Young people with rare genetic conditions that run in families, such as neurofibromatosis type 1 and neurofibromatosis type 2, have an increased chance of developing a brain tumour. Mobile phones, power lines and certain viruses have all been suggested as possible causes of brain tumours. Theres been a lot of research into these possible causes, especially mobile phones. But there has been no strong evidence for any of them. Remember nothing youve done has caused the tumour. If youre worried about brain tumours If you think you might have any of the symptoms of a brain tumour, you should go straight to your GP. Theyll be able to talk to you about your symptoms. They can arrange tests to find out more, or refer you to a specialist doctor. We also have more info about: having tests for brain tumours treatment for brain tumours the brain If youre looking for information about brain tumours in people of all ages, read our general brain tumours section. We also have information about brain tumours in children . Having tests for brain tumours This section on brain tumours is for teenagers and young adults. Seeing your GP Your GP will examine you and, depending on your symptoms, they may arrange some tests. Or they might send you to hospital straight away to see a doctor who specialises in problems to do with the brain. These doctors are called neurologists or neurosurgeons. Sometimes a brain tumour is diagnosed after someone has been taken into hospital to check out symptoms that have happened suddenly, like having a fit. At the hospital Youll usually be seen at a hospital with a centre or unit specialising in treating brain tumours. Your specialist will ask you questions about your symptoms and how youve been feeling. Theyll examine the back of your eyes using an instrument with a light on the end of it to check for swelling. Swelling can be a sign of raised pressure in your head. Theyll usually check: your balance your coordination your muscle strength your reflexes whether you can feel pinpricks on areas of your skin You might also have your eyesight and hearing tested. Tests Youll need to have some more tests before a diagnosis is made. Your doctor will select the most suitable tests for your situation. These tests are important because they help your specialist plan the best treatment for you. Your doctor and specialist nurse will explain things to you, but dont be afraid to ask questions. Macmillan Cancer Support has information on the possible tests, whichinclude: a CT scan or MRI scan these show a detailed picture of the inside of your head blood tests these are done to check your general health and sometimes to measure the level of certain chemicals or hormones in your blood lumbar punctures in this test a small needle is used to collect some fluid from the base of your spine; its sometimes done to look for cancer cells in the fluid surrounding the brain and spinal cord X-rays might be taken to check your skull and chest Having a biopsy Doctors often need to remove a small part of the tumour ( biopsy ) to find out exactly what type of tumour it is. The piece of tumour thats removed is looked at under a microscope by a doctor called a pathologist. The operation will be done under general anaesthetic . This is where you are put into a deep sleep. Youll probably be in hospital for a few days. An MRI or CT scan is used to find the exact position of the tumour. The surgeon makes a small hole in the skull and passes a fine needle through it to remove a piece of the tumour. Guided biopsy This is often used to make sure the doctor takes the biopsy from the most appropriate part of the tumour. You will have a head frame fitted that will help guide the surgeon to exactly the right place before they take the biopsy. This is called a stereotactic biopsy. Tests and waiting for results Having tests and waiting for results can be scary. Remember you dont have to keep your worries to yourself. Talking about how you feel and getting support from family, friends or your specialist nurse and doctor can make it a bit easier. You could also talk to one of Macmillans cancer support specialists on their free helpline. This information is about having tests for brain tumours. We also have more information about: symptoms of brain tumours treatment for brain tumours the brain If youre looking for information about brain tumours in people of all ages, read our general brain tumours section. Treating brain tumours This section on brain tumours is for teenagers and young adults. A team of specialists will plan your treatment. They will talk to you about the best treatment for you. Its normal to have a combination of treatments, so you may be seen by different doctors, such as: a neurosurgeon, who specialises in brain operations a neurologist, who treats brain conditions a cancer specialist (oncologist), who treats brain tumours with radiotherapy and chemotherapy Youll usually see a specialist nurse who looks after people with conditions affecting the brain, or a specialist nurse for teenagers or young adults with cancer. If you have radiotherapy (X-ray treatment) you will be given this treatment by a radiographer. There are different types of brain tumours, so treatment wont be the same for everyone. Your doctors look at the type of brain tumour you have, its size and where it is in the brain before deciding on the best treatment for you. The main treatments for brain tumours are: surgery an operation to remove all, or as much as possible, of the tumour radiotherapy uses high-energy x-rays to treat cancer cells chemotherapy uses anti-cancer drugs to destroy cancer cells Your specialist doctor and nurse will explain your treatment and answer any questions you have. Its important you understand whats involved. Youll probably need some time to talk it through with your family. Medicines you may need to take You might need to take these medicines for a while to reduce or control the symptoms of the brain tumour: steroids, which can reduce swelling or inflammation in the brain and help with symptoms anticonvulsant medicines that help prevent fits (seizures) Surgery for brain tumours Your surgeon will usually try to remove all, or as much as possible, of the tumour. Before the operation, they will talk to you about whats involved and the benefits and risks of the operation. Its important you understand all this, so ask all the questions you want to. Youll usually be in hospital for a week, sometimes longer. Your doctor or nurse will tell you what to expect before and after the operation as it can be different for everyone. Before the operation youll probably need to have some of your hair shaved off. This is done in the anaesthetic room. You may prefer to have all your hair shaved off. You can cover up with a wig or hat while it grows back. For some types of brain tumours, particularly low-grade gliomas, your surgeon might suggest doing an operation while you are awake. This is called an awake craniotomy. If you need this, you will be given plenty of medication to make sure it doesnt hurt. Sometimes surgery is not needed, or its not possible to remove the tumour. Your specialist may think that another treatment would be better for you. They will discuss this with you and you can ask any questions to help you understand your options. What happens after the operation? After the operation you are monitored very closely for the first 12 to 24 hours. At first you might be attached to a machine called a ventilator that helps you breathe. Your nurse or doctor will tell you if this is likely to happen. Your head might be bandaged and youll have a tube draining any extra blood thats collected around the wound into a plastic bottle. You may also have another tube draining extra cerebrospinal fluid (fluid that surrounds the brain). This is to make sure you dont get too much pressure building up inside your brain. Your doctor will remove these tubes as soon as its safe, usually after a couple of days. Youll have a drip to give you fluids until youre eating and drinking again. There may be some swelling and bruising around your face and eyes. This will settle down after a few days. When you wake up you might have a headache. Youll be given painkillers regularly until this eases off. Tell your nurse or doctor if youre in pain so that they can give you something stronger. Radiotherapy for brain tumours Radiotherapy uses high-energy X-rays to treat cancer cells. It can be used: after the operation to treat any cells that may have been left behind instead of an operation when a brain tumour doesnt need to be or cant be removed if a brain tumour comes back after surgery For some brain tumours, its normal to treat your spinal cord (the nerves that go from your brain to your body) as well as your brain. Your doctor will tell you if this is the case. Types of radiotherapy There are3 types of radiotherapy that are used to treat brain tumours: photon radiotherapy (given at your local hospital) proton radiotherapy (until 2018/2019 this is given in Switzerland or America) stereotactic radiosurgery/radiotherapy (given at specialist hospitals in the UK) Your doctor will discuss with you which treatment would be best. Youll have your treatment in the radiotherapy department of the hospital. Its usually given Monday to Friday, with a rest at the weekend. The number of treatments you have will depend on your situation, but it can last from 1 day to 7 weeks. You will have to wear a mask or shell to keep your head as still as possible during radiotherapy treatment. This makes sure treatment is delivered to the exact area each time. Your mask is made before your treatment is planned. Youll be able to see and breathe properly, but it might feel a bit tight. You only have to wear it for a few minutes at a time. Most people find they get used to it pretty quickly. Let your nurse or radiographer know if youre worried about this. The treatment only takes a few minutes. It isnt painful, but you need to lie very still. Youll be on your own in the room but you can talk to the radiographer through an intercom. In some hospitals you can have music playing while you have your treatment. Side effects The side effects you might have will depend on the type of radiotherapy youre having and how long it lasts for. Your doctor and specialist nurse will tell you more about what to expect. Always let them know about any side effects youre having. Theres usually something they can do to make things easier. Hair loss Your hair in the treatment area will start to thin and fall out shortly after your treatment starts. Your doctor or nurse can show you where you will lose your hair . Losing your hair can be scary and really upsetting. There are lots of ways to cover up with hats, bandannas, baseball caps, scarves, or wigs until it grows back. Getting a shorter haircut before it starts to fall out sometimes makes it a little easier to cope with. It usually starts to grow back within 3 months of finishing treatment. Hair may grow back with a slightly different colour and texture and might not be as thick as before. Although hair loss is usually temporary, for some people it can be permanent. Your specialist will usually be able to tell you if this is likely. This can be hard to deal with and youll be given advice and support to help you cope. Skin changes You might get some skin changes a bit like sunburn in the area being treated, usually after 3 to 4 weeks of treatment. At first it can be dry and itchy. If youve got pale skin it might get red. If youve got darker skin it can get darker. You should wash and dry the skin gently using non-perfumed soap and use only the moisturiser that the radiographer gives you. The radiographer or specialist nurse will give you advice on looking after your skin. Tiredness You may feel really tired towards the end of your treatment and for a few weeks after it has finished. This gradually improves after a few weeks. Try to get plenty of rest. Its also a good idea to do some gentle exercise if you can, like taking short walks. This helps to give you more energy and keep your muscles toned. Feeling sick Let your doctor know if this is a problem. They can prescribe anti-sickness medicines to help. Headaches Its important to tell your doctor if you have headaches. They can prescribe painrelief for you. During and after treatment, you might find your symptoms get a bit worse before they get better. This can be scary but its usually a reaction to the radiotherapy. It doesnt mean the radiotherapy hasnt worked or that the tumour has got worse. If it happens, let your doctor or nurse know. Late effects Side effects that happen months or years after treatment has finished are called late (long-term) effects. These depend on the area of the brain treated. They can include patches of hair loss, worse concentration, memory changes and difficulty learning new things, reduced hormones, increased risk of a stroke, and a second tumour. Youll be seen regularly for follow-up appointments and your doctors will be checking you for any late effects of treatment. Your doctors will explain more about this to you. Chemotherapy for brain tumours Chemotherapy is the use of special anti-cancer drugs to destroy tumour cells. You might have chemotherapy: to shrink a tumour to make it easier to remove with surgery when its not possible to remove the tumour completely with surgery during radiotherapy to make the tumour more sensitive to radiation after radiotherapy or surgery to reduce the chance of the tumour coming back (adjuvant chemotherapy) when a brain tumour has come back after treatment. Chemotherapy drugs Macmillan has information on the different chemotherapy drugs that can be used, such as: lomustine (CCNU) procarbazine vincristine cisplatin or carboplatin temozolomide (Temodal) cyclophosphamide ifosfamide etoposide The information on these drugs is written for people of all ages, not just for young people. There are lots of other drugs that are used and your doctor or nurse can tell you more about this. You can also callMacmillans cancer support specialists for more information about chemotherapy drugs. Chemotherapy can be given as a single drug or in combination with others. They can be given by injection into a vein (intravenously) or as tablets. Occasionally chemotherapy is given directly into the spine (intrathecal chemotherapy) or into the brain through a special device (ommaya reservoir). Another way of giving chemotherapy is for the surgeon to place a wafer containing chemotherapy in the area of the brain where the tumour was removed during the surgery. As the wafer dissolves, the chemotherapy drug is slowly released into the area of the brain that needs treatment.| Side effects Chemotherapy causes side effects that usually get better when treatment is over. Being more at risk of an infection You need to let your doctor or nurse know immediately if you have signs of an infection like feeling hot and shivery. This is because you can become unwell quite quickly while you are on chemotherapy. Tiredness This is a common side effect so its important to get plenty of rest. Try to balance rest with some gentle exercise like short walks if you can. This helps give you more energy and keeps your muscles toned. Feeling sick Youll be given anti-sickness medicines to take regularly. Let your nurse or doctor know if the ones youre taking arent working for you. Hair loss If you lose your hair it will usually start to grow back again after your treatment stops. Infertility Some chemotherapy drugs can affect your fertility. Your doctor should discuss this with you before treatment begins. Your doctor and nurse will tell you more about the side effects to expect depending on the chemotherapy you have. Let your doctor or nurse know about any side effects as theres often something that can be done to control them. Supportive treatment for brain tumours As part of your treatment for a brain tumour youll probably be given drugs called steroids. You may also be given some anticonvulsant drugs to prevent fits. Steroids Steroids help reduce the swelling that often surrounds a brain tumour. Although they dont treat the tumour itself, they can improve symptoms and make you feel better. Steroids are often given before and after surgery, and sometimes during or after radiotherapy and chemotherapy. Its important to take steroids as your doctor tells you and not to suddenly stop them. If you take steroids for more than 2 weeks, its important to tell your doctor about them if you are unwell (for example an infection) over the next 6 months. This is because you may need an extra course of steroids. Side effects If you take steroids for some time, you may have some temporary side effects. These can include: weight gain a change in the shape of your face (making it more rounded) indigestion slightly more risk of getting an infection mood changes (feeling hyper or overactive or feeling low) increase in the sugar level in your blood your blood or urine may be tested to check for this Side effects can be hard to cope with, especially with all the other stuff you have to deal with. Remember the side effects will gradually get better when the steroids are stopped, and in the meantime there are lots of people who can support you. Anticonvulsants Tumours in the brain can sometimes cause fits. Anticonvulsant drugs can help prevent them. You might be prescribed these before surgery, or to take on a more long-term basis. Your doctors will tell you about any side effects of these drugs. We also have more information about: symptoms of brain tumours having tests for brain tumours the brain If youre looking for information about brain tumours in people of all ages,read our general brain tumours section.

Breast cancer (female)

Breast cancer (female) - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Breast cancer (female) Breast cancer (female) About breast cancer Symptoms of breast cancer Causes and risk factors of breast cancer Diagnosing breast cancer Treating breast cancer Living with breast cancer Preventing breast cancer About breast cancer Breast cancer is the most common type of cancer in the UK. Most women who get it (8 out of 10) are over 50, but younger women, and in rare cases, men can alsoget breast cancer . If its treated early enough, breast cancer can be prevented from spreading to other parts of the body. The breasts The breasts are made up of fat, connective tissue and thousands of tiny glands called lobules, which produce milk. When a woman has a baby, the milk is delivered to the nipple through tiny tubes called ducts, which allow her to breastfeed. The body is made up of billions of tiny cells, which usually grow and multiply in an orderly way. New cells are only produced when and where theyre needed. In cancer, this orderly process goes wrong and cells begin to grow and multiply uncontrollably. Read more about the causes of breast cancer Symptoms of breast cancer Breast cancer can have a number of symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue. Most breast lumps arent cancerous, but its always best to have them checked by your doctor. You should also speak to your GP if you notice any of the following: a change in the size or shape of one or both breasts discharge from either of your nipples(which may be streaked with blood) a lump or swelling in either of your armpits dimpling on the skin of your breasts a rash on or around your nipple a change in the appearance of your nipple, such as becoming sunken into your breast Breast pain alone isnt a symptom of breast cancer. Learn more about the symptoms of breast cancer After examining your breasts, your GP may refer you to a specialist breast cancer clinic for further tests.This might include a mammography (breast screening)or a biopsy . Read more about breast screening and how breast cancer is diagnosed Types of breast cancer There are several different types of breast cancer, which can develop in different parts of the breast. Breast cancer is often divided into non-invasive and invasive types. Non-invasive breast cancer Non-invasive breast cancer is also known as cancer or carcinoma in situ. This cancer is found in the ducts of the breast and hasnt developed the ability to spread outside the breast. This form of cancer rarely shows as a lump in the breast that can be felt, and is usually found on a mammogram. The most common type of non-invasive cancer is ductal carcinoma in situ (DCIS). Invasive breast cancer Invasive cancer has the ability to spread outside the breast, although this doesnt necessarily mean it has spread. The most common form of breast cancer is invasive ductal breast cancer, which develops in the cells that line the breast ducts. Invasive ductal breast cancer accounts for about 80% of allbreast cancer cases and is sometimes called no special type. Other types of breast cancer Other less common types of breast cancer include invasive lobular breast cancer, which develops in the cells that line the milk-producing lobules, inflammatory breast cancer and Pagets disease of the breast . Its possible for breast cancer to spread to other parts of the body, usually through the lymph nodes (small glands that filter bacteria from the body) or the bloodstream. If this happens, its known as secondary or metastatic breast cancer. Breast cancer screening Theres a good chance of recovery if breast cancer is detected in its early stages. For this reason, its vital that women check their breasts regularly for any changes and always get any changes examined by their GP. Mammographic screening (where X-ray images of the breast are taken) is the best available method of detecting an early breast lesion. However, you should be aware that a mammogram might fail to detect some breast cancers. It might also increase your chances of having extra tests and interventions, including surgery. Women with a higher-than-average risk of developing breast cancer may be offered screening and genetic testing for the condition. As the risk of breast cancer increases with age, all women who are 50to 70 years old are invited for breast cancer screening every 3 years. Women over 70 are also entitled to screening and can arrange an appointment through their GP or local screening unit. The NHS is in the process of extending the programme as a trial, offering screening to some women aged 47to 73. Read more about breast screening and find breast cancer screening services near you Treating breast cancer If cancer is detected at an early stage, it can be treated before it spreads to nearby parts of the body. Breast cancer is treated using a combination of surgery, chemotherapy and radiotherapy . Surgery is usually the first type of treatment youll have, followed by chemotherapy or radiotherapy or, in some cases, hormone or biological treatments. The type of surgery and the treatment you have afterwards will depend on the type of breast cancer you have. Your doctor will discuss the best treatment plan with you. In asmall proportion of women, breast cancer is discovered after its spread to other parts of the body (metastasis). Secondary cancer, also called advanced or metastatic cancer, isnt curable, so the aim of treatment isto achieve remission (symptom relief). Read more about treating breast cancer Preventing breast cancer As the causes of breast cancer arent fully understood, its not possible to know if it can be prevented altogether. If youre at increased risk of developing the condition, some treatments are available to reduce the risk. Studies have looked at the link between breast cancer and diet and, although there are no definite conclusions, there are benefits for women who maintain a healthy weight , exercise regularly and who have a low intake of saturated fat and alcohol . Its been suggested that regular exercise can reduce your risk of breast cancer by as much as a third. If youve been through the menopause, its particularly important that youre not overweight or obese. This is because being overweight or obese causes more oestrogen to be produced, which can increase the risk of breast cancer. Read more about preventing breast cancer Living with breast cancer Being diagnosed with breast cancer can affect daily life in many ways,depending on what stageits at and what treatment youre having. How women cope with their diagnosis and treatment varies from person to person. You can be reassured that there are several forms of support available, if you need it. For example: yourfamily andfriends can be a powerful support system you can communicate with other people in the same situation find out as much as possible about your condition dont try to do too much or overexert yourself make time for yourself Read more about living with breast cancer Symptoms of breast cancer The first symptom of breast cancer most women notice is a lump or an area of thickened tissue in their breast. Mostbreast lumps (90%) arent cancerous, but its always best to have them checked by your doctor. You should speak to your GP if you notice any of the following: a lump or area of thickened tissue in either breast a change in the size or shape of one or both breasts discharge from either of your nipples(which may be streaked with blood) a lump or swelling in either of your armpits dimpling on the skin of your breasts a rash on or around your nipple a change in the appearance of your nipple, such as becoming sunken into your breast Breast pain alone isnt a symptom of breast cancer. Read further information: Breast Cancer Now: Signs and symptoms of breast cancer Cancer Research UK: Breast cancer symptoms Macmillan Cancer Support: Signs and symptoms of breast cancer Breast awareness Its important to be breast aware,so you can pick up any changes as soon as possible. Get to know what is normal for you. For instance, your breasts may look or feel different at different times of your life. This will make it much easier to spotpotential problems. Read further information: Breast Cancer Now: Checking your breasts Breast Cancer Now: Signs and symptoms of breast cancer Causes and risk factors of breast cancer The causes of breast cancer arent fully understood, making it difficult to say why one woman may develop breast cancer and another may not. However, there are risk factors that areknown to affect your likelihood of developing breast cancer. Some of these you cant do anything about, but there are some you can change. Age The risk of developing breast cancer increases with age. The condition is most common among women over 50 who have been through the menopause . About 8 out of 10 cases of breast cancer occur in women over 50. All women who are 50to 70 years of age should be screened for breast cancer every 3 years as part of the NHS Breast Screening Programme. Women over the age of 70 are still eligible to be screened and can arrange this through their GP or local screening unit. Read more about breast screening Family history If you have close relatives who have had breast cancer or ovarian cancer , you may have a higher risk of developing breast cancer. However, because breast cancer is the most common cancer in women, its possible for it to occur in more than one family member by chance. Most cases of breast cancer arent hereditary (they dont run in families), but particular genes, known as BRCA1 and BRCA2, can increase your risk of developing both breast and ovarian cancer. Its possible for these genes to be passed on from a parent to their child. A third gene (TP53) is also associated with an increased risk of breast cancer. If you have, for example, 2 or more close relatives from the same side of your family, such as your mother, sister or daughter, who have had breast cancer under the age of 50, you may be eligible for surveillance for breast cancer or for genetic screening to look for the genes that make developing breast cancer more likely. If youre worried about your family history of breast cancer, discuss it with your GP. Read about predictive genetic tests for cancer risk genes Previous diagnosis of breast cancer If youve previously had breast cancer or early non-invasive cancer cell changes in breast ducts, you have a higher risk of developing it again, either in your other breast or in the same breast again. Previous benign breast lump A benign breast lump doesnt meanyou have breast cancer, but certain types of lump may slightly increase your risk of developing it. Certain benign changes in your breast tissue, such as atypical ductal hyperplasia (cells growing abnormally in ducts), or lobular carcinoma in situ (abnormal cells inside your breast lobes), can make getting breast cancer more likely. Breast density Your breasts are made up of thousands of tiny glands (lobules), which produce milk. This glandular tissue contains a higher concentration of breast cells than other breast tissue, making it denser. Women with dense breast tissue may have a higher risk of developing breast cancer because there are more cells that can become cancerous. Dense breast tissue can also make a breast scan (mammogram) difficult to read, because it makes any lumps or areas of abnormal tissue harder to spot. Younger women tend to have denser breasts. As you get older, the amount of glandular tissue in your breasts decreases and is replaced by fat, so your breasts become less dense. Exposure to oestrogen The female hormone, oestrogen,can sometimes stimulate breast cancer cells and cause them togrow. The ovaries, where your eggs are stored, begin to produce oestrogen when you start puberty , to regulate your periods. Your risk of developing breast cancer may rise slightly with the amount of oestrogenyour body is exposed to. For example, if you started your periods at a young age and experienced themenopause at a late age, youll have been exposed to oestrogen over a longer period of time. In the same way, not having children, or having children later in life, may slightly increase your risk of developing breast cancer because your exposure to oestrogen is uninterrupted by pregnancy. Being overweight or obese If youve experienced the menopause and are overweight or obese , you may be more at risk of developing breast cancer. This is thought to be linked to the amount of oestrogen in your body, because being overweight or obese after the menopause causes more oestrogen to be produced. Being tall If youre taller than average, youre more likely to develop breast cancer than someone whos shorter than average.The reason for this isnt fully understood, but it may be due to interactions between genes, nutrition and hormones. Alcohol Your risk of developing breast cancer can increase with the amount of alcohol you drink . Radiation Certain medical procedures that use radiation, like X-rays and computerised tomography (CT) scans , may slightly increase your risk of developing breast cancer. If you had radiotherapy to your chest area for Hodgkin lymphoma when you were a child, you should have already received a written invitation from the Department of Health for a consultation with a specialist to discuss your increased risk of developing breast cancer. Speak to your GP if you werent contacted, or if you didnt attend a consultation. If you currently need radiotherapy for Hodgkin lymphoma, your specialist should discuss the risk of breast cancer before your treatment begins. Hormone replacement therapy (HRT) Hormone replacement therapy (HRT) is associated with a slightly increased risk of developing breast cancer. Both combined HRT and oestrogen-only HRT can increase your risk of developing breast cancer, although the risk is slightly higher if you take combined HRT. Read further information: Breast Cancer Now: Breast cancer causes Macmillan Cancer Support: Risk factors for breast cancer Diagnosing breast cancer If you have suspected breast cancer, eitherbecause ofyour symptoms or because your mammogram has shown an abnormality, youll be referred to a specialist breast clinic for further tests. What to expect at the breast clinic The tests youll receive at the breast clinic depend on your current symptoms, your age, and the results of the initial examination youll have when you arrive. Many people dont need any further tests after the initial examination. Most of the time you can expect to spend up to 2 hours at the breast clinic. Mammogram and breast ultrasound If you have symptoms and have been referred by your GP, youll meet a specialist wholl examine you to determine if you need further tests. If youre under40 years of age, the specialistmay suggest you only have a breast ultrasound scan. This is because younger women have denser breasts, which means a mammogram isnt as effective as an ultrasoundfor diagnosing breast disease. If you have a mammogram, it will produce an X-ray of your breasts. You may also need an ultrasound scan . Ultrasound uses high-frequency sound waves to produce an image of the inside of your breasts, showing any lumps or abnormalities. Your doctor may also suggest a breast ultrasound if they need to know whether a lump in your breast is solid or contains liquid. Read more about breast screening Biopsy A biopsy is where a sample of tissue cells is taken from your breast and tested to see if its cancerous. You may also need a scan and a needle test on lymph nodes in your armpit (axilla) to see whether these are also affected. Biopsies can be taken in different ways, and the type you have will depend on what your doctor knows about your condition.Different methods ofcarrying outa biopsy are discussed below. Needle aspiration may be used to test a sample of your breast cells for cancer or to drain a benign cyst (a small fluid-filled lump). Your doctor will use a small needle to extract a sample of cells, without removing any tissue. Needle biopsy is the most common type of biopsy. A sample of tissue is taken from a lump in your breast using a large needle. Youll have a local anaesthetic , which means youll be awake during the procedure, but your breast will be numb. Your doctor may suggest that you have a guided needle biopsy (usually guided by ultrasound or X-ray, but sometimes MRI is used) to obtain a more precise and reliable diagnosis of cancer and to distinguish it from any non-invasive change, particularly ductal carcinoma in situ (DCIS). Vacuum-assisted biopsy, also known as a mammotome biopsy, is another type of biopsy. During the procedure, a needleis attached to a gentle suction tube, which helps toobtain the sample and clear any bleeding from the area. Read further information: Breast Cancer Now:What happens at a breast clinic appointment? Breast Cancer Now: Your pathology results Macmillan Cancer Support: Breast cancer Further tests for breast cancer If a diagnosis of breast cancer is confirmed, more tests will be needed to determine the stage and grade of the cancer, and to work out the best method of treatment. Ifyourcancer was detected through the NHS Breast Screening Programme, youll have further tests in the screening centre before being referred for treatment. Scans and X-rays Computerised tomography (CT) scans , or chest X-ray and liver ultrasound scans, may be needed to check whether the cancer has spread to your lungs or liver. An MRI scan of the breast may be needed to clarify or to assess the extent of the condition within the breast. If your doctor thinks that the cancer could have spread to your bones, you may need a bone scan. Before having a bone scan, a substance containing a small amount of radiation, known as an isotope, will be injected into a vein in your arm. This will be absorbed into your bone if its been affected by cancer. The affected areas of bone will show up as highlighted areas on the bone scan, which is carried out using a special camera. Tests to determine specific types of treatment Youll also need tests that show whether the cancer will respond to specific types of treatment. The results of these tests can give your doctors a more complete picture of the type of cancer you have and how best to treat it. The types of test you could be offered are discussed below. In some cases, breast cancer cells can be stimulated to grow by hormones that occur naturally in your body, such as oestrogen and progesterone. If this is the case, the cancer may be treated by stopping the effects of the hormones, or by lowering the level of these hormones in your body. This is known as hormone therapy. Duringa hormone receptor test, a sample of cancer cells will be taken from your breast and tested to see if they respond to either oestrogen or progesterone. If the hormone is able to attach to the cancer cells (using a hormone receptor), theyre known as hormone receptor positive. While hormones can encourage the growth of some types of breast cancer, other types are stimulated by a protein calledhuman epidermal growth factor receptor 2 (HER2). These types of cancer can be diagnosed using a HER2 test, and treated with medication to block the effects of HER2. This is known as biological or targeted therapy. Stage and grade of breast cancer Stage of breast cancer When your breast cancer is diagnosed, the doctors will give it a stage. The stage describes the size of the cancer and how far it has spread. Ductal carcinoma in situ (DCIS) is sometimes described as stage 0. Other stages of breast cancer describe invasive breast cancer: stage 1 the tumour measures less than 2cm, the lymph nodes in the armpit arent affected, and there are no signs that the cancer has spread elsewhere in the body stage 2 the tumour measures 2 to 5cm or the lymph nodes in the armpit are affected, or both, and there are no signs that the cancer has spread elsewhere in the body stage 3 the tumour measures2 to 5cm and may be attached to structures in the breast, such as skin or surrounding tissues, the lymph nodes in the armpit are affected butthere are no signs that the cancer has spread elsewhere in the body stage 4 the tumour is of any size and the cancer has spread to other parts of the body (metastasis) This is a simplified guide. Each stage is divided into further categories: A, B and C. If youre not sure what stage you have, ask your doctor. TNM staging system The TNM staging system may also be used to describe breast cancer, as it can provide accurate information about the diagnosis. T describes the size of the tumour, N describes whether cancer has spread to the lymph nodes, and M gives an indication of whether the cancer has spread to other parts of the body. Grade of breast cancer The grade describes the appearance of the cancer cells. low grade (G1) the cells, although abnormal, appear to be growing slowly medium grade (G2) the cells look more abnormal than low-grade cells high grade (G3) the cells look even more abnormal and are more likely to grow quickly Read further information: Cancer Research UK: TNM breast cancer staging Cancer Research UK: Stages and grades of breast cancer Treating breast cancer Surgery is usually the first type of treatment for breast cancer. The type of surgery you undergo will depend on the type of breast cancer you have. Surgery is usually followed by chemotherapy or radiotherapy or, in some cases, hormone or biological treatments. Again, the treatment youll have will depend onyour type of breast cancer. Your doctor will discuss the most suitable treatmentplan with you. Chemotherapy or hormone therapy will sometimes be the first treatment. Secondary breast cancer Most breast cancers are discovered in the conditions early stages. However, a small proportion of women discover that they have breast cancer after its spread to other parts of the body (known as metastasis). If this is the case, the type of treatment you have may be different. Secondary cancer, also called advanced or metastatic cancer, isnt curable and treatment aims to achieve remission (where the cancer shrinks or disappears, and you feel normal and able to enjoy life to the full). Read further information aboutsecondary breast cancer Surgery There are 2 main types of breast cancer surgery. They are: surgery to remove the cancerous lump (tumour), known as breast-conserving surgery surgery to remove the whole breast, which is called a mastectomy In many cases, a mastectomy can be followed by reconstructive surgery to try to recreate a bulge to replace the breast that was removed. Studies have shown that breast-conserving surgery followed by radiotherapy is as successful as total mastectomy at treating early-stage breast cancer. Breast-conserving surgery Breast-conserving surgery ranges from a lumpectomy or wide local excision, wherejust the tumour and a little surrounding breast tissue is removed, to a partial mastectomy or quadrantectomy, whereup to a quarter of the breast is removed. If you have breast-conserving surgery, the amount of breast tissue you have removed will depend on the: type of cancer you have size of the tumour and where it is in your breast amount of surrounding tissue that needs to be removed size of your breasts Your surgeon will always remove an area of healthy breast tissue around the cancer, which will be tested for traces of cancer. If theres no cancer present in the healthy tissue, theres less chance that the cancer will reoccur. If cancer cells are found in the surrounding tissue, more tissue may need to be removed from your breast. After having breast-conserving surgery, you will usually be offered radiotherapy to destroy any remaining cancer cells. Mastectomy A mastectomy is the removal of all the breast tissue, including the nipple. If there are no obvious signs that the cancer has spread to your lymph nodes, you may have a mastectomy, where your breast is removed, along with a sentinel lymph node biopsy. If the cancer has spread to your lymph nodes, you will probably need more extensive removal (clearance) of lymph nodes from the axilla (under your arm). Reconstruction Breast reconstruction is surgery to make a new breast shape that looks as much as possible like your other breast. Reconstruction can be carried out at the same time as a mastectomy (immediate reconstruction), or it can be carried out later (delayed reconstruction). It can be done either by inserting a breast implant or by using tissue from another part of your body to create a new breast. Read further information aboutbreast reconstruction Lymph node surgery To find out if the cancer has spread, a procedure called a sentinel lymph node biopsymay be carried out. The sentinel lymph nodes are the first lymph nodes that the cancer cells reach if they spread. Theyre part of the lymph nodes under the arm (axillary lymph nodes). The position of the sentinel lymph nodes varies, so theyre identified using a combination of a radioisotope and a blue dye. The sentinel lymph nodes are examined in the laboratory to see if there are any cancer cells present. This provides a good indicator of whether the cancer has spread. If there are cancer cells in the sentinel nodes, you may need further surgery to remove more lymph nodes from under the arm. Radiotherapy Radiotherapy uses controlled doses of radiation to kill cancer cells. Its usually given after surgery and chemotherapy to kill any remaining cancer cells. If you need radiotherapy, your treatment will begin about a month after your surgery or chemotherapy, to give your body a chance to recover. Youll probably have radiotherapy sessions 3 to 5 days a week, for 3 to 6 weeks. Each session will only last a few minutes. The type of radiotherapy you have will depend on your cancer and surgery type. Some women may not need to have radiotherapy at all. The types available are: breast radiotherapy after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue chest wall radiotherapy after a mastectomy, radiotherapy is applied to the chest wall breast boost some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed; however, the boost may affect the appearance of the breast, particularly if you have large breasts, and can sometimes have other side effects, including hardening of the breast tissue (fibrosis) radiotherapy to the lymph nodes where radiotherapy is aimed at the armpit (axilla) and the surrounding area to kill any cancer that may be present in the lymph nodes The side effects of radiotherapy include: irritation and darkening of the skin on your breast, which may lead to sore, red, weepy skin fatigue (extreme tiredness) lymphoedema(excess fluid build-up in your arm caused by blockage of the lymph nodes under your arm) Read further information aboutradiotherapy for breast cancer Chemotherapy Chemotherapy involves using anti-cancer (cytotoxic) medication to kill the cancer cells. Its usually used after surgery to destroy any cancer cells that havent been removed. This is called adjuvant chemotherapy. In some cases, you may have chemotherapy before surgery, which is often used to shrink a large tumour. This is called neo-adjuvant chemotherapy. Several different medications are used for chemotherapy and three are often given at once. The choice of medication and the combination will depend on the type of breast cancer you have and how much its spread. Chemotherapy is usually given as an outpatient treatment, which meansyou wont have to stay in hospital overnight. The medications are usually given through a drip straight into the blood through a vein. In some cases, you may be given tablets that you can take at home. You may have chemotherapy sessions once every 2 to 3 weeks, over a period of 4 to 8 months, to give your body a rest in between treatments. The main side effects of chemotherapy are caused by their influence on normal, healthy cells, such as immune cells. Side effects include: infections loss of appetite nausea and vomiting tiredness hair loss sore mouth Many side effects can be prevented or controlled with medicines that your doctor can prescribe. Chemotherapy medication can also stop the production of oestrogen in your body, which is known to encourage the growth of some breast cancers. If you havent experienced the menopause, your periods maystop while youre undergoing chemotherapy treatment. After youve finished the course of chemotherapy, your ovaries should start producing oestrogen again. However, this doesnt always happen and you may enter an early menopause . This is more likely in women over 40 years old, becausetheyre closer to menopausal age. Your doctor will discuss with you the impact that any treatment will have on your fertility. Chemotherapy for secondary breast cancer If your breast cancer has spread beyond the breast and lymph nodes to other parts of your body, chemotherapy wont cure the cancer, but it may shrink the tumour, relieve your symptoms and help lengthen your life. Read further information aboutchemotherapy for breast cancer Hormone treatment Some breast cancers are stimulated to grow by the hormones oestrogen or progesterone, which are found naturally in your body. These types of cancer are known as hormone-receptor-positive cancers. Hormone therapy works by lowering the levels of hormones in your body or by stopping their effects. The type of hormone therapy youll have will depend on the stage and grade of your cancer, which hormone its sensitive to, your age, whether youve experiencedthe menopause and what other type of treatment youre having. Youll probably have hormone therapy after surgery and chemotherapy, but its sometimes given before surgery to shrink a tumour, making it easier to remove. Hormone therapy may be used as the only treatment for breast cancer if your general health prevents you from having surgery, chemotherapy or radiotherapy. In most cases, youll need to take hormone therapy for up to five years afterhaving surgery. If your breast cancer isnt sensitive to hormones, hormone therapy will have no effect. Tamoxifen Tamoxifen stops oestrogen from binding to oestrogen-receptor-positive cancer cells. Its taken every day as a tablet or liquid. It can cause several side effects, including: tiredness changes to your periods nausea and vomiting hot flushes aching joints headaches weight gain Aromatase inhibitors If youveexperienced the menopause, you may be offered an aromatase inhibitor. This type of medication works by blocking aromatase, a substance that helps produce oestrogen in the body after the menopause. Before the menopause, oestrogen is made by the ovaries. Three aromatase inhibitors may be offered. These areanastrozole, exemestane and letrozole. These are taken as a tablet once a day. Side effects include: hot flushes and sweats lack of interest in sex (loss of libido) nausea and vomiting tiredness aching joints and bone pain headaches skin rashes Ovarian ablation or suppression In women who haventexperienced the menopause, oestrogen is produced by the ovaries. Ovarian ablation or suppression stops the ovaries working and producing oestrogen. Ablation can be carried out using surgery or radiotherapy. Itstops the ovaries working permanently and means youll experience the menopause early. Ovarian suppression involves using a medication called goserelin, which is a luteinising hormone-releasing hormone agonist (LHRHa). Your periods will stop while youre taking it, although they should start again once your treatment is complete. If youreapproaching the menopause (around the age of 50), your periods may not start again after you stop taking goserelin. Goserelin is taken as an injection once a month and can cause menopausal side effects, including: hot flushes and sweats mood swings trouble sleeping Read further information abouthormone therapy Biological therapy (targeted therapy) Some breast cancers are stimulated to grow by a protein called human epidermal growth factor receptor 2 (HER2). These cancers are called HER2-positive. Biological therapy works by stopping the effects of HER2 and by helping your immune system to fight off cancer cells. If you have high levels of the HER2 protein and are able to have biological therapy, youll probably be prescribed a medicine called trastuzumab. Trastuzumab, also known by the brand name Herceptin,is usually used after chemotherapy. Trastuzumab Trastuzumab is a type of biologial therapy

Breast cancer (female)

such as viruses and bacteria. The trastuzumab antibody targets and destroys cancer cells that are HER2-positive. Trastuzumab is usually given intravenously through a drip. Its also sometimes available as an injection under the skin (a subcutaneous injection). You will have the treatment in hospital. Each treatment session takes up to one hour and the number of sessions you need will depend on whether you have early or more advanced breast cancer. On average youll need a session once every three weeks for early breast cancer and weekly sessions if your cancer is more advanced. Trastuzumab can cause side effects including heart problems. This means that its not suitable if you have a heart problem such as angina uncontrolled high blood pressure (hypertension) or heart valve disease. If you need to take trastuzumab youll haveregular tests on your heart to make sure its not causing any problems. Other side effects of trastuzumab may include: an initial allergic reaction to the medication whichcan cause nausea wheezing chills and fever diarrhoea tiredness aches and pains Clinical trials A great deal of progress has been made in breast cancer treatment and more women now live longer and have fewer side effects from treatment. These advances were discovered in clinical trials where new treatments and treatment combinations are compared with standard ones. All cancer trials in the UK are carefully overseen to ensure theyre worthwhile and safely conducted. In fact participants in clinical trials can do better overall than thosein routine care. If youre asked to take part in a trial youll be given an information sheet and if you want to take part youll be asked to sign aconsent form. You can refuse or withdraw from a clinical trial without it affecting your care. Read further information: Breast Cancer Now: Clinical trials Against Breast Cancer:Our research Psychological help Dealing with cancer can be a huge challenge for both patients and their families. It can cause emotional and practical difficulties. Many women have to cope with the removal of part or all of a breast which can be very upsetting. It often helps to talk about your feelings or other difficulties with a trained counsellor or therapist. You can ask for this kind of help at any stage of your illness. There are various ways to find help and support. Your hospital doctor specialist nurse or GP can refer you to a counsellor. If youre feeling depressed talk to your GP. A course of antidepressant drugs may help or your GP can arrange for you to see a counsellor or psychotherapist. It can help to talk to someone whos been through the same thing as you. Many organisations have helplines and online forums. They can also put you in touch with other people whove had cancer treatment. Read further information: Breast Cancer Now: Support for you Macmillan Cancer Support:Online community Complementary therapies Complementary therapies are holistic therapies that can promote physical and emotional wellbeing. Theyre given alongside conventional treatments and include relaxation techniques massage aromatherapy and acupuncture. Complementary therapycan help some women cope with diagnosis and treatment and providea breakfrom the treatment plan. Your hospital or breast unit may be able to provide access to complementary therapies or suggest where you canget them. Its important to speak to your breast cancer specialist nurse about any complementary therapy you wish to use to make sure it doesntinterfere with your conventional treatment. Read further information aboutcomplementary therapies Living with breast cancer Recovery Most women with breast cancer have an operation as part of their treatment. Getting back to normal after surgery can take some time. Its important to take things slowly and give yourself time to recover. During this time avoid lifting things for example children or heavy shopping bags and avoid heavy housework. You may also be advised not to drive. Read more about recovering from an operation Some other treatments particularly radiotherapy and chemotherapy can make you very tired. You may need to take a break from some of your normal activities for a while. Dontbe afraid to ask for practical help from family and friends. Follow-up After your treatment has finished youll be invited for regular check-ups usually every 3 months for the first year. If youve had early breast cancer your healthcare team will agree a care plan with you after your treatment has finished. This plan contains the details of your follow-up. You will receive a copy of the plan which will also be sent to your GP. During the check-up your doctor will examine you and may carry out blood tests or X-rays to see how your cancer is responding to treatment. You should also be offered a mammogram every year for the first 5 years after your treatment. Long-term complications Although its rare your treatment for breast cancer may cause new problems such as: pain and stiffness in your arms and shoulders may occur after surgery and the skin in these areas may be tight lymphoedema (a build-up of excess lymph fluid which causes swelling) this may occurif surgery or radiotherapy damages the lymphatic drainage system in the armpit Talk to your healthcare team if you experience these or any other long-term effects of treatment. Read further information: Breast Cancer Now:Life after treatment Breast Cancer Now: Lymphoedema Cancer Research UK: Follow up after breast cancer treatment Your body and breasts after treatment Dealing with changes to your body A diagnosis of breast cancer may change how you think about your body. All women react differently to the bodily changes that happen as a result of breast cancer treatment. Some women react positively but others find it more difficult to cope. Its important to give yourself time to come to terms with any changes to your body. Read further information: Breast Cancer Now: Coping with breast cancer emotionally healthtalk: Body image and breast cancer Macmillan Cancer Support:Changes to your appearance and body image Early menopause Although most cases of breast cancer occur in women over 50 who have experiencedthe menopause some younger women have to cope with early menopause brought on by cancer treatment. Symptoms can include hot flushes vaginal dryness and loss of sexual desire . Talk to your healthcare team about any symptoms you have and theyll be able to help. Read further information: Breast Cancer Now: Fertility and breast cancer treatment Cancer Research UK: Breast cancer and menopausal symptoms Macmillan: Menopausal symptoms and cancer treatment Prosthesis A breast prosthesis is an artificial breast which can be worn inside your bra to replace the breast thats been removed. Soon after a mastectomy youll be given a lightweight foam breast to wear until the area affected by surgery or radiotherapy has healed. After its healed youll be offered a silicone prosthesis. Prostheses come in many different shapes and sizes and you should be able to find one that suits you. Read further information: Breast Cancer Now: Your body after breast cancer treatment Cancer Research UK: False breast shape (prosthesis) after breast cancer surgery Reconstruction If you didnt have immediate breast reconstruction (carried out at the time of a mastectomy) you can have reconstruction later. This iscalled a delayed reconstruction. There are 2 main methods of breast reconstruction reconstruction using your own tissue and reconstruction using an implant. The type thats most suitable for you will depend on many factors including the treatment youve had any ongoing treatment and the size of your breasts. Talk to your healthcare team about which reconstruction is suitable for you. Read further information about breast reconstruction Relationships with friends and family Its not always easy to talk about cancer either for you or your family and friends. You may sense that some people feel awkward around you or avoid you. Being open about how you feel and what your family and friends can do to help may put them at ease. However dont be afraid to tell them that you need some time to yourself if thats what you need. Read further information: Breast Cancer Now: Telling family and friends about your breast cancer Macmillan Cancer Support: Talking about your cancer Healthtalk: How breast cancer affects families Your sex life Breast cancer and its treatment can affect your sex life. Its common for women to lose interest in sex after breast cancer treatment. Your treatment may leave you feeling very tired. You may feel shocked confused or depressed about being diagnosed with cancer. You may be upset by the changes to your body or grieve the loss of your breasts or in some cases your fertility. Its understandable that you may not feel like having sex while coping with all this. Try to share your feelings with your partner. If you have problems with sex that arent getting better with time you may want to speak to a counsellor or sex therapist. Read further information: Breast Cancer Now: Sex and breast cancer treatment Cancer Research UK: Life after breast cancer surgery Macmillan Cancer Support: Sex and side effects of cancer treatment Money and financial support If you have to reduce or stop work because of your cancer you may find it difficult to cope financially. If you have cancer or youre caring for someone with cancer you may be entitled to financial support for example: if you have a job but cant work because of your illness youre entitled to Statutory Sick Pay from your employer if you dont have a job and cant work because of your illness you may be entitled to Employment and Support Allowance if youre caring for someone with cancer you may be entitled to Carers Allowance you may be eligible for other benefits if you have children living at home or if you have a low household income Find out what help is available to you as soon as possible. The social worker at your hospital will be able to give you the information you need. Talk to other people Your GP or nurse may be able to answer any questions you have about your cancer or treatment. You may find it helpful to talk to a trained counsellor or psychologist or to someone at a specialist helpline. Your GP surgery will have information on these. Some people find it helpful to talk to other people who havebreast cancer either at a local support group or in an internet chatroom. Read further information: Breast Cancer Now: Support for you Macmillan Cancer Support: Online community Preventing breast cancer As the causes of breast cancer arent fully understood its not known if it can be prevented altogether. Some treatments are available to reduce the risk in women who have a higher risk of developing the condition than the general population. Diet and lifestyle Regular exercise and a healthy balanceddiet are recommended for all women because they can help prevent many conditions including heart disease diabetes and many forms of cancer . Regular exercise can reduce your risk of developing breast cancer. If you have been through the menopause its particularly important that youre not overweight or obese . This is because these conditions cause more oestrogen to be produced which can increase the risk of breast cancer. Breastfeeding Studies have shown that women who breastfeed are statistically less likely to develop breast cancer than those who dont. The reasons arent fully understood but it could be because women dont ovulate as regularly while theyre breastfeeding and oestrogen levels remain stable. Treatments to reduce your risk If you have an increased risk of developing breast cancer treatment is available to reduce your risk. Your level of riskis determined by factors such as your age your familys medical history and the results of genetic tests. You will usually be referred to a specialist genetics service if its thought you have an increased risk of breast cancer.Healthcare professionals working at these servicesshould discuss treatment options with you. The 2 main treatments are surgery to remove the breasts (mastectomy) or medication. Mastectomy A mastectomy is surgery to remove the breasts. It can be usedto treat breast cancer and reduce the chances of developing the condition in the small number of women from high-risk families. By removing as much breast tissue as possible a mastectomy canreduceyour risk of breast cancer by up to 90%. However like all operations theres a risk of complications and having your breasts removed can have a significant effect on your body image and sexual relationships. If you want to you can usually chooseto have breast reconstruction either during the mastectomy operation or at a later date. During breast reconstruction surgery your original breast shape is recreated using eitherbreast implants or tissue from elsewhere in your body. An alternative is to usebreast prostheses. These areartificial breaststhat can be worn inside your bra. Read more about your body and your breasts after treatment Medication In 2013 the National Institute for Health and Care Excellence (NICE) announced that 2 medications called tamoxifen and raloxifene would be available on the NHSfor women who have an increased risk of developing breast cancer. Eithertamoxifen or raloxifene can be used in women whove been through the menopause but only tamoxifen should be used in women who havent. Thesemedications may not be suitable if in the past youve had blood clots or womb cancer or if you have an increased risk of developing these problems in the future. Women whove already had a mastectomy to remove both breastswont be offered these medications because their risk of developing breast cancer is very small. Acourse of treatment with tamoxifen or raloxifene will usually involve taking a tablet every day for 5 years. Raloxifene can cause side effects including flu-like symptoms hot flushes and leg cramps. Side effects of tamoxifen can include hot flushes and sweats changes to yourperiods and nausea and vomiting. Your chances of giving birth to a child with birth defects increase while youre taking tamoxifen soyoull be advised to stop taking it at least 2 months before trying for a baby. The medication can also increase your risk of blood clots so you should stop taking it 6 weeks before having any planned surgery. Tamoxifen and raloxifene arent currently licensed for the purpose of reducing the risk of breast cancer in women with an increasedrisk of developing the condition. However they can still be used if you understand the benefits and risks and your doctor believes the treatment will be helpful.

Breast cancer (male)

Breast cancer in men - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Breast cancer (male) Breast cancer (male) About breast cancer in men Symptoms of breast cancer in men Causes of breast cancer in men Diagnosing breast cancer in men Treating breast cancer in men About breast cancer in men Breast cancer is often thought of as a condition that only affects women, but men can also develop it. Itsmuch less common in men than women. The cancer develops in the small amount of breast tissue men have behind their nipples. The most common symptom is a hard, painless lump in one of the breasts. However, the vast majority of breast lumps are caused bya condition called gynaecomastia . This is a common non-cancerous condition where male breast tissue becomes enlarged. Breast cancer in men can also cause nipple problems, such as the nipple turning in on itself (retraction) or nipple discharge. Read more about the symptoms of male breast cancer When to speak to your GP You should always talk to your GP if you notice a lump in your breast or you have problems affecting your nipples, such as discharge. While these symptoms are unlikely to be caused by breast cancer, they should be investigated further. Why it happens The cause of male breast cancer is unclear, but factors known to increase your chances of developing the condition include: age most cases affect men over the age of60 having a family history of breast cancer (male or female) obesity a body mass index (BMI) of 30 or more Read more about causes of breast cancer in men Treating breast cancer in men In most cases, surgery is used to remove the cancer, along with a section of the breast. This may be followed by a long-term course of hormone-blocking therapy using medication, usuallya drugcalled tamoxifen. Tamoxifen helps block the effects of hormonesknown to stimulate the growth of cancerous cells in breast tissue. It should help prevent the cancer returning. In some cases, radiotherapy or chemotherapy may be used for the same purpose. Read more about treating breast cancer in men Outlook The outlook for breast cancer is not as good in men as in women. This is because theres reduced awareness of the condition and it may take longer to diagnose. The survival rates for breast cancer in men largely depend on how far the cancer has spread before its diagnosed. Breast cancer diagnosed at an early stage can often be treated successfully, but effective treatment is more difficult if the cancer has spread beyond the breast tissue. Unfortunately, many cases are diagnosed after the cancer has already started to spread. Read more about diagnosing breast cancerin men . Reducing your risk The most effective way of reducing your risk of developing breast cancer, as well as other serious health conditions, is to: drink alcohol in moderation maintain a healthy weight through a combination of eating a healthy diet and exercising regularly Read more about preventing cancer Symptoms of breast cancer in men The main symptom of breast cancer in men is a hard lump in one of your breasts. The lump is almost always painless. The lump is usually located underneath the nipple and areola (the circle of dark-coloured skin surrounding the nipple). However, the vast majority of breast lumps arecaused bya condition called gynaecomastia . This is a common non-cancerous condition where male breast tissue becomes enlarged. Less common symptoms of male breast cancerinclude: the nipple beginning to turn in on itself (nipple retraction) the nipple becoming hard and inflamed, and looking sore (nipple ulceration) fluid leaking from the nipple (nipple discharge) Advanced symptoms Additional symptoms usually only develop if the cancer spreads from the breast to other parts of the body, such as the bones, liver or lungs. This is known as metastatic breast cancer. Symptoms of metastatic breast cancer include: bone pain swelling of the lymph nodes (glands), usually in or around the armpit shortness of breath feeling unusually tired all the time feeling sick (nausea) itchy skinwithyellowing of the skin and whites of the eyes (jaundice) When to seek medical advice You should always visit your GP if you notice a lump in your breast or you haveproblems affecting your nipples, such as retraction, ulceration or discharge. These problemsare unlikely to be of the result of breast cancer, but theyshould beinvestigated further. Causes of breast cancer in men Its not clear exactly what causes breast cancer in men, although a number of things can increase your risk of developing the condition. Age Like many cancers, men have an increased risk of developing breast cancer as they get older. Most cases are diagnosed in men aged 60 to 70. Its rare for young men todevelop the condition. Genetics and family history A genetic mutation isa permanent alteration in the DNA sequence that makes up a gene.The result is thatone or more of the bodys processes may not work in the way they should. There are a number of genetic mutations known to increase your risk of developing breast cancer. The most significant mutation identified is known as the BRCA2 mutation. Theres also evidence that breast cancer can run in families, especially in men who have a first-degree relative who has developed breast cancer,such as a mother or sister. Routine testing for the faulty genes that cause breast cancer in men isnt usually carried out on the NHS, unless specifically requested by a specialist. However,some private clinics may offer gene testing. Tests can be expensive, with prices ranging from around 2,000 to 3,000. Oestrogen Theres evidence that high levels of the hormone oestrogen, or prolonged exposure to it, can increase the risk of breast cancer in men. Comparedwith women, men tend to have low levels of oestrogen, but there are circumstances that can increase the levels of oestrogen in men. These include: hormone treatments man-made (synthetic) versions of oestrogen are often used to treat prostate cancer, and are also given to transgender patientsundergoing a male to female sex change obesity obese men have higher levels of oestrogen than normal cirrhosis this is scarring of the liver, often caused by long-term alcohol misuse There is also a rare genetic condition affecting males called Klinefelter syndrome . This is a congenital condition thatboys are born with that meansthose who areaffectedproduce less of the hormone testosterone than usual. As testosterone usually helps to limit the effect of oestrogen, men with Klinefelter syndrome are more likely to develop breast cancer than the general male population. Occupational risks Theres some evidence men who work in hot environments are twice as likely to develop breast cancer compared with men who work in cooler environments. Environments linked to an increased risk of breast cancer in men include: blast furnaces steelworks rolling mills a factory where metal (usually steel) is shaped using rollers car manufacturing plants One hypothesis to help explain the link between working environment and the increased risk of developing breast cancer is that excessive heat may damage the testicles, which could lead to an increase in oestrogen levels. Another hypothesis is that working in hot environments usually involves exposure to certain chemicals that may increase the risk of developing breast cancer in men. Rates of breast cancer are also unusually high in men who manufacture perfumes and soaps. They are 7 times more likely to develop breast cancer than the male population at large. The reason for this increased risk is still unclear. Exposure to certain chemicals seems to be an obvious possibility, but this hasnt yet been proven. Radiation Exposure to radiation has been linked to an increased risk of developing breast cancer in men. Research has found men who received a course of radiotherapy where high energy X-rays are used to kill cancerous cellsdirected at the upper chest were seven times more likely to develop male breast cancer comparedwith the population at large. However, even a seven-fold increase means the chance of developing breast cancer is still very low. Diagnosing breast cancer in men If you have symptoms of breast cancer, such as a hard, painless lump in one of your breasts, your GP will carefully examine you. During the examination, theyll also look for other possible signs of male breast cancer, such as swollen lymph nodes (glands). Its likely your GP will refer you for further tests if theres a possibility you may have breast cancer. Mammogram A mammogram is a type of X-ray used to help determine whether there are any changes in breast tissue that could be the result of cancer. During the mammogram procedure, a radiographer (a specialist in taking X-rays) will compress one of your breasts between two X-ray plates. This shouldnt be painful, but you should tell the radiographer if you find it uncomfortable. Once your breast has been correctly positioned, an X-ray will be taken that produces a clear image of the inside of your breast. The procedure will then be carried out on your other breast. Ultrasound An ultrasound scan uses high-frequency sound waves to produce an image of the inside of your breasts, in the same way an unborn baby can be seen in the womb. An ultrasound probe or sensor will be placed over your breasts to create an image of the inside of your breasts on a screen. The image will highlight any lumps or abnormalities that may be present in your breasts. Biopsy A biopsy may be recommended if a mammogram or ultrasound scan highlight any lumps or abnormalities in your breasts. A biopsy is a test that can either confirm or rule out a diagnosis of breast cancer in men. It involves taking a sample of suspected cancerous tissue and examining it in a laboratory for the presence of cancerous cells. A type of biopsy known as a core biopsy is usually recommended for the diagnosis of breast cancer in men. This type of biopsy can usually indicate whether the cancer has started to spread from the breast into the surrounding area. During a core biopsy, a local anaesthetic will be used to numb your breast. A hollow needle will then be used to remove a number of small tissue samples from the breast lump. If cancer is found, its also possible to check whether there are special proteins, known as oestrogen receptors, on the surface of the cancerous cells. This is important, because if oestrogen receptors are found and they are in more than halfof casesits possible to treat the cancer with hormone therapy. Read treating breast cancer in men for more information. Staging After breast cancer has been diagnosed, your care team should provide information about the stage of the cancer. Staging is a system used to describe how far a cancer has spread at the point of diagnosis. A cure may be possible if breast cancer is diagnosed at an early stage. However, treatment can only be used to control symptoms and slow the spread of the cancer if its diagnosed at a later stage. Unfortunately, more than 40% of breast cancers in men are diagnosed at a late stage. In some cases, men are diagnosed with a type of breast cancer called ductal carcinoma in situ (DCIS). This means there are cancer cells in the breast, but theyre contained within the breast ducts and cant spread. If left untreated, DCIS can lead to invasive breast cancer over a period of time. Coping with a diagnosis Being told you have breast cancer can cause a wide range of emotions, such as shock, fear, confusion and, in some cases, embarrassment. Most people assume breast cancer only affects women, so it can be difficult to come to terms with the diagnosis. Feelings of isolation and being alone are common in men with breast cancer. This may be because theres little in the way of advice and support for men with breast cancer, particularly when comparedwith the support available for women with the condition. Sometimes men who find themselves in this situation can become depressed. You may be depressed if youve felt very down and no longer interested in doing activities you used to enjoyduring the past month. If you think you may be depressed, visit your GP. There is a range of effective treatments, such as medication and counselling, that can help relieve feelings of depression. You may also find it useful to talk to other men affected by the condition. Breast Cancer Now is a breast cancer charity that provides an online forum for anyone diagnosed with breast cancer . Cancer Research UK also provides Cancer Chat , an online forum for anyone affected by cancer. Screening for breast cancer in men As breast cancer israre inmen, routine screening for the condition isnt recommended, even for men in high-risk groups, such as those with a family history of breast cancer or those who have had radiotherapy . Treating breast cancer in men Treatment for breast cancer in men largely depends on how far the cancer has spread. Most hospitals use multidisciplinary teams (MDTs) to treat men with breast cancer. These are teams of specialistswho work together to make decisions about the best way to proceed with your treatment. Deciding which treatment is best for you can often be confusing. Your cancer team will recommend what they think is the ideal treatment option, but the final decision will be yours. Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions youd like to ask the specialist. For example, you could ask aboutthe advantages and disadvantages of particular treatments. Your treatment plan Your recommended treatment plan depends on how far the cancer has spread. If the cancer hasnt spread significantly beyond your breast, a complete cure may be possible. In these cases, surgery to remove the affected breast is usually recommended. This is often followed by radiotherapy , hormone therapy, or chemotherapy to help prevent the cancer returning. If the cancer has spread beyond your breast into other parts of your body, such as your lungs, a complete cure wont be possible. However, hormone therapy and chemotherapy can be used to relieve symptoms and slow down the spread of the cancer. More information about these treatments can be found below. Surgery An operation called a mastectomy is usually recommended as the first treatment for breast cancer. A mastectomy involves removing the entire breast,sometimes with the nipple and lymph nodes (glands) in the armpit. A procedure known as asentinel lymph node biopsy may also be performed. In some cases, part of the muscle under the breast may also be removed if theres a risk the cancer has spread to this area. Once surgery has been completed, there will be a straight scar across your chest where your nipple used to be and possibly an indentation around the area where the breast tissue used to be. After surgery Most men are well enough to leave hospital 1 to 3 days after surgery. After the operation, its likely youll feel very tired and it may take a few weeks before youre well enough to start carrying out relatively strenuous activities, such as lifting objects or driving. Your specialist nurse will be able to offer more specific advice about this. The wound takes about 2 to 3 weeks to heal. Its important to keep the wound clean during this time. You should look for any signs that the wound may have become infected, such as redness and swelling around the wound or a discharge of pus. Inform your MDT as soon as possible if you suspect an infection. Its difficult to predict when youll feel able to return to work. Some people choose to remain off work until other treatments, such as radiotherapy, have been completed. Others prefer to return to work in between treatments. Your MDT will be able to advise you, but the final decision will be yours. It can take several weeks to fully recover from the effects of a mastectomy. A structured exercise programme, where the intensity and amount of time spent exercising is gradually increased, will probably be recommended. Yourtreatment teamwill be able to provide you with more advice or refer you to a physiotherapist (a specialist with training in rehabilitation using exercise). Complications of surgery Aftersurgery, you may experience numbness or tingling at the site of the scar and in your upper arm. This is common, and iscaused by nerve damage during surgery. The numbness and tingling should pass within a few weeks or months, although it can occasionally be permanent. Anotherpossible complication is painful swelling in the arms. This is called lymphoedema , which is caused by the disruption of the lymphatic system (a series of channels and lymph nodes normally responsible for removing excess fluid from tissue). If many lymph nodes are surgically removed, it can disrupt the lymphatic systems ability to drain fluid, which can lead to swelling. Theres no cure for lymphoedema, but its possible to control the symptoms using a combination of different techniques, such as massage and compression garments. See treating lymphoedema for more information Radiotherapy Radiotherapy is a type of treatment involving a machine that releases high-energy waves to destroy cancerous cells. It can be given a few weeks after surgery to prevent the cancerous cells returning. A typical course of radiotherapy involves 2 to 5 sessions a week over the course of 3 to 6 weeks. The sessions are short and usually only last for 10 to 15 minutes. Radiotherapy isnt usually painful, although youll probably experience some side effects. This is because the energy released during radiotherapy can also damage healthy cells. Common side effects of radiotherapy can include: extreme tiredness (fatigue) feeling sick (nausea) sore, red and irritated skin on the breast similar in appearance to sunburn The side effects of radiotherapy should pass after your course of treatment has finished, although some men experience prolonged fatigue for several months. Radiotherapy can also be used in cases of advanced breast cancer to slow down the spread of the cancer and relieve the symptoms of pain. This is known as palliative radiotherapy. Palliative radiotherapy is usually given in just 1 or 2 doses and doesnt usually cause any side effects. Hormone therapy Up to90% of cases of breast cancers in men are oestrogen receptor positive, or ER+. E is used because the American spelling of oestrogen is estrogen. This means the cancerous cells require oestrogen to grow. Oestrogen is a type of hormone found in low levels in men and much higher levels in women. The aim of hormone therapy is to block the effects of oestrogen on the breast tissue to prevent the cancer recurring after surgery. It can also be used in cases of advanced breast cancer to slow down the spread of the cancer. Tamoxifen Tamoxifen isone of the hormone-blockingmedications widely used for breast cancer. Its available in tablet or liquid form, and prevents oestrogen entering the breast tissue cells. The ideal length of treatment with tamoxifen is unclear. Studies in women with breast cancer suggest a five-year course of treatment is the most effective for preventing the return of cancer and extending survival rates. However, its unclear if this also applies to men. Tamoxifen can also cause unpleasant side effects, which will be taken into consideration when yourtreatment teamis deciding which treatments to recommend. You can discuss the pros and cons of long-term treatment with tamoxifen with your doctors. Side effects of tamoxifen caninclude: reduced interest in sex (loss oflibido) inability to obtain or maintain an erection (erectile dysfunction) headache feeling sicktaking your medication with food may help reduce this side effect changes in mood, such as feeling irritable or depressed You should inform yourteam if you experience side effects that become particularly troublesome, as alternative medications are available. Aromatase inhibitors Aromatase inhibitors are an alternativetype of hormone medication. They may be used if tamoxifen proves unsuccessful or the side effects of tamoxifen are particularly troublesome. Aromatase inhibitors can also be used to slow the spread of advanced breast cancer. In men, oestrogen is created when a protein called aromatase converts another hormone called androgens. Aromatase inhibitors block the effects of aromatase, which in turn lowers the amount of oestrogen in the body. Aromatase inhibitors are usually given in tablet form and taken daily for two to five years. As with tamoxifen, theres little available evidence about the most effective length of dosage in men, compared with female breast cancer. Side effects of aromatase inhibitors can include: joint pain lack of energy hot flushes skin rashes feeling sick being sick thinning of the hair However, its unlikely youll experience any or all of these side effects. Chemotherapy Chemotherapy is used to treat cases of breast cancer where hormone therapy would be largely ineffective because the cancerous cells are not oestrogen receptor positive (ER+). Its usually given after surgery to help prevent the cancer returning, or its used to treat the symptoms of incurable cancer. Chemotherapy for breast cancer involves taking a combination of cancer-killing medications. Treatment is usually given every 2 to3 weeks over the course of 6 months. You may be given chemotherapy tablets (oral chemotherapy), chemotherapy injections (intravenous chemotherapy), or a combination of both. The side effects of chemotherapy can include: feeling sick being sick diarrhoea loss of appetite mouth ulcers tiredness skin rashes infertility hair loss The side effects should resolve once your treatment has finished.Your hair should grow back about 3 to 6 monthsafter treatment. Chemotherapy can also weaken your immune system, making you more vulnerable to infection. Its important totell your MDT aboutany symptoms of a potential infection, such as: a high temperature of 38C (100.4F) or above flu-like symptoms, such as chills or joint pain a general sense of feeling unwell You should also avoid close contact with people known to have an infection. If youre sexually active, you should use a condom for 48 hours after receiving a dose of chemotherapy medication. This is because the medication used in chemotherapy could pass into your semen and cause irritation in the tissue of your partners genitals. You should avoid having children while receiving chemotherapy as many of the medications can damage your sperm and increase your chances of having a baby with a birth defect. Again, using a reliable method of contraception, such as a condom, is recommended Depending on the medications used, it may be several months after your course of chemotherapy has ended before you can safely have children. Your MDT will be able to give you a more detailed recommendation. Biological therapy Biological therapy uses medication to block the effects of a protein called human epidermal growth factor receptor 2 (HER2) in cases where HER2 is contributing to breast cancer. Biological therapies are sometimes referred to as targeted therapies because they are designed to target biological processes that cancers rely on to grow and reproduce. If you have high levels of the HER2 protein andare able to have biological therapy, youll probably be prescribed a medicine called trastuzumab.Also known by the brand name Herceptin, itis usually used after radiotherapy or chemotherapy to prevent cancerous cells returning. Trastuzumab Trastuzumab is a type of biological therapy known as a monoclonal antibody. Antibodies occur naturally in the body and are created by the immune system to destroy harmful cells, such as viruses and bacteria. The trastuzumab antibody targets and destroys cancer cells designed to respond to the HER2 protein. Trastuzumab is given through a drip, directly into a vein (intravenously). Youll receive the treatment in hospital. Each treatment session takes up to 1 hour, and the number of sessions you need depends on whether your breast cancer is in its early or more advanced stages. On average, for early breast cancer youll need to have a session once every 3 weeks, and for more advanced cancer youll need to have weekly sessions. Trastuzumab can cause side effects, including heart problems. This means its not suitable if you have a heart problem, such as angina , uncontrolled high blood pressure (hypertension), or heart valve disease. If you need to take trastuzumab, youll need to have regular tests on your heart to ensure its not causing any problems. Other side effects of trastuzumabcan include: an initial allergic reaction to the medication, which can cause nausea, wheezing, chills and fever diarrhoea tiredness aches and pains

Bronchiectasis

Bronchiectasis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Bronchiectasis Bronchiectasis About bronchiectasis Symptoms of bronchiectasis Causes of bronchiectasis Diagnosing bronchiectasis Treating bronchiectasis Complications of bronchiectasis About bronchiectasis Bronchiectasis is a long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection. The most common symptoms of bronchiectasis include: a persistent cough that usually brings up phlegm (sputum) breathlessness The severity of symptoms can vary widely. Some people have only a few symptoms that dont appear often, while others have wide-ranging dailysymptoms. The symptoms tend to get worse if you develop an infection in your lungs. Read more about the symptoms of bronchiectasis . When to see your GP You should see your GP if you develop a persistent cough. While this may not becaused bybronchiectasis, it requires further investigation. If your GP suspects you may have bronchiectasis, theyll refer you to a specialist in treating lung conditions (a respiratory consultant) for further tests. Read more about diagnosing bronchiectasis . How the lungs are affected The lungs are full of tiny branching airways, known as bronchi. Oxygen travels through these airways, ends up in tiny sacs called alveoli, and from there is absorbed into the bloodstream. The inside walls of the bronchi are coated with sticky mucus, which protects against damage from particles moving down into the lungs. In bronchiectasis, one or more of the bronchi are abnormally widened. This means more mucus than usual gathers there, which makes the bronchi more vulnerable to infection. If an infection does develop, the bronchi may be damaged again, so even more mucus gathers in them, and the risk of infection increases further. Over time, this cycle can cause gradually worsening damage to the lungs. Why it happens Bronchiectasis can develop if the tissue and muscles that surround the bronchi are damaged or destroyed. There are many reasons why this may happen. The three most common causes in the UKare: alung infection during childhood, such as pneumonia or whooping cough , that damages the bronchi underlying problems with the immune system (the bodys defence against infection) that make the bronchi more vulnerable to damage from an infection allergic bronchopulmonary aspergillosis (ABPA) an allergy to a certain type of fungi that can cause the bronchi to become inflamed if spores from the fungiare inhaled However, in many cases of bronchiectasis, no obvious cause for the condition can be found (known as idiopathic bronchiectasis). Read more about the causes of bronchiectasis . Who is affected Bronchiectasis is thought to be uncommon. Its estimated that around 1 in every 1,000 adults in the UK have the condition. It can affect anyone at any age, butsymptoms dont usually develop until middle age. Over 12,000peoplewere admittedto hospital in England during 2013-14 with bronchiectasis. The majority of thesepeople were over 60 years old. How bronchiectasis is treated The damage caused to the lungs by bronchiectasis is permanent, but treatment can help relieve your symptoms and stop the damage getting worse. The main treatments include: exercises and special devicesto help you clear mucus out of yourlungs medication to help improve airflow within the lungs antibiotics to treat any lung infections that develop Surgeryis usually only considered for bronchiectasis in rare cases where other treatments havent been effective, the damage to your bronchi is confined to a small area and youre in good general health. Read more about the treatment of bronchiectasis . Possible complications Complications of bronchiectasis are rare, but they can be serious. One of the most serious complications is coughing up large amounts of blood, causedby one of the blood vessels in the lungs splitting. This problem can be life-threatening and may require emergency surgery to treat it. Read more about the complications of bronchiectasis . Outlook The outlook for people with bronchiectasis is highly variable and often depends on the underlying cause. Living with bronchiectasis can be stressful and frustrating, but most people with the condition have a normal life expectancy. For people with very severe symptoms, however, bronchiectasis can be fatal if the lungs stop working properly. Around 1,000 deaths reported in England and Wales each year are thought to becaused bybronchiectasis. Information about you If you havebronchiectasis, your clinical team may pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register . Symptoms of bronchiectasis The most common symptom of bronchiectasis is a persistent cough that brings up a large amount of phlegm on a daily basis. The phlegmcan be clear, pale yellow or yellow-greenish in colour. Other peoplemay only occasionallycough up small amounts of phlegm, or none at all. Other symptoms may include: shortness of breath wheezing coughing up blood or blood-stained phlegm chest pain joint pain clubbing of the fingertips the tissue beneath the nail thickens and the fingertips become rounded and bulbous Signs of a lung infection If youdevelop a lung infection, your symptoms usually get worsewithin a few days. This is known as an infective exacerbation and it can cause: coughing up even morephlegm, which may bemore green than usualor smell unpleasant worsening shortness of breath You may also: feel very tired cough up blood, if you havent already done so experience a sharp chest pain thats made worse when breathing ( pleurisy ) feel generally unwell When to seek medical advice If you havent previously beendiagnosed with bronchiectasis and you develop a persistent cough, visit your GP for advice. While persistent coughing may not necessarily be the result of bronchiectasis, it requires further investigation. If youve been previously diagnosed with bronchiectasis and you begin to experience symptoms that suggest you have a lung infection, contact your GP. Youll usually need treatment with antibiotics. Some people with bronchiectasis are given a stock of antibiotics as a precaution, in case they suddenly develop a lung infection. When to seek immediate medical advice Some people with bronchiectasis develop a severe lung infection that may need to be treated in hospital. Signs and symptoms of serious lung infection include: a bluish tinge to theskin and lips (cyanosis) confusion a high temperature of 38C (100.4F) or above rapid breathing (more than 25 breathsa minute) severe chest pain that makes it too painful to cough and clear your lungs If you experience any of the above, phone the healthcare professional in charge of your care immediately. This may be your GP, a doctor who specialises in lung conditions (pulmonologist) or a specialist nurse. If this isnt possible, then phone the NHS 24 111 serviceor your local out-of-hours service. Causes of bronchiectasis Bronchiectasis is caused by the airways of the lungs becoming damaged and widened. This can be due to an infection or another condition. Sometimes, the cause is not known. Your lungs are continually exposed to germs, soyour body has sophisticated defence mechanisms designed to keep the lungs free of infection. Ifa foreign substance (such as bacteria or a virus) gets past these defences, your immune system will attempt to stop the spread of any infection by sending white blood cells to the location of the infection. These cells release chemicals to fight the infection, which can cause thesurrounding tissue to become inflamed. For most people, this inflammation will pass without causing any further problems. However, bronchiectasis can occur if the inflammation permanently destroys the elastic-like tissue and muscles surrounding the bronchi (airways), causing them to widen. The abnormal bronchi then become filled with excess mucus, which can trigger persistent coughing and make the lungs more vulnerable to infection. If the lungs do become infected again, thiscan result in further inflammation and further widening of the bronchi. As this cycle is repeated, the damage to the lungs gets progressively worse. How quickly bronchiectasis progresses can vary significantly. For some people, the condition will get worse quickly, but for many the progression is slow. Commoncauses In around half of all cases of bronchiectasis, no obvious cause can be found. Some of the morecommon triggers that have been identified are described below. Childhood infections Around a third of cases of bronchiectasis in adults are associated with a severe lung infection in childhood, such as: severe pneumonia whooping cough tuberculosis (TB) measles However, as there are now vaccinations available for these infections, it is expected that childhood infections will become a less common cause of bronchiectasis in the future. Immunodeficiency Around 1 in 12 cases of bronchiectasis occur because a person has a weakened immune system, which makes their lungs more vulnerable to tissue damage. The medical term for having a weakened immune system is immunodeficiency. Some people are born with an immunodeficiency because of problems with the genes they inherit from their parents. Its also possible to acquire an immunodeficiencyafter an infection such as HIV . Allergic bronchopulmonary aspergillosis (ABPA) Around 1 in 14 people with bronchiectasis develop the condition as a complication of an allergic condition known as allergic bronchopulmonary aspergillosis (ABPA). People with ABPA have an allergy to a type of fungi known as aspergillus, which is found in a wide range of different environments across the world. If a person with ABPA breathes in fungal spores, it can trigger an allergic reaction and persistent inflammation, which in turn can progress to bronchiectasis. Aspiration Aspiration is the medical term for stomach contents accidentally passing into your lungs, rather than down into your gastrointestinal tract. This is responsible for around 1 in 25 cases of bronchiectasis. The lungs are very sensitive to the presence of foreign objects, such as small samples of food or even stomach acids, so this can trigger inflammation leading to bronchiectasis. Cystic fibrosis Cystic fibrosis is a relatively common genetic disorder, where the lungs become clogged up with mucus. The mucus then provides an ideal environment for a bacterial infection to take place, leading to the symptoms of bronchiectasis. It is estimated that cystic fibrosis is responsible for around 1 in 33 cases of bronchiectasis. Cilia abnormalities Cilia are the tiny, hair-like structures that line the airways in the lungs. They are designed to protect the airways and help move away any excess mucus. Bronchiectasis can develop if there is a problem with the cilia that means they are unable to effectively clear mucus from the airways. Conditions that can cause problems with the cilia include: Youngs disease a rare condition only affecting males that is thought to be caused by exposure to mercury in childhood primary ciliary dyskinesia a rare condition caused by inheriting faulty genes Its estimated that about 1 in every 33 cases of bronchiectasis are caused by Youngs disease and 1 or 2 in every 100 cases are caused by primary ciliary dyskinesia. However, as the regulations regarding the use of mercury are now much stricter than they were in the past, it is expected that Youngs syndrome will become a much less common cause of bronchiectasis in the future. Connective tissue diseases Certain conditions that cause inflammation in other areas of the body are sometimes associated with bronchiectasis, including: rheumatoid arthritis Sjgrens syndrome Crohns disease ulcerative colitis These conditions are usually thought to be caused by a problem with the immune system, where it mistakenly attacks healthy tissue. Diagnosing bronchiectasis You should see your GP for advice if you develop a persistent cough, so they can look for a possible cause. Your GP will ask you about your symptoms, such as how often you cough, whether you bring up any phlegm (sputum) and whether you smoke. They may also listen to your lungs with a stethoscope as you breathe in and out. The lungs of people with bronchiectasis often make a distinctive crackling noise as a person breaths in and out. Youll also probablyhave a chest X-ray to rule out other, more serious, causes of your symptoms, such as lung cancer . If your GP thinks you may have a lung infection, they may take a sample of your phlegm, so it can be checked for bacteria. Referral to a specialist If your GP suspects you could have bronchiectasis, youll be referred to a doctor who specialises in treating lung conditions (a respiratory consultant) for further testing. The maximum time you should have to wait for referral is 18 weeks, although you may not have to wait as long as this. Read more about waiting times. Some of the tests a respiratory consultant may carry out to help diagnose bronchiectasis are described below. HRCT scan Currently, the most effective test available to diagnose bronchiectasis is called a high-resolution computerised tomography (HRCT) scan. A HRCT scan involves taking several X-rays of your chest at slightly different angles.A computer is then used to put all the images together. This produces a very detailed picture of the inside of your body and the airways inside your lungs (the bronchi) should show up very clearly. In a healthy pair of lungs, the bronchi should become narrower the further they spread into your lungs, in the same way a tree branch separates into narrower branches and twigs. If the scan shows that a section of airways is actually getting wider, this usually confirms bronchiectasis. Other tests Other tests can be used to assess the state of your lungs and to try to determine what the underlying cause of your bronchiectasis may be. These tests may include: blood tests to check how well your immune system is working and check for infectious agents, such as bacteria, viruses and fungi phlegm (sputum) testto check for bacteria or fungi a sample of your sweat can be tested to see how much salt is in it high levels of salt can be caused by cystic fibrosis (if this test is positive, then a more detailed genetic test can be carried out; see diagnosing cystic fibrosis for further information) lungfunction test a small, hand-held device (spirometer) that you blow into is used to measure how hard and how quickly you can expel air from your lungs; this can assess how well your lungs are working bronchoscopy a flexible tube with a camera at one end is used to look into your lungs; this is usually only required if you think youveinhaleda foreign object Treating bronchiectasis The damage to the lungs associated with bronchiectasis is permanent, but treatment can help prevent the condition getting worse. In most cases, treatment involves a combination of medication, exercises you can learn and devices to help clear your airways. Surgery for bronchiectasis is rare. There are a number of things you can do to help relieve the symptoms of bronchiectasis and stop the condition getting worse, including: stopping smoking (if you smoke) having the flu vaccine every year making sure you have had the pneumococcal vaccine to protect against pneumonia exercising regularly keeping yourself well hydrated eating a balanced diet Exercises There are a range of exercises, known as airway clearance techniques, which can help to remove mucus from your lungs. This can often help improve coughing and breathlessness in people with bronchiectasis. You can be referred to aphysiotherpist, who can teach you these techniques. Active cycle of breathing techniques (ACBT) The most widely used technique in the UK is called active cycle of breathing techniques (ACBT). ACBT involves you repeating a cycle made up of a number of different steps. These include a period of normal breathing, followed by deep breaths to loosen the mucus and force it up; then you cough the mucus out. The cycle is then repeated for 20 to 30 minutes. Dont attempt ACBT if you havent first been taught the steps by a suitably trained physiotherapist, as performing the techniques incorrectly could damage your lungs. If youre otherwise in good health, youll probably only need to perform ACBT once or twice a day. If you develop a lung infection, you may need to perform ACBT on a more frequent basis. Postural drainage Changing your position can also make it easier to remove mucus from your lungs. This is known as postural drainage. Each technique can involve several complex steps, but most techniques involve you leaning or lying down while the physiotherapist or a carer uses their hands to vibrate certain sections of your lungs as you go through a series of huffing and coughing. Devices There are also a number of handheld devices that can help to remove mucus from your lungs. Although these devices look different, most work in a similar way. Generally, they use a combination of vibrations and air pressure to make it easier to cough out any mucus. Examples of these devicesinclude the flutter, the RC cornet and the Acapella. However, these devices arent always available on the NHS, so you may have to pay for one yourself. They usually cost 45 to 60. Medication In some cases, medications to make breathing or clearing your lungs easier may be prescribed. These are discussed below. Nebulised medications Occasionally, medication inhaled through a device called a nebuliser may be recommended to help make it easier for you to clear your lungs. Nebulisers are devices consisting of a face mask or mouthpiece, a chamber to convert the medication into a fine mist, and a compressor to pump the medication into your lungs. A number of different medications can be administered using a nebuliser, including salt water solutions. These medications help to reduce the thickness of your phlegm so its easier to cough it out. Nebulisers can also be used to administer antibiotics, if necessary (see below). However, while the medications used with a nebuliser can be provided on prescription, the nebuliser device itself isnt always available on the NHS. In some areas, a local respiratory service may provide the device without charge, but if this isnt an option, you may have to pay for a device. Bronchodilators If you have a particularly severe flare-up of symptoms, you may be prescribed bronchodilator medications on a short-term basis. Bronchodilators are inhaled medications that help make breathing easier by relaxing the muscles in the lungs. Examples of this type of medication include beta2-adrenergic agonist, anticholinergics and theophylline. Antibiotics If you experience a worsening of symptoms because of a bacterial infection (known as an infective exacerbation) then youll need to be treated with antibiotics . A sample of phlegm will be taken to determine what type of bacteria is causing the infection, although youll be initially treated with an antibiotic known to be effective against a number of different bacteria (a broad spectrum antibiotic) becauseit can take a few days to get the test results. Depending on the test results, you may be prescribed a different antibiotic, or in some cases, a combination of antibiotics known to be effective against the specific bacteria causing the infection. If youre well enough to be treated at home, youll probably be prescribed two to three antibiotic tablets a day for 10-14 days. Its important to finish the course even if you feel better, as stopping the course prematurely could cause the infection to recur quickly. If your symptoms are more severe (see symptoms of bronchiectasis for a detailed description) you may need to be admitted to hospital and treated with antibiotic injections. Preventative treatment If you have three or more infective exacerbations in any one year, or your symptoms during an infective exacerbation were particularly severe, it may be recommended that you take antibiotics on a long-term basis. This can help to prevent further infections and give your lungs the chance to recover. This could involve taking low-dose antibiotic tablets to minimise the risk of side effects, or using an antibiotic nebuliser (see above for more information about nebulisers). Using antibiotics in this way does increase the risk that one or more types of bacteria will develop a resistance to the antibiotic. Therefore, you may be asked to give regular phlegm samples to check for any resistance. If bacteria do show signs of developing a resistance, then your antibiotic may need to be changed. Surgery Surgery is usually only recommended where bronchiectasis is only affecting a single section of your lung, your symptoms arent responding to other treatment and you dont have an underlying condition that could cause bronchiectasis to recur. The lungs are made up of sections known as lobes the left lung has two lobes and the right lung has three lobes. Surgery for focal bronchiectasis would usually involve removing the lobe affected by the bronchiectasis in a type of operation known as a lobectomy. Surgery wont be used if more than one lobe is affected, as its too dangerous to remove so much lung tissue. Complications of bronchiectasis In some cases, people with bronchiectasis can develop serious complications that require emergency treatment. Coughing up large amounts of blood A rare, but serious, complication of bronchiectasis is coughing up large amounts of blood (the medical term for this is massive haemoptysis). This can occur when a section of one of the blood vessels supplying the lungs suddenly splits open. Symptoms that may indicate massive haemoptysis include: coughing up more than 100ml of blood in a 24-hour period 100ml is roughly equivalent to a third of a can of drink breathing difficulties caused by blood obstructing your airways feeling lightheaded, dizzy and having cold, clammy skin caused by rapid blood loss Massive haemoptysis is a medical emergency. If you think someoneis experiencing massive haemoptysis, then phone 999 for an ambulance. A person with massive haemoptysis needs to be admitted to hospital and a tube may need to be placed into their throat to assist them with their breathing. A procedure called a bronchial artery embolisation (BAE), carried out by specialist radiology doctors, will then be required to stop the bleeding. During a BAE, a special dye is injected into your arteries so they show up clearly on X-rays . Then, using X-ray scans as a guide, the source of the bleeding is located and injected with tiny particles, around the size of a grain of sand, that will help clog the vesselup and stop the bleeding.

Bronchitis

Bronchitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Bronchitis Bronchitis About bronchitis Symptoms of bronchitis Causes of bronchitis Treating bronchitis About bronchitis Bronchitis is an infection of the main airways of the lungs (bronchi), causing them to become irritated and inflamed. The main symptom is a cough , which may bring up yellow-grey mucus (phlegm). Bronchitis may also cause a sore throat and wheezing. Read more about the symptoms of bronchitis . When to see your GP Most cases of bronchitis can be treated easily at home with rest, non-steroidal anti-inflammatory drugs (NSAIDs) and plenty of fluids. You only need to see your GP if your symptoms are severe or unusual for example, if: your cough is severe or lasts longer than three weeks you have a constant fever(a temperature of 38C100.4For above) for more than three days you cough up mucus streaked with blood you have an underlying heart or lung condition, such as asthma or heart failure Your GP may need to rule out other lung infections, such as pneumonia , which has symptoms similar to those of bronchitis. If your GP thinks you may have pneumonia, you will probably need a chest X-ray, and a sample of mucus may be taken for testing. If your GP thinks you might have an undiagnosed underlying condition, they may also suggest a pulmonary function test. You will be asked to take a deep breath and blow into a device called a spirometer, which measures the volume of air in your lungs. Decreased lung capacity can indicate an underlying health problem. Treating bronchitis In most cases, bronchitis will clear up by itself within a few weeks without the need for treatment. This type of bronchitis is known as acute bronchitis. While you are waiting for it to pass, you should drink lots of fluid and get plenty of rest. In some cases, the symptoms of bronchitis can last much longer. If symptoms last for at least three months, it is known as chronic bronchitis. There is no cure for chronic bronchitis, but there are several medications to help relieve symptoms. It is also important to avoid smoking and smoky environments, as this can make your symptoms worse. Read more about treating bronchitis . Why do I have bronchitis? The bronchi are the main airways in your lungs, which branch off on either side of your windpipe (trachea). They lead to smaller and smaller airways inside your lungs, known as bronchioles. The walls of the bronchi produce mucus to trap dust and other particles that could otherwise cause irritation. Most cases of acute bronchitisdevelop when an infection causes the bronchi to become irritated and inflamed, which causes them to produce more mucus than usual. Your body tries to shift this extra mucus through coughing. Smoking is the most common cause of chronic bronchitis. Over time, tobacco smoke can cause permanent damage to the bronchi, causing them to become inflamed. Read more about the causes of bronchitis . Complications Pneumonia is the most common complication of bronchitis. Ithappens when theinfection spreads further into the lungs, causing air sacs inside the lungs to fill up with fluid.1 in 20 cases of bronchitis leads to pneumonia. People at an increased risk of developing pneumonia include: elderly people people who smoke people with other health conditions, such as heart, liver or kidney disease people with a weakened immune system Mild pneumonia can usually be treated with antibiotics at home. More severe cases may require admission to hospital. Read more about the treatment of pneumonia . Who is affected Acute bronchitis is one of the most common types of lung infection, and is one of the top five reasons for GP visits. Acute bronchitis can affect people of all ages, but is most common in younger children under the age of five. It is more common in winter, and often develops following a cold ,sore throat or flu . It is estimated that there are around 2 million people in the UK affected by chronic bronchitis. Most of these are adults over the age of 50. Symptoms of bronchitis The main symptom of bronchitis is a hacking cough. It is likely that your cough will bring up thick yellow-grey mucus (phlegm), although this does not always happen. Other symptoms of bronchitis are similar to those of other infections, such as the common cold or sinusitis , and may include: sore throat headache runny or blocked nose aches and pains tiredness If you have bronchitis,your cough may last for several weeks after other symptoms have gone. You may also find that the continual coughing makes your chest and stomach muscles sore. Some people may experience shortness of breathor wheezing, due to inflamed airways. However, this is more common with long-term (chronic) bronchitis. Long-term (chronic) bronchitis Chronic bronchitis is often known as chronic obstructive pulmonary disease (COPD) . The symptoms of COPD can include: wheezing increasing breathlessness when exercising or moving around a persistent cough that brings up mucus (phlegm) frequent chest infections The symptoms are often worse in the winter, and it is common to have two or more flare-ups a year. A flare-up is when your symptoms are particularly bad. When to see your GP See your GP as soon as possible if: your cough is very severe or lasts longer than three weeks you have a constant fever (a temperature of 38C 100.4F or above) for more than three days this may be a sign of flu or a more serious condition, such as pneumonia you cough up mucus streaked with blood you develop rapid breathing (more than 30 breaths a minute) or chest pains you become drowsy or confused you have had repeated bouts of bronchitis You should also contact your GP if you have an underlying heart or lung condition, such as: asthma heart failure weakness in the heart that leads to fluid in your lungs emphysema damage to the small airways in your lungs Causes of bronchitis The bronchitis infection can be caused by either a virus or bacteria, although viral bronchitis is much more common. In most cases, bronchitis is caused by the same viruses that cause the common cold or flu . The virus is contained in the millions of tiny droplets that come out of the nose and mouth when someone coughs or sneezes. These droplets typically spread about 1m (3ft). They hang suspended in the air for a while, then land on surfaces where the virus can survive for up to24 hours. Anyone who touches these surfaces can spread the virus further by touching something else. Everyday items at home and in public places, such as door handles and keyboards,may have traces of the virus on them. People usually become infected by picking up the virus on their hands from contaminated objects, and then placing their hands near their nose or mouth. It is also possible to breathe in the virus if it is suspended in airborne droplets. Breathing inirritant substances Bronchitis can also be triggered by breathing in irritant substances, such as smog, chemicals in household products or tobacco smoke. Smoking is the main cause of long-term (chronic) bronchitis, and it can affect people who inhale second-hand smoke, as well as smokers themselves. Read information about treatments to quit smoking . Occupational exposure You may also be at risk of bronchitis and other forms of chronic obstructive pulmonary disease (COPD) if you are often exposed to materials that can damage your lungs, such as: grain dust textiles (fabric fibres) ammonia strong acids chlorine This is sometimes referred to as occupational bronchitis, and usually eases once you are no longer exposed to the irritant substance. Read more information about the causes of COPD . You can also readthe Health and Safety Executives report on COPD in Great Britainattributed to occupational exposure (PDF, 275 KB). Treating bronchitis Most cases of bronchitis do not require treatment from a GP, and the symptoms can be easily managed at home. There is no cure for chronic bronchitis, but healthy livingwill help. In particular,you should stop smoking ,if you smoke. Managing symptoms at home If you have bronchitis: get plenty of rest drink lots of fluids this helps prevent dehydration and thins the mucus in your lungs, making it easier to cough up treat headaches, fever, and aches and pains with paracetamol or ibuprofen although ibuprofen is not recommended if you have asthma There is little evidence that cough medicines work readmore abouttreating coughs . TheMedicines and Healthcare Products Regulatory Agency (MHRA)has recommended that over-the-counter cough medicines should not be given to children under the age of six. As an alternative to anover-the-countercough medicine, try making your own mixture of honey and lemon, which can help soothe a sore throat and ease your cough. Stop smoking If you smoke, you should stop immediately. Smoking aggravatesbronchitis and increases your risk of developing a long-term (chronic) condition. Stopping smoking while you have bronchitis can also be the perfect opportunity to quit altogether. Antibiotics Although treatment from a GP is rarely necessary, there may be times when you should see one read more about when to see your GP . Your GP will not routinely prescribe antibiotics , as bronchitis is nearly always caused by a virus. Antibiotics have no effect on viruses, and prescribing them when they are unnecessary can, over time, make bacteria more resistant to antibiotic treatment. Your GP will only prescribe antibiotics if you have an increased risk of developing complications, such as pneumonia .Antibiotics may be recommended for: premature babies elderly people over the age of 80 people with a history of heart, lung, kidney or liver disease people with a weakened immune system, which could be the result of an underlying condition or a side effect of a treatment such as steroid medication people with cystic fibrosis If you are prescribed antibiotics for bronchitis, it is likely to be a five-day course of amoxicillin, oxytetracycline or doxycycline. Possible side effects of these medicines include nausea, vomiting anddiarrhoea, but they are uncommon. Chronic bronchitis Chronic bronchitis is treated in the same way as chronic obstructive pulmonary disease (COPD). For example: a type of medication called mucolytics can be used to make mucus easier to cough up an exercise programme known as pulmonary rehabilitation can help you cope better with your symptoms Stopping smoking is also very important if you have been diagnosed with chronic bronchitis or COPD. Read more about the treatment of COPD .

Bulimia

Bulimia | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Bulimia Bulimia Bulimia nervosa is an eating disorder and mental health condition. People with bulimia are very anxious about their weight and focused on having the right body shape. They also spend a lot of time thinking about food. Symptoms of bulimia The main symptoms of bulimia are: bingeing overeating in a particular pattern purging trying to reduce the effect of binging by attempting to get calories out of your body focus on food thinking about food all the time, even when you dont want to problems with self-esteem focussing on body image when it comes to food and weight Diagnosing bulimia When making a diagnosis, your GP will probably ask questions about your eating habits. For example, they could ask: how you feel about your weight if youre concerned about it if you make yourself vomit regularly if you binge-eat Its important to answer these questions honestly. Your GP isnt trying to judge you or catch you out. They just need to accurately assess how serious your symptoms are. Weight and BMI Your GP may check your weight and calculate your body mass index (BMI). Blood tests and other tests Your GP might check your pulse and blood pressure. Sometimes an (electrocardiogram (ECG) may be needed to check how well your heart is working. Your GP may do blood tests to check the level of: fluids in your body chemicals or minerals, like potassium in your blood Blood tests look for the complications of bulimia. Even if they come back as normal, your GP may still refer you to a specialist if youre experiencing bulimia symptoms. Treating bulimia Before your treatment begins, youll probably have an overall assessment of your health. Your GP or another healthcare professional will do this. The assessment will help your healthcare professional plan for your treatment and care. For example, they may assess: your overall health and any medical needs your social situation, like how much support you have from family and friends your mood any risks that affect you, like whether youre at risk of harming yourself whether there are any physical risks as a result of bulimia that need urgent treatment Guided self-help For many people, guided self-help can be an effective treatment for bulimia. Guided self-help is where you work through information and activities on your own. Youll have regular support sessions with a professional (usually a psychologist). Activities can include: worksheets a food diary meal plan writing about difficult thoughts and feelings Eating disorder service If guided self help is unsuccessful, your GP can refer you for treatment to an eating disorder service. An eating disorder service will usually offer a structured programme of psychological treatment. Psychological treatment The main type of psychological treatment for bulimia is cognitive behavioural therapy (CBT). CBT starts with the idea that thoughts, feelings, and behaviour are linked and affect one another. CBT helps to change the harmful behaviour while working on changing how you think about food, eating, and weight. One alternative to CBT is interpersonal therapy (IPT). IPT explores the way you interact with other people. It also looks at the relationships you have, with the goal of improving them. Learn more about talking therapies Medication Antidepressants like selective serotonin reuptake inhibitors (SSRIs) may be used to treat bulimia. They can reduce the urges to binge and vomit. The medication will usually take several weeks before it starts to work. Youll usually start on a low dose. The dose will gradually increase as your body adjusts to the medicine. Very few drugs are recommended for children and young people below the age of 18. Its best not to take SSRIs if you have epilepsy or a family history of heart, liver or kidney disease. Relapse Recovery from bulimia can take a long time. Its common for bulimia symptoms to return after treatment. This is often called a relapse, and is more likely during times of stress. If relapse happens, the approach to getting treatment is the same. The first step is going to your GP. Complications of bulimia There are physical complications associated with bulimia. These can include: dental problems regular vomiting can cause your stomach acid to damage the enamel on your teeth, which can lead to tooth decay repeated vomiting can cause bad breath and a sore throat due to a lack of nutrients, your skin and hair can become dry and your fingernails can become brittle your saliva glands can become swollen from frequent vomiting, which makes your face appear rounder frequent use of laxatives can damage your bowel muscles, causing permanent constipation (finding it difficult to poo) an increased risk of heart problems Frequent vomiting or laxative use can cause: tiredness weakness abnormal heart rhythms kidney damage convulsions (fits) muscle spasms If you have periods, bulimia can cause them to become unpredictable, or stop altogether. This does not mean bulimia makes you infertile. While it may be harder to get pregnant, you should continue to use birth control if you arent planning a pregnancy. If you have diabetes , youll need regular health checks to help avoid problems with your eyes or other serious complications. This is particularly important if you have type 1 diabetes . Getting help for bulimia People with bulimia can be anxious about seeking treatment that might mean making changes to their eating habits. Helping yourself If you have eating problems or think you may have bulimia, its important to seek help as soon as possible. You could start by: talking to someone you trust, like a friend or member of your family going to see your GP you may find it helpful to bring someone with you for support Helping someone else If someone close to you is showing signs of bulimia, you can offer help and support. You could try talking to them about how they feel, and encourage them to think about getting help. Try not to put pressure on them or be critical of them, as this could make things worse. You could also offer to help by going with the person to see their GP. You could speak to your own GP or a healthcare professional if youd like some advice on how to help someone. You could also get help from a support group for people who have loved ones with eating disorders. Your GP or Scotlands Service Directory can help you find services near you. Beat has a range of information on the help and support available for people with eating disorders, and their friends and families.

Bunion

Bunion (hallax valgus) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Bunion (hallux valgus) Bunion (hallux valgus) This information is useful for those who have been diagnosed with bunions. People experiencing new or ongoing symptoms should contact a healthcare professional for assessment and diagnosis. Read more about self-managing a foot problem A bunion (hallux valgus) is a deformity caused by the base joint of the big toe developing sideways. This pushes the bones of the big toe towards the smaller toes. If you have a bunion, try to stay positive. Theres a lot you can do to help yourself. What causes a bunion? The exact cause of bunions is unknown. Contributing factors can be: a joint problem like osteoarthritis or rheumatoid arthritis poorly fitting footwear a family history Bunion symptoms Bunions can cause: pain and stiffness of the big toe joint swelling of the big toe joint the foot may become so wide it can be difficult to find wide enough shoes difficulty walking Management of bunions Wearing the right footwear is one of the best things you can do to help. Choose well fitting shoes. Ones with laces or an adjustable strap are best as they can adjust to the width of your foot. Avoid wearing high-heeled, pointed or tight shoes. It may be helpful to use insoles and toe spacers to provide support for your foot or reduce pressure between your toes. You may see bunion padding available. The repeated use of sticky padding can cause skin irritation so is not recommended as a regular solution. Pain treatment Pain medication can help you move more comfortably, which can help with the management of this condition. More about taking painkillers Exercise It can be helpful to do exercises to strengthen the muscles in the foot. This can help in the management of the condition Work A foot problem can sometimes mean you need to take some time off work to help recovery. How long youre off will depend on the nature of your condition and your role at work. You do not need to be symptom free before you consider returning to work. Continuing to go to work, or returning to work as soon as is possible for you, will help your recovery. Gradually getting back to your normal daily activities can help to build up your strength and stamina levels Help and support Following this advice, you should see gradual improvements over time. Talk to a healthcare professional about your symptoms if youve been following this advice and: your symptoms havent improved within 12 weeks your symptoms are worsening Find out how to access MSK services in your area When dealing with any health condition its important to also look after your mental wellbeing as this can impact your recovery.

Carcinoid syndrome and carcinoid tumours

Carcinoid syndrome and carcinoid tumours | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Carcinoid syndrome and carcinoid tumours Carcinoid syndrome and carcinoid tumours A carcinoid tumour is a rare cancer of the neuroendocrine system the body system that produces hormones. The tumourusually growsin the bowels or appendix, but it can also be found in the stomach, pancreas, lung, breast, kidney, ovaries or testicles. It tends to grow very slowly. Carcinoid syndrome is the collection of symptoms some people get when a carcinoid tumour usually one that has spread to the liver releases hormones such as serotonin into the bloodstream. Signs and symptoms In the early stages of having a carcinoid tumour, you may not have any symptoms. You may also not have symptoms if the tumour is just in your digestive system, as any hormones it produces will be broken down by your liver. If symptomsdo develop, they tend to be fairly general and can be easily mistaken for signs of other illnesses. Symptoms may result from both the tumour itself and from any hormones it releases into the bloodstream. Symptoms caused by the tumour Symptoms will dependon where in the body the tumour develops: abowel carcinoid tumour may causetummy pain, a blocked bowel ( diarrhoea , constipation , feeling or being sick) andbleeding from the bottom (rectal bleeding) alung carcinoid tumour may cause a cough , which may make you cough up blood, and cause wheezing, breathlessness , chest pain and tiredness astomach carcinoid tumour may cause pain, weight loss, tiredness and weakness Some tumours may not cause any symptoms and are discovered by chance. For example,an appendix carcinoid tumour may only befound when the appendix is being removed for another reason. Symptoms caused by the hormones (carcinoid syndrome) Typical symptoms of carcinoid syndrome include: diarrhoea,tummy pain and loss of appetite flushingof the skin, particularly the face fast heart rate breathlessness and wheezing These symptoms may come on unexpectedly, as the hormones can be produced by the tumour at any time. Some people may also developcarcinoid heart disease, wherethe heart valves thicken andstop working properly. There is also a risk of developing a rare but serious reaction calleda carcinoid crisis, which involves severe flushing, breathlessness and a drop in blood pressure. What causes carcinoid tumours? Itsnotknown exactlywhy carcinoid tumours develop, but its thought that mostoccur by chance. Your chances of developing a carcinoid tumour may be increased if you have: a rare family syndrome called multiple endocrine neoplasia type 1 (MEN1) parents or siblings with a carcinoid tumour parents with squamous cell skin cancer , non-Hodgkins lymphoma , or cancer of the brain, breast, liver, womb, bladder or kidney conditions calledneurofibromatosisor tuberous sclerosis Diagnosing carcinoid tumours Acarcinoid tumour may be found incidentally for example, as a surgeon is removing an appendix. In this case, the tumour will often be caught early and removed along with the appendix, causing no further problems. Otherwise, people usually speak to their GP after they have developed symptoms. A carcinoid tumour may be diagnosed after carrying out a series of scans and tests, which may include measuring theamount ofserotoninin your urine and having an endoscopy . Treating carcinoid tumours and carcinoid syndrome If the tumour is caught early, it may be possible to completely remove it and cure the cancer altogether. Otherwise, surgeons will remove as much of the tumour as possible (debulking). You can read more about thesurgery for carcinoid tumourson theCancer Research UK website. If the tumour cannot be removed, but its not growing or causing symptoms, you may not need treatment straight away it might just be carefully monitored. If its causing symptoms, you may be offered one of thefollowing treatments: injections of medicines called somatostatin analogues, such as octreotide and lanreotide, which can slow down the growth of the tumour radiotherapy to kill some of the cancer cells a procedure to block the blood supply tothetumour (for tumours in the liver), known ashepatic artery embolisation a procedure that uses a heated probe to kill cancer cells (for tumours in the liver), calledradiofrequency ablation chemotherapy to shrink the tumour and control your symptoms Symptoms of carcinoid syndrome canbe treated with injections of octreotide and lanreotide.You may also be givenmedication to widen your airways (to relieve wheezing and breathlessness) and anti-diarrhoea medication. What can I do to help myself? There are things you can do yourself to manage some of the symptoms of carcinoid syndrome. Generally, you should avoid triggers of flushing, such as: alcohol large meals spicy foods foods containing the substance tyramine, such as aged cheese and salted or pickled meats stress Some medications, such as selective serotonin reuptake inhibitor (SSRI) antidepressants , may make symptoms worse by further increasing your levels of serotonin but never stop taking medication without seeking medical advice. If you have diarrhoea, its important to keep drinking little and often to avoid dehydration . Outlook If the whole tumour can be removed, this may cure the cancer and symptoms altogether. But even if surgeons cannot remove the entire tumour, it usually grows slowly and can be controlled with medication. Overall,people with carcinoid tumourshave a good life expectancy compared to many other cancers. Many people remain relatively well and lead active lives, with only occasional symptoms. Butas the tumourgrows or spreads, it will produce more and more hormones, and it may eventually be difficult to completely control symptoms with medication. You may need further surgery or other treatments. Unfortunately, life expectancy is not as good for cancer that has spread to other parts of your body, because it wont usually be possible to remove all of it. However, treatment can still control your symptoms and slow down the spread of cancer. Information about you If you have carcinoid syndrome, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register Source: NHS 24 - Opens in new browser window Last updated: 13 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Neuroendocrine tumours Other health sites Cancer Research UK: Carcinoid syndrome Cancer Research UK: Neuroendocrine tumours Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Catarrh

Catarrh | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Catarrh Catarrh About catarrh About catarrh Catarrh is a build-up of mucus in an airway or cavity of the body. It usually affects the back of the nose, the throat or the sinuses (air-filled cavities in the bones of the face). Its often temporary, but some people experience it for months or years. This is known as chronic catarrh. Catarrh can be a nuisance and may be difficult to get rid of, but its not harmful and there are treatments available. Symptoms associated with catarrh Catarrh can lead to a: constant need to clear your throat feelingthat your throat is blocked blockedor stuffy nose that you cant clear runny nose feeling of mucus running down the back of your throat persistent cough headache or facial pain reduced sense ofsmell and taste crackling sensation in your ear and some temporary hearing loss These problems can be frustrating to live with and mayaffect your sleep, making you feel tired. Treatments for catarrh Catarrh will often passin a few days or weeks as the condition that causes it improves. There are things you can try at home to relieve your symptoms, such as: avoiding things that trigger your symptoms, such as allergens or smokyplaces taking sips of cold water when you feel the need to clear your throat constantly clearing your throat may make things worse using a saline nasal rinse several times a day these can be bought from apharmacy or made at home with half a teaspoon of salt in a pint of boiledwater thats been left to cool avoiding warm, dry atmospheres, such asplaces with air conditioning and car heating systems placing plants or bowls of water in a roommay help to keep theair humid staying well hydrated talking to a pharmacist about suitable over-the-counter medications including decongestants ,antihistamines or steroid nasal sprays There are also several remedies, such as herbal medicines, available from health shops and pharmacies that claim to treat catarrh. Some people find these helpful, but theres generally little scientific evidence to suggest they work. When to see your GP Speak to your GP if your catarrh persists and is becoming difficult to live with. They may want to rule out conditions that could be causing it, such asnasal polypsor allergies . This may mean youneed to be referred to a specialist for tests. If youre diagnosed with a specific underlyingcondition, treating it may help relieve your catarrh. For example, nasal polypsmay be treated with a steroid nasal spray, or in some cases surgery. If a cause for you catarrh cannot be found, the self-help techniques above may be recommended.Unfortunately, however,chronic catarrh can be hard to treat and may last for a long time. What causes catarrh? Catarrh is usually caused by the immune system reacting to an infection or irritation, which causes the lining of your nose and throat to become swollen and produce mucus. Thiscan be triggered by: a cold or other infections hay fever or other types of allergic rhinitis non-allergic rhinitis nasal polyps Itsunclear what causes chronic catarrh, but its not thought to be the result of an allergy or infection. It may be related to an abnormality in the way mucustravels withinthe nose or an increasedsensitivity to mucus in the back of thenoseand throat. Source: NHS 24 - Opens in new browser window Last updated: 10 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Allergic rhinitis Common cold Catarrh Decongestants Other health sites ENT UK: patient information Allergy UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Cellulitis

Cellulitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Cellulitis Cellulitis About cellulitis Symptoms of cellulitis Causes of cellulitis Treating cellulitis About cellulitis Cellulitis is an infection of the deeper layers of skin and the underlying tissue. It can be serious if not treated promptly. The infection develops suddenly and can spread through the body quickly. Severe infections can spread deep into the body, andcanbe life threatening. Most casesare successfully treated with antibiotics at home, although sometimesit needs to be treated in hospital. Symptoms of cellulitis Cellulitis causes an area of skin to suddenly become: red hot swollen painful tender It most often affects the lower legs, but can occur anywhere. Cellulitis causes swelling, redness, pain and tenderness in the affected area. Source: https://dermnetnz.org/ In more severe cases, cellulitis can also be accompanied and often preceded by: a high temperature (fever) of 38C (100.4F) or above vigorous shaking (rigors) nausea and vomiting dizziness confusion These are signs that the infection has spread deeper into the body. Read more about the symptoms of cellulitis Pharmacy First Scotland: Cellulitis treatment from your local pharmacy Adults 18 years and over with symptoms of cellulitis can get advice and treatment directly from a pharmacy in certain instances. This includes cases where cellulitis is linked to an insect bites on the arms or body. If the pharmacist cannot treat you they may recommend you see your GP. Pharmacies When to get professional advice See your pharmacist as soon as possible if an area of your skin suddenly turns red, painful and hot. Early treatment can help reduce the risk of the infection becoming severe. Phone 999 or go to A&E if: your face or the area around your eye is affected your symptoms are getting rapidly worse you experience other symptoms in addition to the changes in your skin, such as a fever or vomiting you have a weak immune system for example, because of HIV or chemotherapy or severe lymphoedema ,a condition that causes swelling in the bodys tissues a young child or elderly person has possible cellulitis Treatments for cellulitis Cellulitis is usually treated with antibiotics . Many infections can be treated with antibiotic tablets at home. Youll usually be given a five-day course of treatment, and your symptomsshould start to improve after a few days. Make sure you complete the whole course of medicine youve been given, even if youre feeling better. Contact your GP if your symptoms get worse after a few days or dont improve within a week. For serious infections, treatment is usually started in hospital. Youll normally be given antibiotics directly into a vein through an injection or a drip. Many hospitals can then arrange for this treatment to continue at home or in an outpatient clinic. Treatment is usually for five days. If the infection responds to treatment quickly, it may be possible to complete the course with antibiotic tablets instead of having injections or a drip. Read more about how cellulitis is treated . Outlook for cellulitis Cellulitis can usually be treated successfully with antibiotics, and most people make a full recovery. But there is a risk it could cause potentially serious problems, particularly if its not treated quickly, such as: blood poisoning (sepsis) where the bacteria enter the blood kidney damage leg ulcers Septicaemia and kidney problems can be life threatening and require immediate treatment in hospital. Causes of cellulitis Cellulitis is usually caused by a bacterial infection. The bacteria that cause it often live harmlessly on the skin, but they can lead to an infection if they get into a break in your skin, such as: a bruise, cut or graze an animal bite or insect bite a legulcer dry, crackedskin for example, because of eczema or athletes foot In most cases the trigger for the infection is unknown. The infectionisnt normally spread from person to person. Readabout the causes of cellulitis , including information on whos most at risk of the condition. Preventing cellulitis If youve had cellulitis before, youre more likely to get it again. Its not always possible to prevent it, but the following measures may help reduce your risk: use moisturiser if your skin is dry or prone to cracking lose weight if youre overweightbeing obese can increase your risk of cellulitis try to ensure any conditions that can increase your risk of cellulitis such as eczema, athletes foot, leg ulcers and lymphoedema are well managed make sure any cuts, grazes or bites are kept clean wash them under running tap water and cover them with a plaster or dressing wash your hands regularlyparticularly when treating or touching a wound or skin condition If you get cellulitis often or severely, your GP may refer you to a skin specialist called a dermatologist, or aninfection specialist, to discuss the option of taking antibiotics on a long-term basis to protect against further infections. Symptoms of cellulitis Symptoms of cellulitis develop suddenly and can get worse quickly. It affects the skin and can also cause additional symptoms. Skin symptoms Cellulitis causes the affected skin to become: red hot swollen painful tender There may also be a break in the skin, although this isnt always obvious, and pus or blood-filled blisters . Any part of the body can be affected. Commonly affected areas include the lower legs, feet, arms or hands, and sometimes the face, particularly around the eyes. See your GP or visit your nearest minor injuries unit as soon as possible if an area of your skin suddenly turns red, painful and hot. The symptoms of cellulitis include redness, swelling and tenderness. Source: https://dermnetnz.org/ Additional symptoms Cellulitis can also cause additional symptoms that may develop before or alongside the changes to yourskin. These can include: feeling generally unwell feeling sick shivering chills Occasionally the infection can spread to other parts of the body, such as the deeper layers of tissue, blood, muscle and bone. This canbe very serious and potentially life threatening. Signs the infection has spread include: a high temperature (fever) of 38C (100.4F) or above a fastheartbeatorfast breathing being sick diarrhoea feeling dizzy or faint confusionor disorientation cold, clammy,paleskin unresponsiveness or loss of consciousness Call 999 orgo to your nearest accident and emergency (A&E) department immediately if you have other symptoms in addition to changes to your skin. Causes of cellulitis Cellulitis is usually caused by a bacterial infection. It occurs when bacteria get into the tissues beneath the skin. Howthe infectionoccurs The bacteria that cause cellulitis often live harmlessly on the skin. But if the surface of your skin is damaged, they can get into the layers underneath and cause an infection. The break in the skin may be so small its not noticeable. Itmay be caused by: a cut or graze a burn an animal or human bite an insect bite a puncture wound a legulcer the skin becoming dry and cracked for example, because of eczema or athletes foot Cellulitis isnt normally spread from person to person as the infection occurs deep within the skin and is often caused by bacteria that live on the skins surface without causing problems. Increased risk Anyone can get cellulitis, but youre at an increased risk if: youre obese you have poor circulation in your arms, legs, hands or feet you have a weakened immune system for example, because of HIV or chemotherapy treatment you have lymphoedema a condition that causes fluid to build up under your skin you have poorlycontrolled diabetes youve had cellulitis before you use injected drugs Ensuringthe underlying health conditionsmentioned above are well controlled may help reduce your risk of getting cellulitis. Treating cellulitis Cellulitis can often be treated at home with a course of antibiotics, although severe cases may need to be treated in hospital. Treatment at home Antibiotics If youre treated at home, youll usually be prescribed antibiotic tablets to take two to four times a day for a week. A longer course may be needed if your symptoms dont improve after a week or youhave an underlying condition that makes cellulitis more difficult to treat,such as lymphoedema . Commonly prescribed antibiotics include flucloxacillin and clarithromycin. Possible side effects can includean upset stomach or diarrhoea . Your symptoms may get worse in the first 48 hours after treatment starts, but should start to improve soon afterwards. Make sure you complete the whole course of medicine youre given, even if youre feeling better. Looking after yourself While youre recovering at home, the followingstepscan help ease your symptoms and aid your recovery: take paracetamol or ibuprofen for the pain raise the affected body part to reduce swelling for example, if your leg is affected, rest it on pillows or a chair when youre sitting or lying down try to regularly move the joint near the affected body part, such as your wrist or ankle, to stopit getting stiff drink plenty of fluids to avoid dehydration if you usually wear compression stockings for example, for lymphoedema avoid these until youve recovered When to get medical advice Contact your GP as soon as possible if: your symptoms get worse after 48 hours your symptoms havent improved after a week you develop additional symptoms, such as a high temperature (fever) or vomiting Treatment in hospital If you need to be admitted to hospital for treatment, youll be given antibiotics directly into a vein through an injection or a drip (intravenous antibiotics). Once youve recovered from the initial symptoms, you can usually be treated with antibiotic injections or tablets at home or as an outpatient, rather than staying in hospital. Source: NHS 24 - Opens in new browser window Last updated: 09 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Cerebral palsy

Cerebral palsy | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Cerebral palsy Cerebral palsy Cerebral palsy is a condition caused by either damage to the brain, or abnormal development of the brain. This damage normally occurs before birth or during a childs early development. Cerebral palsy is not normally progressive in nature. Cerebral palsy usually causes abnormal muscle tone and movement. The main types of abnormal muscle tone are: Spastic cerebral palsy This is the most common type of abnormal muscle tone. Someone with spastic cerebral palsy is likely to experience a tightening of the muscles throughout the body. This tightening can be persistent or intermittent. The amount of stiffness experienced will vary from person to person. Dyskinetic cerebral palsy Individuals with this type of muscle tone may have dystonia or more rarely athetosis. This describes a type of abnormal muscle control where the muscles can shift from tight to floppy without warning, resulting in involuntary movements. Ataxic cerebral palsy This is the least common type of cerebral palsy. It can be identified by shaky movement and poor balance. Someone with ataxic cerebral palsy may struggle with fine motor movements and coordination, like writing or using cutlery. They may have a tremor that increases with activity, and struggle with balance. This can make standing or sitting in an upright position difficult. Mixed cerebral palsy Someone with mixed cerebral palsy may have signs of more than one type of abnormal muscle tone at the same time. Symptoms of cerebral palsy The symptoms of cerebral palsy can vary from person to person and are dependent on the type of brain injury or abnormality. Someone with cerebral palsy may: struggle with movement and balance, and may be unable to walk struggle to speak, and possibly need to use electronic aids have difficulties with eating, drinking and swallowing have problems with their vision experience pain symptoms experience fatigue (tiredness) have problems with their sleep have epilepsy have a learning disability display behavioural problems have bladder control problems have problems with their digestive system ( constipation ) struggle to control their saliva struggle to process information from their senses A person with cerebral palsy may have secondary symptoms. These are caused by the impact of the condition on their body, rather than directly by cerebral palsy. These can include: tightness in joints and muscles dislocations a change in their physical abilities changes in the amount of pain they experience increased fatigue Causes of cerebral palsy Cerebral palsy is caused by damage to the brain during pregnancy, birth or early development. There are some things that can increase the risk of a child developing cerebral palsy. These include: premature birth (being born early) neonatal encephalopathy (caused by lack of oxygen to the brain in pregnancy or around the time of birth) stroke or bleeding in the babys brain during pregnancy or after birth infection during pregnancy or after birth meningitis head injuries Its not always possible to tell why a child has developed cerebral palsy. A child can develop cerebral palsy despite their parents having done everything right during pregnancy and childbirth. The parents of a child with cerebral palsy are not to blame. Diagnosing cerebral palsy There isnt one single test that can diagnose cerebral palsy. Your medical professional will need to see how your child develops over time to make a diagnosis. They may also use tests such as brain scans to confirm the diagnosis. Coping with waiting for a diagnosis Waiting for a diagnosis can be very stressful for parents. Its natural to feel anxious when your child is unwell. NHS inform has advice on dealing with anxiety and stress, and information on where to go to find support for your mental wellbeing. Read more about mental wellbeing services Most children are diagnosed by two years old. Some children are diagnosed earlier if theyve spent time in medical settings, for example children who were born premature. To diagnose cerebral palsy, your medical professional will examine your childs medical history, and how well they can move, balance, and react. They may also use scans like an MRI to see if theres any sign of damage or abnormal development of the brain. Living with cerebral palsy While cerebral palsy is a non-progressive condition (it doesnt normally get worse over time), it may not stay the same throughout life. Symptoms can change with age, even in adulthood. Contact your GP if: you or your child is experiencing a change in condition you or your childs symptoms are getting worse Cerebral palsy doesnt normally shorten life expectancy. People with cerebral palsy often go on to live long, rich and rewarding lives. There are resources and treatments available to help both children and adults with cerebral palsy. Everyone with cerebral palsy will have individual needs and these needs may change over time. Your healthcare professional will help you find treatments and resources that work for you or your child. Physiotherapy Targeted physiotherapy can help you or your child improve and maintain posture, coordination, strength and balance. Physiotherapists may recommend specialist mobility equipment and advise about the use of orthotic splints. Occupational therapy Occupational therapists help people who struggle to complete everyday tasks find new ways of completing them. They can show you or your child how to break down activities into smaller movements, helping build confidence. Occupational therapists also have good knowledge of the medical aids and technologies available to help you or your child. Speech and language therapy If you or your child is struggling to talk, a speech and language therapist can help. They have a range of techniques that can help people improve at talking, like helping you or your child learn to shape a sound. Some speech therapists will recommend the use of specialist communication aids. If you or your child is having issues with swallowing, a speech and language therapist can also help by performing an assessment and making recommendations. Orthotics An orthotic device is a piece of equipment that supports a part of the body. This can help improve you or your childs ability to move and be active. Orthotics can help with a wide range of the physical problems that can be caused by cerebral palsy. Some will only be used for a short period of time, while others may be used throughout you or your childs entire life.The need for them can also changewith time. An orthotist will examine you or your childs ability to move and make recommendations according to you or your childs personal needs. Mental health support for those with cerebral palsy If you have cerebral palsy and need support with your mental health, there are services available through the NHS. Read more about mental health Mental wellbeing support for the parents of children with cerebral palsy Finding out that your child has cerebral palsy can be very overwhelming for parents. You may feel anxious about the future and isolated from other parents. There are resources available from NHS inform that can help you cope with the emotions youre feeling. If youre feeling isolated, an online support group might help you feel less alone. Read more about mental wellbeing services Find out more about online support groups for parents of children with cerebral palsy Medication Although medication cannot cure cerebral palsy, some types may help ease some of the symptoms, like muscle relaxants for those with spastic or dystonic cerebral palsy. Speak to your healthcare provider for further information about medication. Surgery Surgery may be recommended to help with certain symptoms of cerebral palsy. For example, surgery on muscles, bones and nerves can help mobility. Speak to your healthcare provider for further information on surgical options. Last updated: 06 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Other health sites Cerebral Palsy Scotland NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Cervical cancer

"Cervical cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Cervical cancer Cervical cancer About cervical cancer Symptoms of cervical cancer Causes of cervical cancer Diagnosing cervical cancer Treating cervical cancer Complications of cervical cancer Living with cervical cancer Preventing cervical cancer About cervical cancer Cervical cancer is a type of cancer that develops in a womans cervix (the entrance to the womb from the vagina). Cancer of the cervix often has no symptoms in its early stages. If you do have symptoms,the most common is unusual vaginal bleeding, which can occur after sex, in between periods or after the menopause . Abnormal bleeding doesnt mean that you definitely have cervical cancer, but it should be investigated by your GP as soon as possible. If your GP thinks you might have cervical cancer, you should be referred to see a specialist within 2 weeks. Read more about the symptoms of cervical cancer and diagnosing cervical cancer Screening for cervical cancer Cervical screening (also known as a smear test) is routinely offered to anyone with a cervix in Scotland, between the ages of 25 and 64, every 5 years.You may be recalled more often depending on your test results. Those on non-routine screening (where screening results have shown changes that need further investigation or follow up) will be invited up to 70 years of age. If you have unusual discharge, or bleeding after sex, between periods or after the menopause, contact your GP practice. These symptoms are not usually caused by cancer but its important to have them checked. Youwill be sent a letter confirming when your screening appointment is due. Contact your GP if you think you may be overdue for a screening appointment. Read more about cervical screening What causes cervical cancer? Almost all cases of cervical cancer are caused by the human papilloma virus (HPV) . HPV is a very common virus that can be passed on through any type of sexual contact with a man or a woman. There are more than 100 different types of HPV, many of which are harmless. However, some types of HPV can cause abnormal changes to the cells of the cervix, which can eventually lead to cervical cancer. Two strains of the HPV virus (HPV 16 and HPV 18)are known to be responsible for 70% of all cases of cervical cancer.These types of HPV infection dont have any symptoms, so many women wont realise they have the infection. However, its important to be aware that these infections are relatively common and most women whohavethem dont develop cervical cancer. Using condoms during sex offers some protection against HPV, but it cant always prevent infection, because the virus is also spread through skin-to-skin contact of the wider genital area. Since 2008, a HPV vaccine has been routinely offered to girls aged 12 and 13. Read more about the causes of cervical cancer and preventing cervical cancer Treating cervical cancer If cervical cancer is diagnosed at an early stage, its usually possible to treat it using surgery. In some cases, its possible to leave the womb in place, but itmay need to be removed. The surgical procedure used to remove the womb iscalled a hysterectomy . Radiotherapy is an alternative to surgery for some women with early-stage cervical cancer. In some cases, its used alongside surgery. More advanced cases of cervical cancer are usually treated using a combination of chemotherapy and radiotherapy . Some of the treatments used can have significant and long-lasting side effects, including early menopause and infertility . Read more about treating cervical cancer Complications Many women with cervical cancer will have complications. These can arise as a direct result of the cancer or as a side effect of treatments such as radiotherapy, chemotherapy andsurgery. Complications associated with cervical cancer can range from the relatively minor, such as minor bleeding from the vagina orhaving to urinate frequently, to life-threatening, such as severe bleeding or kidney failure. Read more about the complications of cervical cancer Outlook The stage at which cervical cancer is diagnosed is an important factor in determining outlook. The staging, given as a number from 1 to 4, indicates how far the cancer has spread. The chances of living for at least 5 years after being diagnosed with cervical cancer are: stage 1 80-99% stage 2 60-90% stage 3 30-50% stage 4 20% Read more about the staging of cervical cancer Whos affected by cervical cancer? Following the success of the NHS Cervical Screening Programme and the early detection of cell changes, the number of cervical cancer cases in the UK has reduced. Around 3,000 cases of cervical cancer are diagnosed in the UK each year. Its possible for women of all ages to develop cervical cancer, but the condition mainly affects sexually active women aged between 30 and 45. Cervical cancer is very rare in women under 25. Symptoms of cervical cancer The symptoms of cervical cancer arent always obvious, and it may not cause any symptoms at all until its reached an advanced stage. This is why its very important that you attend all of your cervical screening appointments. Unusual bleeding In most cases, vaginal bleeding is the first noticeable symptom of cervical cancer. It usually occurs after having sex. Bleeding at any other time, other than your expected monthly period is also considered unusual. This includes bleeding after the menopause (when a womans monthly periods stop). Visit your GP for advice if you experience any type of unusual vaginal bleeding. Other symptoms Other symptoms of cervical cancer may include pain and discomfort during sex and an unpleasant smelling vaginal discharge. Advanced cervical cancer If the cancer spreads out of your cervix and into surrounding tissue and organs, it can trigger a range of other symptoms, including: constipation blood in your urine (haematuria) loss of bladder control ( urinary incontinence ) bone pain swelling of one of your legs severe pain in your side or back caused by swelling in your kidneys, related to acondition called hydronephrosis changes to your bladder and bowel habits loss of appetite weight loss tiredness and a lack of energy When to seek medical advice You should contact your GP if you experience: bleeding after sex (postcoital bleeding) bleeding outside of your normal periods new bleeding after the menopause Vaginal bleeding is very common and can have a wide range of causes, so it doesnt necessarily mean you have cervical cancer. However, unusual vaginal bleeding is a symptom that needs to be investigated by your GP. Causes of cervical cancer In almost all cases, cervical cancer is the result of a change in cell DNA caused by the human papilloma virus (HPV). Cancer begins with a change in the structure of the DNA thats present in all human cells. DNA provides the cells with a basic set of instructions, including when to grow and reproduce. A change in the DNAs structure is known as a mutation. It can alter the instructions that control cell growth, which means the cells continue growing instead of stopping when they should. If the cells reproduce uncontrollably, they produce a lump of tissue called a tumour. Human papilloma virus (HPV) More than99% of cervical cancercases occur in women who have been previously infected with HPV. HPV is a group of viruses, rather than a single virus. There are more than 100 different types. HPV is spread during sexual intercourse and other types of sexual activity (such as skin-to-skin contact of the genital areas, or using sex toys) and is thought to be very common.Its estimated that 1 in 3 women will develop an HPV infection within 2 years of starting to have regular sex, and about 4 in 5women will develop the infection at some point in their lives. Some types of HPV dont cause any noticeable symptoms and the infection will pass without treatment. Other types of HPV can cause genital warts , although these types arent linked to an increased risk of causing cervical cancer. About 15 types of HPV are considered high-risk for cervical cancer. The 2 types known to have the highest risk are HPV 16 and HPV 18, whichcause about 7 out of every 10 cervical cancers. High-risk types of HPV are thought to contain genetic material that can be passed into the cells of the cervix. This material begins to disrupt the normal workings of the cells, which can eventually cause them to reproduce uncontrollably, leading to the growth of a cancerous tumour. As most types of HPV dont cause any symptoms, you or your partner could have the virus for months or years without knowing it. See preventing cervical cancer for more information about reducing your chances of developing an HPV infection. Cervical intraepithelial neoplasia (CIN) Cancer of the cervix usually takes many years to develop. Before it does, the cells in the cervix often show changes known as cervical intraepithelial neoplasia (CIN) or, less commonly, cervical glandular intraepithelial neoplasia (CGIN). CIN and CGIN are pre-cancerous conditions. Pre-cancerous conditions dont pose an immediate threat to a persons health, but they can potentially develop into cancer in the future. However, even if you develop CIN or CGIN, the chances of it developing into cervical cancer are very small, and if the changes are discovered during cervical screening , treatment ishighly successful. The progression from becoming infected with HPV to developing CIN or CGINand then developing cervical cancer is very slow, oftentaking 10 to 20 years. Read more about cervical screening results Increased risk The fact that HPV infection is very common but cervical cancer is relatively uncommonsuggests that only a very small proportion of women are vulnerable to the effects of an HPV infection. There appear to be additionalrisk factors that affecta womans chance of developing cervical cancer. These include: smoking women who smoke are twice as likely todevelop cervical cancer than women who dont; this may be caused by the harmful effects of chemicals found in tobacco on the cells of the cervix having a weakened immune system this can occur as a result of taking certain medications, such as immunosuppressants, which are used to stop the body rejecting donated organs, or as a result of a condition such as HIV or AIDS taking the oral contraceptive pill for more than 5 years women who take the pill are thought to have twice the risk of developing cervical cancer than those who dont, although its not clear why having children (the more children you have, the greater your risk) women who have 2 children have twice the risk of getting cervical cancer comparedwith women who dont have any children The reason for the link between cervical cancer and childbirth is unclear. One theory is that the hormonal changes that occur during pregnancy may make the cervix more vulnerable to the effects of HPV. The spread of cervical cancer If cervical cancer is undiagnosed and untreated, it will slowly spread out of the cervixand into the surrounding tissue and organs. The cancer can spread down to the vagina and the surrounding muscles that support the bones of the pelvis. Alternatively, it can spread upwards, blocking the tube that runs from your kidneys to your bladder (ureters). The cancercan then spread into your bladder, rectum (back passage) and eventually into your liver, bones and lungs. Cancerous cells can also spread through your lymphatic system. The lymphatic system is a series of nodes (glands) and channels spread throughout your body in a similar way to the blood circulation system. The lymph nodes produce many of the specialised cells needed by your immune system (the bodys natural defence against infection and illness). If you have an infection, the nodes in your neck or under your armpits can become swollen. In some cases of early cervical cancer, the lymph nodes close to the cervix contain cancerous cells. In some cases of advanced cervical cancer, lymph nodes in the chest and abdomen can be affected. Diagnosing cervical cancer If cervical cancer is suspected, youll be referred to a gynaecologist (a specialist in treating conditions of the female reproductive system). Referral will be recommended if the results of your cervical screening test suggest that there are abnormalities in the cells of your cervix. However, in most cases, the abnormalities dont mean you have cervical cancer. You may also be referred to a gynaecologist if you have abnormal vaginalbleeding, or if your GP has noticed a growth inside your cervix during an examination. The sexually transmitted infection (STI) chlamydia is one of the most common reasons why women experience unusual vaginal bleeding. Your GP may recommend that youre tested for it first before being referred. Testing for chlamydia involves taking a small tissue sample from your cervix, or carrying out a urine test. Colposcopy If youve had an abnormal cervical screening test result, or your symptoms suggest that you may have cervical cancer, your gynaecologist will usually carry out a colposcopy . This is an examination to look for abnormalities in your cervix. During a colposcopy, a small microscope with a light source at the end (colposcope) is used. As well as examining your cervix, your gynaecologist may remove a small tissue sample ( biopsy ) so that it can be checked under a microscope for cancerous cells. Cone biopsy In some cases, a minor operation called a cone biopsy may also be carried out. The operation is carried out in hospital, usually under a local anaesthetic . During a cone biopsy, a small, cone-shaped section of your cervix will be removed so that it can be examined under a microscope for cancerous cells. You may experience vaginal bleeding for up to four weeks after the procedure. You may also have period-like pains. Further testing If the results of the biopsy suggest you have cervical cancer and theres a risk that the cancer may have spread, youll probably need to have some further tests to assess how widespread the cancer is. These tests may include: a pelvic examination carried out under general anaesthetic your womb, vagina, rectum and bladder will be checked for cancer blood tests these can be used to help assess the state of your liver, kidneys and bone marrow computerised tomography (CT) scan scans are taken of the inside of your body and a computer is used to assemble them into a detailed three-dimensional image; the CT scan can help to identify cancerous tumours and show whether cancerous cells have spread magnetic resonance imaging (MRI) scan this type of scan uses strong magnetic fields and radio waves to produce detailed pictures of the inside of your body; it can also be used to check whether cancer has spread chest X-ray this will indicate whether cancer has spread to your lungs positive emission tomography (PET) scan a specialised scan, where a mildly radioactive substance is injected into your veins so the cancerous tissue shows up more clearly; its often combined with a CT scanand is used to see if the cancer has spread, or to check how well a person is responding to treatment Staging After all of the tests have been completed and your test results are known, it should be possible to tell you what stage cancer you have. Staging is a measurement of how far the cancer has spread. The higher the stage, the further the cancer has spread. The staging for cervical cancer is as follows: stage 0 (pre-cancer) there are no cancerous cells in the cervix, but there are biological changes that could trigger cancer in the future; this is called cervical intraepithelial neoplasia (CIN) or carcinoma in situ (CIS) stage 1 the cancer is still contained inside the cervix stage 2 the cancer has spread outside of the cervix into the surrounding tissue, but hasnt reached the tissues lining the pelvis (pelvic wall) or the lower part of the vagina stage 3 the cancer has spread into the lower section of the vagina and/or into the pelvic wall stage 4 the cancer has spread into the bowel, bladder or other organs, such asthe lungs Treating cervical cancer Treatment for cervical cancer depends on how far the cancer has spread. As cancer treatments are often complex, hospitals use multidisciplinary teams (MDTs) to treat cervical cancer and tailor the treatment programme to the individual. MDTs are made up of a number of different specialists who work together to make decisions about the best way to proceed with your treatment. Your cancer team will recommend what they thinkthe best treatment options are, but the final decision will be yours. In most cases, the recommendations will be: early cervical cancer surgery to remove some or all of the womb, radiotherapy ,or a combination advanced cervical cancer radiotherapy and/or chemotherapy , althoughsurgery is also sometimes used The prospect of a complete cure is good for cervical cancer diagnosed at an early stage, although the chances of a complete cure decrease the further the cancer has spread. In cases where cervical cancer isnt curable, its often possible to slow its progression, prolong lifespan and relieve any associated symptoms, such as pain and vaginal bleeding. This is known as palliative care . Removing abnormal cells If your screening results show that you dont have cervical cancer, but there are biological changes that could turn cancerous in the future, a number of treatment options are available. These include: large loop excision of the transformation zone (LLETZ) the abnormal cells are cut away using a fine wire and an electrical current cone biopsy the area of abnormal tissue is removed during surgery laser therapy a laser is used to burn away the abnormal cells Read more about treating abnormal cells in the cervix Surgery There are 3 main types of surgery for cervical cancer. They are: radical trachelectomy the cervix, surrounding tissue and the upper part of the vagina are removed, but the womb is left in place hysterectomy the cervix and womb are removed; depending on the stage of the cancer, it may also be necessary to remove the ovaries and fallopian tubes pelvic exenteration a major operation in which the cervix, vagina, womb, bladder, ovaries, fallopian tubes and rectum are removed Radical trachelectomy A radical trachelectomy is usually only suitable if cervical cancer is diagnosed at avery early stage. Its usually offered to women who want to preserve their child-bearing potential. During the procedure, the surgeon will make a number of small incisions (cuts)in your abdomen. Specially designed instruments will be passed through the incisions and used to remove your cervix and the upper section of your vagina. Lymph nodes from your pelvis may also be removed. Your womb will then be reattached to the lower section of your vagina. Comparedwith a hysterectomy or pelvic exenteration,the advantage of this type of surgeryis that your womb remains intact, which means that you maystill be able to have children. However, its important to be aware that the surgeons carrying out this operation cant guarantee youll still be able to have children. If you do have children after the operation, your child would have to be delivered bycaesarean section. Its also usually recommended that you wait 6 to 12 months after having surgery before trying for a baby, so that your womb and vagina have time to heal. Radical trachelectomy is a highly skilled procedure. Its only available at a number of specialist centres in the UK, so it may not be available in your area and you may have to travel to another city to be treated. Hysterectomy A hysterectomy is usually recommended for early cervical cancer. This may be followed by a course of radiotherapy to help prevent the cancer coming back. There are 2 types of hysterectomies used to treat cervical cancer: simple hysterectomy where the cervix and womb are removed and, in some cases, the ovaries and fallopian tubes are also removed; this is only appropriate for very early stage cervical cancers radical hysterectomy where the cervix, womb, surrounding tissue and lymph nodes, ovaries and fallopian tubes are all removed; this is the preferred option in advanced stage 1 and some early stage 2 cervical cancers Short-term complications of a hysterectomy include infection, bleeding, blood clots and accidental injury to your ureter, bladderor rectum. The risk of long-term complications issmall, but they can be troublesome. They include: the risk that your vagina canbecome shortened and drier, which can make sex painful urinary incontinence swelling of your arms and legs, caused by a build-up of fluid ( lymphoedema ) your bowel becomes obstructedbecause ofa build-up of scar tissue this may require further surgery to correct As your womb is removed during a hysterectomy, youll no longer be able to have children. If your ovaries are removed, it will also trigger the menopause if you havent already experienced it. See complications of cervical cancer for more information about the menopause. Pelvic exenteration A pelvic exenteration is a major operation thats usually only recommended when cervical cancer returns after what was thought to be a previously successful course of treatment. Its offered if the cancer returns to the pelvis, but hasnt spread beyond this area. A pelvic exenteration involves two phases of treatment: the cancer is removed, plus your bladder, rectum, vagina and the lower section of your bowel 2 holes called stomas are created in your abdomen the holes are used to pass urine and faeces out of your body into collection pouches called colostomy bags Following a pelvic exenteration, your vagina can be reconstructed using skin and tissue taken from other parts of your body. This means youll be able to have sex after the procedure, although it may be several months until you feel well enough to do so. Radiotherapy Radiotherapy may beused on its own or combined with surgeryfor early-stagecervical cancer. It may be combined with chemotherapy for advanced cervical cancer, where it can be used to control bleeding and pain. There are 2 ways that radiotherapy can be delivered. These are: externally a machine beams high-energy waves into your pelvis to destroy cancerous cells internally a radioactive implant is placed inside your vagina and cervix In most cases, a combination of internal and external radiotherapy will be used. A course of radiotherapy usually lasts for around 5 to 8 weeks. As well as destroying cancerous cells, radiotherapy can sometimes also harm healthy tissue.This means it can cause significant side effects many months, and even years, after treatment. However,the benefits of radiotherapy often tend to outweigh the risks. For some people, radiotherapy offers the only hope of getting rid of the cancer. Side effects of radiotherapy are common and can include: diarrhoea pain when urinating bleeding from your vagina or rectum feeling very tired (fatigue) feeling sick (nausea) sore skin in your pelvis regionsimilar to sunburn narrowing of your vagina, which can make having sex painful infertility damage to the ovaries, which will usually trigger an early menopause (if you havent already experienced it) bladder and bowel damage, which could lead to incontinence Most of these side effects will resolve within about eight weeks of finishing treatment, although in some cases they can be permanent. Its also possible to develop side effects several months, or even years after treatment has finished. If infertility is a concern for you, it may be possible to surgically remove eggs from your ovaries before you have radiotherapy, so that they can be implanted in your womb at a later date. However, you may have to pay for this. It may also be possible to prevent early menopause by surgically removing your ovaries and replanting them outsidethe area of your pelvis that will be affected by radiation. This is known as an ovarian transposition. Your MDT can provide more information about the possible options for treating infertility and whether youre suitable for an ovarian transposition. Chemotherapy Chemotherapy can be combined with radiotherapy to tryto cure cervical cancer, or it can be used as a sole treatment for advanced cancer to slowits progression and relieve symptoms (palliative chemotherapy). Chemotherapy involves using either a single chemotherapy medication called cisplatin or a combination of different chemotherapy medications to kill thecancerous cells. Chemotherapy is usually given using an intravenous drip on an outpatient basis, so youll be able to go home once youve received your dose. As with radiotherapy, these medications can also damage healthy tissue. Side effects are thereforecommon and caninclude: nausea and vomiting diarrhoea feeling tired all the time reduced production of blood cells, which can make you feel tired and breathless (anaemia) and vulnerable to infection because of a lack of white blood cells mouth ulcers loss of appetite hair loss your hair should grow back within three to six months of your course of chemotherapy being completed, although not all chemotherapy medications cause hair loss Some types of chemotherapy medication can damage your kidneys, so you may need to have regular blood tests to assess the health of your kidneys. Follow-up After your treatment has been completed and the cancer has been removed, youll need to attend regular appointments for testing. This will usually involve a physical examination of your vagina and cervix (if it hasnt been removed). As theres a risk of cervical cancer returning, these examinations will be used to look for signs of this. If anything suspicious is found,a further biopsy can be carried out. If cervical cancer does return, it usually returns around 18 months after a course of treatment has been completed. Follow-up appointments are usually recommended every four months after treatment has been completed for the first 2 years, and then every 6 to 12 months for a further 3 years. Complications of cervical cancer Complications of cervical cancer can occur as a side effect of treatment or as the result of advanced cervical cancer. Side effects Early menopause If your ovaries are surgically removed or theyre damaged during treatment with radiotherapy , it will trigger an early menopause (if you havent already had it). Most women experience the menopause in their early fifties. The menopause is caused when your ovaries stop producing the hormones oestrogen and progesterone. This leads to the following symptoms: you no longer have monthly periodsor your periods become much more irregular hot flushes vaginal dryness loss of sex drive mood changes stress incontinence (leaking urine when you cough or sneeze) night sweats thinning of the bones, which can lead to brittle bones ( osteoporosis ) These symptoms can be relieved by taking a number of medications that stimulate the production of oestrogen and progesterone. This treatment is known as hormone replacement therapy (HRT) . Narrowing of the vagina Radiotherapy to treat cervical cancer can often cause your vagina to become narrower, which can make having sex painful or difficult. There are 2 main treatment options if you have a narrowed vagina. The first is to apply hormonal cream to your vagina. This should increase moisture within your vagina and make having sex easier. The second is to use a vaginal dilator, which is a tampon-shaped device made of plastic. You insert it into your vagina and is designed to help make it more supple. Its usually recommended that you insert the dilator for 5 to 10 minutes at a time on a regular basis during the day over the course of 6 to 12 months. Many women find discussing the use of a vaginal dilator embarrassing, but its a standard and well-recognised treatment for narrowing of the vagina. Your specialist cancer nurse or radiographers in the radiotherapy department should be able to give you more information and advice. You may find that the more times you have sex, the less painful it becomes. However, it may be several months before you feel emotionally ready to be intimate with a sexual partner. The Macmillan Cancer Support website has more information about sexuality and cancer Lymphoedema If the lymph nodes in your pelvis areremoved, it can sometimes disrupt the normal workings of your lymphatic system. One of the functions of the lymphatic system is to drain away excess fluid from the bodys tissue. A disruption to this process can lead to a build-up of fluid in the tissue known as lymphoedema . This can cause certain body parts to become swollen usually the legs, in cases of cervical cancer. There are exercises and massage techniques that can reduce the swelling. Wearing specially designed bandages and compression garments can also help. Read more about treating lymphoedema Emotional impact The emotional impact of living with cervical cancer can be significant. Many people report experiencing a rollercoaster effect. For example, you may feel down when you receive a diagnosis, but feel better when removal of the cancer has been confirmed. You may then feel down again as you try to come to terms with the after-effects of your treatment. This type of emotional disruption can sometimes trigger depression . Typical signs of depression include feeling sad, hopeless and losing interest in things you used to enjoy. Contact your GP if you think you may be depressed. There is a range of effective treatments available, including antidepressant medication and talking therapies, such as cognitive behavioural therapy (CBT). You may also find Jos Cervical Cancer Trust a useful resource. Its the UKs only charity dedicated to women affected by cervical cancer. Local cancer support groups may also be availablein your area for women affected by cancer. Your specialist cancer nurse should be able to provide contact details. Read more aboutfeelings andcancer Advanced cervical cancer Some of the complications that can occur in advanced cervical cancer are discussed below. Pain If the cancer spreads into your nerve endings, bones or muscles, it can often cause severe pain. A number of effective painkilling medications can usually be used to control the pain. Depending on the levels of pain, they can range from paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen , to more powerful opiate-based painkillers, such as codeine and morphine. Tell your care team if the painkillers youre prescribed arent effective in reducing your pain. You may need to be prescribed a stronger medication. A short course of radiotherapy may also be effective in controlling the pain. Macmillan nurses , who work both in hospitals and in the community, can also provide expert advice about pain relief. Kidney failure Your kidneys remove waste material from your blood. The waste is passed out of your body in urinethrough tubes called the ureters. Kidney function can be monitored by a simple blood test called serum creatinine level. In some cases of advanced cervical cancer, the cancerous tumour can press against the ureters, blocking the flow of urine out of the kidneys. The build-up of urine inside the kidneys is known ashydronephrosis and can cause the kidneys to become swollen and stretched. Severe cases of hydronephrosis can cause the kidneys to become scarred, which can lead to the loss of most or all of the kidneys functions. This is known as kidney failure. Kidney failure can cause a wide range of symptoms, including: tiredness swollen ankles, feet or hands, caused bywater retention shortness of breath feeling sick blood in your urine (haematuria) Treatment options for kidney failure associated with cervical cancer include draining urine out of the kidneys using a tube inserted through the skin and into each kidney (percutaneous nephrostomy). Another option is to widen the ureters by placing a small metal tube called a stent inside them. Blood clots As with other types of cancer, cervical cancer can make the blood stickier andmore prone to forming clots. Bed rest after surgery and chemotherapy can also increase the risk of developing a clot. Large tumours can press on the veins in the pelvis, which slows the flow of blood and can lead to a blood clot developing in the legs. Symptoms of a blood clot in your legs include: pain, swelling and tenderness in one of your legs (usually your calf) a heavy ache in the affected area warm skin in the area of the clot redness ofthe skin, particularly at the back of your leg, be

Cervical cancer

A major concern in these cases is that the blood clot from the leg vein will travel up to the lungs and block the supply of blood. This is known as apulmonary embolism andcan be fatal. Blood clots in the legs are usually treated using a combination of blood-thinning medication such as heparin or warfarin and compression garmentsdesigned to help encourage the flow of blood through the limbs. Read more about treating deep vein thrombosis Bleeding If the cancer spreads into your vagina bowel or bladder it can cause significant damage resulting in bleeding. Bleeding can occur in your vagina or rectum (back passage) or you may pass blood when you urinate. Minor bleeding can often be treated using a medication called tranexamic acid which encourages the blood to clot and stop the bleeding. Radiotherapy can also be highly effective in controlling bleeding caused by cancer. Major bleeding may be treated temporarily by vaginal packing (using gauze to stem the bleeding)and later by surgery radiotherapy or by cutting off blood supply to the cervix. Fistula A fistula is an uncommon but distressing complication that occurs in around 1 in 50 cases of advanced cervical cancer. A fistula is an abnormal channel that develops between 2 sections of the body. In most cases involving cervical cancer the fistula develops between the bladder and the vagina. This can lead to a persistent discharge of fluid from the vagina. A fistula can sometimes develop between the vagina and rectum. Surgery is usually required to repair a fistula although its often not possible inwomen with advanced cervical cancer because theyre usually too frail to withstand the effects of surgery. In such cases treatment often involves using medication creams and lotions to reduce the amount of discharge and protect the vagina and surrounding tissue from damage and irritation. Vaginal discharge Another uncommon but distressing complication of advanced cervical cancer is an unpleasant-smelling discharge from your vagina. The discharge can occur for a number of reasons such as the breakdown of tissue the leakage of bladder or bowel contents out of the vagina or a bacterial infection of the vagina. Treatment options for vaginal discharge include an antibacterial gel called metronidazole and wearing clothing that contains charcoal. Charcoal is a chemical compound thats very effective in absorbing unpleasant smells. Palliative care If your doctors cant do any more to treat your cancer your care will focus on controlling your symptoms and helping you to be as comfortable as possible. This is called palliative care . Palliative care also includes psychological social and spiritual support for you and your family or carers. There are different options for terminal care in the late stages of cancer. You may want to think about whether youd like to be cared for in hospital in a hospice or at home anddiscuss these issues with your doctor. Some organisations who provide care for people with cancer include: Macmillan Cancer Support whichhas specially trained nurses who help to look after people with cancer at home. To be referred to a Macmillan nurse ask your hospital doctor or GP or call 0808 808 00 00. Marie Curie Cancer Care have specially trained nurses who help to look after people with cancer at home. They also run hospices for people with cancer. Hospice UK provides information about hospice care and how to find a hospice. Living with cervical cancer The impact of cervical cancer on your daily life will depend on the stage of cancer and the treatment youre having. Many women with cervical cancer have a radical hysterectomy . This is a major operationthat takes around 6 to 12 weeks to recover from. During this time you need to avoid strenuous tasks and lifting such aslifting childrenorheavy shopping bags. You wont be able to drive for 3 to 8 weeks after the operation. Most women will also need 8 to 12 weeks off work to recover after having a radical hysterectomy. Some of the treatments for cervical cancer can make you very tired particularly chemotherapy and radiotherapy . Because of this you may need to take a break from some of your normal activities for a while. Dont be afraid to ask for practical help from family and friends if you need it. Practical help may also be available from your local authority. Ask your doctor or nurse about who to contact. Work Having cervical cancer doesnt necessarily mean youll have to give up work althoughyou may need quite a lot of time off. During treatment you may not be able to carry on as you did before. If you have cancer youre covered by the Disability Discrimination Act . This means that your employer isnt allowed to discriminate against you because of your illness. They have a duty to make reasonable adjustments to help you cope. Examples of these include: allowing you time off for treatment and medical appointments allowing flexibility with working hours the tasks you have to perform or your working environment The definition of whats reasonable depends on the situation such as how much it would affect your employers business for example. You should give your employer as much information as possible about how much time youll need off and when. Speak toa member of your human resources department if you have one. Your union or staff association representative can also give you advice. If youre having difficulties with your employer your union or local Citizens Advice Bureau may be able to help. Macmillan Cancer Support also has more information and advice about work and cancer . Money and benefits If you have to reduce or stop work because of your cancer you may find it difficult to cope financially. If you have cancer or youre caring for someone with cancer you may be entitled to financial support. For example: if you have a job but cant work because of your illness youre entitled to Statutory Sick Pay from your employer if you dont have a job and cant work because of your illness you may be entitled to Employment and Support Allowance if youre caring for someone with cancer you may be entitled to Carers Allowance you may be eligible for other benefits if you have children living at home or you have a low household income Its a good idea to find out what help is available as soon as possible. You could ask to speak to the social worker at your hospital who can give you the information you need. Your sex life Many women feel nervous about having sex soon after treatment for cervical cancer but its perfectly safe.Sex wont make the cancer come back and your partner cant catch cancer from you. Ifyou want to you can resume your normal sex life within a few weeks of finishing radiotherapy or having surgery. This will give your body time to heal. If youre having chemotherapy male partners should wear a condom when you have sex because its not clear if having sex after chemotherapy can have an effect on them. Some women find sex difficult after being treated for cervical cancer because theside effects of some treatments can include vaginal dryness and narrowing of the vagina. In these cases there are treatments that can help such as vaginal dilators. See complications of cervical cancer for more information Preventing cervical cancer Theres no single way to completely prevent cervical cancer but there are things that can reduce your risk. Safer sex Most cases of cervical cancer are linked to an infection with certain types of human papillomavirus (HPV) . HPV can be spread through unprotected sex so using a condom can reduce your risk of developing the infection. However the virus isnt just passed on through penetrative sex it can be transmitted during other types of sexual contact such as skin-to-skin contact between genital areas and by using sex toys. Your risk of developing an HPV infection increases the earlier you start having regular sex and with the more sexual partners you have although women who have only had 1 sexual partner can also develop it. Read more about sexual health Cervical screening Regular cervical screening is the best way to identify abnormal changes in the cells of the cervix at an early stage. Cervical screening (also known as a smear test) is routinely offered to anyone with a cervix in Scotland between the ages of 25 and 64 every 5 years. You may be recalled more often depending on your test results. Make sure that your GP surgery has your up-to-date contact details so that you continue getting screening invitations. Its important that you attend yourcervical screeningtests even if youve been vaccinated for HPV because the vaccine doesnt guarantee protection against cervical cancer. If youve been treated for abnormal cervical cell changes youll be invited for screening more frequently for several years after treatment. How regularly you need to go will depend on how severe the cell change is. Although it can identify most abnormal cell changes in the cervix cervical screening isnt always 100% accurate. Therefore you should report symptoms such as unusual vaginal bleeding to your GP even if youve recently been tested. Cervical cancervaccination The NHS cervical cancer vaccination programme uses a vaccine called Gardasil. Gardasil protects against four types of HPV including the 2 strains responsible for more than 70% of cervical cancers in the UK (HPV16 and HPV 18). It also prevents genital warts . Girls are offered the childhood immunisation programme . The vaccine isgiven to girls when theyre12to 13 years old with 3 doses givenover a 6-month period. Although the HPV vaccine can significantly reduce the risk of cervical cancer it doesnt guarantee that you wont develop the condition. You should still attend cervical screening tests evenif youve had the vaccine. Avoidsmoking You can reduce your chances of getting cervical cancer by not smoking. People who smoke are less able to get rid of the HPV infection from the body which can develop into cancer. If you decide to give up smoking youcouldcontactthe Quit Your Way Scotland on0800 84 84 84.Quit Your Way Scotlandis run by NHS 24 and is staffed by trained advisors wholl be able to give you expert advice. If you want to give up smoking but you dont want to be referred to a stop smoking service your GP should be able to prescribe medical treatment to help with any withdrawal symptoms that you may experience after giving up. For more information and advice on giving up smoking see stopping smoking and treatments for stopping smoking .

Chest infection

Chest infection | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Chest infection Chest infection Chest infections are common, especially after a cold or flu during autumn and winter. Although most are mild and get better on their own, some can be serious or even life-threatening. Signs and symptoms of a chest infection The main symptoms of a chest infection can include: a persistent cough coughing up yellow or green phlegm (thick mucus), or coughing up blood breathlessness or rapid and shallow breathing wheezing a high temperature (fever) a rapid heartbeat chest pain or tightness feeling confused and disorientated You may also experience more general symptoms of an infection, such as a headache , fatigue, sweating, loss of appetite, or joint and muscle pain. What causes chest infections? A chest infection is an infection of the lungs or airways. The main types of chest infection are bronchitis and pneumonia . Most bronchitis cases are caused by viruses, whereas most pneumonia cases are due to bacteria. These infections are usually spread when an infected person coughs or sneezes. This launches tiny droplets of fluid containing the virus or bacteria into the air, where they can be breathed in by others. The infections can also be spread to others if you cough or sneeze onto your hand, an object or a surface, and someone else shakes your hand or touches those surfaces before touching their mouth or nose. Certain groups of people have a higher risk of developing serious chest infections, such as: babies and very young children children with developmental problems people who are very overweight elderly people pregnant women people who smoke people with long-term health conditions, such as asthma , heart disease , diabetes , kidney disease , cystic fibrosis or chronic obstructive pulmonary disease (COPD) people with a weakened immune system this could be due to a recent illness, a transplant, high-dose steroids, chemotherapy or a health condition, such as an undiagnosed HIV infection Read more about the causes of bronchitis and the causes of pneumonia Caring for your symptoms at home Many chest infections arent serious and get better within a few days or weeks. You wont usually need to see your GP, unless your symptoms suggest you have a more serious infection. While you recover at home, there are things you can do to improve your symptoms. Do get plenty of rest drink lots of fluid to prevent dehydration and to loosen the mucus in your lungs, making it easier to cough up treat headaches, fever and aches and pains with pain relief such as paracetamol or ibuprofen drink a warm drink of honey and lemon to relieve a sore throat caused by persistent coughing raise your head up with extra pillows while youre sleeping to make breathing easier stop smoking if you smoke Avoid cough medicines, as theres little evidence they work. Coughing actually helps you clear the infection more quickly by getting rid of the phlegm from your lungs. Antibiotics arent recommended for many chest infections, because they only work if the infection is caused by bacteria, rather than a virus. Your GP will usually only prescribe antibiotics if they think you have pneumonia, or youre at risk of complications such as fluid building up around the lungs ( pleurisy ). If theres a flu outbreak in your local area and youre at risk of serious infection, your GP may also prescribe antiviral medication. Read more about treating bronchitis and treating pneumonia When to contact your GP practice Contact your GP practice if: you feel very unwell or your symptoms are severe your symptoms are not improving you feel confused, disorientated or drowsy you have chest pain or difficulty breathing you cough up blood or blood-stained phlegm your skin or lips develop a blue tinge (cyanosis) youre pregnant youre 65 or over youre very overweight and have difficulty breathing you think a child under five has a chest infection you have a weakened immune system you have a long-term health condition you have a cough that has lasted more than 3 weeks Your GP should be able to diagnose you based on your symptoms and by listening to your chest using a stethoscope (a medical instrument used to listen to the heart and lungs). In some cases, further tests such as a chest X-ray , breathing tests and testing phlegm or blood samples may be needed. Preventing chest infections There are measures you can take to help reduce your risk of developing chest infections and stop them spreading to others. Stop smoking If you smoke, one of the best things you can do to prevent a chest infection is to stop. Smoking damages your lungs and weakens your defences against infection. Read more information and advice about stopping smoking Good hygiene Although chest infections generally arent as contagious as other common infections, like flu, you can pass them on to others through coughing and sneezing. Therefore, its important to cover your mouth when you cough or sneeze, and to wash your hands regularly. Put tissues in the bin immediately. Alcohol and diet Excessive and prolonged alcohol misuse can weaken your lungs natural defences against infections and make you more vulnerable to chest infections. To keep your risk of alcohol-related harm low, the NHS recommends: not regularly drinking more than 14 units of alcohol a week if you drink as much as 14 units a week, its best to spread this evenly over 3 or more days if youre trying to reduce the amount of alcohol you drink, its a good idea to have several alcohol-free days each week Regular or frequent drinking means drinking alcohol most weeks. The risk to your health is increased by drinking any amount of alcohol on a regular basis. Eating a healthy, balanced diet can help strengthen the immune system, making you less vulnerable to developing chest infections. Read more about healthy eating and tips on cutting down on alcohol Vaccinations If youre at an increased risk of chest infections, your GP may recommend being vaccinated against flu and pneumococcal infections (a bacterium that can cause pneumonia). These vaccinations should help to reduce your chances of getting chest infections in the future. Flu and pneumococcal vaccinations are usually recommended for: babies and young children pregnant women (flu jab only) people aged 65 and over people with long-term health conditions or weakened immune systems Source: NHS 24 - Opens in new browser window Last updated: 04 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Chronic obstructive pulmonary disease NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Chest pain

Chest pain | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Heart and blood vessels Conditions Chest pain Chest pain Phone 999 immediately if: You or someone else has symptoms like: central chest pain or discomfort in the chest that doesnt go away it may feel like pressure, tightness or squeezing pain that radiates down the left arm, or both arms, or to the neck, jaw, back or stomach unconsciousness seizures or fitting difficulty breathing (snoring or rasping) rapid heart beat low or undetectable heart beat chest pain and breathlessness, nausea, sweating or coughing up blood Causes of chest pain There are a number of different conditions that can cause chest pain. You should always seek medical advice to make sure you get a proper diagnosis. Depending on your symptoms and circumstances, you may need further investigation. Heart attack A heart attack occurs when the blood supply to part of the heart is suddenly blocked. Chest pain is more likely to be caused by a heart attack if it: lasts more than 15 minutes occurs while resting Angina Angina is a condition where the blood supply to the muscles of the heart is restricted. Chest pain caused by angina is usually triggered by physical activity (exertion). It usually gets better with rest after a few minutes. Pulmonary embolism A pulmonary embolism is a blockage in the blood vessel that carries blood from the heart to the lungs. This can cause sharp, stabbing chest pain that may get worse when you breathe in. It can also be accompanied by: breathlessness a cough dizziness coughing up blood Pericarditis Pericarditis is inflammation of the sac surrounding your heart. This can cause a sudden, sharp and stabbing pain in your chest. It may also cause more of a dull ache. This pain usually gets worse when you lie down. Lung conditions Lung conditions that can cause chest pain include: pneumonia inflammation of the lungs (usually caused by an infection) pleurisy inflammation of the membrane surrounding the lungs (usually caused by an infection) Conditions affecting the lungs can cause sharp chest pain that: gets worse when you breathe in and out is accompanied by other symptoms like coughing or breathlessness If someone has severe pneumonia or pleurisy, they may also have symptoms like: rapid breathing confusion Seek medical advice immediately if you or someone else has symptoms of: a heart attack angina a pulmonary embolism pericarditis pneumonia pleurisy Other causes of chest pain There are many other potential causes of chest pain, including: gastro-oesophageal reflux disease (GORD) acid from the stomach comes up into the oesophagus (gullet) causingburning chest pain (heartburn) and an unpleasant taste in the mouth acute cholecystitis inflammation of the gallbladderthat can cause a sudden sharp pain in the upper right side of your tummy that spreads towards your right shoulder strained muscle can cause chest pain thats painful and tender to touch costochondritis inflammation in the cartilage that joins the ribs to the breastbone (sternum) that can cause pain, swelling and tenderness around the ribs panic attack or anxiety can sometimes be accompanied by chest pain Source: Scottish Government - Opens in new browser window Last updated: 08 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Angina What to do in a heart emergency Other health sites NICE: Chest pain NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Chickenpox

Chickenpox | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Chickenpox Chickenpox Chickenpox is a mild and common illness that mostly affects children but can be caught at any age. Causes of chickenpox Chickenpox (known medically as varicella) is caused by a virus called the varicella-zoster virus. Its spread quickly and easily from someone who is infected. Chickenpox is most common in children under the age of 10. Children usually catch chickenpox in winter and spring, particularly between March and May. Symptoms of chickenpox Chickenpox causes a rash of red, itchy spots that turn into fluid-filled blisters . They then crust over to form scabs, which eventually drop off. Chickenpox spots The spots normally appear in clusters and tend to be: behind the ears on the face over the scalp on the chest and belly on the arms and legs But, the spots can be anywhere on the body, including: inside the ears and mouth on the palms of the hands soles of the feet inside the nappy area. The rash starts as small, itchy red spots. These develop a blister on top and become very itchy after about 12 to 14 hours. After a day or two, the fluid in the blisters gets cloudy and they begin to dry out and crust over. After 1 to 2 weeks, the crusting skin will fall off naturally. New spots can keep appearing in waves for 3 to 5 days after the rash begins. So, different groups of spots may be at different stages of blistering or drying out. Before chickenpox spots appear Before the rash appears, you or your child may have some mild flu -like symptoms, including: feeling sick a high temperature (fever) of 38C (100.4F) or over aching, painful muscles headache generally feeling unwell loss of appetite These symptoms, especially the fever, tend to be more common and worse in adults than in children. Contacting your doctor about chickenpox For most children, chickenpox is a mild illness that gets better on its own. Chickenpox tends to be more severe in adults than children. Adults have a higher risk of developing complications. Contact your GP practice if: You or your child develop any abnormal symptoms, such as: the skin around the blisters becomes hot, red and painful, (redness may be harder to see on brown or black skin) pain in the chest or difficulty breathing signs of dehydration , such as fewer wet nappies, drowsiness and cold hands and feet blisters on their skin become infected any of your or your childs symptoms suddenly get worse or You have been in contact with someone who has chickenpox, or you have chickenpox symptoms and: you are pregnant or have given birth in the last 7 days you have a weakened immune system (the bodys defence system) your baby is less than 4 weeks old you are breastfeeding If your GP is closed, phone 111. Contact your GP practice if: youre not sure if you or your child has chickenpox youre worried about your child Tell the receptionist you think it might be chickenpox before going in to a GP practice. Chickenpox treatment There is no treatment for chickenpox. But, you can get remedies from your pharmacy that can help symptoms. These include: paracetamol to help bring down a fever calamine lotion and cooling gels to ease itching. In most children, the blisters crust up and fall off naturally within 1 to 2 weeks. Adults with chickenpox may be helped by taking antiviral medicine if its diagnosed early enough. Stopping the spread of chickenpox You should keep children off school or nursery until all their spots have crusted over. This will help stop chickenpox being spread. Adults with chickenpox should stay off work until all the spots have crusted over. Chickenpox is infectious from 1 to 2 days before the rash starts. It stops being infectious when all the blisters have crusted over. This happens usually 5 to 6 days after the start of the rash. If you or your child has chickenpox, try to keep them away from public areas. This will help them avoid contact with people who may not have had it. You should especially stay away from people who are at risk of serious problems, such as: newborn babies pregnant women anyone with a weakened immune system, (for example people having cancer treatment or taking steroid tablets) Whos at higher risk from chickenpox? Some children and adults are at special risk of serious problems if they catch chickenpox. They include: pregnant women newborn babies people with a weakened immune system These people should speak to their GP as soon as they are exposed to the chickenpox virus or they develop chickenpox symptoms. They may need a blood test to check if they are protected from (immune to) chickenpox. Chickenpox in pregnancy If youre pregnant, chickenpox can occasionally cause complications. Chickenpox occurs in approximately 3 in every 1,000 pregnancies. Your risk of developing pneumonia is slightly higher if youre pregnant, especially if you smoke. The further you are into your pregnancy, the more serious the risk of pneumonia tends to be. If you get chickenpox while youre pregnant, there is also a small but significant risk to your unborn baby. If you get chickenpox during the first 28 weeks of your pregnancy, there is a risk that your unborn baby could develop a condition known as foetal varicella syndrome (FVS). This syndrome is rare. FVS can cause serious complications, including: scarring eye defects, such as cataracts shortened limbs brain damage There are also other risks from catching chickenpox after week 20 of pregnancy. Its possible that your baby may be born prematurely (before week 37 of the pregnancy). If you are infected with chickenpox 7 days before or 7 days after giving birth, your newborn baby may develop a more serious type of chickenpox. In a few severe cases, this type of chickenpox can be fatal. Chickenpox and shingles Once you have had chickenpox, you usually develop antibodies to the infection and become immune to catching it again. But, the virus that causes chickenpox, the varicella-zoster virus, stays inactive in your bodys nerve tissues. This can come back later in life as an illness called shingles. Its possible to catch chickenpox from someone with shingles, but not the other way around. Read more about shingles . Is there a vaccine against chickenpox? There is a chickenpox vaccine, but it is not part of the routine childhood vaccination schedule. Only children and adults who are more vulnerable to the complications of chickenpox will get offered the vaccine. It may be possible to develop the infection after vaccination. There is also a chance that someone who has had the vaccine could develop chickenpox after coming into close contact with a person who has shingles. Source: NHS 24 - Opens in new browser window Last updated: 24 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Self-help guide: Rash Skin rashes in children NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Chilblains

Chilblains | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Chilblains Chilblains Chilblains are small, itchy swellings on the skin that occur as a reaction to cold temperatures. They most often affect the bodys extremities, such as the toes, fingers, heels, ears and nose. Chilblainscan beuncomfortable, but rarely cause any permanent damage.They normally heal within a few weeks iffurther exposure to the cold is avoided. Chilblains can turn the skin red and may cause a burning or stinging sensation. Source: https://dermnetnz.org/ In severe cases, chilblains can cause the skin to blister. Source: https://dermnetnz.org/ Signs and symptoms of chilblains Chilblainsusually develop several hours after exposure to the cold. Theytypically cause a burning and itching sensation in the affected areas, whichcan become more intense if you go into a warm room. The affected skin may also swell and turn red or dark blue. In severe cases, the surface of the skin may break and sores or blisters can develop. Its importantnot to scratch the skin as it can break easily and become infected. When to seek medical advice for chilblains Most people dont need to seek medical advice if they have chilblains as they usually heal within a few weeks and dont cause any permanent problems. Speak to your GP or chiropodist if you have: severe or recurring chilblains chilblains that dont improve within a few weeks You should also seek medical advice if you think your skin may have become infected. Signs of infection include: swelling and pus forming in the affected area feeling generally unwell a high temperature (fever)of 38C (100.4F) or above swollen glands What causes chilblains? Chilblains are the result ofan abnormal reaction to the cold.Theyre common in the UKbecause damp, cold weather is usual in the winter. Some people develop chilblains that last for several monthsevery winter. When the skin is cold, blood vessels near its surface get narrower.If the skin is then exposed to heat, the blood vessels become wider. If this happens too quickly, blood vessels near the surface of the skin cant always handle the increased blood flow. This can cause blood toleak into the surrounding tissue, which may cause theswelling and itchiness associated with chilblains. Whos more at risk of chilblains? Some people are more at risk of chilblains than others. This includes people with: poor circulation a family history of chilblains regular exposure to cold, damp or draughty conditions a poor diet or low body weight lupus a long-term condition that causes swelling in the bodys tissues Raynauds phenomenon a common condition that affects the blood supply to certain parts of the body, usually the fingers and toes People who smoke are more at risk of chilblains as nicotine constricts blood vessels. Chilblains can also occur on areas of the feetexposed to pressure, such as a bunion or a toe thats squeezed by tight shoes. Treating chilblains Chilblains often get better on their own after a week or twowithout treatment. It may help to use a soothing lotion, such as calamine or witch hazel, to relieve itching. Your pharmacist may also be able to recommend a suitable product. If your chilblains are severe and keep returning, speak to your GP. They may recommend taking a daily tablet or capsule of a medication called nifedipine. This works by relaxing the blood vessels, improving your circulation. Nifedipine can be used to help existing chilblains heal, or can be taken during the winter tostopthem developing. Preventing chilblains If youre susceptible to chilblains, you canreduce your risk of developing themby: limiting your exposure to the cold looking after your feet taking stepsto improve your circulation If your skin gets cold, its important to warm it up gradually. Heating the skin too quicklyfor example, by placing your feet in hot water or near a heateris one of the main causes of chilblains. Do stop smoking nicotine causes the blood vessels to constrict, which can make chilblains worse keep active this helps improve your circulation wear warm clothes and insulate your hands, feet and legs wearing long johns, long boots, tights, leg warmers or long socks will help, and its a good idea to wear a clean pair of socks if you get cold feet in bed avoid tight shoes and boots these can restrict the circulation to your toes and feet moisturise your feet regularly this stops them drying out and the skin cracking eat at least one hot meal during the day thisll help warm your whole body, particularly in cold weather warm your shoes on the radiator before you put them on make sure damp shoes are dry before you wear them; if your feet are already cold, make sure your shoes arent too hot to avoid causing chilblains warm your hands before going outdoors soak them in warm water for several minutes and dry thoroughly, and wear cotton-lined waterproof gloves if necessary; if your hands are already cold, make sure not to warm them up too quickly to avoid causing chilblains keep your house well heated try to keep one room in the house warm and avoid drafts if youre diabetic, regularly check your feet (or ask someone else to do this) people with diabetes may not be able to feel their feet and could have infected chilblains without realising it Complications of chilblains If you havesevereor recurring chilblains, theres a small risk of further problems developing, such as: infection from blistered or scratched skin ulcers forming on the skin permanent discolouration of the skin scarring of the skin Avoiding complications of chilblains Its often possible to avoid complications of chilblains. Dont do not scratch or rub the affected areas of skin do not directly overheat the chilblains (by using hot water, for example) You can also help reduce your risk of infection bycleaning any breaks in your skin with antiseptic and covering the area withan antiseptic dressing. The dressing should be changed every other day until the skin heals. If the skin does become infected, antibiotics may be prescribed to treat the infection. Source: NHS 24 - Opens in new browser window Last updated: 25 November 2022 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Chlamydia

Chlamydia | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Chlamydia Chlamydia British Sign Language (BSL) | Polski | slovenina | | Romn Chlamydia is a bacterial infection. Its one of the most common sexually transmitted infections (STIs) in the UK. Symptoms of chlamydia Most people with chlamydia dont notice any symptoms and dont know they have it. So its important to get tested if you think youre infected. If you do get symptoms, its usually 1 to 3 weeks after having unprotected sex. Some people dont get symptoms until months later. If you do develop symptoms, you may experience: pain when peeing unusual discharge from the vagina, penis or anus pain in the lower tummy, bleeding after sex, and bleeding between periods pain in the testicles red, sticky eyes Sometimes symptoms can disappear after a few days. Even if symptoms go away you may still have the infection and could pass it on. Testing for chlamydia If you think you might have chlamydia, get tested for free by: booking an appointment at your local sexual health service (if you have symptoms) contacting your GP practice for an appointment (if you have symptoms) ordering a home test kit (if you do not have symptoms) Services available may vary depending on where you live. What does a chlamydia test involve? The test for chlamydia is simple, painless and very reliable. It involves sending a sample from the area of the body thought to be infected to a lab for analysis. You usually dont have to be examined by a doctor or nurse and can often collect the sample yourself. The 2 main ways the sample can be collected are: using a swab a small cotton bud is gently wiped over the area that might be infected, such as inside the vagina, throat, or inside the anus urine sample (if you have a penis) this is more accurate if its at least 1 or 2 hours after you last peed People who have had anal or oral sex may have a swab taken from their anus or throat. Treatment for chlamydia Antibiotics will treat the chlamydia infection. You should avoid having sex until 1 week after you and your partner(s) have been treated. This includes oral sex and sex using a condom. If chlamydia is left untreated you may pass it on to other sexual partners. If chlamydia is left untreated in women, it can spread to the womb and cause a serious condition called pelvic inflammatory disease (PID) . This is a major cause of ectopic pregnancy and infertility in women. If men are not treated, the infection may spread to the testicles and cause discomfort. This could affect your fertility. How chlamydia is passed on You can get chlamydia by having unprotected vaginal, anal or oral sex (sex without a condom). Other ways of getting chlamydia include: sharing sex toys that arent washed or covered with a new condom each time theyre used infected semen or vaginal fluid getting into your eye Chlamydia can be passed from a pregnant woman to her baby during childbirth. Any sexually active person can get chlamydia. Its most common in people under the age of 30. You can have had chlamydia for a while without knowing. How to prevent chlamydia The best way to reduce your risk of STIs is to practice safer sex . This means using a condom for vaginal, anal and oral sex. Other STIs If you have been diagnosed with chlamydia you should get tested for all STIs including: gonorrhoea syphilis HIV Find your local sexual health clinic Source: Scottish Government - Opens in new browser window Last updated: 26 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Other languages and formats British Sign Language (BSL) | Polski | slovenina | | Romn British Sign Language (BSL) | Polski | slovenina | | Romn Add this page to\n Info For Me Also on NHS inform Book a sexual health appointment online Chlamydia (BSL) Chlamydia (Chinese) Chlamydia (Polish) Chlamydia (Romanian) Chlamydia (Slovak) NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Chronic fatigue syndrome

ME or CFS | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS) Myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS) Myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS) is a long term (chronic) neurological condition that affects the nervous and immune systems. People with ME/CFS experience severe pain and fatigue associated with post-exertional malaise (PEM). This is when the body is not able to recover after using even small amounts of energy. This fatigue feels very different from ordinary tiredness. It might take a day or 2 to kick in after physical, mental, or emotional exertion. ME/CFS affects more women than men, can affect children and adults of all ages and from all social and ethnic groups. It doesnt go away with sleep or rest and affects everyday life. It cansometimes be diagnosed as post viral fatigue syndrome (PVFS). Symptoms of ME/CFS The symptoms ofthe condition vary from person to person. There may be times when your symptoms improve and youll be able to do some normal everyday activities. At other times, symptoms may get worse, affecting your daily life. If you experience new symptoms, talk to your GP or specialist as the new symptoms may be unrelated to ME/CFS. Women often find that symptoms worsen at different times in their menstrual cycle. Not everyone will experience all of the symptoms. Post-exertional malaise People with ME/CFS experience severe pain, fatigue and a range of other symptoms associated with PEM. This is the body and brains inability to recover after using even small amounts of energy. Simple physical or mental activities, or combinations of activities, can leave people with ME/CFS feeling completely exhausted. It can also lead to an increase in other symptoms. Other symptoms of ME/CFS include: feeling generally unwell pain broken sleep problems with concentration, thinking and memory (brain fog) speech and language problems, including word-finding difficulties poor temperature control dizziness being very sensitive to light and sound nausea loss of appetite muscle pain (myalgia) Read more about the symptoms of ME/CFS Frustration, anxiety , low mood and depression are sometimes experienced by people with ME/CFS because of the impact of the condition and its symptoms on their lives. This does not mean that ME/CFS is a mental health condition. Causes of ME/CFS Further research is needed to confirm what causes ME/CFS. There might be various factors involved and there may be a number of different types of the illness. These different sub-groups still need more research to be identified, including how they lead to different experiences of the condition and how it develops. ME/CFS may appear suddenly or more slowly over time. It may follow an infection, typically, but not always, viral. Other possible triggers can be: trauma surgery stressful major life events In some cases, there may be no identifiable trigger. How is ME/CFS diagnosed? Theres no single test to detect ME/CFS. A diagnosis is made after other possible known causes for symptoms have been excluded. The earlier the illness is recognised, the sooner you can get help to manage your symptoms. Many people with ME/CFS find it helps to keep a diary of their symptoms so that they can take this to their GP or specialist. Your GP will usually: do a physical and mental examination to rule out other conditions ask about recent travel, tick or insect bites, unusual infections, and drug and alcohol use review current medication arrange tests They may be able to make a diagnosis after 3 or 4 months of seeing a pattern of symptoms. Anyone suspected of having ME/CFS should be considered for routine blood tests to identify other possible illnesses. More investigation may be needed if the diagnosis remains in doubt. Some people with ME/CFS also have another long-term condition and its important that you talk to your GP about how to manage the symptoms of the 2 conditions. Treating ME/CFS Although theres no cure for ME/CFS, there are ways to help manage your symptoms. Because of the complexity of the illness different things work for different people. Your GP may be able to support you through managing your individual symptoms. To decide what treatment is right for you, you should look at the evidence, including published research and patient surveys. Make sure you fully understand what the treatment involves before you make a decision. You have the right to decline any treatment option you do not feel comfortable with. Your GP may suggest some of the following treatment options. Management of medicines Your GP may suggest reviewing and changing the medicines you take. Theyll consider other conditions you may already be receiving treatment for alongside the most important ME/CFS symptoms that need to be treated. Your GP may also need to consider the combined impact of medication for symptoms and possibly for managing other conditions, especially as sensitivity to medicine is a feature of ME/CFS. This could mean there may be issues around polypharmacy (use of many medications) for your healthcare professional to consider. Dietary advice Your illness might make it more difficult for you to eat the right balance of nutrients in your diet due to loss of appetite and food intolerances. Your GP may be able to advise you on how you can alter and adjust your diet. Disability support advice Your GP may work with you or refer you to another therapist to suggest aids, activities or support that can help you to recover or adjust. Pacing advice Balancing periods of activity and rest and noticing what activities demand most from you, can allow you to reduce the number of episodes of PEM. Pacing yourself involves stopping activities before you feel the impact so that you have energy in reserve. Its easy to do too much on a good day and then feel the impact later. It can take time to change your habits and stop doing something even while things are going well. However, doing this is key to managing your condition in the long term. Counselling Counselling can support you to adjust to the impact ME/CFS can have on your life. This does not mean that the condition itself is psychological. Cognitive behavioural therapy (CBT) CBT should only be delivered by a healthcare professional with the right training and experience in CBT for ME/CFS. The 2021 NICE guidelines suggest that CBT might help some people with ME/CFS manage their symptoms. CBT can sometimes be used to help changes in mood that can come with having a long-term condition. Alternative and holistic therapies Alternative or holistic therapies may provide some comfort but be cautious of any method that claims to offer a cure for ME/CFS. You should discuss any alternative or holistic therapy with your GP before you try it. Until further research is done, no one can be certain whether someone with ME/CFS might benefit from alternative therapies. Living with ME/CFS There are some things that you can do for yourself to help you manage the condition. Small changes make a difference to your energy and mobility. This is called self-management. To help with this, you might try: Planning your time Record what you do so that you can build a picture of what uses more energy and what activities you can ask others to do for you. This will show you if there are patterns of symptoms and when they appear during your day. Rest and relaxation This is very important for managing ME/CFS. You may need some support and advice on what that might mean for you in terms of your physical, mental and emotional activities for resting. Getting support Being open with people and asking for help when you need it before youre exhausted is a key approach to managing your condition. Talking about how youre feeling is important for long term health conditions because of the impact your symptoms have on the way you live your life. Talk to your GP about emotional support available to you. How will ME/CFS affect my quality of life? Not everyone will experience the same symptoms so its important not to compare people with ME/CFS. People with ME/CFS can have very different experiences of the condition and how long their symptoms last. The impact of symptoms can be: mild moderate severe very severe As symptoms change over time so does the impact they have on peoples lives. How long will it last? Most people with ME/CFS improve over time, although some people dont make a full recovery. Its also likely there will be periods when symptoms get better or worse. Children and young people with ME/CFS are more likely to recover fully. Where can I get support? ME/CFS can have a significant emotional and financial impact on your life. A lack of understanding and awareness about ME/CFS means patients can experience disbelief, and even discrimination, from friends, family, health and social care professionals and employers. Information on entitlements to welfare benefits, accessing health and social care and others sources of support for patients and carers are available from Action for M.E . They also offer resources and services for children and young people affected by ME/CFS and their families. Peer support In some regions of Scotland there are local support groups providing peer support, information and advice. ALISS and Action for ME can assist with signposting to these groups. Source: Action for ME - Opens in new browser window Last updated: 25 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Depression Fibromyalgia Insomnia Other health sites Action for ME NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Chronic kidney disease

Chronic kidney disease - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Kidneys, bladder and prostate Chronic kidney disease Chronic kidney disease About chronic kidney disease Symptoms of chronic kidney disease Causes of chronic kidney disease Diagnosis of chronic kidney disease Treating chronic kidney disease Preventing chronic kidney disease Living with chronic kidney disease About chronic kidney disease Chronic kidney disease (CKD) is a long-term condition where the kidneys do not work effectively. CKD does not usually cause symptoms until it reaches an advanced stage. Its usually detected at earlier stages by blood and urine tests. Symptoms of advanced kidney disease The main symptoms of advanced kidney disease include: tiredness swollen ankles, feet or hands (due to water retention) shortness of breath nausea blood in the urine Read more about the symptoms of chronic kidney disease Diagnosing chronic kidney disease Chronic kidney disease is most frequently diagnosed through blood and urine tests. If youre at a high risk of developing CKD, you may be screened annually. Screening may be recommended if you have: high blood pressure (hypertension) diabetes a family history of CKD Read more about diagnosing chronic kidney disease Why does it happen? The kidneys are 2 bean-shaped organs, the size of your fist. Theyre located on either side of the body, just beneath the ribcage. The main role of the kidneys is to filter waste products from the blood before converting them into urine. The kidneys also: help maintain blood pressure maintain the correct levels of chemicals in your body which, in turn, will helpheart and muscles function properly produce the active form of vitamin D that keeps bones healthy produce a substance called erythropoietin, which stimulates production of red blood cells Chronic kidney disease is the reduced ability of the kidney to carry out these functions in the long-term. This is most often caused by damage to the kidneys from other conditions, most commonly diabetes and high blood pressure. Read more about the causes of chronic kidney disease Who is affected? CKD is common andmainly associated with ageing. The older you get, the more likely you are to have some degree of kidney disease. Its estimated that about 1 in 5 men and 1 in 4 women between the ages of 65 and 74 has some degree of CKD. CKD is more common in people of south Asian origin (those from India, Bangladesh, Sri Lanka and Pakistan) and black people than the general population. The reasons for this include higher rates of diabetes in south Asianpeople and higher rates of high blood pressure in African or Caribbean people. Treating chronic kidney disease There is no cure for chronic kidney disease, although treatment can slow or halt the progression of the disease and can prevent other serious conditions developing. People with CKD are known to have an increased risk of a heart attack because of changes that occur to the circulation. Inaminority of people, CKD may cause kidney failure, also known as established renal failure (ERF) or end-stage kidney disease. In this situation, the usual functions of the kidney stop working. To survive, people with ERF may need to have artificial kidney treatment, called dialysis , or a kidney transplant. Read more about treating chronic kidney disease Living kidney donation A kidney transplant from a living donor can be planned to avoid or reduce the time someone is on dialysis. This can offer a better long term outcome for the person receiving the organ. There are 2 types of living kidney donation: directed donation a person can donate a kidney to someone they know, like a family member or a friend altruistic kidney donation a person can donate a kidney anonymously to someone they do not know Further information about living donation. Living with chronic kidney disease Being diagnosed with chronic kidney disease can be worrying, but support and advice are available to help you cope. Read more about living with chronic kidney disease Preventing chronic kidney disease The main way to reduce the chances of CKD developing is to ensure any existing conditions, such as diabetes and high blood pressure, are carefully managed. Some lifestyle changes can also reduce the risk of CKD developing, these include: having a healthy diet avoiding drinking excessive amounts of alcohol exercising regularly avoiding medicines that can damage the kidney Read more about preventing chronic kidney disease Symptoms of chronic kidney disease Most people with CKD have no symptoms because the body can tolerate even a large reduction in kidney function. In other words, we are born with a lot more kidney function than is necessary for survival. Kidney function is often sufficient if only 1 kidney is working. That is why people can give a kidney to someone needing a kidney transplant. A change in kidney function is usually discovered through a routine blood or urine test. If you are diagnosed with kidney disease, your kidney function will be monitored with regular blood and urinetests, and treatment aims to keep any symptoms to a minimum. If the kidneys continue to lose function and there is progression towards kidney failure (established renal failure or ERF), this will usually be tracked by blood tests and monitoring. If kidney failure does occur, the symptoms may include: weight loss and poor appetite swollen ankles, feet or hands (due to water retention) shortness of breath blood or protein in your urine (protein in your urine is not something you will notice as it can only be detected during a urine test) an increased need to urinate, particularly at night insomnia itchy skin muscle cramps high blood pressure (hypertension) nausea erectile dysfunction in men(an inability to get or maintain an erection) These are general symptoms and can be caused by many less serious conditions. Many of the symptomsabove can be avoided if treatment begins at an early stage, before any symptoms appear. If you are worried by any of these symptoms, arrange to see your GP. Causes of chronic kidney disease Kidney disease is most often caused by other conditions that put a strain on the kidneys. High blood pressure (hypertension) and diabetes are the most common causes of kidney disease. High blood pressure Blood pressure is a measure of the pressure your heart generates in your arteries with each pulse. Too much pressure can damage your bodys organs, leading to heart disease, stroke and worsening of kidney function. The cause of around 90% of cases of high blood pressure is unknown. There appears to be a link between the condition and a persons general health, diet, and lifestyle. Known risk factors for high blood pressure include: age (the risk of developing high blood pressure increases as you get older) family history of high blood pressure (the condition seems to run in families) being of African-Caribbean or south Asian origin obesity lack of exercise smoking excessive alcohol consumption high amount of salt in your diet high-fat diet stress Hypertension causes damage by putting strain on the small blood vessels in the kidneys. This prevents the filtering process from working properly. Diabetes Diabetes is a condition in which the body produces no or too little insulin ( type 1 diabetes ) or has become unable to make effective use of insulin ( type 2 diabetes ). Insulin is needed to regulatelevels of glucose (sugar) in your blood, preventing the levels going too high after a meal and too low between meals. If diabetes is poorly controlled, too much glucose can build up in your blood. The glucose can damage the tiny filters in the kidneys, which affects the ability of your kidneys to filter out waste products and fluids. It is estimated that 20% to 40% of people with type 1 diabetes will develop kidney disease before they reach 50 years of age. Around 30% of people with type 2 diabetes also show signs of developing kidney damage. The first sign of diabetic kidney disease is the appearance of low levels of protein in the urine. Therefore, your GP will ask for an annual urine test so any kidney disease can be detected as early as possible. All people with diabetes should have a kidney check every year. Early detection of kidney dysfunction in diabetes is important because it identifies people at risk or complications, such as eye problems and impotence. Other causes There are many other conditions that less commonly cause CKD, including: glomerulonephritis (inflammation of the kidney) pyelonephritis (infection in the kidney) polycystic kidney disease (an inherited condition where both kidneys are larger than normal due to the gradual growth of masses of cysts) failure of normal kidney development in an unborn baby while developing in the womb systemic lupus erythematosus (a condition of the immune system where the body attacks the kidney as if it were foreign tissue) long-term, regular use of medicines, such as lithium and non-steroidal anti-inflammatory drugs (NSAIDs) , including aspirin and ibuprofen blockages, for example due to kidney stones or prostate disease Diagnosis of chronic kidney disease Chronic kidney disease (CKD) is most frequently diagnosed through blood and urine tests. Screening If you are in a high-risk group for developing CKD, it is importantto be regularly screened for the condition. People who are not in a high-risk group are not normally screened for CKD. Annual screening is recommended for the following groups: people with high blood pressure (hypertension) people with diabetes people withacute kidney injury caused by medications such as lithium or NSAIDs such as ibuprofen, kidney stones or an enlarged prostate people with cardiovascular disease (conditions that affect the heart, arteries and veins, such as coronary heart disease or heart failure ) people with a family history of stage 5 CKD (see below for more information about staging) or an inherited kidney disease people with diseases that affect several parts of the body and may affect the kidneys, such as systemic lupus erythematosus people with blood in the urine (haematuria) or protein in the urine (proteinuria) where there is no known cause Your GP can advise you about whether or not you should be screened for CKD. Most often, the diagnosis of kidney disease is made because a routine blood or urine test indicates the kidneys may not be functioning normally. If this happens, the test is usually repeated toconfirm the diagnosis. Glomerular filtration rate (GFR) An effective way of assessing how well your kidneys are working is to calculate your glomerular filtration rate (GFR). GFR is a measurement of how many millilitres (ml) of waste fluid your kidneys can filter from the blood in a minute (measured in ml/min). A healthy pair of kidneys should be able to filter more than 90ml/min. It is difficult to measure the GFR directly, so it is estimated using a formula. The result is called the estimated GFR or eGFR. Calculating your eGFR involves taking a blood sample and measuring the levels of a waste product called creatinine and taking into account your age, gender and ethnic group. The result is similar to the percentage of normal kidney function. For example, an eGFR of 50ml/min equates to 50% kidney function. The following tests are used to detect proteinuria (protein in the urine) urine tests used to see whether there is blood or protein in your urine albumin and creatinine testing this is another urine test which compares the amounts of albumin (a protein) and creatinine in your urine, and the ratio of the 2 (the albumin:creatinine ratio or ACR) can be used with eGFR to give doctors a more accurate idea of how the kidneys are functioning Staging A 6-stage system, based on eGFR levels, is used to describe the progression of CKD. The higher the stage, the more severe the CKD. Stage 1 (sometimes called G1): the eGFR is normal (above 90 or more), but other testing shows evidence of kidney damage. Stage 2 (G2): the eGFR has decreased slightly (60 to 89), but is still considered to be in the normal range for a young adult. If you have stage 1 or 2 CKD, it is recommended you have annual eGFR tests so the progression of the condition can be carefully monitored. Stage 3 is divided into 2: stage 3a (G3a) and 3b (G3b). In stage 3a, the eGFR has decreased mildly (45 to 59) and this is termed a mild to moderate decrease in kidney function and should be checked annually. In stage 3b (G3b) it has decreased moderately (30 to 44) and is termed a moderate to severe reduction in kidney function and should be checked every 6 months. Stage 4 (G4): the eGFR has reduced severely (15 to 29). By this time, it is possible you will be experiencing symptoms of CKD. Further testing should be carried out every 6 months. Stage 5 (G5): the kidneys have lost almost all of their function (an eGFR of below 15), which is known as establishedrenal failure. Further testing should be carried out every 3 months. However, over time, GFR can fluctuate, so one abnormal test result does not automatically mean you have CKD. A diagnosis of CKD is usually only confirmed if repeated eGFR tests show your eGFR is consistently lower than normal over 3 months. Other tests Other tests are also used to assess the levels of damage to your kidneys: kidney scans, such as an ultrasound scan, a magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan, are used to find out whether there are any unusual blockages in your urine flow in cases of advanced kidney disease, the kidneys are shrunken and have an uneven shape kidney biopsy a small sample of kidney tissue is taken so that the cells can be examined under a microscope for damage Treating chronic kidney disease Lifestyle changes The following lifestyle changes are known to help reduce your blood pressure and help control CKD: stopping smoking eating a healthy, low-fat, balanced diet restricting your salt intake to less than 6g (0.2oz) a day notusing over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen, except when advised to by a medical professional moderating your alcohol intakeso it is within recommended limits losing weight if you are overweight or obese doing regular exercisefor at least 30 minutes a day, 5 times a week Readmore about preventing high blood pressure through lifestyle changes. Medications for high blood pressure One of the main ways to reduce the progression of kidney damage is to manage high blood pressure . Good control of blood pressure isvital to protect the kidneys. People with CKD should aim to get their blood pressure down to below 140/90mmHg but if you also have diabetes you should aim to get it down to below 130/80mmHg. There are many types of blood pressure drugs.Medicines called angiotensin converting enzyme (ACE) inhibitors are used to control high blood pressure in people with CKD. As well as reducing blood pressure around the body and reducing the strain on blood vessels,ACE inhibitorsgive additional protection to the kidney. ACE inhibitors include: ramipril enalapril lisinopril perindopril Side effects of ACE inhibitors include: a persistent, dry cough dizziness tiredness or weakness headaches Most of these side effects should pass within a few days, although some people continue to have a dry cough. If the side effects of ACE inhibitors are particularly troublesome, you can be given an alternative medication called an angiotensin-II receptor blocker (ARB).This group of medicines includes: candesartan eprosartan irbesartan azilsartan olmesartan temisartan valsartan losartan The side effects of ARBs are uncommon, but can include dizziness. Both ACE inhibitors and ARBs can cause a reduction in kidney function in some peopleand increased levels of potassium in the blood, so blood tests will need to be performed after you start treatment and whenever the dose changes. If you are on an ACE inhibitor or ARB and you develop a fever/infection or need medicines for other conditions, its important to ask your doctor if the ACE inhibitor or ARB needs to be temporarily stopped. Medication to reduce cholesterol Studies have shown that people with CKD have a higher risk of cardiovascular disease, including heart attacks and strokes. This is because some of the risk factors for CKD are the same as those for heart attacks and strokes, including high blood pressure and high levels of cholesterol in the blood (atherosclerosis). Statins are a type of medication used to lower cholesterol levels. Cholesterol causes narrowing of the arteries that can lead to a blockage of the blood supply to the heart (causing a heart attack) or the brain (causing a stroke). Statins work by blocking the effects of an enzyme in your liver (called HMG-CoA reductase), which is used to make cholesterol. Statins sometimes have mild side effects, including: constipation diarrhoea headaches abdominal pain Occasionally, statins can cause muscle pain, weakness and tenderness. If you experience any of these symptoms, contact your GP. Youmay need to have a blood test or change your treatment. If you have kidney disease, you may be asked to reduce your daily fluid and salt intake. You may develop a build-up of fluid as your kidneys will not be able to get rid of fluid as well as they did before. If you are asked to reduce the amount of fluid you drink, you must also take into account fluid in foods, such as soup and yoghurt. Your GP or dietitian can advise you about this. The excess fluid that occurs as a result of kidney disease often builds up in your ankles or around your lungs. You may also be given diuretics (water tablets), such as furosemide, which will help get rid of the excess fluid from your body. If you do not have any fluid retention and youhave notbeen toldto reduce your fluid intake, there is no need to do so.In fact, it could be harmful in some circumstances. Anaemia Many people with stage three, four and five CKD develop anaemia . Anaemia is a condition in which you do not have enough red blood cells. Symptoms of anaemia include: tiredness lethargy shortness of breath (dyspnoea) palpitations (awareness of heartbeat) Anaemia can occur because of many other conditions and your doctor will investigate to rule outother possible causes. Most people with kidney disease will be given iron supplements because iron is needed for the production of red blood cells. To boost iron levels, iron may be given as tablets, such as daily ferrous sulphate tablets, or as occasional intravenous infusions. If this is not enough to treat anaemia, you may be started on injections of erythropoietin, a hormone which helps your body produce more red blood cells. These injections are often administered into a vein (intravenously)or under the skin (subcutaneously). Examples of these injections include epoetin alfa, beta and zeta, darbepoetin and methoxy polyethylene glycol-epoetin beta. Correction of phosphate balance If you have stage 4 or 5 kidney disease, you can get a build-up of phosphate in your body because your kidneys cannot get rid of it. Phosphate is a mineral that, with calcium, makes up most of your bones. Phosphate is obtained through diet, mainly dairy foods. The kidneys usually filter outexcess phosphate. If phosphate levels rise too much, it can upset the normal calcium balance of the body. This can lead to thinning of the bones and furring of the arteries. You may be asked to limit the amount of phosphate in your diet. Foodshigh in phosphate include red meat, dairy produce, eggs and fish. Your GP or dietitian should be able to advise you about how much phosphate you can eat. However, there is no advantage in reducing your intake of these foods unless you have a raised phosphate level.Always aska healthcare professional before changing your diet. If reducing the amount of phosphate in your diet does not lower your phosphate level enough, you may be given medicines called phosphate binders. These medicines bind to the phosphate in the food inside your stomach and stop it from being absorbed into your body. To work properly, phosphate binders must be taken just before meals. The most commonly used phosphate binderis calcium carbonate, but thereare also alternatives that may be more suitable foryou. The side effects of phosphate binders are uncommon but include: nausea stomach ache constipation diarrhoea flatulence (wind) skin rash itchy skin Vitamin D supplements People with kidney disease can have low levels of vitamin D, necessary for healthy bones. This is because the kidneys need to activate the vitamin D from food andthe sun before it can be used by the body. Treatment for kidney failure transplant or dialysis Many people with kidney failure can continue with treatment using medicines and will have good-functioning kidneys for the rest of their lives. In a few people, kidney disease will progress to the stage where the kidneysstop working and it becomes life threatening. This is called kidney failure or established renal failure (ERF). This rarelyhappens suddenly, and there will be time to plan the next stage of your condition. The decision whether to have dialysis, a kidney transplant or supportive treatment should be discussed with your healthcare team. Read more about dialysis andkidney transplants. Supportive treatment If you decide not to have dialysis or a transplant for kidney failure, or they are not suitable for you,you will be offered supportive treatment. This is also called palliative care. The aim is to treat and control the symptoms of kidney failure without using dialysis or transplantation. Supportive treatment includes medical, psychological and practical care for both the person with kidney failure and their family, including discussion about how you feel and planning for the end of life . Many people choose supportive treatment because they: are unlikely to benefit or have quality of life with treatment do not want to go through the inconvenience of treatment with dialysis are advised against dialysis because they have other serious illnesses that will shorten their life, and the negative aspects of treatment outweigh any likely benefits have been on dialysis but have decided to stop this treatment are being treated with dialysis, but have another serious physical illness, especially severe heart disease or stroke, that will shorten their life If you choose to have supportive treatment, your kidney unit will still look after you. Doctors and nurses will make sure you receive: medicines to protect your remaining kidney functionfor as long as possible medicines to treat other symptoms of kidney failure, such as feeling out of breath, anaemia, loss of appetite or itchy skin helpto plan your home and money affairs bereavement support for your family after your death Read more information: Kidney Research UK: Information on choosing not to start dialysis Bereavement support from CRUSE What is good kidney disease care? Kidney disease services should: identify people at risk of kidney disease, especially people with high blood pressure or diabetes, and treat them as early as possible to maintain their kidney function give people access to investigative treatment and follow them up to reduce the risk of the disease getting worse give people good-quality information about managing their condition provide information about the development of the disease and treatment options provide access to a specialist renal (kidney) team give people access to transplant or dialysisservices if required provide supportive care Your treatment for kidney disease will need to be reviewed regularly. It may be helpful for you to make a care plan because this can help you manage your day-to-day health. Your kidney disease specialist nurse may be able to help with this. Preventing chronic kidney disease In most cases, chronic kidney disease (CKD) cannot be completely prevented, although you can take steps to reduce the chances of the condition developing. Managing your condition If you have a chronic (long-term) condition, such as diabetes, that could potentially cause chronic kidney disease, it is importantit is carefully managed. Follow the advice of your GP and keep all appointments relating to your condition. People with diabetes are advised to have their kidney function tested every year. Read more about Type 1 diabetes and Type 2 diabetes Smoking Smoking increases your risk of cardiovascular disease, includingheart attacks or strokes, and it can increase the likelihood that any existing kidney problems will get worse. If you stop smoking, you will improve your general health and reduce your risk of developing other serious conditions, such as lung cancer and heart disease. The NHS smoking helpline can offer you advice and encouragement to help you quit smoking.Phone Quit Your Way Scotland on0800 84 84 84. Read moreabout stopping smoking Diet A healthy diet is importantfor preventing chronic kidney disease. It will lower the amount of cholesterol in your blood and keep your blood pressure at a healthy level. Eat a balanced diet that includes plenty of fresh fruit and vegetables ( 5 a day ) and whole grains. Limit the amount of salt in your diet to no more than 6g (0.2oz) a day. Too much salt will increase your blood pressure. One teaspoonful of salt is equal to about 6g. Avoid eating foods high in saturated fat because this will increase your cholesterol level. Foods high in saturated fat include: meat pies sausages and fatty cuts of meat butter ghee (a type of butter often used in Indian cooking) lard cream hard cheese cakes and biscuits foods that contain coconut oil or palm oil Eating some foods that are high in unsaturated fat can help decrease your cholesterol level. Foodshigh in unsaturated fat include: oily fish avocados nuts and seeds sunfloweroil rapeseedoil olive oil Read more abouthealthy food and diet Alcohol Drinking excessive amounts of alcohol will cause your blood pressure to rise, as well as raising cholesterol levels in your blood. Therefore, sticking to the recommended alcohol consumption limits is the best way to reduce your risk of developing high blood pressure (hypertension) and CKD. Exercise Regular exercise should help lower your blood pressure and reduce your risk of developing CKD. At least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (such as cycling or fast walking) every week, is recommended. Read more about health and fitness Painkillers Kidney disease can be caused by the improper use (such as taking too many)of non-steroidal anti-inflammatories (NSAIDs) , such as aspirin and ibuprofen . If you need to take painkillers,make sure you follow the instructions. This can help to avoid kidney damage. Living with chronic kidney disease Relationships and support Coming to terms with a condition such as kidney disease can put a strain on you, your family and your friends. It can be difficult to talkto people about your condition, even if they are close to you. Learning about kidney disease often helps because you and your family will understand more about what to expect and feel more in control of the illness, instead of feeling that your lives are now dominated by kidney disease and its treatment. Be open about how you feel, and let your family and friends know what they can do to help. However, do not feel shy about telling them that you need some time to yourself, if that is what you need. Get support Your GP or nurse can reassure you if you have questions about your kidney disease, or you may find it helpful to talk to a trained counsellor, psychologist or specialist telephone helpline operator. Your GP practice will have information on these. Some people find it helpful to talk to other people with kidney disease at a local support group or online. Money and finances If you have to stop work or work part time because of your kidney disease, you may find it hard to cope financially. You may be entitled to one or more of the following types of financial support: if you have a job but cannot work because of your illness, you are entitled to Statutory Sick Pay from your employer if you do not have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance if you are aged 64 or under and need help with personal care or have walking difficulties, you may be eligible for Disability Living Allowance if you are aged 65 or over, you may be able to get Attendance Allowance if you are caring for someone with kidney disease, you may be entitled to Carers Allowance you may be eligible for other benefits if you have children living at home or if you have a low household income Sex and pregnancy The symptoms of kidney disease and the stress it causes in your life can affect your sexual relationships. Some couples become closer after a diagnosis of kidney disease, while others find that their loved ones are affected by worries about how they will cope with the effects of the illness. Both men and women may experience issues about body image and self-esteem, and this can affect the relationship. Try to share your feelings with your partner. If you have problems with sex that do not get better with time, speak to a counsellor or sex therapist. People on dialysis often experience specific sexual difficulties. Loss of sex drive in both men and women and impotence in men are commonly reported problems. Treatment is available, butit may take some time and requires commitment from both partners. The first step is to discuss it with your healthcare team. Pregnancy Both men and women with early stage kidney disease will findtheir fertility is unaffected. This means it is important to use contraception unless you want to have a baby. Later stage kidney disease may affectwomens periods, which can make pregnancy more difficult. For men, later stage kidney disease can cause a reduction in sperm count. However, having kidney disease does not mean you will not get pregnant or be able to father a child, soboth men and womenneed to use an effective method of contraception unless they want to have a baby. Women who want to have a baby should talk to their renal specialist or an obstetrician with an interest in kidney disease.Depending on the stage of kidney disease, there can be risks to both the mother and the baby. It is important to minimise any risk with a planned pregnancy. Your healthcare team can advise you about this. Holidays and insurance If you have mild kidney disease or youve had a transplant, going on holiday shouldnt pose additional health problems, whether youre staying in the UK or going abroad. If youre on dialysis, you can still enjoy holidays provided you book your treatment before you go away. If youre on dialysis and want to travel, discuss your plans with your renal unit as early as you can. It can sometimes be more difficult to arrange dialysis in the UK than it is abroad. The NHS will look after you if you get ill while on holiday in the UK. If youre in Europe, the European Health Insurance Card (EHIC) entitles you to free or reduced-cost hospital treatment. Its a good idea to take out holiday health insurance in addition to carrying the EHIC. Anyone with kidney disease should declare it as a pre-existing medical condition on standard insurance application forms. It may exclude you from some policies. Using over-the-counter medicines Some remedies are potentially harmful for people with kidney disease. Make sure you check with your doctor before taking a new over the counter medicine. Youre at higher risk of being harmed by certain over the counter remedies if: you have advanced kidney disease (stage 4 or 5, or a kidney function below 30% of normal) you have mild-to-moderate kidney disease (stage 3 with a kidney function between 30 and 60% of normal) and are elderly with another serious illness, such as coronary heart disease Whats safe and whats not Summarised below is a list of which over the counter remedies are safe for people with kidney disease to use and which should be avoided. This is just a guide. For more detailed information, consult your pharmacist, renal specialist or GP. Headaches Paracetamol is safe and the best choice of painkiller to treat a headache, but avoid soluble products as they are high in sodium. If your kidney function is less than about 50%, avoid painkillers containing aspirin, ibuprofen or similar drugs such as diclofenac. These products can deteriorate the function of damaged kidneys. Low-dose aspirin of 75mg to 150mg a day can be used if its

Chronic kidney disease

rescribed for the prevention of vascular disease. You should also avoid ibuprofen if youre taking anti-rejection treatment following a kidney transplant. Coughs and colds Many of the products available for coughs and colds contain a mixture of ingredients so check the packaging carefully. Some products contain paracetamol which is safe but others contain high doses of aspirin which its best to avoid. Many cold remedies also contain decongestants which you should avoid if you have high blood pressure. The best way to clear congestion is by steam inhalation with menthol or eucalyptus. For coughs try a simple linctus or glycerine honey and lemon to soothe your throat. Muscle and joint pains If you have muscle or joint pain its ideal to use topical preparations (applied to the skin) which are rubbed on to the painful area. Avoid tablets containing ibuprofen or similar drugs such as diclofenac if your kidney function is below 50%. Ibuprofen gel or spray is safer than ibuprofen tablets but it isnt completely risk-free as a small amount of the drug penetrates the skin into the bloodstream. Kidney failure About 1% of people with stage three CKD develop kidney failure also called established renal failure (ERF). Kidney failure has a major impact on your life and the lives of those close to you. People diagnosed with kidney failure usually go through shock grief and denial before they accept their condition. Choices if you have established renal failure If you have established renal failure (ERF) you will need to decide whether to have treatment with dialysis or a kidney transplant. You may decide to have neither treatment and to have supportive care. These choices should be made with your healthcare team. For people who want active treatment for their ERF a transplant would be the best option. However a transplant is only suitable for about half of all people with ERF. This is because they may have had recent cancer orare not physically fit. Many people who have slowly progressive kidney failure and other serious health problems and who are usually older may choose to avoid dialysis. Supportive care can still allow you to live for some time with a good quality of life. Transplant A kidney transplant when suitable is the best treatment for ERF. The transplanted kidney can be obtained from a deceased or living donor and survival rates are now extremely good. About 90% of transplants still function after five years and many transplants work usefully after 20 years. The main reason people have to wait for a transplant is the shortage of available donors. Over a third of kidney transplants are now from live donors. A live donor kidney can be transplanted before the need for dialysis rather than after a period of time on dialysis. One major risk after transplantation is rejection where the immune system attacks the donated kidney because it mistakes it for a foreign object. This is prevented with the use of strong drugs to suppress the immune system. These drugs need to be taken meticulously. They are usually well tolerated but may have side effects including an increased susceptibility to infections and some forms of cancer. For this reason transplant patients are given regular reviews in a specialist transplant clinic. Dialysis Dialysis can take place at home or in hospital. It involves filtering the blood of waste products and excess water. It is not as efficient as a human kidney so people with kidney failure usually need to restrict their intake of fluid and certain foods. They also require additional medicines such as iron supplements phosphate binders and antihypertensive medicine (to reduce blood pressure). There are 2 types of dialysis: peritoneal dialysis and haemodialysis. Peritoneal dialysis The abdomen (tummy) has a lining called the peritoneal membrane which can be used as a filter to remove excess waste and water. If you have opted for peritoneal dialysis a tube (catheter) will be inserted into your abdomen during an operation. This will allow you to drain dialysis fluid in and out of your tummy yourself. You will not need to go into hospital to be treated but you will have to spend an hour or two each day draining the fluid. The treatment involves either four exchanges spaced out during the day each taking half an hour or attaching yourself to a machine overnight that pumps the fluid in and out for you. Haemodialysis Haemodialysis removes waste products and excess fluid that build up in the body when the kidneys stop working. Blood is taken from the body to be cleaned in a filter known as a dialyser. It is effectively an artificial kidney. The whole process takes about four hours and usually has to be repeated three times a week. Most people go into hospital to have haemodialysis. However some people choose to have the treatment in their own home. Home haemodialysis will give you more flexibility but comes with greater responsibility. Youll need to have the space in your home for a dedicated machine and in most cases a lot of support from a close family member or friend. Some people choose to have their dialysis at night while they are asleep. Most people who choose home haemodialysis have it every day so their fluid intake is not as restricted. Quality vascular access During haemodialysis it is important that large volumes of blood are passed through the machine. This requires special measures to get into large enough blood vessels. For this reason haemodialysis patients need a minor operation to join one of the deep arteries to a superficial vein (called a fistula). This is carried out in day surgery and should be done at least 6 weeks before dialysis is required because it needs time to mature before it can be used. Occasionally there will be insufficient time for a fistula to be created before dialysis is required. In this case a temporary solution is found usually involving the use of an indwelling plastic dialysis catheter. A catheter is a surgical tube inserted into the body to allow for the transfer of fluid. All the issues will be discussed in detail with you by the dialysis team before any decisions are made.

Chronic lymphocytic leukaemia

Chronic lymphocytic leukaemia | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Chronic lymphocytic leukaemia Chronic lymphocytic leukaemia About chronic lymphocytic leukaemia Diagnosing chronic lymphocytic leukaemia Treating chronic lymphocytic leukaemia Complications of chronic lymphocytic leukaemia Causes of chronic lymphocytic leukaemia About chronic lymphocytic leukaemia Chronic lymphocytic leukaemia is a type of cancer that affects the white blood cells and tends to progress slowly over many years. It mostly affects people over the age of 60 and is rare in people under 40.Children are almost never affected. In chronic lymphocytic leukaemia (CLL),the spongy material found inside some bones (bone marrow)produces too many white blood cells called lymphocytes thatarent fully developed and dont work properly. Over time this can cause a range of problems, such as an increased risk of picking up infections, persistent tiredness,swollen glandsin the neck, armpits or groin, and unusual bleeding or bruising. CLL is differentfrom other types of leukaemia, including chronic myeloid leukaemia , acute lymphoblastic leukaemia and acute myeloid leukaemia . Symptoms of CLL CLL doesnt usually cause any symptoms early on and may only be picked up during a blood test carried out for another reason. When symptoms develop, they may include: getting infectionsoften anaemia persistent tiredness, shortness of breath and pale skin bleeding and bruising more easily than normal a high temperature (fever) night sweats swollen glands in yourneck, armpits or groin swelling and discomfort in your tummy unintentional weight loss You should speak to your GP if you have any persistent or worrying symptoms. These symptoms can have other causes other than cancer, but its a good idea to get them checked out. Read more about diagnosing CLL and complications of CLL . Treatmentsfor CLL As CLLprogresses slowly and often has no symptoms at first, you may not need to be treated immediately. If its caught early on, youll have regular check-ups over the following months or yearsto see if its getting any worse. If CLLstarts to cause symptoms, or isnt diagnosed until later on, the main treatments are: chemotherapy where medicationis taken as a tablet or given directly into a vein is used to destroy the cancerous cells a stem cell or bone marrow transplant where donated cells called stem cells are transplanted into your body so you start to produce healthy white blood cells Treatment cantusually cureCLL completely, but can slow its progression and lead toperiods where there are no symptoms. Treatment may be repeated if the condition comes back. Read more about treating CLL . Outlook for CLL The outlook for CLL depends on how advanced it is when its diagnosed, how old you are when diagnosed, andyour general health. Younger, healthier people who are diagnosed whenCLL isstill in the early stages generally have the best outlook. Although it cant normally be cured, treatment can help control the condition for many years. Causes of CLL Its not clear what causes CLL. Theres no proven linkwith radiation or chemical exposure, diet or infections. You cant catch it from anyone else or pass it on. However, having certain genes can increase your chances of developing CLL. You may be at a slightly higher risk of it if you have a close family member with it, although this risk is still small. Diagnosing chronic lymphocytic leukaemia Most cases of chronic lymphocytic leukaemia (CLL) are detected during blood tests carried out for another reason. However, you should speak to your GP if you have worrying symptoms of CLL , such aspersistent tiredness, unusual bleeding or bruising, unexplained weight loss or night sweats. Your GP may: ask about your symptoms and your medical and family history carry out a physical examination to check for problems such as swollen glands and a swollen spleen send off a bloodsample for testing Ifyour GPthinks you could have CLL, youll be referred to a hospital doctor called a haematologist, a specialist in blood disorders, for further tests. Blood tests The main test used to help diagnose CLL is a type of blood test called a full blood count. This is where the number and appearance of the different blood cells in a sample of your blood are checked in a laboratory. An abnormally high number of unusual white blood cells(lymphocytes) can be a sign ofCLL. A detailed examination of these cells can usually confirm the diagnosis. X-rays and scans You may also have: a chest X-ray an ultrasound of your tummy a computerised tomography (CT) scan These tests can check for problems caused by CLL, such as swollen glandsora swollenspleen,and helprule out other possible causes of your symptoms. Bone marrow biopsy Sometimesthehaematologistmayrecommend removing a sample of your bone marrow(bone marrow biopsy) so they canexamine itunder a microscope to check it for cancerous cells. The sample is removedusinga needle inserted into your hip bone. Local anaesthetic is normally used tonumb the area where the needle is inserted, although you may experience some discomfort during the biopsy. The procedure willlast around 15 minutes and you shouldnt need to stay in hospital overnight. You mayhave some bruising and discomfort for a few days afterwards. Lymph node biopsy In some cases, removing and examining a swollen lymph gland can help confirm a diagnosis of CLL. This is known as a lymph node biopsy. The gland is removed during a minor operation carried out under either local or general anaesthetic , where youre asleep. You wont usually need to stay in hospital overnight. After the operation, youll be left with a small wound that will be closed with stitches. Genetic tests Tests may also be carried out on your blood and bone marrow samples to check for any unusual genes in the cancerous cells. Identifying unusual genes in these cells can help your doctors decide how soon you should start treatment and which treatment is best for you. Some treatments for CLL dont work as well in people with certain abnormal genes in the affected cells. Treating chronic lymphocytic leukaemia Treatment for chronic lymphocytic leukaemia (CLL) largely depends on what stage the condition is at when its diagnosed. You may just need to be monitored at firstif its caught early on. Chemotherapy is the main treatment if its more advanced. Treatment can often help keep CLL under control for manyyears. Itmay go away after treatment initially (known as remission), but will usually come back (relapse) a few months or years later and may need to be treated again. Stages of CLL Doctors use stages to describe how far CLL has developed and help them determine when it needs to be treated. There are 3 main stages of CLL: stage A you have enlarged lymphglands in fewer than 3 areas (such as your neck, armpit or groin) and a high white blood cell count stage B you have enlarged lymph glands in 3 or more areas and a high white blood cell count stage C you have enlarged lymphglands or an enlarged spleen, a high white blood cell count, and a low red blood cell or platelet count Stage B and C CLL are usually treated straight away. Stage A generally only needs to be treated if its getting worse quickly or starting to cause symptoms. Monitoring early-stage CLL Treatment may not be needed if you dont have any symptoms when youre diagnosed with CLL. This is because: CLLoften develops very slowly and may not cause symptoms formany years theres no benefit in starting treatment early treatment can cause significant side effects In these cases, you will normally just need regular visits to your doctor and blood tests to monitor the condition. Treatment with chemotherapy will usually only be recommended if you develop symptoms, or tests show that the condition is getting worse. Chemotherapy for more advanced CLL Many people with CLL will eventually need to have chemotherapy. This involves taking medication to keep the cancer under control. There are a number of different medicines for CLL, but most people will take 3 main medications in treatment cycles lasting 28 days. These medicines are: fludarabine usually taken as a tabletfor 3 to 5 days at the start of each treatment cycle cyclophosphamide alsousually taken as a tabletfor 3 to 5 days at the start of each treatment cycle rituximab giveninto a vein over the course ofa few hours (intravenous infusion) at thestart of each treatment cycle Fludarabine and cyclophosphamide can usually be taken at home. Rituximab is given in hospital, and sometimes you may need to stay in hospital overnight. A number of different medicines can also be tried if you cant have these medicines, youve tried them but they didnt work, or your CLL has come back after treatment. These include bendamustine, chlorambucil, ibrutinib, idelalisib, obinutuzumab, ofatumumab and prednisolone (a steroid medication ). Side effects of treatment The medicines used to treat CLL can cause some significant side effects, including: persistent tiredness feeling sick an increased risk of infections easy bruising or bleeding anaemia shortness of breath , weakness and pale skin hair loss or thinning an irregular heartbeat an allergic reaction Most side effects will pass once treatment stops. Let your care team know if you experience any side effects, asthere are some treatments that can help. Read more about the side effects of chemotherapy Stem cell or bone marrow transplants Stem cell or bone marrow transplants are sometimes used to try toget rid of CLL completely, or control it for longer periods. Stem cellsare cells produced by the spongy material found in the centre of some bones (bone marrow) that can turn into different types of blood cells, including white blood cells. A stem cell transplant involves: having high-dose chemotherapy and radiotherapy to destroythe cancerous cells in your body removing stem cells from the blood or bone marrowof a donor this will ideally be someone closely related to you, such as a sibling transplanting the donor stem cells directly into one of your veins Thisis the only potential cure for CLL,but its not done very oftenas its an intensive treatment and many people with CLL are older and not well enough for the benefits to outweigh the risks. The initial treatment with chemotherapy and radiotherapycan place a significant strain on your body and causetroublesome side effects. Theres also a risk of serious problems after the transplant, such as graft versus host disease. This is wherethe transplanted cells attack the other cells in your body. Other treatments for CLL There are also a number of other treatments that are sometimes used to help treat some of the problems caused by CLL, particularly if you cant have chemotherapy or it doesnt work. These include: radiotherapy toshrink enlarged lymph glands or a swollen spleen surgery to remove a swollen spleen antibiotics ,antifungals and antiviral medications to help reduce your risk of picking up an infection during treatment blood transfusions to provide more red blood cells andplatelets (clottingcells)if you experience severe anaemia or problems with bleeding and bruising immunoglobulin replacement therapy a transfusion ofantibodies taken from donated blood thatcan help prevent infections injections of medication calledgranulocyte-colony stimulating factor (G-CSF) to help boost the number of white blood cells You may also need additional treatment for any complications of CLL that develop. Deciding against treatment As many of the treatments for CLL can have unpleasant side effects that may affect your quality of life, you may decide against having a particular type of treatment. This is entirely your decision and your treatment team will respect any decision you make. You wont be rushed into deciding about your treatment, and before making a decision you can talk to your doctor, partner, family and friends. Pain relief and nursing care will still be available as and when you need it. Complications of chronic lymphocytic leukaemia Chronic lymphocytic leukaemia (CLL) can sometimes cause a number of further complications. Infections People with CLL usually have a weakened immune system and are more vulnerable to infectionsbecause they have a lack of healthy, infection-fighting white blood cells. Treatment with chemotherapy can also further weaken the immune system. If you have CLL, its a good idea to: report any possible symptoms of an infection to your GP or care team immediately things to look out for include a high temperature (fever), aching muscles, diarrhoea or headaches ensure your vaccinations are up-to-date speak to your GP or care team for advice about any additional vaccines you might need, as some arent safe if you have a weak immune system avoid close contact with anyone who has an infection even if its an infection to which you were previously immune, such as chickenpox You may also be prescribed regular doses of medications such as antibiotics to help reduce the risk of infection. Richters syndrome In up to1 in every 20 people withCLL, the condition will change to become very similar to an aggressive form of non-Hodgkin lymphoma . This is called Richters transformation or Richters syndrome. Symptoms of Richters syndrome include: sudden swelling of your lymph glands a high temperature (fever) night sweats unintentional weight loss tummy (abdominal) pain Richter syndrome is usually treated with a combination of chemotherapy and other powerful medicines. TheCancer Research UK website has more information on Richters syndrome . Autoimmune haemolytic anaemia Around1 in every 10 people with CLL will develop a condition called autoimmune haemolytic anaemia. This is where theimmune systemstarts to attack and destroy red blood cells. It can cause severe anaemia, making you feel breathless and easily tired. Its usually treated with steroid medication Psychological effects Being diagnosed with CLL can be very distressing and difficult to take in at first, particularly as it cant necessarily be cured and you may be advised to wait for it to get worse before starting treatment. Having to wait years to see how the condition develops can also be very stressful and make you feel anxious or depressed . Speak to your GP or care team if youre finding it difficult to cope. You may also find it useful to talk to other people who are living with leukaemia. Your GP or care team willbe able to provide you with the details of support groups in your area. Macmillan Cancer Support provides an excellent level of help and support. Their helpline number is 0808 808 00 00 , Monday to Friday, 9am to 8pm. Causes of chronic lymphocytic leukaemia Its not known what causes most cases of leukaemia. However, there are many risk factors that are known to increase your chances of getting chronic lymphocytic leukaemia. Risk factors for chronic lymphocytic leukaemia include: having a family history of the condition being of European, American or Australian origin having certain medical conditions being male Family history In some cases, chronic lymphocytic leukaemia appears to run in families. Its thought that an inheritedgene mutation (change to a gene) could increase your susceptibility to developing the condition. This means there may be certain genes in your family that make it more likely that youll develop chronic lymphocytic leukaemia. More research is needed, but having a parent or sibling (brother or sister) withchronic lymphocytic leukaemia slightlyincreases your chances of also developing the condition. Ethnicity Chronic lymphocytic leukaemia most commonly affects people of European, American and Australian origin. Its rare in people from China, Japan and South East Asia, and it affects more white people than black people. Its not known why the condition affects people of some ethnic backgrounds and not others. Other medical conditions Research has shown that having certain medical conditions slightly increases your chances of developing chronic lymphocytic leukaemia. These conditions include: pneumonia (chest infection) sinusitis shingles autoimmune haemolytic anaemia long-term (chronic) osteoarthritis prostatitis (an inflamed prostate) However, rather than causingchronic lymphocytic leukaemia, some of these conditions may occur as a result ofhaving lowered immunity during the early stages of the condition. Having a lowered immunity due to having a condition such as HIV or AIDS , or taking immunity lowering medication following an organ transplant can also increase your risk of developing chronic lymphocytic leukaemia. Radiation exposure Exposure toradiation is known to increase the risk of getting other types of leukaemia, butits not been linked specifically to chronic lymphocytic leukaemia. The Cancer Research UK website has more information about the risk factors for chronic lymphocytic leukaemia . Sex and age For reasons that are unclear, men are around twice as likely to develop chronic lymphocytic leukaemia than women. The risk of developing leukaemia also increases as you get older. Source: NHS 24 - Opens in new browser window Last updated: 13 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Chemotherapy Other health sites Cancer Research UK: Chronic lymphocytic leukaemia (CLL) Blood Cancer UK: Chronic lymphocytic leukaemia (CLL) Lymphoma Action: Chronic lymphocytic leukaemia (CLL) and small lymphocytic lymphoma (SLL) Macmillan Cancer Support: Leukaemia Macmillan Cancer Support: Chemotherapy Chronic Lymphocytic Leukaemia Support Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Chronic myeloid leukaemia

Chronic myeloid leukaemia - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Chronic myeloid leukaemia Chronic myeloid leukaemia About chronic myeloid leukaemia Symptoms of chronic myeloid leukaemia Causes of chronic myeloid leukaemia Diagnosing chronic myeloid leukaemia Treating chronic myeloid leukaemia Complications of chronic myeloid leukaemia About chronic myeloid leukaemia Leukaemia is cancer of the white blood cells. Chronic leukaemia means the condition progresses slowly over many years. Chronic leukaemia is classified according to the type of white blood cells that are affected by cancer. There are 2 main types: lymphocytes mostly used to fight viral infections myeloid cells which perform a number of different functions, such as fighting bacterial infections, defending the body against parasites and preventing the spread of tissue damage These pages focus on chronic myeloid leukaemia, which is a cancer of the myeloid cells. The following other types of leukaemia are covered elsewhere: chronic lymphocytic leukaemia acute myeloid leukaemia acute lymphoblastic leukaemia What happens in chronic leukaemia Your bone marrow produces stem cells. These are unique cells because they have the ability to develop into three important types of blood cell: red blood cells which carry oxygen around the body white blood cells which help fight infection platelets which help stop bleeding In leukaemia, a genetic mutation in the stem cells causes a huge over-production of white blood cells and a corresponding drop in red blood cells and platelets. Its this lack of red blood cells which causes symptoms of anaemia, such as tiredness, and the lack of platelets that increases the risk of excessive bleeding. Warning signs of chronic myeloid leukaemia In its early stages, chronic myeloid leukaemia usually causes no noticeable symptoms. As the condition develops, symptoms include: tiredness weight loss night sweats a feeling of bloating bruising bone pain Read more about the symptoms of chronic myeloid leukaemia How common is chronic myeloid leukaemia? Chronic myeloid leukaemia is quite a rare type of cancer. Chronic myeloid leukaemia can affect people of any age, but it is more common in people aged 40 to 60. There is no evidence that it runs in families. Symptoms of chronic myeloid leukaemia In its early stages, chronic myeloid leukaemia usually causes no noticeable symptoms and it is often diagnosed during tests for a different condition. When symptoms do develop, they are similar to those of many other illnesses and can include: tiredness frequent infections unexplained weight loss a feeling of bloating less commonly, swollen lymph nodes glands found in the neck and under your arms, which are usually painless Chronic myeloid leukaemia can also cause swelling in your spleen (an organ that helps to filter impurities from your blood). This can cause a lump to appear on the left side of your abdomen, which may be painful when touched. A swollen spleen can also put pressure on your stomach, causing a lack of appetite and indigestion. The symptoms of chronic myeloid leukaemia in its advanced stage will be much more noticeable and troublesome. They include: severe fatigue bone pain night sweats fever easily bruised skin Causes of chronic myeloid leukaemia Chronic myeloid leukaemia is caused by a DNA mutation in the stem cells which produce white blood cells. The change in the DNA causes thestem cells toproduce more white blood cells than are needed. They are also released from the bone marrow before they are matureand able to fight infection like healthy adult white blood cells. As the number of immature cells increases,the number ofhealthy red blood cells and platelets fall, and its thisfallwhich causes many of thesymptoms of chronic leukaemia. Philadelphia chromosome Although the cause of chronic myeloid leukaemia is genetic, it is not inherited as it is an acquired genetic abnormality. Most people with the condition have an abnormal chromosome, where a section of DNA from one chromosomehas been swapped with a section from another. This is called thePhiladelphia chromosome and it makes the cell produce a protein that encourages the leukaemic cells to resist normal cell death andgrow and multiply far more quickly than usual. Possible triggers for chronic leukaemia What triggers the development of chronic leukaemia and causes the initial mutation in stem cells is unknown. The one proven risk factor is exposure to radiation. However, radiation is only a significant risk if the levels are extremely high, such as those recorded after an atomic bomb explodes, or those released after a nuclear reactor accident, such as the one at Chernobyl. Benzene There is limited evidence that prolonged exposure to the chemical benzene leads to an increased risk of chronic myeloid leukaemia. Benzene is found in petrol and is also used in the rubber industry, but in the UKthere are strict controls to protect people from prolonged exposure. Benzene is also found in cigarettes. However, it is thought that smoking is more of a risk factor in acute leukaemia than it is in chronic leukaemia. Occupational risks A number of occupations have been linked to an increased risk of chronic leukaemia, possibly due to exposure to certain substances such as pesticides or chemicals. These occupations include: all types of agricultural workers people who are involved with rubber or plastic manufacture tailors and dressmakers cleaners builders labourer Other risk factors There is some evidence to show an increased risk of chronic leukaemia in people who: are obese have a weakened immune system due to HIV or AIDS or taking immunosuppressants after an organ transplant have inflammatory bowel disease such as ulcerative colitis or Crohns disease Diagnosing chronic myeloid leukaemia Chronic myeloid leukaemia is often first detected when a routine blood test is carried out to diagnose another, unrelated, condition. A blood test that reveals abnormally high levels of white blood cells could be a sign of chronic leukaemia. If you have a blood test with abnormal results, you will be referred to a haematologist (a specialist in treating blood conditions) for further testing. Bone marrow biopsy To confirm a diagnosis of chronic leukaemia, the haematologist will take a small sample of your bone marrow to examine under a microscope. This procedure is known as a bone marrow biopsy . A bone marrow biopsy is usually carried out under a local anaesthetic . The haematologist will numb an area of skin at the back of your hip bone, before using a needle to remove the bone marrow sample.Youmay experience some painonce the anaesthetic wears off andsome bruising and discomfort for a few days afterwards. The procedure takes around 15 minutes to complete and you should not have to stay in hospital overnight. The bone marrow sample will be checked to see if there are cancerous cells. Ifthere are, the biopsy will also be able to help determine which type of chronic leukaemia is present. Further tests There are a number of additional tests that can be used to help reveal more information about the progress and extent of the leukaemia. These can also provide an insight into how the leukaemia should be treated. Cytogenetic testing Cytogenetic testing involves identifying the genetic make-up of the cancerous cells. There are a number of specific genetic variations that can occur during leukaemia and knowing what these variations are can have an important impact on treatment. For example, 90% of people with chronic myeloid leukaemia have the Philadelphia chromosome. People who have thischromosome are known to respond well to a medicine called imatinib. Polymerase chain reaction (PCR) A polymerase chain reaction (PCR) testcan bedone on a blood sample. This is an important test to diagnose and monitor the response to treatment. The blood test is repeated every 3 months for at least 2 years after starting treatment, then less often once remission is achieved. Imaging tests In some cases, the hospital may want to perform some imaging tests to help rule out other conditions or confirm a diagnosis. This may be either: an X-ray usually to examine your chest an ultrasound scan usually to examine your spleen and liver Treating chronic myeloid leukaemia Imatinib tablets are usually given as soon as you have been diagnosed withchronic myeloid leukaemia, to slow its progression. These tablets are taken every day for life, and most patients do really well on them. The aim of treatment is to achieve the following: by 3 months, correct the blood count by 12 months, clear the bone marrow of cells containing the Philadelphia chromosome (see Causes page for information on this) by 18 months, get to a stage wherethe leukaemia can only be detected by a very sensitive molecular test (molecular remission) Chemotherapy is usually offered if the cancer reaches an advanced stage. Treating early-stage chronic myeloid leukaemia Imatinib A medicine called imatinib is the main treatment recommended for chronic myeloid leukaemia. It is usually given as soon as a diagnosis is made because the medicine is designed to slow the progression of the cancer and toprevent the condition reaching the accelerated or advanced phase. Imatinib is a type of tyrosine kinase inhibitor. This means it blocks a protein called tyrosine kinase(tyrosine kinasehelps to stimulate the growth of cancer cells). This reduces the production of abnormal white blood cells. Imatinib is taken as a tablet. The side effects of imatinib are usually mild and should improve with time. They include: nausea vomiting swelling in the face and lower legs muscle cramps rash diarrhoea Nilotinib It is estimated that 10to 40% of people who take imatinib become resistant to its effects, so an alternative treatment is required. The National Institute for Health and Care Excellence (NICE) has recommended nilotinib for the treatment of chronic myeloid leukaemia that is resistant or intolerant to imatinib. In some cases, nilotinib is recommendedas the first treatment. Nilotinibworks in a similar way to imatinib in that it blocks the effects of proteins that help stimulate the growth of cancer cells. Side effects of nilotinib can include: vomiting abdominal pain bone and joint pain dry skin loss of appetite hair loss insomnia night sweats dizziness tingling or numbness If theside effects become particularly troublesome, temporarily stopping the treatment usually helps to bring them under control. Treatment can then be resumed, possibly using a lower dose of medication. Read about the complications of chronic myeloid leukaemia for more information and advice about being vulnerable to infection and bleeding. Treating advanced chronic myeloid leukaemia Chemotherapy Once chronic myeloid leukaemia has progressed toa more advanced stage, chemotherapy is the next treatment. Chemotherapy tablets are usually used first because they have fewer and milder side effects than chemotherapy injections. Side effects include: tiredness skin rash increased vulnerability to infection Chemotherapy can weaken your immune system, which helps protect you against infection. This is known as being immunocompromised. Read chronic leukaemia complications for more information about this. If your symptoms persist or get worse, chemotherapy injections (intravenous chemotherapy) will need to be used. Intravenous chemotherapy causes more side effects than chemotherapy tablets and they tend to be more severe. Side effects include: nausea vomiting tiredness hair loss infertility These side effects should resolve after your treatment has finished, although there is a risk that infertility could be permanent. Bone marrow and stem cell transplants A bone marrow transplant can offer a cure forchronic leukaemia, although it is only suitable and necessaryforsome patients. Before transplantation can take place, the person receiving the transplant has to have aggressive, high-dose chemotherapy and radiotherapy to destroy any cancerous cells in their body. This can put enormous strain on the body and can cause significant side effects and potential complications. Transplantations have better outcomes if the donor has the same tissue type as the person who is receiving the donation. The best candidate to provide a donation is usually a brother or sister with the same tissue type. Due to these issues, transplantations are usually only successful when they are carried out in children and young people, or older people in good health, and there is a suitable brother or sister who can provide a donation. In most cases of chronic leukaemia, the potential risks of transplantation far outweigh any benefit. However, your specific circumstances may mean that the benefits of treatment outweigh the risks. Read more about bone marrow transplants Complications of chronic myeloid leukaemia Being immunocompromised (having a weakened immune system) is a possible complication for some patients with chronic leukaemia. There are 2 reasons for this: the lack of healthy white blood cells means your immune system is less able to fight infection many of the medicines used to treat chronic leukaemiacan weaken the immune system This means you are more vulnerable to developing an infection, and that any infection you have has an increased potential to cause serious complications. You may be advised to take regular doses of antibiotics to prevent infections from occurring. You should immediately report any possible symptoms of an infection to your GP orcare teambecause prompt treatment may be required to prevent serious complications. Symptoms of infection include: high temperature (fever) of 38C (101.4F) or above headache aching muscles diarrhoea tiredness Avoid contact with anyone who is known to have an infection, even if it is a type of infection that you were previously immune to, such as chickenpox or measles. This is because your previous immunity to these conditions will probably be suppressed (lowered). While it is important to go outside on a regular basis, both for exercise and for your psychological wellbeing, avoid visiting crowded places and using public transport during rush hour. Also ensure that all of your vaccinations are up-to-date. Your GP or care team will be able to advise you about this. You will be unable to have any vaccine that contains activated particles of viruses or bacteria, such as: themumps, measles and rubella (MMR) vaccine the polio vaccine the oral typhoid vaccine the BCG vaccine (used to vaccinate against tuberculosis) the yellow fever vaccine Psychological effects of chronic leukaemia Receiving a diagnosis of chronic leukaemia can be very distressing, particularly if it is unlikely that your condition can be cured. At first, the news may be difficult to take in. The situation can be made worse if you are confronted with the knowledge that even though your leukaemia may not currently be causing any symptoms, it could be a serious problem in later life. Having to wait many years to see how the leukaemia develops can be immensely stressful and can trigger feelings of stress, anxiety and depression . If you have been diagnosed with leukaemia, talking to a counsellor or psychiatrist (a doctor who specialises in treating mental health conditions) may help you to combat feelings of depression and anxiety. Antidepressants or medicines that help to reduce feelings of anxiety may also help you cope better with the condition. You may find it useful to talk to other people who are living with leukaemia. Your GP or multidisciplinary team may be able to provide you with details of local support groups. Another excellent resource is Macmillan Cancer Support . Their helpline number is 0808 808 00 00 and is open Monday to Friday, 9am-8pm. Further information You can read more information from Cancer Research UK about coping with chronic myeloid leukaemia . Source: NHS 24 - Opens in new browser window Last updated: 13 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Chronic lymphocytic leukaemia Acute myeloid leukaemia Other health sites Blood cancer UK: Chronic myeloid leukaemia Macmillan Cancer Support: Chronic myeloid leukaemia Cancer Research UK: Chronic myeloid leukaemia Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Chronic obstructive pulmonary disease

Chronic obstructive pulmonary - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways COPD Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease About COPD Symptoms of COPD Causes of COPD Diagnosing COPD Treating COPD About COPD Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease. People with COPDhave difficulties breathing, primarily due to the narrowing of their airways, this is called airflow obstruction. Typical symptoms of COPD include: increasing breathlessness when active a persistent cough with phlegm frequent chest infections Read more about the symptoms of chronic obstructive pulmonary disease Why does COPD happen? The main cause of COPD is smoking. The likelihood of developing COPD increases the more you smoke and the longer youve been smoking. This is because smoking irritates and inflames the lungs, which results in scarring. Over many years, the inflammation leads to permanent changes in the lung. The walls of the airways thicken and more mucus is produced. Damage to the delicate walls of the air sacs in the lungs causes emphysema and the lungs lose their normal elasticity. The smaller airways also become scarred and narrowed.These changes cause the symptoms of breathlessness, cough and phlegm associated with COPD. Some cases of COPD are caused by fumes, dust, air pollution and genetic disorders, but these are rarer. Read more about the causes of chronic obstructive pulmonary disease Who is affected? COPD is one of the most common respiratory diseases in the UK. It usually only starts to affect people over the age of35, although most people are not diagnosed until they are in their 50s. It is thought there are more than 3 million people living with the disease in the UK, of which only about 900,000 have been diagnosed. This is because many people who develop symptoms of COPD do notget medical help because they often dismiss their symptoms as a smokers cough. COPD affects more men than women, althoughrates in womenare increasing. Diagnosis It is important that COPD is diagnosed as early as possible sotreatment can be used to try to slow down the deterioration of your lungs. You should see your GP if you have any of the symptoms of COPD. COPD is usually diagnosed after a consultation with your doctor, which may be followed by breathing tests. Read more about diagnosing chronic obstructive pulmonary disease TreatingCOPD Although the damage that has already occurred to your lungs cannot be reversed, you can slow down the progression of the disease. Stopping smoking is particularly effective at doing this. Treatments for COPD usually involve relieving the symptoms with medication, for example by using an inhaler to make breathing easier. Pulmonary rehabilitation may also help increase the amount ofexercise you are capable of doing. Surgery is only an option for a small number of people with COPD. Read more about treating chronic obstructive pulmonary disease Living with COPD COPD can affect your life in many ways, but help is available to reduce its impact. Simple steps such as living in a healthy way, being as active as possible,learning breathing techniques, and taking your medication can help you to reduce the symptoms of COPD. Financial support and advice about relationships and end of life careis also available for people with COPD. Read more about living with chronic obstructive pulmonary disease . Can COPD be prevented? Although COPD causes about 25,000 deaths a year in the UK, severe COPD can usuallybe prevented by making changes to your lifestyle. If you smoke, stopping is the single most effective way to reduce your risk of getting the condition. Research has shown you are up to four times more likely to succeed in giving up smoking if you use NHS support along with stop-smoking medicines such as patches or gum. Ask your doctor about this, phone Quit Your Way Scotland on 0800 84 84 84orread more about stopping smoking . Also avoid exposure to tobacco smoke as much as possible. Symptoms of COPD Symptoms of chronic obstructive pulmonary disease (COPD) usually develop over a number of years, so you may not be aware you have the condition. COPD does not usually become noticeable until after the age of 35 and most people diagnosed with the condition are over 50 years old. See your GP if you have the following symptoms: increasingbreathlessness when exercising or moving around a persistent cough with phlegm that never seems to go away frequent chest infections , particularly in winter wheezing Middle-aged smokers and ex-smokers who have a persistent chesty cough (especially in the morning), breathlessness on slight exertion or persistent coughs and colds in the winter should see their GP or practice nurse for a simple breathing test. If you have COPD, the airways of the lungs become inflamed and narrowed. As the air sacs get permanently damaged, it will become increasingly difficult to breathe out. While there is currently no cure for COPD, the sooner the condition is diagnosed and appropriate treatment begins, the less chance there is of severe lung damage. Read more about treating COPD . Flare-ups Symptoms of COPD are often worse inwinter, and it is common to have two or more flare-ups a year. A flare-up (also known as an exacerbation) is when your symptoms are particularly bad.This is one of the most common reasons for people being admitted to hospital in the UK. If youre experiencing a flare-up that is worse than normal day to day, you should visit your GP or call NHS 24 on 111. Other signs of COPD Other signs of COPD can include: weight loss tiredness and fatigue swollen ankles Chest painandcoughing up blood (haemoptysis) are not common symptoms of COPD. They are usually caused by other conditions such as a chest infection or, less commonly, lung cancer . Causes of COPD There are several things that may increase your risk of developing chronic obstructive pulmonary disease (COPD), many of which can be avoided. Things you can change You can reduce your risk of developing COPD bynot smoking and avoidingexposure to certain substances at work. Smoking Smoking is themain cause of COPD and is thought tobe responsible foraround 90% of cases. The lining of the airways becomes inflamed and permanently damaged by smoking and this damage cannot be reversed. Up to 25% of smokers develop COPD. Passive smoking Exposure to other peoples smoke increases the risk of COPD. Fumes and dust Exposure to certain types of dust and chemicals at work, including grains, isocyanates, cadmium and coal, has been linked to the development of COPD, even in people who do not smoke. The risk of COPD is even higher if you breathe in dust or fumes in the workplace and you smoke. Air pollution According to some research, air pollution may be an additional risk factor for COPD. However, at the moment it is notconclusive and research is continuing. Read further information: stopping smoking treatments to help you stop smoking Health and Safety Executive: COPD Things you cannot change There are a few factors for COPDthat you cannot change. Having a brother or sister with severe COPD A research study has shown that smokers who have brothers and sisters with severe COPD are at greater risk of developing the condition than smokers who do not. Having a genetic tendency to COPD There is a rare genetic tendency to develop COPD called alpha-1-antitrypsin deficiency. This causes COPD in a small number of people (about 1%). Alpha-1-antitrypsin is a protein that protects your lungs. Without it, the lungs can be damaged by other enzymes that occur naturally in the body. People who have an alpha-1-antitrypsin deficiency usually develop COPD at a younger age, often under 35. Read further information: British Lung Foundation: Alpha-1-antitrypsin Alpha1 Awareness UK Diagnosing COPD Chronic obstructive pulmonary disease (COPD) is usually diagnosed after a consultation with your GP, as well as breathing tests. If you are concerned about the health of your lungs and have symptoms that could be COPD, see your GP as soon as you can. Being diagnosed early means you will receive appropriate treatment, advice and help to stop or slow the progression of COPD. At a consultation, your doctor will askabout your symptoms, how long you have had them, and whether you smoke, or used to smoke. They will examine you and listen to your chest using a stethoscope. You may also be weighed and measured to calculate your body mass index (BMI). Your doctor will also check how well your lungs are working with a lung function test called spirometery. Spirometry To assess how well your lungs work, a breathing test calledspirometry is carried out. You will be asked to breathe into a machine called a spirometer. The spirometer takes two measurements: the volume of air you can breathe out in one second (called the forced expiratory volume in one second or FEV 1 ) and the total amount of air you breathe out (called the forced vital capacity or FVC). You may be asked to breathe out a few times to get a consistent reading. The readings are compared with normal measurements for your age, which can show if your airways are obstructed. Other tests Youmay have other tests as well as spirometry. Often, these other tests will help the doctor rule out other conditionsthat cause similar symptoms. Chest X-ray A chest X-ray will show whether you have another lung conditionwhich may be causing symptoms, such as a chest infection orlung cancer. Blood test A blood test will show whether your symptoms could be due to anaemia , as this can also cause breathlessness. Further tests Some people may need more tests. The tests may confirm the diagnosis or indicate the severity of your COPD. This will help you and your doctor plan your treatment. Electrocardiogram (ECG) and echocardiogram An electrocardiogram (ECG) or echocardiogram may be used to check the condition of your heart. An ECG involves attaching electrodes (sticky metal patches) to your arms, legs and chest to pick up the electrical signals from your heart. An echocardiogram uses sound waves to build a detailed picture of your heart. This is similar to an ultrasound scan . Peak flow test To confirmyou haveCOPD and not asthma, you may beasked to take regular measurements of your breathing using a peak flow meter, at different times over several days. The peak flow meter measures how fast you can breathe out. Blood oxygen level The level of oxygen in your blood is measured using a pulse oximeter, which looks like a peg and isattached to the finger. If you have low levels of oxygen, you may need an assessment to see whether extra oxygen would help you. Blood test for alpha-1-antitrypsin deficiency If the condition runs in your family or you developed the symptoms of COPD under the age of35 and have never smoked, you will probably have a blood test to see if you are alpha-1-antitrypsin deficient. Computerised tomography (CT) scan Some people may need a CT scan . This provides more information than an X-ray and can be useful in diagnosing other lung diseases or assessing changes to your lungs due to COPD. Other breathing tests If your symptoms seem worse than would be expected from your spirometry results, your doctor may decide you need more detailed lung function tests. You may be referred to a hospital specialist for these tests. Phlegm sample The doctor may take a sample of phlegm (sputum) to check whether it has been infected. Treating COPD Stop smoking Stopping smoking is themost effectiveway for people with COPD to help themselves feel better and is the only proven way to reduce the rate of decline in lung function. Stopping smoking at an early stage of the disease makes a huge difference. Any damage already done to the airways cannot be reversed, but giving up smoking can slow the rate at which the condition worsens. If COPD is in the early stages and symptoms are mild, no other treatments may be needed. However, it is never too late to stop smoking. Even people with fairly advanced COPD are likely to benefit from quitting, which may prevent further damage to the airways. Research has shownyou are up to four times more likely to give up smoking successfully if you use NHS support along with stop-smoking medicines such as tablets, patches or gum. Ask your doctor about this. Read more about stopping smoking . Inhalers If an inhaler is prescribed for you, your GP, practice nurse or pharmacist can explain how to use it. They will check you are using it properly. Most people learn to use an inhaler successfully, but if you are having problems, a spacer or adifferent type of inhaler device may help you take your medicines correctly. A spacer is a device that increases the amount of medication that reaches the lungs. Short-acting bronchodilator inhalers Short-acting bronchodilator inhalers deliver a small dose of medicine directly to your lungs, causing the muscles in your airways to relax and open up. There are two types of short-acting bronchodilator inhaler: beta-2 agonist inhalers, such as salbutamol and terbutaline antimuscarinic inhalers, such as ipratropium The inhaler should be used when you feel breathless and this should relieve the symptoms. Long-acting bronchodilator inhalers If a short-acting bronchodilator inhaler does not help relieve your symptoms, your GP may recommend a long-acting bronchodilator inhaler. This works in a similar way to a short-acting bronchodilator, but each dose lasts for at least 12 hours. There are two types of long-acting bronchodilator inhalers: beta-2 agonist inhalers, such as salmeterol, formoterol and indacaterol antimuscarinic inhalers, such as tiotropium, glycopyronium and aclidinium Steroid inhalers Steroid inhalers, also called corticosteroid inhalers, work by reducing the inflammation in your airways. If you are still getting breathless or having flare-ups even when taking long-acting bronchodilator inhalers, your GP may suggest including a steroid inhaler as part of your treatment. Most people with COPD will be prescribed a steroid inhaler as part of a combination inhaler. Medicines Theophylline tablets If you are getting breathless or having flare-ups when using a combination of inhalers, your GP may prescribe theophylline tablets. Theophylline causes the muscles of your airways to relax and open up. When you have been taking theophylline tablets regularly, youmay need to give a blood sample to measure the amount of theophylline in your blood and help your GP prescribe the appropriate dose of tablet. This will allow you to get the correct dose of theophylline while reducing the likelihood of side effects. Due to the risk of potential side effects, such as increased heart rate and headaches, other medicines, such as a bronchodilator inhaler, are usually tried before theophylline. Mucolytic tablets or capsules Mucolytics, such as carbocisteine, make the mucus and phlegm in your throat thinner and easier to cough up. They are particularly beneficial for people with a persistent cough with lots of thick phlegm or who have frequent or bad flare-ups. Antibiotics and steroid tablets If you have a chest infection, your GP may prescribe a short course of antibiotics . Steroid tablets may also be prescribed as a short course if you have a bad flare-up. They work best if they are taken as the flare-up starts, so your GP may give you a course to keep at home. Occasionally, you may have to take a longer course of steroid tablets. Your GP will give you the lowest effective dose and monitor you for side effects. Side effects are uncommon if steroid tablets are given for less than three weeks. Read more about the medicines used inthe chronic obstructive pulmonary disease medicines guide . Other types of treatment Nebulised medication Nebulised medicationcan be used for severe cases of COPD if other inhaler devices have not worked effectively. A compressor is a machine that administers nebulised medicine through a mouthpiece or a face mask. The medicine is in a liquid form and is converted into a fine mist. This enables a large dose of medicine to be taken in one go. You can usually choose whether to use nebulised medicationwith a mouthpiece or a facemask. Your GP will advise you onhow to use the machine correctly. Long-term oxygen therapy If the oxygen level in your blood is low, you maybe advised to have oxygen at home through nasal tubes, also called a nasal cannula, or through a mask. Oxygen is not a treatment for breathlessness, but it is helpful for some patients with persistently low oxygen levels in the blood. You will probably be referred for more detailed assessment to see whether you might benefit from long-term oxygen therapy. If you are prescribed long term oxygen therapy, it must be taken for at least 15 hours a day to be effective. However, the longer you use it, the more effective it is. The tubes from the machine are long so you will be able to move around your home while you are connected. Portable oxygen tanks are available if you need to use oxygen away from home. The aim of long-term oxygen therapy is to extend your life. Do not smoke when you are using oxygen. The increased level of oxygenproduced is highly flammable, and a lit cigarette could trigger a fire or explosion. Ambulatory oxygen therapy Part of the oxygen assessment is likely to consider if you may benefit from ambulatory oxygen oxygen used when you walk or are active in other ways. If your oxygen levels are normal while you are resting, but fall when you exercise, you may not need long-term oxygen therapy alongside ambulatory oxygen therapy. Read more about home oxygen treatment . Non-invasive ventilation (NIV) Non-invasive ventilation (NIV) helps a person breathe using a portable machine connected to a mask covering the nose or face. You may receive it if you are taken to hospital because of a flare-up. You may be referred to a specialist centre to see ifhome NIV could help you.NIV is used to improve the functioning of your lungs. Pulmonary rehabilitation programmes Pulmonary rehabilitation is a programme of exercise and education designed to help people with chronic lung problems. It can increase your exercise capacity, mobility and self-confidence. Pulmonary rehabilitation is based on a programme of physical exercise training tailored to your needs. It usuallyinvolves walking or cycling, andarm and strength-building exercises. It also includes education aboutyour disease foryou andyour family, dietary assessment and advice, and psychological, social and behavioural changes designed to helpyou cope better. A rehabilitation programme is provided by a multidisciplinary team, whichincludes physiotherapists, respiratory nurse specialists and dietitians. Pulmonary rehabilitation takes place in a group and the course usually lasts for about six weeks. During the course, you will learn more about your COPD and how to control your symptoms. Pulmonary rehabilitation can greatly improve your quality of life. Source: NHS 24 - Opens in new browser window Last updated: 31 January 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Living well with COPD Bronchodilators Corticosteroids Quit Your Way Scotland Other health sites HSE: COPD British Lung Foundation: COPD NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Chronic pain

Chronic pain | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Chronic pain Chronic pain Chronic or persistent pain is pain that lasts longer than 12 weeks, or beyond the natural healing time What is chronic pain? Read about chronic pain symptoms and causes Living with chronic pain Read about pain management strategies to live better with chronic pain Coping with a flare up of chronic pain Find out how to cope with a flare up of chronic pain Fibromyalgia Read about fibromyalgia symptoms, causes and treatment. NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Chronic pancreatitis

Chronic pancreatitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Chronic pancreatitis Chronic pancreatitis About chronic pancreatitis Symptoms of chronic pancreatitis Causes of chronic pancreatitis Diagnosing chronic pancreatitis Treating chronic pancreatitis Complications of chronic pancreatitis About chronic pancreatitis Chronic pancreatitis is a condition where the pancreas (a small organ located behind the stomach and below the ribcage) becomes permanently damaged from inflammation. Its different to acute pancreatitis , where the inflammation is only short-term. The most common symptom of chronic pancreatitis is repeated episodes of abdominal(tummy) pain, which can be severe. Other symptoms tend to develop as the damage to the pancreas progresses, such as producing greasy, foul-smelling stools. Read more about the symptoms of chronic pancreatitis and diagnosing chronic pancreatitis . When to seek medical advice Always visit your GP if youre experiencing severe pain its a warning sign that something is wrong. Why it happens Long-term alcohol misuse is responsible for around 7 out of every 10 cases of chronic pancreatitis. This is because heavy drinking over a number of years can repeatedly damage the pancreas. Less common causes include: smoking a problem with the immune system, causing it to attack the pancreas an inheritedgenetic mutation disrupting the functions of the pancreas Inas many as3 out of 10 people with the condition, the cause cannot be identified this is known as idiopathic chronic pancreatitis. Read more about the causes of chronic pancreatitis . Whos affected Chronic pancreatitis can affect people of any age, but is most common in middle-aged men aged between 45 and 54. How its treated In most cases of chronic pancreatitis, theres no specific treatment to reduce the inflammation and repair the damage to the pancreas. Treatment mainly focuses on lifestyle changes and medication to relieve the pain. Surgery is sometimes needed to treat severe chronic pain that doesnt respond to painkillers. However, the pain can be difficult to treat and can seriously affect your quality of life. People who dont smoke cigarettes and avoid drinking alcohol tend to experience less pain and live longer than those who continue to drink and smoke after receiving a diagnosis. Read more about treating chronic pancreatitis . Complications Living with chronic paincan cause mental as well as physical strain. Its important to speak to your GP if youre experiencing stress , anxiety or depression caused by chronic pancreatitis. Diabetes is a common complication of chronic pancreatitis and affects about a third of people with the condition. It occurs when the pancreas is damaged and unable to produce insulin. People with chronic pancreatitis also have an increased risk of developing pancreatic cancer . Read more about the possible complications of chronic pancreatitis . Symptoms of chronic pancreatitis The most common symptom of chronic pancreatitis is repeated episodes of abdominal (tummy) pain. Eventually, there may also be digestion problems. The pain usually develops in the middle or left side ofthe abdomen and can sometimes travel along your back. Its been described as a burning or shooting pain which comes and goes, but can last for several hours or days, in some cases. Some people also experience symptoms of nausea and vomiting during the pain. As chronic pancreatitis progresses, the painful episodes may become more frequent and severe. Although the pain sometimes occurs after eating a meal, theres often no trigger. Eventually, a constant mild to moderate pain can develop in the abdomen in between episodes of severe pain. This is most common in people who continue to drink alcohol after being diagnosed with chronic pancreatitis. Some people who stopdrinking alcohol and stop smoking may experience a reduction in the severity of their pain. Advanced chronic pancreatitis Additional symptoms can occur when the pancreas loses its ability to produce digestive juices, which help to break down food in the digestive system. The pancreas usually only loses these functions many years after the original symptoms started. The absence of digestive juicesmakes it difficult for your digestive system to breakdown fats and certain proteins. This can cause your stools to become particularly smelly and greasy, and make them difficult to flush down the toilet. You may also experience: weight loss loss of appetite jaundice(yellowing of the skin and eyes) symptoms of diabetes such as feeling very thirsty, urinating frequently and feeling very tired ongoing nausea and vomiting When to seek medical advice Always visit your GP if youre experiencing severe pain, as this is a warning sign that something is wrong. You should also visit your GP if you develop symptoms of jaundice. Jaundice can have a range of causes other than pancreatitis, but its usually a sign that theres something wrong with your digestive system. You should also visit your GP if you develop persistent vomiting. Causes of chronic pancreatitis Most cases of chronic pancreatitis are associated with drinking excessive amounts of alcohol over a long period of time. However,in up to3 out of 10 people with the condition,the causecant beidentified known as idiopathic chronic pancreatitis. Alcohol consumption Heavy drinking over many years can cause repeated episodes of acute pancreatitis . Acute pancreatitis is usually a short-term condition, but it can recur if you continue to drink alcohol. Over time, repeated inflammation causes permanent damage to the pancreas, resulting in chronic pancreatitis. Anyone who regularly consumes alcohol has an increased risk of chronic pancreatitis, although only a minority develop the condition. Read more about alcohol misuse . Problems with the immune system Rare cases of chronic pancreatitis are the result of a problem with the immune system, which causes it to attack the pancreas. This is known as autoimmune pancreatitis and its not clear exactly why it happens. Many people with autoimmune pancreatitis also have other conditions caused by the immune system attacking healthy tissue. These include ulcerative colitis or Crohns disease , both of which cause inflammation inside the digestive system. Genetics Some cases of chronic pancreatitis are inherited. This is thought to be caused by mutations (alterations) in a number of genes, including genes called PRSS1 and SPINK-1. These mutations disrupt thenormal working of the pancreas. Genetic mutations may also have a role in the effect of alcohol on your pancreas. Evidence suggests that certain genetic mutations makethe pancreas more vulnerable to the harmful effects of alcohol. Certain mutations of the CFTR gene, responsible for cystic fibrosis ,are also thought to cause chronic pancreatitis in a small amount of cases. Other causes Several other rare causes of chronic pancreatitis have also been identified, including: injury to the pancreas blockedor narrowedopenings (ducts)of the pancreas smoking radiotherapy to theabdomen (tummy) Diagnosing chronic pancreatitis Chronic pancreatitis can usually only be diagnosed by carrying out scans of the pancreas. Your GP will ask about your symptoms and may carry out a simple physical examination, but theyll refer you for further tests if they suspect chronic pancreatitis. Thesetests are usually carried outinyour local hospital andmay include: requesting a stool sample an ultrasound scan where sound waves are used to build up a picture of the inside of your pancreas a computerised tomography (CT) scan where a series of X-rays are taken to build up a more detailed, three-dimensional image of the pancreas an endoscopic ultrasonography a magnetic resonance cholangiopancreatography or MRCP Endoscopic ultrasonography During an endoscopic ultrasonography, a thin, flexible telescope (endoscope) is passed through your mouth and towards your stomach. An ultrasound probe attached to the tip of theendoscope is able to get close to the pancreas and take very accurate pictures of it. Youll usually be given a sedative to help you relax during the procedure. MRCP An MRCP involves injecting you with a substance known as a contrast agent thatmakes your pancreas and surrounding organs, such as the gallbladder and liver, show up very clearly on a magnetic resonance imaging (MRI) scanner . AnMRI scanner is a type of imaging system that uses magnetic fields and radio waves to build up a detailed image of the inside of your body. An MRCP is a useful way of checking whether gallstones may be contributing to your symptoms. Biopsy Sometimes, the symptoms of chronic pancreatitis can be very similar to pancreatic cancer . Therefore, if you have symptoms such asjaundice (yellowing of the skin and whites of the eyes)and weight loss, a biopsy may be recommended to rule out a diagnosis of pancreatic cancer. A biopsy involves taking a small sample of cells from the pancreas and sending it to a laboratory, so it can be checked under a microscope for the presence of cancerous cells. A biopsy can be taken using a long, thin needle thats passed through your abdomen. The needle can be guided towards the tumour using an ultrasound scan or CT scan. Alternatively, a biopsy can be taken during an endoscopic ultrasonography. Treating chronic pancreatitis Treatment for chronic pancreatitis aims to help control the condition and reduce any symptoms. Lifestyle changes If youre diagnosed with chronic pancreatitis, some lifestyle changes will be recommended. Avoiding alcohol The most important thing you can do is to stop drinking alcohol, even ifit isnt the cause of your condition. This helps toprevent further damage to your pancreas and may help to reduce the pain. If you continue to drink alcohol, its likely that youll experience debilitating pain and youll be more likely to die from a complication of chronic pancreatitis . Some people with chronic pancreatitis caused by alcohol consumption have a dependency on alcohol and require additional help and support to stop drinking. If this applies to you, talk to your GP about getting help to stop drinking. Treatment options for alcohol dependence include: one-to-onecounselling self-help groups such as Alcoholics Anonymous a medication called acamprosate that can help to reduce cravings for alcohol Read more about treating alcohol misuse . Stopping smoking If you smoke, you should stop. Smoking can speed up the progress of chronic pancreatitis, making it more likely that your pancreas will lose its function. Its recommended that you use an anti-smoking treatment, such as nicotine replacement therapy (NRT) or bupropion (a medication used to reduce cravings for cigarettes). People who use these types of treatments have a much greater success rate in permanently stopping smoking than those who try to quit using willpower alone. If you want to give up smoking, its a good idea to start by visiting your GP. Theyll be able togive youhelp and advice about quitting and can refer you to an NHS Stop Smoking support service. These services offer the best support for people who want to give up smoking. Studies show you are 4times more likely to give up smoking if you do it through the NHS. Read more about stopping smoking . Dietary changes As chronic pancreatitiscan affect your ability to digest certain foods, you may need to change your diet. Your GPmay be able to provide you with appropriate dietary advice, ormay refer you to a dietitian, who will draw up a suitable dietary plan. Alow-fat, high-protein, high-calorie diet with fat-soluble vitamin supplements is usually recommended, but dont make changes to your diet without consulting a health professional. Enzyme supplements You may be givenpancreatic enzyme supplements, which is medication containing an artificial version of the enzymes produced by your pancreas. These supplementsmay help to improve the effectiveness of your digestive system. Side effects ofpancreatic enzyme supplements can include diarrhoea , constipation , nausea, vomiting and stomach pains. Talk to your GP if youre experiencing troublesome side effects, as your dosage may need to be adjusted. Steroid medication If you have chronic pancreatitis caused by problems with your immune system, treatment is relatively straightforward. The inflammation affecting the pancreas can usually be relieved using steroid medication ( corticosteroids ). However, taking corticosteroids for a long time can cause side effects, such as osteoporosis and weight gain. Pain relief Pain relief is an important part of the treatment of chronic pancreatitis. At first,mildpainkillers will be used, but more powerful ones will beneededif these dont work. Mild painkillers In most cases, the first painkiller used is paracetamol or a non-steroidal anti-inflammatory drug (NSAID) , such as ibuprofen . Taking NSAIDs on a long-term basis can increase your risk of developing stomach ulcers , so you may be prescribed an additional medication called a proton pump inhibitor (PPI) to protect against this. Stronger painkillers If NSAIDs or paracetamol prove to be ineffective in controlling your pain, its likely that youll need an opiate-based painkiller, such as codeine or tramadol. Side effects of these types of medication can include constipation, nausea, vomiting and drowsiness. The side effect of constipation can be particularly troublesome if you need to take an opiate-based painkiller on a long-term basis. You may be prescribed a laxative to help relieve your constipation. See the page on treating constipation for more information. If you feel drowsy after taking an opiate-based painkiller, avoid driving and using heavy tools or machines. Severe pain If you experience an attack of very severe pain, you may need a stronger opiate-based painkiller, such as morphine or pethidine. These have similar side effects to opiate-based painkillers. Long-term use of these stronger opiate-based painkillers isnt usually recommended, because theres a high risk of addiction. Therefore, if you have persistent severe pain, surgeryis usually recommended. In some cases, an additional medication called amitriptyline may be recommended. Amitriptyline was originally designed to treat depression, but it can help to relieve pain in some people. If medication isnt effective, severe pain can sometimes be temporarily relieved fora few weeks ormonths using a procedure calleda nerve block. This is an injection that blocks the pain signals from the pancreas. Severe episodes If the inflammation of your pancreas suddenly gets worse, you may need a short stay in hospital for treatment. This may involve having fluids delivered directly into a vein, and oxygen supplied through tubes into your nose. Read more about treating acute pancreatitis . Surgery Surgery can be used to treat severe pain in people with chronic pancreatitis. Depending on the exact cause of your pain, there are a variety of surgical techniques that may be used. Endoscopic surgery Patients with stones in the opening of their pancreas (the pancreatic duct) may benefit from endoscopic surgery and a treatment called lithotripsy. Lithotripsy involves using shock waves to break the stone into smaller pieces. Anendoscope (a long, thinflexible tube with a light source and a video camera at one end) is then used to pass surgical instruments into the pancreatic duct so the pieces can be removed. This treatment may improve pain to some extent, but the benefit may not be permanent. Pancreas resection In cases where specific parts of the pancreas are inflamed and causing severe pain, these parts can be surgically removed. This type of surgery is called a pancreas resection. Pancreas resection can also be used if endoscopic treatment is ineffective. Thetechnique usedfor pancreas resection depends on exactly which parts need to be removed. For example, some techniques involve removing the gallbladder, along with parts of the pancreas. The different surgical techniques tend to have the same levels of effectiveness in terms of reducing pain and preserving the function of the pancreas, althoughsome of the more complex techniques have an increased risk of complications, such as infection and internal bleeding. Simpler procedures have a lower risk of complications and usually have faster recovery times. Discuss the pros and cons of the appropriate pancreas resection techniques with your surgical team before making a decision. Total pancreatectomy In the most serious cases of chronic pancreatitis, where the pancreas has been extensively damaged, it may be necessary to remove the entire pancreas. This is known as a total pancreatectomy. A total pancreatectomy can be very effective in treating pain. However, youll no longer be able to produce the insulin thats needed by your body. To overcome this problem, a relatively new technique called autologous pancreatic islet cell transplantation (APICT) is sometimes used. During APICT,the islet cells responsible for producing insulin are removed from your pancreas, before your pancreas is surgically removed. Theislet cells are mixed with a special solution, which is injected into your liver. If the APICT procedure is successful, the islet cells remain in your liver and begin to produce insulin. In the short term, APICT appears to be effective, but you may need additional insulin treatment in the long term. See guidelines from the National Institute for Health and Care Excellence (NICE) about autologous pancreatic islet cell transplantation for more information. Complications of chronic pancreatitis Complications of chronic pancreatitis are relatively common and usually caused by living with chronic pain or damage to the pancreas. Psychological effects of chronic pancreatitis Any chronic health condition, particularly one causing recurring or constant pain, can have an adverse effect on your emotional and psychological health.The InternationalAssociation for the Study of Painfound that up to 94% of people withchronic pancreatitis experience pain. One study ofpeople living with chronic pancreatitis found that one inseven people had some sort of psychological or emotional problem, such as stress , anxiety or depression . Contact your GP if youre experiencing psychological and emotional difficulties. Effective treatments are availableto help improve the symptoms of stress, anxiety and depression. Joining a support group for people with chronic pancreatitismay also help. Talking to other people with the same condition can often help to reduce feelings of isolation and stress. Diabetes Around a third of people with chronic pancreatitis develop diabetes , usually many years after receiving their diagnosis (its not unusual for 20 years to pass before diabetes occurs). Diabetes develops when your pancreas is no longer able to produce insulin (a chemical the body uses to break glucose down into energy). The main symptoms of diabetes are: feeling very thirsty going to the toilet a lot, particularly at night extreme tiredness weight loss and muscle wasting (loss of muscle bulk) If you develop diabetes because of chronic pancreatitis, youll probably need to have regular insulin injections to compensate for the lack of natural insulin in your body. Pseudocysts Another common complication of chronic pancreatitis is pseudocysts (sacs of fluid which develop on the surface of your pancreas). Theyre thought to affect around1 in10people with chronic pancreatitis. In many cases, pseudocysts dont cause any symptoms and are only detected during a computerised tomography (CT) scan . However, in some people, pseudocysts can cause the following symptoms: bloating indigestion dull abdominal pain If the pseudocysts are small and not causing any symptoms, there may be no need for treatment, because they usually disappear on their own. Treatment is usually recommended if youre experiencing symptoms or the pseudocysts are larger than 6cm (2.3 inches) in diameter. Larger pseudocysts are at risk of bursting open, which could cause internal bleeding or trigger an infection. Pseudocysts can be treated by draining the fluid out of the cyst. This can be done by inserting a needle through your skin and into the cyst. Alternatively, an endoscopymay be used. This is where a thin, flexible tube called an endoscope is passed down your throat, and tiny tools are used to drain away the fluid. Sometimes, pseudocysts are treated by removing part of the pancreas using laparoscopic or keyhole surgery. This is known as a laparoscopic distal pancreatectomy. See guidelines from the National Institute for Health and Care Excellence (NICE) on laparoscopic distal pancreatectomy . Pancreatic cancer Chronic pancreatitis increases your risk of developing pancreatic cancer . However, the increased risk is relatively small. For example, its estimated that for every 100 people with chronic pancreatitis, only 1or 2will develop pancreatic cancer. The most common initial symptoms of pancreatic cancer are much the same as chronic pancreatitis. Theyinclude jaundice, abdominal pain and weight loss. Source: NHS 24 - Opens in new browser window Last updated: 12 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Acute pancreatitis Other health sites NICE: Autologous pancreatic islet cell transplantation for improved glycaemic control after pancreatectomy NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Cirrhosis

Cirrhosis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Cirrhosis Cirrhosis About cirrhosis Symptoms of cirrhosis Causes of cirrhosis Diagnosing cirrhosis Treating cirrhosis Preventing cirrhosis About cirrhosis Cirrhosis is scarring of the liver caused by continuous, long-term liver damage. Scar tissue replaceshealthy tissue in the liver and prevents the liver from working properly. The damage caused by cirrhosis cant be reversed and can eventually become so extensive that your liver stops functioning. This is called liver failure. Cirrhosis can be fatal if the liver fails. However, it usuallytakesyears forthe conditionto reach this stage and treatment can help slow its progression. Each year inthe UK, around 4,000 people die from cirrhosis and 700 people with the condition need a liver transplant to survive. Signs and symptoms There are usually few symptoms in the early stages of cirrhosis. However, as your liver loses its ability to function properly, youre likely to experience a loss of appetite, nausea anditchy skin. In the later stages, symptoms can include jaundice, vomiting blood, dark, tarry-looking stools, and a build-up of fluid in the legs (oedema) and abdomen (ascites). Read more about the symptoms of cirrhosis. When to see your GP As cirrhosis doesnt have many obvious symptoms during the early stages, its often picked up during tests for an unrelated illness. See your GP if you have any of the following symptoms: fever and shivering shortness of breath vomiting blood very dark or black, tarry stools (faeces) periods of confusion or drowsiness Read more about diagnosing cirrhosis . What causes cirrhosis? Inthe UK, the most common causes of cirrhosis are: drinking too much alcohol ( alcohol misuse ) over many years beinginfected with the hepatitis C virus for a long time acondition called non-alcoholic steatohepatitis (NASH) that causes excess fat to build up in the liver NASH is on the rise in the UK, due to increasing levels of obesity and reduced physical activity. Its likely that it will overtake alcohol and hepatitis C as the most common cause of cirrhosis. Less common causes of cirrhosis include hepatitis B infection and inherited liver diseases, such as haemochromatosis. Read more about the causes of cirrhosis . Treating cirrhosis Theres currently no cure for cirrhosis.However, its possible to managethe symptomsand any complications, and slowits progression. Treating underlying conditions that may be the cause, such as using anti-viral medication to treat a hepatitis C infection, can also stop cirrhosis getting worse. You may be advised to cut down or stop drinking alcohol, or to lose weight if youre overweight.A widerange of alcohol support services are available. In its more advanced stages, the scarring caused by cirrhosis can make your liver stop functioning. In this case, a liver transplant is the only treatment option. Read more about treating cirrhosis . Preventing cirrhosis Notexceedingthe recommended limits for alcohol consumption is the best way of preventing alcohol-related cirrhosis. Hepatitis B and C are infections you can get by having unprotected sex or sharing needles to inject drugs. Using a condom during sex and not injecting drugs will reduce your risk of developing hepatitis B and C. A vaccine forhepatitis B is available, but theres currently no vaccine for hepatitis C. Read more about preventing cirrhosis . Symptoms of cirrhosis There are usually few symptoms during the early stages of cirrhosis. Noticeable problems tend to develop as the liver becomes more damaged. Inearly stage cirrhosis, the liver is able to function properly despite being damaged. As the condition progresses, symptoms tend to develop when functions of the liver are affected. Symptoms of cirrhosiscan include: tiredness and weakness loss of appetite weight loss and muscle wasting feeling sick(nausea) and vomiting tenderness or pain around the liver area tiny red lines (blood capillaries) on the skin above waist level very itchy skin yellowing of the skin and the whites of the eyes (jaundice) a tendency to bleed and bruise more easily, such as frequent nosebleeds or bleeding gums hair loss fever and shivering attacks swelling in the legs, ankles and feet due to a build-up of fluid (oedema) swelling in your abdomen (tummy), due to a build-up of fluid known as ascites (severe casescan make you look heavily pregnant) You mayalso notice changes in your personality, problems sleeping ( insomnia ), memory loss, confusion and difficulty concentrating. This is known as encephalopathy andoccurs when toxins affect your brain because your liver is unable to remove them from your body. Late-stage symptoms In the later stages of cirrhosis, you may vomit blood or have tarry, black stools. This is because blood cant flow through the liver properly, which causes an increase in blood pressure in the vein that carries blood from the gut to the liver (portal vein). The increase in blood pressure forces blood through smaller, fragile vessels that line your stomach and gullet (varices). These can burst under high blood pressure, leading to internal bleeding, which is visible in vomit and/or stools. Over time, the toxins that would normally be removed from the body by a healthy liver can cause multiple organ failure, followed by death. When toseek medical help You should see your GP if you have persistent signs and symptoms of cirrhosis. Seek immediate medical help if you develop the following symptoms, particularly if youve been previously diagnosed with cirrhosis: fever and shivering attacks shortness of breath vomiting blood very dark or black tarry stools periods of mental confusion or drowsiness Causes of cirrhosis There are many different causes of cirrhosis. In the UK, the most common causes are drinking excessive amounts of alcohol and long-term hepatitis C infections. Insome cases, no specific cause is identified. Alcohol consumption The liver breaks down toxins (poisons), such as alcohol, but too much alcohol can scar and damage the livers cells. Men and women who drink more than 14units of alcohol a week are considered to be drinking too much. If youre a heavy drinker, your chances of developing cirrhosis are increased. However, its important to realise that cirrhosis of the liver isnt just a condition that affects people dependent on alcohol. If youre a heavy social drinker, you can also develop cirrhosis. Alcohol-related cirrhosis usually develops after 10 or more years of heavy drinking. For unknown reasons, some people are more susceptible to liver cell damage than others. Women who drink heavily are more susceptible to liver damage than men, partly because of their different body size and build. Stages of alcoholic liver damage People who drink excessively and continue to drink heavily develop cirrhosis in 3separate stages. The first stage of alcohol-related liver disease is known as fatty liver, which almost all excessive drinkers develop. Its a side effect of the liver breaking alcohol down and disappears when you drink less. The second stage of alcohol-related liver disease is alcoholic hepatitis. Around 20% to 30% of people who continue to drink heavily develop alcoholic hepatitis. During this stage, the liver becomes inflamed. If alcoholic hepatitis deteriorates into its most extreme form (liver failure) it can lead to death. About 10% of heavy drinkersdevelop cirrhosis, which is the third stage of alcohol-related liver disease. This risk of developing cirrhosis, along with the risk of alcoholic hepatitis, is one of the main reasons the government recommends that men and women should not regularly drink more than 14 units a week. If you do drink as much as 14 units a week, it is advised that you spread your drinking over 3 or more days. A unit of alcohol is roughly equivalent to half a pint of normal-strength lager or a single measure (25ml) of spirits. A small glass of wine (125ml) is about 1.5 units. Read more about alcohol units . Your GP can give you help and advice if youre finding it difficult to cut down the amount you drink. Hepatitis Hepatitisisinflammationof the liver. Left untreated, it can damage the liver over many years, eventually resulting in cirrhosis. Inthe UK, hepatitis C isthe most common form of hepatitis. The hepatitis Cvirusis usually transmitted through blood-to-blood contact,most commonly by sharing needles used to inject drugs. Two other types of hepatitis infection, hepatitis B and D, can also cause cirrhosis. Non-alcoholic steatohepatitis Non-alcoholic steatohepatitis (NASH) is a severe liver condition that can lead to cirrhosis. As with alcohol-related liver disease, the early stage of NASH is the build-up of excess fat in the liver. This fat is associated with inflammation and scarring, which could lead to cirrhosis. NASH can develop in peoplewho areobese, have diabetes , havehigh levels of fat in the blood ( high cholesterol ) and high blood pressure . Most people with NASH feel well and arent awarethey have a problem until cirrhosis occurs and liver function is affected. NASH is on the rise in the UK due to increasing levels of obesity and reduced physical activity. Its likely that it will overtake alcohol and hepatitis C as the most common cause of cirrhosis. Other causes There are a number of other conditions that can prevent the liver functioning healthily and can lead to cirrhosis. These include: autoimmuneliver disease the immune system usually makes antibodies to attack bacteria and viruses; however, if you have an autoimmune disease, such as autoimmune hepatitis, primary biliary cirrhosis or primary sclerosing cholangitis (PSC),your immune system will make antibodies that attack healthy organs some rare, genetic conditions such as haemochromatosis (a build-up of iron in the liver and other parts of the body) and Wilsons disease (a build-up of copper in the liver and other parts of the body) any condition that causes the bile ducts to become blocked such as cancer of the bile ducts or pancreatic cancer Budd-Chiari syndrome caused by blood clots blocking the veins that carry blood from the liver Less commonly, the use of certain medications, such as amiodarone and methotrexate, can also cause cirrhosis. Diagnosing cirrhosis If your GP suspects cirrhosis, theyll check your medical history and carry out a physical examination to look for signs of chronic liver disease. If your GP suspects your liver is damaged, youll be referred for tests to confirm the diagnosis. Tests You may have a number of different tests. Blood tests Blood tests can measure your liver function and the amount of liver damage. A blood test may be used to measure the levels of the liver enzymes alanine transaminase (ALT) and aspartate transferase (AST) in your blood, as these will be raised if you have inflammation of the liver (hepatitis). Scans An ultrasound scan ,transient elastography scan, computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan may be carried out on your liver. Atransient elastography scan is similar to an ultrasound scan carried out during pregnancy (its sometimes known as a Fibroscan). These scans can produce detailed images of your liver or check liver stiffness to identify any scarring. The Lab Tests Online UK website hasmore information about ALT and AST measurements. Liverbiopsy A liver biopsy is where afine needle is inserted into your body (usually between your ribs) to removea small sample of liver cells. The sample is sent to a laboratory so it can be examined under a microscope. The biopsy is usually carried out under local anaesthetic , as a day case or with an overnight stay in hospital. The outcome of the biopsy will confirm a diagnosis of cirrhosis and may provide more information about the cause.However, transient elastography is increasingly being used as an alternative to a biopsy in the diagnosis of cirrhosis. Endoscopy Anendoscopy is where an endoscope (a thin, long, flexible tube with a light and video camera at the end) is passed down your throat and into your stomach. Images of your oesophagus (tube from your throat to your stomach) and stomach are transmitted to an external screen where any varices (swollen vessels),which are a sign of cirrhosis, can be seen. Grading There are several different grading systems for cirrhosis according to how serious it is. One system is theChild-Pugh score which, based on your examination and laboratory tests, grades cirrhosis from A (relatively mild) to C (severe). An alternativesystem calledmodel of end-stage liver disease (MELD) uses the results of a blood test to help identifypeople who need an urgent liver transplant. Treating cirrhosis Cirrhosis cant be cured, so treatment aims to manage the symptoms and any complications and stop the condition getting worse. Its usually not possible to reverseliver damage thats already occurred, although recent research suggests this may eventually be possible in cases where the underlying cause of the liver damage can be successfully treated. Treatment is likely to take place at a hospital with a specialist hepatology unit, which treats disorders of the liver, gall bladder and biliary ducts. Stoppingcirrhosis getting worse Taking medication to treatthe underlying cause of the liver damageand making healthy lifestyle changes can help stop cirrhosis getting worse and reduce your risk of developing further health problems. Medication The medication you need will depend on the specific cause of the damage to your liver. For example, if you have viralhepatitis you may be prescribed anti-viral medications. If you have autoimmune hepatitis you may be given steroid medication ( corticosteroids ) or medication to suppress your immune system (immunosuppressants). Lifestyle changes There are a number of things you can do to help yourself stay healthy and reduce your chances of developing further problems if you have cirrhosis, including: completely avoid alcohol , regardless of the cause of your cirrhosis, asalcohol consumption increases the rate at which the condition progresses lose weight if youre overweight or obese regular exercise toreduce muscle wasting practisegood hygiene to reduce your chances of developing infections speak to your GP about vaccinations you may need, such as the annual flu vaccine ortravel vaccines speak to your GP or pharmacist ifyoure taking over-the-counter or prescription medications, as cirrhosis can affect the way your body processes some medicines Malnutrition is common in people with cirrhosis, so its important to ensure you have a balanced diet to help you get all the nutrients you need. Avoiding salty foods andnot adding salt to foods you eat can helpreduce your risk of developing swelling in yourlegs, feet and abdomen (tummy) caused by a build up of fluid. Seetips for a lower salt diet for more information. The damage to your liver can alsomean itsunable to store glycogen,a carbohydrate that provides short-term energy. When this happens, the body uses its own muscle tissue to provide energy between meals, which leads to muscle wasting and weakness. Therefore, youmay need extra calories and protein in your diet. Healthy snacking between meals can top up your calories and protein.It may also be helpful to eat 3or 4small meals a day, rather than 1or 2large meals. Easing symptoms A number of treatments can ease the symptoms of cirrhosis, including: a low-sodium (salt) diet ortablets called diureticsto reduce the amount of fluid in your body tablets to reduce high blood pressure in your portal vein (the main vein that transports blood from the gut to the liver) and prevent or treat any infection creams to reduce itching Managing complications of advanced cirrhosis In cases of advanced cirrhosis, complications caused by the condition mayneed treatment. Swollen varices If you vomit blood or pass blood in your stools, you probably have swollen veins in your oesophagus (the long tube that carries food from the throat to the stomach). These are known as oesophageal varices. In these cases,urgent medical attention is required. This means seeing your GP or going to theaccident and emergency (A&E) department of your nearest hospital immediately. Certain procedures can help stop the bleeding and reduce the risk of it happening again, such as: banding anendoscopy is carried out (a thin, flexible tube is passed down your throat) and a small band is placed around the base of the varices to help control the bleeding injection glue therapy following an endoscopy, a type of medical super glue is injected into the varices to make the blood clot, which helps to stop the bleeding a Sengstaken tube with a balloon on the end a specialtube is passed down your throat into your stomach and the balloon is inflated; thisputs pressure on the varices and helps stop the bleeding and youll be heavily sedated during the procedure a transjugular intrahepatic portosystemic stent shunt (TIPSS) a metal tube called a stent is passed across your liver to join 2 large veins (the portal vein and hepatic vein); this creates a new route for your blood to flow through, therefore relieving the pressure that causes the varices You may also be given a type of medication called a beta-blocker , such as propanolol, to reduce the risk of bleeding or reduce the severity of any bleed thatdoes occur. Fluid in thetummy and legs Ascites (a build-up of fluid around your stomach area) and peripheral oedema (fluid around your legs and ankles) are common complications of advanced cirrhosis. Theyll need to be addressed as soon as possible. You may have 20 to 30 litres of free water in your stomach area (abdomen), which can make it difficult for you to eat and breathe properly. The main treatments for ascites and oedema are restricting sodium (salt) in your diet and taking diuretic tablets, such as spironolactone or furosemide. If thefluid around your stomach becomes infected, you may need to be treated with antibiotics . Alternatively, antibiotics may be used on a regular basisto prevent infection in people at high risk. In severe cases of ascites, tubes may be used to drain the fluid from your abdomen. This will usually be repeated every few weeks. Encephalopathy People with cirrhosis can sometimes develop problems with their brain function (encephalopathy). This occurs because the liver isnt clearing toxins properly. The main treatment for encephalopathy is lactulose syrup. This acts as a laxative (it helps clear the bowels) and helps the body remove the toxins that build up in the body when the liver is failing. In some cases, other laxatives or an enema may be used. Bleeding Cirrhosis can affect the livers ability to make the blood clot (thicken), leaving you at risk of severe bleeding if you cut yourself. Vitamin K and a blood product called plasma can be given in emergencies to treat episodes of bleeding. Youll need to apply pressure to any cuts that bleed. Therefore,you should seek specialist advice before having medical procedures, including any dental work. Liver transplant Your liver may stop functioning if its severely damaged by scarring. In this situation, a liver transplant is the only option. This is a major procedure that involves removing your diseased liver and replacing it with a healthy donor liver. However, youll probably have to wait a long time for a liver transplant because there are more people waiting for a transplant than there are donors. The NHSBT Organ Donation website has more information about transplants and joining the Organ Donor Register . Preventing cirrhosis You can reduce your chances of developing cirrhosis by limiting your alcohol consumption and protecting yourself from a hepatitis infection. Limiting your alcohol consumption Heavy alcohol consumption is one of the most common causes of cirrhosis of the liver.One of the best ways to avoid thisis to keep withinrecommended limits. men and women are advised not to regularly drink more than 14 units a week spread your drinking over 3days or more if you drink as much as 14 units a week If you have cirrhosis, you should stop drinking alcohol immediately because it speeds up the rate at which the condition progresses, regardless of the cause. Read more about alcohol misuse . Protect yourself from hepatitis Cirrhosis can be caused by infectious conditions, such as hepatitis B and C. Hepatitis B and C can be caught through having unprotected sex or by sharing needles to inject drugs. Using a condom when having sex will help you avoid the risk of getting hepatitis, as will avoiding injecting drugs. Anyone whos at risk of getting hepatitis B, such as police officers and social care workers, can be protected by being vaccinated against the condition. However, theres currently no vaccine for hepatitis C . People born in areas of the world where hepatitis B and C are widespread, such as parts of South Asia and Africa, need to be screened for hepatitis, as early treatment can help prevent the onset of cirrhosis. Source: NHS 24 - Opens in new browser window Last updated: 12 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Other health sites Lab Tests Online UK: bilirubin Adfam: support for families British Liver Trust British Liver Trust: hepatitis C PBC Foundation: primary biliary cholangitis Hepatitis C Trust NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Clostridium difficile

Clostridium difficile | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Clostridium difficile Clostridium difficile Clostridium difficile, also known as C. difficile or C. diff, is a bacterium that can infect the bowel and cause diarrhoea. The infection most commonly affects people who have recently been treated with antibiotics , but can spread easily to others. C. difficileinfections are unpleasant and can sometimescauseserious bowel problems, butthey can usually be treated with another course of antibiotics. Symptoms of a C. difficile infection Symptoms of a C. difficileinfection usually develop when youre taking antibiotics, or when youve finished taking them within the last few weeks. The most common symptoms are: watery diarrhoea , which can be bloody painful tummy cramps feeling sick signs of dehydration , such asa dry mouth , headaches and peeing less often than normal a high temperature (fever) of above 38C (100.4F) loss of appetite and weight loss Insome cases, serious complications can develop, such as damage to the bowel or severe dehydration, which may causedrowsiness, confusion, a rapid heart rate and fainting. Whos most at risk of C. difficile? C. difficile mostly affects people who: have been treated with broad-spectrum antibiotics (antibiotics that work againstseveral types of bacteria) or several different antibiotics at the same time, or thosetakinglong-term antibiotics have had to stayin a healthcare setting, such as a hospital or care home, for a long time are over 65 years old havecertain underlyingconditions, including inflammatory bowel disease (IBD), cancer or kidney disease have a weakened immune system, which can be because of a condition such as diabetes or a side effect of a treatment such as chemotherapy or steroid medication are takinga medication called a proton pump inhibitor (PPI) to reduce the amount of stomach acid they produce have had surgery on their digestive system Many C. difficile infections used to occur in places where many people take antibiotics and are in close contact with each other, such as hospitals andcare homes. However, strict infection control measures have helped to reduce this risk, and an increasingnumber of C. difficile infections now occur outside these settings. When to get medical advice Visiting your GP surgery with a possible C. difficile infectioncan put others at risk, so its best to phone your GP or NHS 111 if youre concerned or feel you need advice. Phone your GP if: you have persistent diarrhoea after finishinga course ofantibiotics you have bloody diarrhoea you have diarrhoea andexperiencesevere tummy pain,a high fever, a rapid heart rate or fainting you have symptoms of severe dehydration , such as confusion, drowsiness, only passing small amounts of urine or no urine at all If your GP is closed, phone 111. Diarrhoea can be caused by a number of conditions and isa common side effect of antibiotics, so having diarrhoea while taking antibiotics doesnt necessarily mean you have aC. difficile infection. Your GP may suggest sending off a sample of yourpoo to confirm whether you have C. difficile. A blood test may also be carried out to help determine how severe the infection is, and sometimes you may need tests or scans in hospital to check if your bowel is damaged. Treatment for C. difficile Your GP will decide whether you need hospital treatment (if youre not already in hospital). Ifthe infection isrelatively mild, you may be treated at home. If youre in hospital, youmight be moved to a room of your own during treatment to reduce the risk of the infection spreading to others. Treatment for C. difficile can include: stoppingthe antibiotics thought to be causing the infection, if possible in mild cases, this may be the only treatment thats needed taking a 10 to 14-day course of antibiotics that are known to kill C. difficile bacteria rarely,seriousinfections mayrequiresurgery to remove a damaged section of the bowel C. difficile infectionsusually respond well to treatment, with most people making a full recovery in a week or two. However, the symptoms come back in around 1 in 5 cases and treatment may need to be repeated. Looking after yourself at home If youre well enough to be treated at home, the following measures can helprelieve your symptoms and prevent the infection spreading. Do make sure you finish the entire course of any antibiotics youre prescribed, even if youre feeling better drink plenty of fluids to avoid dehydration and eat plain foods such as soup, rice, pasta and bread if you feel hungry take paracetamol for tummy pain or a fever regularly wash your hands and contaminated surfaces, objects or sheets stay at home until at least 48 hours after your last episode of diarrhoea Dont do not take anti-diarrhoeal medication, as this can stop the infection being cleared from your body Your GP may contact you regularly to make sure youre getting better. Phone them if your symptoms return after treatment finishes, as it may need to be repeated. How you get C. difficile C. difficile bacteria are found in thedigestive systemof about 1 in every 30 healthy adults. The bacteriaoften live harmlessly because the other bacteria normally found in the bowel keep it under control. However, some antibiotics can interfere with the balance of bacteria inthe bowel, whichcan cause the C. difficile bacteria to multiplyand produce toxins that make the person ill. When this happens, C. difficile can spread easily to other people because the bacteria are passed out of the body in the persons diarrhoea. Once out of the body, the bacteria turn into resistant cells called spores. These can survive for long periods on hands, surfaces (such as toilets), objects and clothing unless theyre thoroughly cleaned, and can infect someone else if they get into their mouth. Someone with a C. difficile infection is generally considered to be infectious until at least 48 hours after their symptoms have cleared up. How to stop C. difficile spreading C.difficileinfections canbe passed onvery easily. You can reduce your risk of picking it up or spreading it by practising good hygiene, both at homeand in healthcare settings. The following measures can help: stay at home until at least 48 hours after your symptoms have cleared up wash your hands regularly with soap and water, particularly after going to the toiletand before eating use liquid rather than bar soap and dont use flannels or nail brushes clean contaminated surfacessuch as the toilet, flush handle, light switches and door handleswith a bleach-based cleaner after each use dont share towels and flannels wash contaminated clothes and sheets separately from other washing at the highest possible temperature when visiting someone in hospital,observe anyvisiting guidelines, avoid taking any children under the age of 12, and wash your hands with liquid soap and water when entering and leaving ward areas dont rely on alcohol hand gels, as theyre not effective against C. difficile avoid visiting hospitalif youre feeling unwell or have recently had diarrhoea Source: NHS 24 - Opens in new browser window Last updated: 29 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Antibiotics Preparing and cooking food safely Other health sites Lab Tests Online UK: C. difficile test Food Standards Scotland: Food safety and hygeine NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Coeliac disease

Coeliac disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Coeliac disease Coeliac disease Coeliac disease About coeliac disease Symptoms of coeliac disease Causes of coeliac disease Diagnosing coeliac disease Treating coeliac disease Complications of coeliac disease About coeliac disease Coeliac disease is a common autoimmune condition where the immune system in a persons intestine (gut) reacts when they eat gluten. This causes chronic inflammation. What is gluten? Gluten is a protein found in wheat, barley and rye. Gluten is found in food and drink that contains wheat, barley and rye, such as: most types of bread pasta cakes biscuits crackers many breakfast cereals pastry certain types of sauces some types of ready meals most beers and lagers certain fruit squashes How many people have coeliac disease? Coeliac disease affects 1 person in every 100. Only about one third of them are ever diagnosed. Coeliac disease can be diagnosed at any age. Reported cases of coeliac disease are twice as high in women than men. Symptoms Coeliac disease can cause a wide range of symptoms in the digestive system and rest of the body. Symptoms can develop at any age, but coeliac disease is most commonly diagnosed between the ages of 40 and 60 years. More about the symptoms of coeliac disease or what is coeliac disease? Causes Coeliac disease is more common in people with certain conditions and in relatives of people with coeliac disease. Its unknown exactly why people develop the condition. More about the causes of coeliac disease Diagnosis Most people with coeliac disease have antibodies in their blood. The first stage in diagnosis is a simple blood test. The second stage might result in a biopsy, if necessary. More about how coeliac disease is diagnosed Treatment Coeliac disease can be effectively treated with a gluten-free diet. By adopting a gluten-free diet and lifestyle, you can manage your condition and improve your quality of life. More about how coeliac disease is treated Complications If coeliac disease isnt treated, youre at greater risk of conditions like osteoporosis and cancer in later life. More about the complications of coeliac disease Living well with coeliac disease Living with coeliac disease can be challenging but with the right support and information, its completely manageable. Symptoms of coeliac disease Symptoms of coeliac disease vary from person to person and can range from mild to severe. Some people may have no symptoms at all. Sometimes the symptoms of coeliac disease are mistaken for: irritable bowel syndrome (IBS) wheat intolerance stress just getting older Common symptoms Some common symptoms of coeliac disease include: severe diarrhoea, excessive wind and/or constipation persistent or unexplained gastrointestinal symptoms, such as nausea and vomiting recurrent stomach pain, cramping or bloating iron, vitamin B12 or folic acid deficiency anaemia tiredness sudden or unexpected weight loss (but not in all cases) mouth ulcers skin rash ( dermatitis herpetiformis ) depression repeated miscarriages neurological (nerve) problems such as ataxia (loss of coordination, poor balance) and peripheral neuropathy (numbness and tingling in the hands and feet) If youve any of these symptoms, speak to your GP. You must continue eating gluten as part of your diet until youve been diagnosed. You can also take Coeliac UKs online assessment . Symptoms in children Children with coeliac disease might also not grow at the expected rate, or be late to reach puberty. Causes of coeliac disease Its not known exactly why people develop coeliac disease or why some have mild symptoms while others have severe symptoms. It could be that a persons genetics and the environment play a part in why this condition develops. Pre-exisiting conditions Coeliac disease is more common in people with certain conditions such as type 1 diabetes, Downs syndrome or autoimmune thyroid disease. Also, in close family members (parents or siblings) of people with coeliac disease. Genetics Coeliac disease often runs in families. If youve a close relative with the condition such as a parent or sibling your chance of developing it is higher. This risk is approximately 10% for those with a family history, compared with 1% for someone without a close relative with the condition. If you have a close relative with coeliac disease and you have symptoms you should speak to your GP. If youve an identical twin with coeliac disease, theres an 85% chance youll also develop the condition. Diagnosing coeliac disease Coeliac disease can be diagnosed at any age, and both children and adults can show symptoms Delayed diagnosis is common. It can take an average of 13 years to diagnose. Blood tests Most people with coeliac disease have antibodies that show up in their blood. The first stage in diagnosis can be a blood test. Wholl have a blood test A blood test should be offered if youve any of the following: type 1 diabetes autoimmune thyroid disease dermatitis herpetiformis irritable bowel syndrome (IBS) anaemia without an obvious cause certain symptoms related to your digestive system such as frequent diarrhoea, abdominal pain or vomiting, nausea or sudden weight loss close relatives (parents, siblings or children) with coeliac disease A blood test might also be offered if: you feel tired all the time a child is not growing as fast as expected youve other symptoms or conditions that sometimes occur in people with coeliac disease such as mouth ulcers, particular types of problems with your bones or liver, Downs syndrome, Turner syndrome or persistent constipation Blood tests for coeliac disease are not recommended for infants whove not started to eat foods containing gluten. Before a blood test Before a blood test is taken, its important that you eat gluten-containing foods in more than one meal every day for at least 6 weeks before the test. Remember to eat a normal gluten diet for 6 weeks before any tests. This means eating more than one meal a day that includes gluten-based foods. Whats involved in a blood test? A blood test for coeliac disease involves taking a blood sample and testing it for antibodies in the blood. You must have been eating gluten-containing food in more than 1 meal for at least 6 weeks before the test, for it to be successful. Blood tests are 95% accurate at diagnosing coeliac disease. Positive result If the coeliac antibodies are found in your blood, further investigation will be needed. Thisll be discussed with you. Your GP will refer you to your local coeliac service for confirmation of the diagnosis. You should remain on a normal diet until all investigations are complete. Negative result Its sometimes possible to have coeliac disease and not have antibodies in your blood. If you continue to have coeliac disease-like symptoms your GP may still refer you for a biopsy of your gut. Biopsy A biopsy can help confirm a diagnosis of coeliac disease. If youre referred for a biopsy, this will be carried out in hospital. Usually, a biopsy will be done by a gastroenterologist. This is a doctor who specialises in treating conditions of the stomach and intestines. Whats involved in a biopsy? If you need to have a biopsy, a thin flexible tube with a light called an endoscope will be inserted into your mouth or nose and passed down to your small intestine. Before the procedure, a local anaesthetic is given to numb the throat and/or a sedative to help you relax. During the procedure, the endoscopist will pass a tiny biopsy tool through the endoscope to take samples of the lining of your small intestine. The sample will then be examined under a microscope for signs of coeliac disease. For those under 16 years the endoscopy would be under an anaesthetic. Diet before and after testing You should continue to eat gluten-containing foods every day until a diagnosis has been confirmed. A biopsy will only show coeliac disease if the person being tested has been eating gluten-containing foods regularly. Only after coeliac disease is confirmed can you start a gluten-free diet. If youre already on a gluten-free diet and find it hard to eat gluten again, your GP should refer you to a specialist. You may not be able to get gluten-free foods on prescription if you do not have coeliac disease confirmed by a biopsy. Read further information: Diet advice when being tested for Coeliac Disease NICE guidelines coeliac disease recognition, assessment and management BSG guidelines on the diagnosis and management of adult coeliac disease Lynseys diagnosis story Tests after diagnosis If youve been diagnosed with coeliac disease, you may also have other tests to assess how the condition has affected you so far. Additional blood tests You may have further blood tests to check levels of iron and other vitamins and minerals in your blood. Thisll help check for anaemia . Dual energy X-ray (DEXA) scan (adults only) In coeliac disease, a lack of nutrients caused by poor absorption can make bones weak and brittle (osteoporosis). A DEXA scan is a type of very low dose X-ray that measures bone density. This may be required if your risk score (FRAX/Qfracture) is high. This will be calculated as part of your assessment. Over-the-counter tests You can buy over-the-counter tests for coeliac disease at pharmacies. There isnt enough evidence that these tests are reliable. If youve used one, its important that you talk to your GP about the result. Before a diagnosis can be confirmed, youll still need to have a blood test and biopsy. Treating coeliac disease The only treatment for confirmed coeliac disease is a lifelong gluten-free diet. How does a gluten-free diet help? Following a gluten-free diet helps prevent gluten damaging the lining of the intestines (gut). This will improve or remove the symptoms. A gluten-free diet will also help to prevent the complications later in life. What if I continue to eat gluten? If youre diagnosed with coeliac disease and continue to eat foods that contain gluten, your symptoms will return and could cause long-term damage to your health. Gluten-free food on prescription If youve a confirmed diagnosis of coeliac disease or dermatitis herpetiformis, you can access gluten-free foods on prescription through your GP or Scottish Gluten-free Food Service. How to register with the Scottish Gluten-free Food Service\u200b How long does treatment take to work? Symptoms should improve within weeks of starting a gluten-free diet. However, it may take up to 2 years for the digestive system to heal completely. Dietary advice After a confirmed diagnosis of coeliac disease, youll be seen by a dietitianfor help with adjusting to your new gluten-free diet and lifestyle. The dietitian will help by: making sure the diet is balanced and contains all the nutrients you need advising how to adjust your diet and lifestyle to ensure its gluten-free The dietitian should provide you with: guidance on gluten-free food alternatives information on shopping, preparing, cooking and storing gluten-free foods information about gluten-free prescriptions and the Scottish Gluten-free Food Service details of local and national support groups More about a dietitians perspective Dietary supplements As well as adopting a gluten-free diet and lifestyle, your GP or dietitian might also recommend that you take vitamin and mineral supplements for at least the first 6 months after diagnosis. This will ensure that the you get all the nutrients you need while your digestive system repairs itself. Taking supplements can also help correct any deficiencies, such as anaemia (a lack of iron in the blood). Feeding your baby If youve coeliac disease, you shouldnt introduce gluten into your babys diet before its 6 months old. Breast milk is naturally gluten-free and all infant milk formulas are too. Foods with gluten should be introduced slowly when a child is around 6 months old. The situation should be carefully monitored. Vaccinations If you have coeliac disease, you should get vaccinations for: pneumococcus flu (annually) You should discuss this with your GP or specialist before having any vaccinations. Annual health checks After starting treatment, youll need to have an annual coeliac disease health check to monitor your condition. This will be done by your GP, a dietitian or a pharmacist. At this health check, theyll ask you: about your health in relation to coeliac disease how youre managing your gluten-free diet Youll also be given the chance to discuss any concerns. Living with coeliac disease can be challenging but with the right support and information, its completely manageable. More about living well with coeliac disease Complications of coeliac disease Complications of coeliac disease only tend to affect people that continue to eat gluten, or in people that have taken a long time to diagnose. Possible complications of coeliac disease include: lactose intolerance nutritional deficiencies osteoporosis cancer Lactose intolerance If youve coeliac disease, you may also develop lactose intolerance because the body lacks the enzyme to digest milk sugar (lactose) found in dairy products. Lactose intolerance is only temporary. It normally disappears when you follow a gluten-free diet. More about lactose intolerance Nutritional deficiencies Severe symptoms of coeliac disease can lead to malnutrition. However, this is rare. More common is malabsorption where your body fails to absorb nutrients from the foods you eat. This can lead to anaemia if the body doesnt take in enough iron, and osteoporosis if theres not enough calcium and vitamin D being taken in. More about nutritional deficiencies Osteoporosis Osteoporosis causes the bones to become brittle, weak and fracture more easily. Bones need a wide variety of vitamins and minerals to stay dense and strong. If youve coeliac disease, youve an increased risk of developing osteoporosis due to the damaged gut failing to absorb key bone nutrients from food. This decreases blood vitamin and mineral levels and the body compensates for this by taking nutrients like calcium from the bones. This weakens your bones and puts you at increased risk of fracture. If you have coeliac disease, you should make sure youre eating enough calcium and take vitamin D supplements. Read further information: NHS inform: Vitamin D NHS inform: osteoporosis Cancer Having undiagnosed or untreated coeliac disease can increase your risk of developing lymphoma and some types of bowel cancer but these are rare. Risks are reduced by following a gluten-free diet. Less common complications Less common complications of coeliac disease include low birth weight in newborn babies and in rare cases, hyposplenia. Source: Scottish Government - Opens in new browser window Last updated: 12 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Living well with coeliac disease Gluten-free diet Gluten-free Food Service Other health sites Coeliac UK NICE: Coeliac disease NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Cold sore

Cold sore | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mouth Cold sore Cold sore About cold sores Symptoms of cold sores Causes of cold sores Treating cold sores About cold sores Cold sores are small blisters that develop on the lips or around the mouth. Theyre caused by the herpes simplex virus and usually clear up without treatment within 7 to 10 days. Youmay nothave any symptoms when you first become infected with the herpes simplex virus. An outbreak of cold sores mayhappen some time later. Cold sores often start with a tingling, itching or burning sensation around your mouth. Small fluid-filled sores then appear, usually on the edges of your lower lip. Read more about the symptoms of cold sores . When toget professional advice Pharmacy First Scotland: Cold sore treatment from your pharmacy If you have cold sores you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotlands Service Directory. Search for a pharmacy near you Cold sores arent usually serious and can be treated by a pharmacist. Your pharmacist may recommend that you contact your GP practice if required. If youve had outbreaks of cold sores before, its likely that youll know what they are if they return. You only need to visit your pharmacist if youre unsure whether its a cold sore or if its severe and spreading further than just the lip. See your pharmacistifa cold sore hasnt healed after 7 to 10 days. What causes cold sores? The strain of herpes simplex virus usually responsible for cold sores is known as HSV-1. In rare cases,cold sorescan also be caused by the herpes simplex virus type 2 (HSV-2). This canbe the result of having oral sex with someone who has genital herpes . Read more about the causes of cold sores . Herpes simplex virus The herpes simplex virusor cold sore virusis highly contagious and can be easily passed from person to person by close direct contact. After someone has contracted the virus, it remains inactive (dormant) most of the time. However, every so often the virus can be activated by certain triggers, resulting in an outbreak of cold sores. These triggers vary from person to person, but can include sunlight,fatigue, an injury to the affected area, and, in women, their period. Some people have frequently recurring cold sores around two or three times a year, while others have one cold sore and never have another. Some people never get cold sores at all because the virus never becomes active. Treating cold sores Cold sores usually clear up by themselves without treatment within 7 to 10 days. However, antiviral creams are available over the counter from pharmacies without a prescription. If used correctly, these can help ease your symptoms and speed up the healing time. To be effective, these treatmentsshould be applied as soon as the first signs of a cold sore appear when youfeela tingling, itching or burning sensation around your mouth. Using an antiviral cream after this initial period is unlikely to have much of an effect. Cold sore patches are also available that contain hydrocolloid gel, which is an effective treatment for skin wounds. The patch is placed over the cold sore while it heals. Antiviral tablets may be prescribed for severe cases. Read more about treating cold sores . Complications of cold sores Cold sores are usually mild, but may cause complications in rare cases. People with weak immune systems caused by illness or treatments such as chemotherapy are particularly at risk of complications. Dehydration sometimes occurs if drinking fluids becomes painful. Young children are particularly at risk of becoming dehydrated. The herpes simplex virus can also spread to other parts of your body. Examples of when this can occur include: skin infections these oftenoccur if the virus comes into contact with broken skin, such as a cut or graze , ora skin condition such as eczema herpetic whitlow (whitlow finger) thiscausespainful sores and blisters to appear on and around your fingers herpetic keratoconjunctivitis this causes swelling and irritation (inflammation) of your eye area and sores to develop on your eyelids Left untreated, herpetic keratoconjunctivitis can cause the cornea, the transparent layer at the front of your eye, to become infected, which can eventually lead to blindness. Its therefore important not to touch your eyes if you have an unhealed cold sore. If you must touch your eyes for example, to remove contact lenses wash your hands thoroughly first. In very rare cases,encephalitis, a condition where the brain becomes inflamed and swollen, can be caused by the cold sore virus spreading to the brain. It can be treated with intravenous injections of antiviral medications, such asaciclovir. Preventing infection Its not possible to prevent infection with the herpes simplex virus or prevent outbreaks of cold sores, but you can take steps to minimise the spread of infection. Cold sores are at their most contagious when they burst (rupture), but remain contagious until theyre completely healed. Avoid close contact with others until your cold sore has completely healed and disappeared. However, theres no need to stay away from work or miss schoolif you or your child have a cold sore. You can help minimise the risk of the cold sore virus spreading and cold sores recurring by following the advice below: avoid touching cold sores unless youre applying cold sore cream creams should be dabbed on gently rather than rubbed in,as this can damage your skin further always wash your hands before and after applying cold sore cream and after touching the affected area do not share cold sore creams or medication with other peopleas this can cause the infection to spread do not share items that come into contact with the affected area, such as lipsticks or cutlery avoid kissing and oral sex until your cold sores have completely healed be particularly careful around newborn babies, pregnant women and people with a low immune system, such as those with HIV or those having chemotherapy if you know what usually triggers your cold sores, try to avoid the triggers for example, a sun block lip balm (SPF 15 or higher) may help prevent cold sores triggered by bright sunlight Symptoms of cold sores You wont usually have any symptoms when you first become infected with the herpes simplex virus (the primary infection). An outbreak of cold sores may occur some time later and keep coming back (recurrent infection). However, if the primary infection does cause symptoms, they can be quite severe. Herpes simplex virus primary infection In children Symptoms of the primary infection are most likely to develop in children younger than 5 years old. Symptoms include: swollen and irritated gums with small, painful sores in and around the mouth this is known as herpes simplex gingivostomatitis sore throat and swollen glands producing more saliva than normal high temperature (fever) of 38C (100.4F) or above dehydration feeling sick (nausea) headaches Herpes simplex gingivostomatitis usually affects young children, but adults can alsodevelop it. It can last 7 to 14 days, with the sores taking up to 3 weeks to heal. However, gingivostomatitis doesnt usually recur after the primary infection. In adults Primary herpes simplex viruses are rare in adults, but the symptoms are similar to those experienced by children. Youll usually have a sore throat with or without swollen glands. You may also havebad breath (halitosis) and painful sores in and around your mouth. These can develop into ulcers with grey or yellow centres. If you develop the herpes simplex virus at an early age, it may be triggered periodically in later life and can cause recurring bouts of cold sores. After the primary infection, the symptoms are usually reduced to just the cold sores themselves. Recurrent infections (cold sores) Recurrent infections usually last for less time and areless severe than the primary infection. The only symptom is an outbreak of cold sores, although you may also have swollen glands. An outbreak of cold sores usually starts with a tingling, itching or burning sensation around your mouth. Small fluid-filled sores then develop, usually on the edges of your lower lip. If you have frequent recurrent infections, you may develop cold sores in the same place every time. They may grow in size and cause irritation and pain. Initially, they may ooze before crusting or scabbing over within 48 hours of the initial tingling sensation. If the cold sores are very troublesome, its possible to suppress them by taking an antiviral tablet called acyclovir regularly, every day for a few months. This is usually only recommended if cold sores are causing a lot of problems, and they may come back when treatment is stopped. Most cold sores disappear within 7 to 10 days without treatment and usually heal without scarring. Causes of cold sores Cold sores are usually caused by the herpes simplex virus type 1 (HSV-1). In most cases the virus is passed on in early childhoodfor example, when a child is kissed by a family member or friend with a cold sore. The virus passes through the skin and travels up the nerves, where it lies inactive (dormant) until its triggered at a later date. Cold sore triggers Factors thought to trigger outbreaks of cold sores include: having another infection, such as arespiratory tract infection having a high temperature (fever) emotional upset or psychological stress tiredness and fatigue an injury to the affected area menstruation (periods) strong sunlight However, in many cases theres no obvious trigger for an outbreak. Herpes simplex virus type 2 Occasionally, cold sores can be caused by the herpes simplex virus type 2 (HSV-2). This can happen after having oral sex with a man or woman who has genital herpes , which is usually caused by HSV-2. In genital herpes, painful blisters develop on your genitals and the surrounding area. Treating cold sores Cold sores usually clear up without treatment within 7 to 10 days. Antiviral tablets or cream can be used to ease your symptoms and speed up the healing time. If you develop a cold sore, some general advice to follow includes: drink plenty of fluids to avoid dehydration avoid acidic or salty foods and eat cool, soft foods if brushing your teeth is painful, use an antiseptic mouthwash dab creams on to sores rather than rubbingthem in wash your hands using soap and water before and after applying cold sore creams avoid touching your cold sores, other than to apply cream, and dont share your cold sore cream with others Antiviral creams and tablets Antiviralcreams such asaciclovir or penciclovir (also known as Fenistil ) may speed up the healing time of a recurrent cold sore infectionif used correctly. Cold sorecreams are widely available over the counter from pharmacies without a prescription. Theyre only effective if you apply them as soon as the first signs of a cold sore appear, when the herpes simplex virus is spreading and replicating. Using an antiviralcream after this initial period is unlikely to have much effect. If you have frequently recurring bouts of cold sores,use antiviral medicationas soon as you feel the tingling sensation thatindicates a cold sore is about to develop. Youll need to apply the cream up to 5 times a day for 4 to 5 days. Antiviral creams can only help toheal a current outbreak of cold sores. They dont get rid of the herpes simplex virus or prevent future outbreaks of cold sores occurring. Antiviral tablets are generally more effective than creams at treating cold sores, but are usually only prescribed for more severe cases. Cold sore patches Cold sore patches that contain a special gel called hydrocolloid are also available. Theyre an effective treatment for skin wounds and are placed over the cold sore to hide the sore area while it heals. Non-antiviral treatments Several non-antiviral creams are also available over the counterfrom pharmacieswithout the need for a prescription. These creams arent specifically designed to treat cold sores and wont help them heal faster, but theymay help ease any pain orirritation. Ask your pharmacist to recommend a suitable treatment for you. Pain can also be treated with painkillers such as ibuprofen or paracetamol both are available in liquid form for young children. However, dont take ibuprofen if you have asthma or stomach ulcers , or youve had them in the past. Children under the age of 16 shouldnt be given aspirin. Speak to your pharmacist if you have cold sores and youre pregnant. Treating complications If your cold sores are particularly severe or your immune system is damaged for example, if you have HIV or youre having chemotherapy treatment you may be at risk of developing serious complications. For example, your risk of developingencephalitisor the infection spreading to other parts of your body, such as your eyes, is increased. Speak to your GP if youre at risk. Theymay prescribe antiviral tablets and refer you for specialist treatment. The type of treatment recommended will depend on the severity of your cold sore symptoms and the complication thats causing problems. For example, if you develop herpetic keratoconjunctivitis a secondary eye infectionyou may need to see an ophthalmologist, a specialist eye doctor. Gingivostomatitis Visit your pharmacist if you or your child developsswollen, painful gums (gingivostomatitis) as a result ofthe primary herpes simplex infection. Theyll be able to suggest treatments to help ease your symptoms. If the infection is painful, your pharmacist may suggest using a preparation that contains benzydamine, which is available as anoral rinse or oral spray, to help relieve any pain in your mouth or throat. Brushing your teeth may also be painful because of the swelling of your gums. Your pharmacist may suggest using an antiseptic mouthwash. This helps prevent secondary infections and will also control a build-up of plaque if you cant brush your teeth effectively. As with the treatment of cold sores, any pain or fever can be treated using ibuprofen or paracetamol. In rare cases of gingivostomatitis, its possible for your lips to become stuck together in places. Using a lip barrier cream available from your local pharmacist will help prevent this. Dehydration If you or your child has gingivostomatitis, its important to drink plenty of fluids to avoid becoming dehydrated. Young children are particularly at riskas they may refuse to eat or drink because ofthe pain in their mouth. Its important to watch out for signs of dehydration , such as: headaches tiredness irritability lightheadedness low urine output Most cases of gingivostomatitis get better in 7 to 14 days, although it may take up to 3 weeks for the sores to heal completely. Specialist treatment If you or your child still has symptoms of gingivostomatitis after 2 weeks or the infection is severe your pharmacist may advise you to contact your GP, who may refer you for specialist treatment. Specialist referral may also be needed for gingivostomatitis if youre pregnant or have a weakened immune system. Visit your GP if you have a newborn baby who develops gingivostomatitis, as they may also need to be referred for specialist treatment. Source: NHS 24 - Opens in new browser window Last updated: 05 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Search for a pharmacy near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Coma

Coma - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Coma Coma A coma is a state of unconsciousness where a person is unresponsive and cannot be woken. It can result from injury to the brain, such as a severe head injury or stroke . A coma can also be caused by severe alcohol poisoningor a brain infection (encephalitis). People with diabetes could fall into a coma if their blood glucose levels suddenly became very low (hypoglycaemia) or very high (hyperglycaemia) . What is a coma? Someone who is in a coma is unconscious and has minimal brain activity. Theyre alive, butcant be woken up and show no signs of being aware. The persons eyes will be closed andtheyllappear to be unresponsive to their environment. They wontnormally respond to sound or pain, or be able to communicate or move voluntarily. Someone in a coma will also have very reduced basic reflexes such as coughing and swallowing. They may be able to breathe on their own, although some people require a machine to help them breathe. Over time, the person may start to gradually regain consciousness and become more aware. Some people will wake up after a few weeks, while others may go into a vegetative state or minimally conscious state. Caring for and monitoring a person in a coma Doctors assess a persons level of consciousness using a tool called the Glasgow Coma Scale . This level is monitored constantly for signs of improvement or deterioration. The Glasgow Coma Scale assesses three things: eye opening a score of one means no eye opening, andfour means opens eyes spontaneously verbal response to a command a score of onemeans no response, andfive means alert and talking voluntary movements in response to a command a score of one means no response, and six means obeys commands Most people in a coma will have a total score ofeight or less.A lower score means someone may have experienced more severe brain damage and could be less likely to recover. In the short term, a person in a coma will normally be looked afterin an intensive care unit (ICU). Treatment involves ensuring their condition is stable and their body functions, such as breathing and blood pressure, are supported while the underlying cause is treated. In the longer term, healthcare staff will give supportive treatment on a hospital ward. This can involve providing nutrition, trying to prevent infections, moving the person regularly so they dont develop bedsores, and gently exercising their joints tostop thembecoming tight. What you can do as a visitor The experience of being in a coma differs from person to person. Some people feel they can remember events that happened around them while theywere in a coma, while others dont. Some people have reported feeling enormous reassurance from the presence of a loved one when coming out of a coma. When visiting a friend or loved one in a coma, you may find the advice below helpful: when you arrive, announce who you are talk to them about your day as you normally wouldbe aware that everything you say in front of them might be heard show them your love and support even just sitting and holding their hand or stroking their skin can bea great comfort Research has also suggested thatstimulating the main senses touch, hearing, vision and smell could potentially helpa personrecover from a coma. As well as talking to the person and holding their hand, you might want to try playing them their favourite music through headphones, putting flowers in their room or spraying a favourite perfume. Recovering from a coma A coma usually only lasts a few weeks, during which time the person may start to gradually wake up and gain consciousness, or progress into a different state of unconsciousness called a vegetative state or minimally conscious state. a vegetative state where a person is awake but shows no signs of being aware of their surroundings or themselves a minimally conscious state where a person has limited awareness that comes and goes Some people may recover from these states gradually, while others may not improve for years, if at all. People who do wake up froma coma usually come round gradually. They may be very agitated and confused to begin with. Some people will make a full recovery and be completely unaffected by the coma. Otherswill have disabilities caused by the damage to their brain. They may needphysiotherapy, occupational therapy and psychological assessment and support during a period of rehabilitation, and may need care for the rest of their lives. Thechances of someone recovering from a coma largely depend on the severity andcause of their brain injury, their age and how long theyve been ina coma. But its impossible to accurately predict whether the personwill eventually recover,how long the coma will last and whether theyll have any long-term problems. Further information and support For further information and support from healthcare professionals and the families of people in a coma, you may find the followingwebsites helpful: Brain and Spine Foundation Headway : the brain injury association ICUsteps : the intensive care patient support charity Source: NHS 24 - Opens in new browser window Last updated: 06 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Severe head injury Other health sites Brain and Spine Foundation: Moderate to severe head injuries Headway: coma ICUsteps: patients and relatives NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Common cold

Common cold | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Common cold Common cold A cold is a very common mild viral infection. You can often treat a cold without seeing a GP. You should begin to feel better in about 1 to 2 weeks. There is a separate page on if your child has cold or flu symptoms . Symptoms of a cold The main symptoms of a cold include: a sore throat a blocked or runny nose sneezing a cough a hoarse voice generally feeling unwell Less common symptoms of a cold include: high temperature (fever) this is usually about 37C to 39C (98.6F to 102.2F) a headache earache severe earache may be a sign of a middle ear infection muscle aches loss of taste and smell mild irritation of your eyes a feeling of pressure in your ears and face When to get medical advice Speak to your GP practice if: your symptoms do not improve after 3 weeks your symptoms get suddenly worse your temperature is very high or you feel hot and shivery youre concerned about your childs symptoms youre feeling short of breath or develop chest pain you have a long-term medical condition for example, diabetes, or a heart, lung or kidney condition you have a weakened immune system for example, because youre having chemotherapy If your GP is closed, phone 111. Speak to a pharmacist if you have a cold and would like advice and treatment. Find your local pharmacy Treatment for a cold Theres no cure for a cold, but there are things you can do to look after yourself at home. You should begin to feel better in about 1 to 2 weeks. Things you can do to help your symptoms Do rest drink plenty of fluids eat healthily take over-the-counter pain relief, such as paracetamol or ibuprofen , to relieve high temperature and aches use decongestant sprays or tablets to relieve a blocked nose try remedies such as gargling salt water and sucking on menthol sweets Always read the leaflet that comes with your medicine before taking it. Follow the recommended dosage instructions. If youre not sure which treatments are suitable for you or your child, speak to a pharmacist for advice. Be careful not to use cough and cold medicines if youre taking paracetamol and ibuprofen tablets. Cough and cold medicines often also contain paracetamol and ibuprofen so it can be easy to take more than the recommended dose. How do colds spread? A person can start spreading a cold from a few days before their symptoms start until their symptoms have gone. You can catch the virus from an infectious person by: touching an object or surface contaminated by infected droplets and then touching your mouth, nose or eyes touching the skin of someone who has the infected droplets on their skin and then touching your mouth, nose or eyes breathing in tiny droplets of fluid that contain the cold virus these are launched into the air when an infected person coughs or sneezes Different viruses can cause a cold. Its possible to have different colds one after the other, as each one may be caused by a different virus. How to prevent a cold from spreading Do wash your hands often, especially before touching your nose or mouth and before handling food always sneeze and cough into tissues throw away used tissues straight away and wash your hands clean surfaces regularly use your own cup, plates, cutlery and kitchen utensils do not share towels or toys with someone who has a cold Is it a cold or flu? It can sometimes be difficult to tell if you have a cold or flu, as the symptoms can be similar. The main differences are that flu symptoms: come on quickly usually include a headache, high temperature (fever) and sore muscles make you feel too unwell to continue your usual activities Cold symptoms: come on slowly mainly affect your nose and throat are fairly mild, so you can still get around and are usually well enough to go to work Whats the difference between a cold and flu? Complications of a common cold Colds usually clear up without causing any further problems. But the infection can sometimes spread to your chest , ears or sinuses . Source: NHS 24 - Opens in new browser window Last updated: 01 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform If your child has cold or flu symptoms Search for a pharmacy near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Common heart conditions

Common heart conditions - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Heart and blood vessels Conditions Common heart conditions Common heart conditions There are many different heart conditions and problems which are collectively called heart disease. Its always best to discuss your heart condition with your health professional or heart specialist who can advise you on the correct diagnosis and name of your condition and treatment plan. Heart disease and different conditions affect the hearts ability to work efficiently. It can be worrying and confusing to be diagnosed with a heart condition, but theres a lot of information and support available to you. Sometimes understanding what is happening can help you worry less. Coronary heart disease The most common heart condition in Scotland is coronary heart disease. This is caused when the hearts blood vessels the coronary arteries become narrowed or blocked and cant supply enough blood to the heart. It can lead to angina and/or a heart attack. Read more aboutcoronary heart disease Angina Angina is a pain or discomfort in your chest, arm, neck, stomach or jaw that happens when the blood supply to your heart becomes restricted because of your arteries becoming narrowed. This clogging is called atheroma. Angina is a symptom of coronary heart disease, not an illness in itself. Angina is your hearts way of telling you its not getting enough oxygen when youre doing something strenuous or youre feeling under stress. Many people learn to recognise how much activity will bring on an angina attack this is called stable angina. If you have unexplained chest pain, seek urgent medical advice you will need an assessment of your overall health. Unstable angina Unstable angina can be undiagnosed chest pain or a sudden worsening of existing angina. It happens when the blood supply to the heart is severely restricted and angina attacks occur more frequently, with less and less activity. These attacks may even happen at rest or wake you from sleep. They can last up to 10 minutes. You should see your doctor urgently, and you may be admitted to hospital. Until tests confirm the diagnosis, this is sometimes called Acute Coronary Syndrome (ACS). Read m ore about angina Heart attack A heart attack also known as myocardial infarction or MI happens when the blood supply to part of your heart muscle becomes completely blocked. This is most commonly caused by a piece of fatty materialbreaking off and ablood clot forms within a coronary artery. This can cause damage to the part of your heart muscle which that particular coronary artery was supplying. Read more about the symptoms of a heart attack Heart failure If the hearts pumping action cant work effectively, your heart muscle cant meet your bodys demand for blood and oxygen, and your body develops various different symptoms, like fatigue and shortness of breath. This is called heart failure because of the failure of your heart to work efficiently. Read more about heart failure Arrhythmia (abnormal heart rhythms) The heart muscle has its own electrical system which helps to stimulate the heartbeat. If the electrical signals within your heart are interrupted or disturbed, your heart can beat too quickly (tachycardia), too slowly (bradycardia) and/or in an irregular way. This is called an arrhythmia. Read about arrhythmia on theChest Heart & Stroke Scotland website Valve disease The valves open and close to regulate the flow of blood through the heart. Problems with the valves can increase the workload of your heart and can put a strain on your heart muscle, leading to a range of symptoms, like: shortness of breath swollen ankles fatigue chest pain (angina or palpitations) dizziness or fainting Read about heart valve problems on theChest Heart & Stroke Scotland website High blood pressure Another condition which can affect the heart is high blood pressure or hypertension. Although its not a disease in itself, hypertension can lead to an increased risk of developing serious conditions such as coronary heart disease, heart attacks and strokes. Read moreabout high blood pressure and reducing the risks to your heart Congenital heart conditions Congenital heart conditions occur when theres an abnormality or defect with the structure of the heart of a developing foetus while inside the mothers womb. A baby may be born with only one defect or with several defects. Some types of congenital heart defects are life-threatening, either immediately to the newborn or over time. Read more about congenital heart disease Inherited heart conditions Inherited conditions can be passed on through families. They are sometimes called familial or genetic heart conditions. They can affect people of any age and can be life-threatening. The first sign theres a problem is often when someone dies suddenly with no obvious cause. These conditions are different from most congenital heart conditions, although some congenital conditions can also be inherited. Read more about inherited heart conditions Source: Chest Heart & Stroke Scotland - Opens in new browser window Last updated: 09 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Adjusting to life with a heart condition Congenital heart disease Angina NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Congenital heart disease

Congenital heart conditions - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Heart and blood vessels Conditions Congenital heart disease Congenital heart disease About congenital heart disease Symptoms of congenital heart disease Causes of congenital heart disease Diagnosing congenital heart disease Treating congenital heart disease Complications of congenital heart disease About congenital heart disease Congenital heart disease is a general term used to refer to a series of birth defects that affect the heart. Types of congenital heart disease There are over 30 different types of heart defect. The two main types of congenital heart disease are: cyanotic heart disease acyanotic heart disease Cyanotic heart disease Cyanotic heart is where problems with the heart mean there isnt enough oxygen present in the blood. Babies born with cyanotic heart disease generally have a blue-coloured tinge to areas such as their fingers, toes and lips because of a lack of oxygen. They may also experience symptoms of: breathlessness chest pain palpitations fainting fatigue Acyanotic heart disease Acyanotic heart disease is where the blood contains enough oxygen but its pumped abnormally around the body. Babies born with acyanotic heart disease may not have any apparent symptoms but, over time, the condition can cause health problems. In this group of conditions there can be a significant increase in blood pressure, putting the heart under more strain as it works much harder. This can weaken the heart, and increases the risk of developing heart failure, where the muscle is unable to efficiently pump blood around the body. In addition, the blood pressure in the lungs is often too high. This is known as pulmonary hypertension and can damage the lungs and cause symptoms such as: breathlessness fatigue dizziness fainting How common is congenital heart disease? Congenital heart disease is the most common type of birth defect, with 1 in 180 babies being born with the condition. Some babies born with congenital heart disease will require immediate surgery after birth, while many others will probably require surgery or medication at some point during their childhood. Congenital heart disease can sometimes develop alongside certain genetic conditions, such as Downs syndrome . An infection during pregnancy, such asrubella, can also cause congenital heart disease. However, many cases of congenital heart disease have no clear cause. Outlook for congenital heart disease The outlook for congenital heart disease varies depending on the type and severity of the heart defect. Research into the causes and improved treatments have meant that, 80% of children with congenital heart disease will survive into adulthood. This poses new challenges for healthcare services because some of these adults have complex health needs and require life-long specialised care. In response to this, the Department of Health has recommended the creation of specialised centres to care for adults with congenital heart disease. Congenital heart disease in adults is sometimes known as grown-up congenital heart disease (GUCH) or Adult Congenital Heart Disease (ACHD). Congenital and rare condition register Babies with congenital heart disease are included in the secure congenital and rare condition (CARDRISS) register. The register is maintained by Public Health Scotland. The register records how many babies have this condition, and some relevant personal information. Its also used to support the planning and improvement of health, care, and other public services. Further information about CARDRISS Symptoms of congenital heart disease As stated in the introduction, the two main types of congenital heart disease are: cyanotic heart disease acyanotic heart disease Symptoms of cyanotic heart disease The symptoms of cyanotic heart disease include: a blue coloured tinge to the lips, fingers and toes (cyanosis) palpitations fainting fatigue chest pains breathing problems Children with cyanotic heart disease have lower levels of oxygen in their blood, this is known as hypoxia. Sometimes, their oxygen levels can fall further and cause additional symptoms such as anxiety and confusion or disorientation. Symptoms of acyanotic heart disease The symptoms of acyanotic heart disease include: severe tiredness palpitations chest pain shortness of breath (particularly during activities such as climbing the stairs) Common symptoms of congenital heart disease There are some symptoms that are present in both cyanotic and acyanotic heart disease. These include: poor appetite and feeding difficulties sweating, particularly when a baby is feeding delayed growth Children with acyanotic heart disease are usually underweight, and children with cyanotic heart disease are usually underweight and small for their age. Causes of congenital heart disease To understand how congenital heart disease can affect your childs heart and general health, its useful to first understand how a healthy heart works. Find out how your heart works, on the British Heart Foundation website . Congenital heart disease develops when abnormalities in the hearts structure prevent it from working as it should. As outlined in the introduction , the two main types of congenital heart disease are: cyanotic heart disease acyanotic heart disease Find common causes of each below. Common types of acyanotic heart disease Ventricular septal defect (VSD) Ventricular septal defect (VSD) is a very common cause of acyanotic heart disease. In cases of VSD, there is a hole between the left and right ventricle. As blood pressure is higher on the left-hand side of the heart, blood is pushed through the hole and into the right ventricle. The heart then has to work harder to pump the excess blood out of the right ventricle, which can put a strain on the heart. The excess level and pressure of the blood can also increase the blood pressure in the lungs and damage them (pulmonary hypertension). Atrial septal defect (ASD) Atrial septal defect (ASD) is a similar type of defect to VSD, but the hole is between the left and right atria rather than the ventricles. ASD can place extra strain on the heart, and potentially damage the lungs. When referring to a hole in the heart, healthcare professionals are usually referring to either VSD or ASD. Find out more about ASD on the British Heart Foundation website . Pulmonary stenosis In pulmonary stenosis, the pulmonary valve in the right side of the heart is unusually narrow meaning that the heart has to work harder to pump blood into the lungs, which can put a strain on the heart. Find out more about pulmonary stenosis on the British Heart Foundation website . Aortic stenosis In aortic stenosis, the aortic valve in the left side of the heart is unusually narrow, which means that the heart has to work harder to pump blood through the valve. Because the aortic valve is the main route for oxygen-rich blood to supply the body, the narrowing can lower the bodys oxygen supply, which can cause symptoms of breathlessness and dizziness. Find out more about aortic stenosis on the British Heart Foundation website . Patent ductus ateriosus (PDA) Patent ductus ateriosus (PDA) is a duct or passage in the heart that is meant to close shortly after birth. When an unborn baby is in the womb, there is no need for the babys heart to send blood to the lungs because the baby is getting all the oxygen it needs from the mother through the placenta. Therefore, the ductus ateriosus acts as a bypass, meaning that the blood can flow back into the heart without entering the lungs. Shortly after birth, the duct should close as the baby begins to breathe normally. However, in cases of PDA, the duct fails to completely close, which means that some oxygen-rich blood that is meant to be pumped away from the lungs leaks back through the duct and back into the lungs. This can place strain on the heart and the lungs because they have to work harder to compensate for the problems caused by the duct. Common types of cyanotic heart disease Tetralogy of Fallot (TOF) Tetralogy of Fallot (TOF) is the most common cause of cyanotic heart disease. TOF is not one heart defect but a combination of four different heart defects. Tetralogy is a Greek word that means four-fold, and Fallot is the name of the doctor who first identified the condition. In cases of TOF, there are four defects that affect the heart: A hole between the left and right ventricle (Ventricular Septal Defect). A narrowing of the pulmonary valve (pulmonary stenosis). The muscles of the right ventricle are unusually thick (right ventricular hypertrophy). The aorta sits over both the left and right ventricles, instead of just the left ventricle in a normal heart (overriding aorta). As a result of this complex set of heart defects, oxygen-rich blood and oxygen-low blood become mixed. This leads to blood with lower-than-normal oxygen content being pumped around the body. As the bodys cells and tissue are not receiving enough oxygen, the child will develop symptoms of cyanotic heart disease. Find out more about TOF on the British Heart Foundation website . Transposition of the great arteries (TGA) Transposition of the great arteries (TGA) is a major cause of cyanotic heart disease. In cases of TGA, the pulmonary artery is attached to the left side of the heart, and the aorta is attached to the right side of the heart. This leads to oxygen-low blood, which should be pumped into the lungs, being pumped around the body, causing symptoms of cyanotic heart disease. Find out more about TGA on the British Heart Foundation website . Risk factors for congenital heart disease In many cases of congenital heart disease, there is no clear reason why a baby is born with a defective heart. The known risk factors for congenital heart disease are listed below. Maternal diabetes Women with diabetes are five times more likely to give birth to a baby with congenital heart disease compared with women who do not have diabetes. It is estimated that out of every 100 pregnancies in women with diabetes, three to four will result in the birth of a baby with a heart defect. The increased risk is thought to be due to the high levels of insulin in the blood, which may interfere with the development of the foetus. Rubella The viral infection rubella (also known as German measles) is a major risk factor for congenital heart disease if a woman contracts an infection during early pregnancy. If a woman contracts the viral infection rubella (also known as German measles) during the first 12 weeks of pregnancy, there is an 80% chance that her baby will be born with a birth defect, such as congenital heart disease. Maternal alcohol abuse Mothers who exceed the recommended daily alcohol intake during pregnancy have an increased risk of their baby being born with congenital heart disease. Alcohol is best avoided during pregnancy; however no more than 2-3 units should be consumed on a daily basis for any adult. Genetic conditions There are a number of genetic conditions (health conditions that a baby inherits from one or both parents) that can cause congenital heart disease. Downs syndrome is the most widely known genetic condition that can cause congenital heart disease. Downs syndrome is a condition where children are born with a range of disabilities as the result of a genetic abnormality. Approximately half of children with Downs syndrome will have congenital heart disease. Other genetic conditions linked to congenital heart disease include: Turner syndrome Noonan syndrome Diagnosing congenital heart disease An increasing number of cases of congenital heart disease are now diagnosed by carrying out a foetal echocardiograph before a baby is born. A foetal echocardiograph is made possible by using a type of ultrasound scanner that has been specially designed to build a picture of the unborn babys heart. It should be carried out during routine antenatal examinations, usually sometime between the 18th and 20th week of pregnancy. It is not always possible to detect heart defects (particularly mild ones) using a foetal echocardiography. Postnatal diagnosis If a baby is born with cyanotic heart disease, a diagnosis can usually be made quickly and confidently due to the distinctive blue colour of their skin. If your baby is born with acyanotic heart disease, their symptoms may not become immediately apparent for several months, or possibly years, after birth. Possible signs that your child may have a cyanotic heart disease include: problems feeding slow growth shortness of breath after exercising tiredness after exercising swelling of their hands, feet and ankles You should contact your GP if your child has any of the above symptoms. Further testing can confirm or disprove a diagnosis of congenital heart disease. Further testing Echocardiogram An echocardiogram may be used to check your childs heart. Sometimes, underlying problems with the heart, which were missed during a foetal echocardiogram, can be detected as a child grows up. Find out more about an echocardiogram on the British Heart Foundation website . Electrocardiogram (ECG) An electrocardiogram (ECG) is a test that measures the electrical activity of the childs heart. Electrodes are placed on the skin across the chest, arms and legs, and then connected to an ECG machine. The machine analyses the electrical signals produced by the heart in order to assess the heart rhythm. Find out more about an ECG on the British Heart Foundation website . Chest X-ray A chest X-ray of the heart and lungs can check whether there are any abnormalities in the lungs, or whether the heart is larger than normal. Both of these can be signs of congenital heart disease. Find out more about a chest x-ray on the British Heart Foundation website. Pulse oximetry Pulse oximetry is a test that measures how much oxygen is present in the blood. The test involves placing a special sensor on your childs fingertip, ear or toe. The sensor sends out light waves. A computer that is connected to the sensor measures how the light waves are being absorbed, and gives a percentage reading. A healthy person should have a reading of 94% or above. It is common for those with cyanotic heart defects to have readings below this value. Cardiac catheterisation Cardiac catheterisation is a useful way of finding out more information about exactly how the blood is pumping through the childs heart. During a cardiac catheterisation, a small flexible tube, known as a catheter, will be inserted into one of the childs blood vessels, usually in the groin or arm. The tube is moved up into the heart, using X-rays to help guide it. A contrast dye that shows up on X-rays can be injected into the tube. The dye can then be studied as it moves through the heart, enabling medical staff to see how well each chamber of the heart is working. Blood pressure readings in different parts of the heart can also be taken; this will help with diagnosis and treatment planning. Cardiac catheterisation is usually performed under a local anaesthetic and is a relatively painless procedure. Treating congenital heart disease There are a number of different surgical techniques that can be used to treat congenital heart disease. Some of these are explained below. Catheters A catheter, similar to the tube that is used during diagnosis, is inserted into the heart and tools are passed down the catheter to repair the heart defects. The advantage of this type of surgery is that its minimally invasive, which means that your child will not have to have open heart surgery. Open heart surgery For more serious types of heart defects, it may be necessary to operate directly on the heart. During open heart surgery, the heart may be stopped and a machine used to pump blood around your childs body (bypass machine). An incision is made in your childs chest so that the heart defects can be surgically repaired, or damaged parts of the heart, such as the valves, can be replaced. Heart transplant In more serious cases of congenital heart disease, the heart may be too damaged, and the child too ill, for corrective surgery to be safely carried out. In this circumstance, their heart may have to be replaced with a donated heart. If your child requires a heart transplant, their details will be placed on the National Transplant Database (NTD). Depending on the condition of your childs heart, it may be necessary to keep them in hospital in order to support the function of their heart until a donated heart becomes available. Machines, such as the ventricle assist device (VAD), act like an external mechanical heart, and can assist in pumping blood around the body. Priority for heart transplants is based on clinical need, rather than on a first-come-first-served basis. If your child is in a very unstable condition, they will be prioritised whereas more stable children will have to wait for a longer period of time. Once a donated heart of the right size and blood group becomes available, you will be contacted by the transplant team and asked to go to the transplant unit as soon as possible. You may be given a bleeper so that you can be contacted as soon as possible. Find out more about heart transplantation on the British Heart Foundation website. Treatment for common types of congenital heart disease Specific treatments for the most common types of congenital heart disease are described below. Septal defects If your child is diagnosed with a ventricular septal defect (VSD) or an atrial septal defect (ASD), the recommended treatment will depend on the size of the defect. If the defect is small, a policy of watchful waiting may be recommended, where your child receives no immediate treatment but their health is carefully monitored. This is because 90% of small defects will close as the child grows older. In cases of mild to medium-sized defects, it may be possible to seal the defect using a catheter. The catheter is guided to the site of the hole, and a specially designed mesh is passed through the catheter to seal the defect. In cases of medium to large-sized defects, open-heart surgery may be required. This involves a patch being stitched directly over the defect. Stenosis If your child is diagnosed with a stenosis (a narrowing one of their valves) the treatment that is recommended will depend on the extent of the stenosis and if they are symptomatic. In mild cases, a policy of watchful waiting may be recommended. Medication that lowers blood pressure may also be recommended to reduce the strain on your childs heart and lungs. In more serious cases of stenosis, a catheter can be used to widen the valve. A small balloon is passed up through the catheter and then inflated to widen the affected valve. This is known as a balloon angioplasty. Once the valve has been widened, the balloon is removed. Sometimes, a metal coil (stent) is used to keep the valve widened. In more serious cases of stenosis, its sometimes necessary to replace the valve using open heart surgery. Replacement valves can be obtained from human donors, or made from artificial materials, such as titanium, or taken from pigs and modified for human use. Pigs are used because their hearts are the most similar to the human heart. For people who are too ill or weak to withstand the effects of open heart surgery, a catheter approach can be used. The catheter is passed through a blood vessel in the groin and up into the heart. A replacement valve is passed through the catheter and into position. Patent ductus ateriosus (PDA) Many cases of patent ductus ateriosus (PDA) can be treated shortly after birth, using medication. Two types of medication indomethacin and a special type of ibuprofen have been shown to effectively stimulate the closure of the duct that is responsible for PDA. If a PDA does not respond to medication, a catheter can be used to seal the duct with a metal coil or plug. Tetralogy of Fallot (TOF) Babies born with Tetralogy of Fallot (TOF) who are experiencing severe symptoms of breathlessness may require emergency surgery such as a Blalock-Taussig shunt (a BT shunt). During a BT shunt, an artery is diverted (or shunted) into the lungs so that a supply of oxygen-rich blood becomes available. Further open-heart surgery is then recommended when the baby is old enough to withstand the after-effects of surgery. During open-heart surgery, the defect between the ventricles is sealed and the pulmonary valve is widened. Transposition of the great arteries (TGA) Transposition of the great arteries (TGA) will require open-heart surgery, which is usually done shortly after your baby is born. A surgical technique, known as an arterial switch, is usually used to treat cases of TGA. During an arterial switch, the affected arteries are cut and reattached to their correct position on the other side of the heart. Congenital heart disease in adulthood About 80% of children with congenital heart disease will survive into adulthood. Living as an adult with congenital heart disease involves a new set of challenges. Some adults will require specialised care. Routine medical procedures, such as giving birth or having a general anaesthetic, will need to be closely supervised by specialist staff with experience in treating adults with congenital heart disease. There is also the risk that previous heart surgery, such as the insertion of a replacement valve, will fail and that further surgery will be required. Due to these factors, its recommended that older teenagers register with a specialised adult congenital heart disease clinic. The clinic will be able to provide regular check-ups and assessments, liaise with other specialised medical services as required, and provide on-going support and advice. Your GP or treatment team can give you more information about services in your area for adults with congenital heart disease. Complications of congenital heart disease Many children with congenital heart disease will experience delays in their development, and may take longer to reach certain stages in their development, such as walking or talking. Some children with congenital heart disease also have associated learning difficulties and require specialised educational and psychological assistance. If your child has congenital heart disease, your local educational authority should draw up an individual education plan (IEP). The IEP makes an assessment of your childs current and future needs, and provides access to any specialised services that your child needs, such as speech and language therapy or an educational psychologist. The IEP will take into account what level of physical activity is safe for your child. Children with congenital heart disease should be encouraged to be as active as possible, but certain activities, such as contact sports, may have to be avoided. Endocarditis Both children and adults with congenital heart disease have an increased risk of developing endocarditis. Endocarditis is an infection of the lining of the heart and, left untreated, it can be life-threatening because it damages the valves of the heart. Symptoms of endocarditis include: fever chills sweating (including night sweats) muscular aches and pains chest pain coughs weakness and fatigue headache shortness of breath Endocarditis will need to be with injections of antibiotics (intravenous antibiotics). This will involve a hospital stay for several weeks. Endocarditis usually develops when an infection in another part of the body, such as on the skin or the gums spreads through the blood into the heart. Due to the risk of gum disease leading to endocarditis, it is very important that you have excellent oral hygiene if you have congenital heart disease. It is also usually recommended that you avoid having any cosmetic procedure that involves the piercing of the skin, such tattoos or body piercings. Source: Chest Heart & Stroke Scotland - Opens in new browser window Last updated: 22 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Other health sites British Heart Foundation: Congenital heart disease NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Conjunctivitis

Conjunctivitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Eyes Conjunctivitis Conjunctivitis Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF Conjunctivitis (or red eye) is a common eye condition. It usually gets better in a few weeks without treatment. Symptoms of conjunctivitis Conjunctivitis usually causes symptoms in both eyes like: inflammation redness itching a burning or gritty feeling watering pus that sticks to the eyelashes Causes of conjunctivitis Conjunctivitis happens when the conjunctiva becomes inflamed. This is a thin layer of cells covering the front of your eyes. The 3 most common causes of this inflammation are: infection (infective conjunctivitis) an allergic reaction (allergic conjunctivitis) something irritating the conjunctiva, like a loose eyelash (irritant conjunctivitis) Treating and preventing conjunctivitis Do boil water and let it cool down before you gently wipe your eyelashes to clean off crusts with a clean cotton wool pad (1 piece for each eye) hold a cold towel over your eyes for a few minutes wash your hands regularly this is particularly important after touching your eyes use lubricant eye drops these are available at pharmacies or they may be prescribed for you Dont do not rub your eyes do not wear contact lenses until the symptoms have cleared up dont re-use old lenses after the infection has gone they could cause re-infection do not not share pillows or towels You dont need to take time off school or work if you have conjunctivitis unless youre feeling very unwell. Get advice from a pharmacist Speak to a pharmacist for advice about conjunctivitis. They can suggest eyedrops or antihistamines to help with your symptoms. Find your nearest pharmacy Phone an optometrist urgently if you have: pain in your eyes sensitivity to light changes in your vision, like wavy lines or flashing very red eyes (1 eye or both eyes) a baby less than 28 days old with red eyes These can be signs of a more serious eye problem. If your optometrist is closed phone 111. Speak to an optometrist if: your baby has red eyes get an urgent appointment if your baby is less than 28 days old you wear contact lenses and have conjunctivitis symptoms as well as spots on your eyelids you might be allergic to the lenses you have symptoms that havent cleared up after 2 weeks Treatments for conjunctivitis Treatment for conjunctivitis will depend on whats causing it. You may be prescribed antibiotics to treat a bacterial infection. But these wont work if the symptoms are caused by a virus or an allergy. Allergic conjunctivitis can usually be treated with antihistamines. If possible, you should also try to avoid the substance that triggered the allergy. Irritant conjunctivitis will ease when whatever is causing the symptoms is removed. Some sexually transmitted infections (STIs) can cause conjunctivitis. This type takes longer to get better. Eye problems self-help guide Complete our self-help guide to check your symptoms and find out what to do next. Source: Scottish Government - Opens in new browser window Last updated: 27 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Self-help guide: Eye problems Other health sites Look after your eyes: conjunctivitis NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Constipation

Constipation | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Constipation Constipation About constipation Symptoms of constipation Causes of constipation Diagnosing constipation Treating constipation Complications of constipation Preventing constipation About constipation Constipation is a common condition that affects people of all ages. It can mean that youre not passing stools regularly or youre unable to completely empty your bowel. Constipation can also cause your stools to be hard and lumpy, as well asunusually large or small. The severity of constipation varies from person to person. Many people only experience constipation for a short time, but for others, constipation can be a long-term (chronic) condition that causes significant pain and discomfort and affects quality of life. Read more about the symptoms of constipation . What causes constipation? Its often difficult to identify the exact cause of constipation.However, there are a number of things thatcontribute to the condition, including: not eating enough fibre, such as fruit, vegetables and cereals a change in your routine or lifestyle, such as a change in your eating habits ignoring the urge to pass stools side effects of certain medications not drinking enough fluids anxiety or depression In children, poor diet, fear about using the toilet and problems toilet trainingcan allleadto constipation. Read more about the causes of constipation . Whos affected Constipation can occur in babies, children and adults. Its estimated that around 1in every 7adults and up to 1in every 3children in the UK has constipation at any one time. The condition affects twice as many women as men and is also more common in older adults and during pregnancy. When to get professional advice Pharmacy First Scotland: Constipation treatment from your pharmacy If you have constipation you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotlands Service Directory. Search for a pharmacy near you Constipation isnt usually serious and can be treated by a pharmacist. Your pharmacist may recommend that you contact your GP practice if required. Also speak to your pharmacist if you think your child might be constipated. Laxatives are often recommended for children alongside diet and lifestyle changes. You may be able to treat constipation yourself by making simple changes to your diet and lifestyle (see below). If these changes dont help and the problem continues, you should see your pharmacist. However, you should see your GP for advice if: you notice any rectal bleeding you notice any unexplained weight loss you have persistent tiredness yourconstipation lasts longer than 14 days without improvement Treating constipation Diet and lifestyle changes are usually recommended as the first treatment for constipation. This includes gradually increasing your daily intake of fibre, making sure you drink plenty of fluids, and trying to get more exercise. If these arent effective, yourpharmacist may recommend an orallaxative medicationthat canhelp you empty your bowels. Treatment for constipation is effective, although in some cases it can take several months before a regular bowel pattern is re-established. Read more about treating constipation . Preventing constipation Making the diet and lifestyle changes mentioned above can alsohelp to reduce your risk of developing constipation in the first place. Giving yourself enough time and privacy to pass stools comfortably may also help, and you should try not toignore the urge to go to the toilet. Read more about preventing constipation . Complications For most people constipation rarely causes complications, but people withlong-term constipation can develop: haemorrhoids (piles) faecal impaction (where dry, hard stools collect in the rectum) bowel incontinence (the leakage of liquid stools) Read more about the complications of constipation . Symptoms of constipation When youre constipated, passing stools becomes more difficult and less frequent than usual. Normal bowel habits vary from person to person. Some adults go to the toilet more than once a day, whereas others may only go every 3or 4days. Similarly, some infants pass stools several times a day, while others only pass them a few times a week. If you or your child pass stools less than usual, it could be a sign of constipation. It may also be more difficult to pass stools and you may feel unable to empty your bowelcompletely. Your stools may appear dry, hard and lumpy, as well as abnormally large or small. Other symptoms of constipation can include: stomach ache and cramps feeling bloated feelingsick loss of appetite Constipation in children As well as infrequent or irregular bowel movements, a child with constipation may also have any of the following symptoms: loss of appetite a lack of energy being irritable, angry or unhappy foul-smelling wind and stools stomachpain and discomfort soiling their clothes generally feeling unwell Causes of constipation Constipation usually occurs when stools remain in the colon (large intestine) for too long, and the colon absorbs too much water from the stools, causing them to become hard and dry. Most cases of constipation arent caused by a specific condition and it may be difficult to identify the exact cause. However, several factors can increase your chances of having constipation, including: not eating enough fibre, such as fruit, vegetables and cereals a change in your routine or lifestyle, such as a change in your eating habits having limited privacy when using the toilet ignoring the urge to pass stools immobility or lack of exercise not drinking enough fluids having a high temperature (fever) being underweight or overweight anxiety or depression psychiatric problems, such as those brought on by sexual abuse, violence or trauma Medication Constipation may sometimes be a side effect of a medicine youre taking. Common types of medication that can cause constipation include: aluminiumantacids (medicine to treat indigestion ) antidepressants antiepileptics (medicine to treat epilepsy ) antipsychotics (medicine to treat schizophrenia and other mental health conditions) calciumsupplements opiate painkillers, such as codeine and morphine diuretics (water tablets) ironsupplements If constipation is caused by medication, the condition will usually ease once you stop taking the medicine. However, you shouldnt stop taking any prescribed medication unless your GP advises you to. Speak to your pharmacist if you have constipation thats caused bya medicine. They may be able toadvise you on how to treat the problem, or they might recommend you see your GP for an alternative medicine if appropriate. Pregnancy About 2in every 5women experience constipation during their pregnancy, mostly during the early stages. Constipation occurs during pregnancy because your body produces more of the female hormone progesterone, which acts as a muscle relaxant. The bowel normally moves stools and waste products to the anus by a process known as peristalsis. This is when the muscles lining the bowel contract and relax in a rippling, wave-like motion. An increase in progesterone makes it more difficult for the bowel muscles to contract, making it harder to move waste products along. If youre pregnant, there are ways to safely treat constipation without harming you or your baby. Read more about treating constipation . Other conditions In rare cases, constipation can be a sign of an underlying condition, such as: irritable bowel syndrome (IBS) diabetes hypercalcaemia where theres too much calcium in the bloodstream underactive thyroid gland (hypothyroidism) muscular dystrophy a genetic condition that causes muscle wasting multiple sclerosis a condition that affects the nervous system Parkinsons disease where part of the brain becomes progressively damaged, affecting the co-ordination of body movements spinal cord injury anal fissure a small tear or ulcerin the skinjust inside the anus inflammatory bowel disease a condition that causes the intestines to become inflamed (irritated and swollen) bowel cancer Babies and children Constipation in babies and children is quite common. Its estimated that up to 1in every 3children in the UK has constipation at any time. Poor diet, fear about using the toilet and poor toilet trainingcan all be responsible. Poor diet Children who are over-fed are more likely to have constipation, as are those who dont get enough fluids. Babies who have too much milk are also more likely to get constipation. As with adults, its very important that your child has enough fibre in their diet. Toilet training Its important that you dont make your child feel stressed or pressured about using the toilet. Its also important to let your children try things by themselves (when appropriate). Constantly intervening when theyre using the toilet may make them feel anxious and may contribute to constipation. Toilet habits Some children can feel stressed or anxious about using the toilet. They may have a phobia about using the toilet, or feel they are unable to use the toilets at school. This fear may be the result of your child experiencing pain when passing stools. This can lead to poor bowel habits, where children ignore the urge to pass stools and instead withhold them for fear of experiencing pain and discomfort. However, if they do this, their condition will only get worse. Other conditions In rare cases, constipation in babies and children can be a sign of an underlying condition, such as: Hirschsprungs disease which affects the bowel, making it difficult to pass stools anorectal malformation where the babys anus and rectum dont form properly spinal cord abnormalities including rare conditions such as spina bifida and cerebral palsy cystic fibrosis a genetic condition that causes the body to produce thick and sticky mucus, which can lead to constipation Diagnosing constipation Constipation is a very common condition. Your pharmacist wont usually need to carry out any tests or procedures, but will confirm a diagnosis based on your symptoms and medical history. Your pharmacist will ask you some questions about your bowel habits. Dont feel embarrassed about discussing this with your pharmacist. Its important theyre aware of all of your symptoms, so they can make the correct diagnosis. Your pharmacist may also ask questions about your diet, level of exercise and whether there have been any recent changes to your routines. Constipation can be defined in a number of ways: opening the bowels less than 3times a week needing to strain to open your bowels on more than a quarter of occasions passing a hard or pellet-like stool on more than a quarter of occasions Physical examination If your pharmacist thinks you may have faecal impaction (when dry, hard stools collect in your rectum), they may advise you to contact your GP for a physical examination. Read complications of constipation for more information about faecal impaction. A typical examination will begin with you lying on your back, while the GP feels your abdomen (tummy). Youll then lie on your side while your GP carries out a rectal examination using a lubricated, gloved finger. Your GP will be able to feel for any stools that may have collected. An internal physical examination rarely needs to be carried out on a child. Instead, the diagnosis can usually be made by feeling the childs tummy. Further tests If youre experiencing severe symptoms, your doctor may request further tests, such as blood tests or thyroid tests, to diagnose or rule out other conditions. Other tests you may have include: an abdominal X-ray where X-rayradiation is used to produce images of the inside of your abdomen transit study examination where you take a short course of special capsules that show up on X-rays; one or more X-rays are taken later on to see how long it takes for the capsules to pass through your digestive system anorectal manometry where a small device with a balloon at one end is inserted into your rectum andattached to a machine that measures pressure readings from the balloon as you squeeze, relax and push your rectum muscles; this gives an idea of how well the muscles and nerves in and around your rectum are working As theres an increased risk of bowel cancer in older adults, your doctor may also request tests to rule out a diagnosis of cancer, including a computerised tomography (CT) scan or colonoscopy. Treating constipation Treatment for constipation depends on the cause, how long youve had it and how severe your symptoms are. In many cases, its possible to relieve the symptoms by making dietary and lifestyle changes. Lifestyle advice Changes to diet and lifestyle are often recommended as the first treatment for constipation. In many cases,this will improve the conditionwithout the need for medication. Some self-help methods of treating constipation are: increase your daily intake of fibre (you should eat at least 18 to 30g of fibre a day) add some bulking agents, such as wheat bran, to your diet to help make your stools softer and easier to pass avoid dehydration by drinking plenty of water exercise more regularly for example,by going for a daily walk or run if constipation is causing pain or discomfort, you may want to take a painkiller, such as paracetamol always follow the dosage instructions carefully; children under 16 shouldnt take aspirin keep to a routine (a place and time of day) when youre able to spend time on the toilet and respond to your bowels natural pattern: when you feel the urge, dont delay try resting your feet on a low stool while going to the toilet, so that your knees are above your hips; this can make passing stools easier if medication youre takingcould be causing constipation, your GP may be able to prescribe an alternative Read about preventing constipation for more ways to change your diet and lifestyle. Your pharmacist may recommend an oral laxative if diet and lifestyle changes dont help. Laxatives Laxatives are a type of medicine that help you pass stools. There are several different types of laxative and each one has a different effect on your digestive system. Bulk-forming laxatives Your pharmacist will usually startyou ona bulk-forming laxative. These work by helping your stools to retain fluid. This means theyre less likely to dry out, which can lead to faecal impaction. Bulk-forming laxatives also make your stools softer, which means they should be easier to pass. Commonly prescribed bulk-forming laxatives include ispaghula husk,methylcellulose and sterculia. When taking this type of laxative, you must drink plenty of fluids, and dont take them before going to bed. It will usually be 2to 3days before you feel the effects of a bulk-forming laxative. Osmotic laxatives If your stools remain hard after youve taken a bulk-forming laxative, your pharmacist may prescribe an osmotic laxative instead. Osmotic laxatives increase the amount of fluid in your bowels. Thissoftens your stools and stimulates your body to pass them. Commonly prescribed osmotic laxatives includelactulose and macrogols. As with bulk-forming laxatives, make sure you drink enough fluids. It will usually be 2to 3days before you feel the effect of the laxative. Stimulant laxatives If your stools are soft, but you still have difficulty passing them, your pharmacist may recommend a stimulant laxative. This type of laxative stimulates the muscles that line your digestive tract, helping them to move stools and waste products along your large intestine to your anus. The most commonly prescribed stimulant laxatives are senna, bisacodyl and sodium picosulphate. These laxatives are usually only used on a short-term basis, and they start to work within 6 to 12 hours. According to your individual preference andhow quicklyyou needrelief, your pharmacist may decide to combine different laxatives. How long will I need to take laxatives for? If youve had constipation for a short time, your pharmacist will usually advise you to stop taking the laxative once your stools are soft and easily passed. However, if your constipationis caused byan underlying medical condition or a medicine youre taking,your GP may advise you to take laxatives for much longer, possibly many months oreven years. If youve been taking laxatives for some time, you may have to gradually reduce your dose, rather than coming off them straight away. If you have been prescribed a combination of laxatives, youll normally have to reduce the dosage of each laxative, one at a time, before you can stop taking them. This can take several months. Your GP will advise you about when its best to stop taking long-term laxatives. Treating faecal impaction Faecal impaction occurs when stools become hard and dry and collect in your rectum. This obstructs the rectum, making it more difficult for stools to pass along. Sometimes as a result of impaction, overflow diarrhoea may occur (where loose stools leak around the obstruction). You may have difficulty controlling this. If you have faecal impaction, youll initially be treated with a high dose of the osmotic laxative macrogol. After a few days of using macrogol, you may also have to start taking a stimulant laxative. If you dont respond to these laxatives, and/or if you have overflow diarrhoea, you may need one of the following medications. Suppository this type of medicine is inserted into your anus. The suppository gradually dissolves at body temperature and is then absorbed into your bloodstream. Bisacodyl is an example of a medication that can be given in suppository form. Mini enema where a medicine in fluid form is injected through your anus and into your large bowel. Docusate and sodium citrate can be given in this way. Pregnancy or breastfeeding If youre pregnant, there are ways for you to safely treat constipation without harming you or your baby. Your pharmacist will first advise you to change your diet by increasing fibre and fluid intake. Youll also be advised to do gentle exercise. If dietary and lifestyle changes dont work, you may be prescribed a laxative to help you pass stools more regularly. Lots of laxatives are safe for pregnant women to use because most arent absorbed by the digestive system. This means that your baby wont feel the effects of the laxative. Laxatives that are safe to use during pregnancy include the osmotic laxatives lactulose and macrogols. If these dont work, your pharmacist may recommend taking a small dose of bisacodyl or senna (stimulant laxatives). However, senna may not be suitable if youre in your third trimester of pregnancy, because its partially absorbed by your digestive system. Read more about constipation and other common pregnancy problems . Babieswho havent been weaned If your baby is constipated but hasnt started to eat solid foods, the first way to treat them is to give them extra water between their normal feeds. If youre using formula milk, make the formula as directed by the manufacturer and dont dilute the mixture. You may want to try gently moving your babys legs in a bicycling motion or carefully massaging their tummy to help stimulate their bowels. Babies who are eating solids If your baby is eating solid foods, give them plenty of water or diluted fruit juice. Try to encourage them to eat fruit, which can be pured or chopped, depending on their ability to chew. The best fruits for babies to eat to treat constipation are: apples apricots grapes peaches pears plums prunes raspberries strawberries Never force your baby to eat food if they dont want to. If you do, it can turn mealtimes into a battle and your child may start to think of eating as a negative and stressful experience. If your baby is still constipated after a change in diet, they may have to be prescribed a laxative. Bulk-forming laxatives arent suitable for babies, so theyll usually be given an osmotic laxative. However, if this doesnt work, they can be prescribed a stimulant laxative. Children Forchildren, laxatives are often recommended alongside changes to diet. Osmotic laxatives are usually tried first, followed by a stimulant laxative if necessary. As well as eating fruit, older children should have a healthy, balanced diet , which also contains vegetables and wholegrain foods, such as wholemeal bread and pasta. Try to minimise stress or conflict associated with meal times orusing the toilet. Its important to be positive and encouraging when it comes to establishing a toilet routine. Allow your childat least 10 minutes on the toilet, to make sure theyve passed as many stools as possible. To encourage a positive toilet routine, try making a diary of your childs bowel movements linked to a reward system. This can help them focus on using the toilet successfully. Complications of constipation Constipation rarely causes any complications or long-term health problems. Treatment is usually effective, particularly if its started promptly. However, if you have long-term (chronic) constipation, you may be more at risk of experiencing complications. Rectal bleeding Continually straining to pass stools can cause pain, discomfort and rectal bleeding. In some cases, bleeding is the result of a small tear around the anus (anal fissure), but its more often caused by haemorrhoids (piles) . Piles are swollen blood vessels that form in the lower rectum and anus. As well as bleeding, piles can also cause pain, itching around the anus, and swelling of the anus. The symptoms of piles often settle down after a few days without treatment. However, creams and ointments are available to reduce any itching or discomfort. See your pharmacist as soon as possible if you experience any rectal bleeding. Faecal impaction Long-term constipation can increase the risk of faecal impaction, whichis where dried, hard stools collect in your rectum and anus. Once you have faecal impaction, its very unlikely that youll be able to get rid of the stools naturally. Faecal impaction makes constipation worse because its harder for stools and waste products to pass out of your anus, as the path is obstructed. Faecal impaction can sometimes lead to a number of other complications, including: swelling of the rectum a loss of sensation in and around your anus bowelincontinence bleeding from your anus rectal prolapse where part of your lower intestine falls out of place and protrudes from your anus (this can also occuras a result ofrepeated straining in people withchronic constipation) Faecal impaction is usually treated with laxative medication, although suppositories (medication inserted into the anus) andmini enemas (where medicine in fluid form is injected through your anus) may sometimes be used. Preventing constipation There are a number of things you can do to prevent constipation, including making diet and lifestyle changes. Fibre Includingenough fibre in your diet can significantly reduce your chances of developing constipation. Most adults dont eat enough fibre. You should aim to have about 30g of fibre a day. You can increase your fibre intake by eating more: fruit and vegetables wholegrain rice wholewheat pasta wholemeal bread seeds and oats Eating more fibre will keep your bowel movements regular, because it helps food pass through your digestive system more easily. Foods high in fibre also make you feel fuller for longer. Its important to increase your fibre intake gradually, because a sudden increase may make you feel bloated. Suddenly increasing your intake of fibre may also cause you to produce more wind( flatulence ) and experience stomach cramps. Read more abouthow to increase your intake of fibre and eating a healthy, balanced diet . Fluids Make sure you drink plenty of fluids to avoid dehydration , and steadily increase your intake when exercising or when its hot. Try to cut back on the amount of caffeine, alcohol and fizzy drinks you consume. Toilet habits Never ignore the urge to go to the toilet, because it can significantly increase your chances of having constipation. When going to the toilet, make sure you have enough time and privacy to pass stools comfortably. Exercise Keeping active andmobile will greatly reduce your risk of getting constipation. You should do at least 150 minutes of physical activity every week. As well as regular exercise reducing your risk of becoming constipated, it will also leave you feeling healthier and improve your mood, energy levels and general fitness. Read more about health and fitness and physical activity guidelines for adults . Source: NHS 24 - Opens in new browser window Last updated: 12 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Haemorrhoids (piles) Laxatives Other health sites British Nutrition Foundation The IBS Network Education and Resources for Improving Childhood Continence (ERIC) NICE: laxatives Search for a pharmacy near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Coronavirus (COVID-19)

Coronavirus (COVID-19) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Coronavirus (COVID-19) Coronavirus (COVID-19) Coronavirus (COVID-19) British Sign Language (BSL) Coronavirus, and other respiratory infections such as flu, can spread easily and cause serious illness in some people. Vaccinations are very effective at preventing serious illness from coronavirus. But theres still a chance you might catch coronavirus, or another respiratory infection, and pass it on to other people. Most people no longer need to take a coronavirus test. To prevent the spread of infection, you should try to stay at home if youre unwell. You can still access testing if you have a health condition which means youre eligible for coronavirus treatments . Symptoms To prevent the spread of coronavirus, try to stay at home and avoid contact with other people if you have symptoms of a respiratory infection such as coronavirus and you: have a high temperature or do not feel well enough to go to work or carry out normal activities Try to do this until you no longer have a high temperature (if you had one) or until you feel better. Symptoms of coronavirus include: continuous cough high temperature, fever or chills loss of, or change in, your normal sense of taste or smell shortness of breath unexplained tiredness, lack of energy muscle aches or pains that are not due to exercise not wanting to eat or not feeling hungry headache thats unusual or longer lasting than usual sore throat, stuffy or runny nose diarrhoea feeling sick or being sick How to help your symptoms Do drink fluids like water to keep yourself hydrated get plenty of rest wear loose, comfortable clothing dont try to make yourself too cold take over-the-counter medications like paracetamol always follow the manufacturers instructions Antibiotics will not relieve your symptoms or speed up your recovery. You might continue to have a cough or feel tired after your other symptoms have improved. This does not mean that youre still infectious. Phone 999 or to go A&E if: You or your child: seems very unwell, is getting worse or you think theres something seriously wrong children and babies in particular can get unwell very quickly gets sudden chest pain is so breathless theyre unable to say short sentences when resting, or breathing suddenly gets worse in babies their stomach may suck under their ribs starts coughing up blood collapses, faints, or has a seizure or fit for the first time has a rash that does not fade when you roll a glass over it, the same as meningitis Speak to your GP if: your symptoms worsen youre concerned about your symptoms you have symptoms that you can no longer manage at home youre worried about your child, especially if theyre under 2 years If your GP is closed, phone 111. In an emergency phone 999. Its particularly important to get help if youre at increased risk of becoming more unwell from coronavirus such as if youre pregnant, aged 60 or over, or have a weakened immune system. Stay at home advice There are things you can do to reduce the spread of infection if you have symptoms, have tested positive, or are a close contact. If you arent eligible for testing and you have symptoms of a respiratory infection such as coronavirus and have a high temperature or do not feel well enough to go to work or carry out normal activities, try to stay at home and avoid contact with other people. Try to do this until you no longer have a high temperature (if you had one) or until you feel better. If you have a positive coronavirus test result, try to stay at home and avoid contact with other people for 5 days after the day you took your test, or from the day your symptoms started (whichever was earlier). You should count the day after you took the test as day 1. If a child or young person aged 18 or under has a positive coronavirus test result, they should try to stay at home and avoid contact with other people for 3 days after the day they took the test or from the day their symptoms started (whichever was earliest), if they can. Children and young people tend to be infectious for less time than adults. If youve had a positive test result, and have completed 5 days of self-isolation Although many people will no longer be infectious to others after 5 days, some people may be infectious to other people for up to 10 days from the start of their infection. If you have a high temperature or still feel unwell after the 5 days, continue to try to stay at home. Try to stay at home until you: feel well enough to go back to normal activities no longer have a high temperature (if you had one) This will help reduce the risk of spreading the virus. You should avoid meeting people at higher risk of becoming seriously unwell from coronavirus, especially those whose immune system means that they are at higher risk of serious illness from coronavirus for 10 days after the day you took your test. If youve received a positive test result and have been following the stay at home advice, you do not need to test after the 5 day period unless youve been advised to do so by a health professional. How to reduce the spread of infection Do work from home if you can if you cant, talk to your employer about your options if youve been asked to attend a medical or dental appointment in person, tell them about your symptoms or positive test ask friends, family or neighbours to get food and other essentials for you, if you wish tell people you have recently been in contact with that youre feeling unwell or have tested positive so they can be aware of symptoms keep your distance from the people you live with if you can ventilate rooms you have been in by opening windows and leaving them open for at least 10 minutes after you have left the room wear a well-fitting face covering made with multiple layers or a surgical face mask if you do leave home or in shared areas in your home, especially if you live with someone with a weakened immune system regularly clean frequently touched surfaces, such as door handles and remote controls, and shared areas such as kitchens and bathrooms if you do leave home, exercise outdoors in places where you will not have close contact with other people cover your mouth and nose when you cough or sneeze wash your hands regularly with soap and water for 20 seconds or use hand sanitiser after coughing, sneezing, blowing your nose, and before you eat or handle food tell anyone who needs to come into your home that you have symptoms or have tested positive so they can protect themselves Dont do not have close contact with anyone who is at higher risk, especially individuals with a weakened immune system, if you can avoid it do not go to crowded places or anywhere that is enclosed or poorly ventilated if you do leave home do not touch your face with unwashed hands, if you can avoid it Children and young people aged 18 and under Respiratory infections are common in children and young people, particularly during the winter months. Symptoms can be caused by several respiratory infections including the common cold, coronavirus and RSV. For most children and young people, these illnesses will not be serious. Theyll soon recover following rest and plenty of fluids. Very few children and young people with respiratory infections become seriously unwell. When to stay at home Children and young people with mild symptoms who are otherwise well, can continue to attend their education setting. Mild symptoms include a runny nose, sore throat, or slight cough. Children and young people who are unwell and have a high temperature should stay at home and avoid contact with other people, where they can. They can go back to school, college or childcare, and resume normal activities when they no longer have a high temperature and theyre well enough to attend. Its not recommended that children and young people are tested for coronavirus unless advised to by a healthcare professional. Children and young people who usually go to school, college or childcare and who live with someone who has a positive coronavirus test result should continue to attend as normal. Financial Support The Self-Isolation Support Grant closed on 5 January 2023. Visit the Scottish Governments Cost of Living support to find out about other financial help available. Source: Scottish Government - Opens in new browser window Last updated: 01 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Other languages and formats British Sign Language (BSL) British Sign Language (BSL) Add this page to\n Info For Me Also on NHS inform Long-term effects of COVID-19 (long COVID) NHS Scotland COVID Status Self-help guide: Coronavirus (COVID-19) Coronavirus (COVID-19): Treatments COVID 19 vaccine Other health sites Scottish Government: Respiratory infections including coronavirus (COVID-19) Report your test result NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852

Cough

Cough | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Cough Cough British Sign Language (BSL) | | | Polski | Romn | Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF A cough is a reflex action to clear your airways of mucus and irritants such as dust or smoke. Its rarely a sign of anything serious. Most coughs clear up within 3 weeks and dont require any treatment. A dry cough means itstickly and doesnt produceany phlegm(thick mucus). A chesty cough meansphlegm is produced to help clear your airways. Cough self-help guide Complete our self-help guide to check your symptoms and find out what to do next. Speak to a pharmacist for: advice about coughs cough treatments Find your local pharmacy Speak to a GP if: youve had a cough for more than 3 weeks your cough is particularly severe youcough up blood you experience shortness of breath, breathing difficulties or chest pain you have any other worrying symptoms, such as unexplained weight loss, a persistent change in your voice,orlumps or swellings in your neck If your GP is unsure whats causing your cough, they may refer you to a hospital specialist for an assessment. They may also request some tests, such asa chest X-ray , allergy tests, breathing tests, and an analysis of a sample of your phlegm to check for infection. If youre concerned about coronavirus (COVID-19):visit our coronaviruspage . Short-term coughs Common causes of a short-term cough include: an upperrespiratory tract infection(URTI) that affects the throat, windpipe or sinuses examples area cold , flu , laryngitis , sinusitis or whooping cough a lower respiratory tract infection (LRTI) that affects your lungs or lower airwaysexamples areacute bronchitis or pneumonia an allergy , such as allergic rhinitis or hay fever a flare-up of a long-term condition such as asthma , chronic obstructive pulmonary disease (COPD) or chronic bronchitis inhaled dust or smoke coronavirus (COVID-19) In rare cases, a short-term cough may be the first sign of a health condition that causes apersistent cough. Persistentcoughs A persistent cough may be caused by: along-termrespiratory tract infection, such aschronic bronchitis asthma this also usually causes other symptoms, such as wheezing, chest tightness and shortness of breath an allergy smokinga smokers cough can also be a symptom ofCOPD bronchiectasis where the airways of the lungs become abnormally widened postnasal drip mucus dripping down the throat from the back of the nose, caused by a condition such asrhinitisorsinusitis gastro-oesophageal reflux disease (GORD) where the throat becomesirritated by leaking stomach acid a prescribed medicine, such as an angiotensin-converting enzyme inhibitor (ACE inhibitor), which is used to treathigh blood pressure andcardiovascular disease In most cases, a doctor wont worry whether a cough is dry or chesty, but will need to know if you are producing much more or darker phlegm than usual. Rarely, apersistent cough can bea symptom of a more serious condition, such as lung cancer , heart failure , a pulmonaryembolism(blood clot on the lung) or tuberculosis . Coughsin children Coughsin childrenoften have similar causes to those mentioned above. For example, respiratory tract infections,asthma andGORD can all affect children. Causes of coughs that are more common in children than adults include: bronchiolitis amild respiratory tract infection that usually causes cold-like symptoms croup this causes a distinctive barking cough and a harsh sound known as stridor when the childbreathes in whooping cough look out for symptoms such as intense, hacking bouts of coughing, vomiting, and a whoop sound with each sharp intake of breath after coughing Occasionally, a persistent cough in a child can be asign of a serious long-term condition, such as cystic fibrosis . Read more about what to do if your child has cold or flu symptoms Cough treatments Treatment isnt always necessary for short-term coughs because its likely to be a viral infection that will getbetter on its own within a few weeks. Do rest drink plenty of fluids take painkillers such as paracetamol or ibuprofen Cough medicines and remedies Although some people find them helpful,medicines that claim to suppress your cough or stop you bringing up phlegm are not usually recommended. This is becausetheres little evidence to suggest theyre any betterthan simple home remedies, and theyre not suitable for everyone. The Medicines and Healthcare products Regulatory Agency (MHRA) recommends that over-the-counter cough and cold medicines shouldnt be given to children under the age of six. Children aged 6 to 12 should only use them on the advice of a pharmacist or doctor. Ahomemade remedy containing honey and lemon is likely to be just as useful and safer to take. Honey shouldnt be given to babies under the age of one because of the risk of infant botulism. Treating the underlying cause If your cough has a specific cause, treating this may help. For example: asthmacan be treatedwithinhaledsteroidsto reduce inflammation inyour airways allergies can be treated by avoiding things youre allergic to and takingantihistaminesto dampen down your allergic reactions bacterial infections can be treated with antibiotics GORD can be treated withantacidsto neutralise your stomach acid and medication to reduce the amount of acid your stomach produces COPD can be treated withbronchodilators to widen your airways If you smoke, quittingis also likely to help improve your cough. Read more about stopping smoking . Contact your GP or, if your GPs closed, phone 111 if your child: is under 3 months old and has a temperature of 38C or above is older than 3 months and has a temperature of 39C or above has fewer wet nappies or nappies that seem drier than usual or has a dry nappy for over 12 hours isnt getting better after a few days is taking less than half their usual amount during their last 2 or 3 feeds If youre very concerned about your child trust your instincts and phone your GP or 111 for advice, or phone 999 in an emergency. Source: NHS 24 - Opens in new browser window Last updated: 10 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Crohns disease

"Crohn's disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Inflammatory bowel disease (IBD) Crohns disease Crohns disease Crohns disease is a long-term condition that causes inflammation of the lining of the digestive system. Inflammation can affect any part of the digestive system, from the mouth to the back passage. But it mostly occurs in the last section of the small intestine (ileum) or the large intestine (colon). Crohns disease can affect people of all ages, but its usually diagnosed between the age of 15 and 40. Symptoms The symptoms of Crohns disease vary. They depend on which part of the digestive system is inflamed. Common symptoms include: recurring diarrhoea abdominal pain and cramping, which is usually worse after eating extreme tiredness (fatigue) unintended weight loss blood and mucus in your poo You may have long periods without symptoms, or very mild symptoms. This is known as remission. This may be followed by periods where the symptoms are particularly troublesome. These are known as flare-ups or relapses. Less common symptoms include: a high temperature (fever) of 38C (100F) or above feeling sick (nausea) being sick (vomiting) joint pain and swelling ( arthritis ) inflammation and irritation of the eyes (uveitis) areas of painful, red and swollen skin most often the legs mouth ulcers anal pain and discharge due to perianal Crohns Children with Crohns disease may grow at a slower rate than expected. Speak to your GP practice if you have: diarrhoea for more than 7 days persistent abdominal pain unexplained weight loss blood in your poo concern about your childs development Causes The exact cause of Crohns disease is unknown. A combination of factors may be responsible, including: genetics genes you inherit from your parents a problem with the immune system (the bodys defence against infection and illness) where it attacks healthy bacteria in the gut and causes inflammation environmental factors like air pollution, medication or previous infections smoking smokers are twice as likely to develop Crohns disease, and usually have more severe symptoms than non-smokers Diagnosis Your GP will usually ask you about: your pattern of symptoms your diet any recent travel for example, you may have developed travellers diarrhoea whether youre taking any medication, including any over-the-counter medicines whether anyone else in your family has any bowel conditions Your GP may also carry out a tests to check your general health. For example, they may: check your pulse check your blood pressure measure your height and weight measure your temperature examine your abdomen (tummy) Your GP may also: arrange blood tests to check for inflammation, infection and anaemia ask for a stool (poo) sample to use a qFIT test to check for blood and mucus, infection or inflammation via a faecal calprotectin test Referral to a specialist You may be referred to a gastroenterologist. A gastroenterologist is a specialist in conditions of the digestive system. They might recommend more tests, such as: gastroscopy a thin flexible tube with a camera is put into your mouth to look at your food pipe and stomach colonoscopy a thin, flexible tube with a camera is put into your bottom to look at the whole of your large bowel sigmoidoscopy a thin, flexible tube with a camera is put into your bottom to look at the end of your large bowel a colon capsule endoscopy (pill camera) X-ray or barium enema MRI scan or CT scan You will be told what tests you need and what you need to do to prepare for them. Treatment Theres currently no cure for Crohns disease, but treatment can improve the symptoms and keep the inflammation under control. Your treatment will usually be provided by a range of healthcare professionals. Once your symptoms are under control, you are likely to be offered treatment to help keep them under control. If your Crohns stays under control for a long time, you may choose to stop treatment. You may need to start again if your symptoms come back. Steroid medication The first treatment offered is usually steroids, such as prednisolone or budesonide ( corticosteroids ) to reduce inflammation quickly. Steroids are often effective in reducing your symptoms. But they can have significant side effects . So theyre not suitable for long-term use and your dose will slowly be reduced when your symptoms start to improve. Medicines to suppress your immune system Medicines to suppress your immune system (immunosuppressants) may be given alongside steroids if your symptoms flare up twice or more during 12 months, or return when your steroid dose is reduced. Common types include azathioprine, mercaptopurine and methotrexate. Biological therapies If steroids and immunosuppressants dont help or arent right for you, biological therapies may be used. Biological therapies block particular chemicals involved in the immune response, which helps reduce inflammation. Theyre made using living cells in a lab. They can be given as a drip or an injection. Treatment usually lasts at least 12 months. Your inflammatory bowel disease (IBD) team will be able to discuss these with you. Common types are adalimumab, infliximab, ustekinumab or vedolizumab. Theres a risk that these medicines may cause side effects, which can cause symptoms such as: itchy skin a high temperature joint and muscle pain swelling of the hands or lips problems swallowing You should seek immediate medical help if you experience these symptoms. Reactions can occur immediately after treatment or months later, even after treatment stops. Surgery Surgery to treat Crohns disease may be an option if: you choose to have surgery instead of taking medications that may cause side effects medications dont control your symptoms your quality of life is severely affected by your condition you have serious complications of Crohns disease Surgery might involve widening narrow parts of your bowel, or removing parts of it (resection). Resection involves removing the inflamed area of the intestine. If you have a resection, you might have the healthy sections of bowel joined back together. Or you might have the end of your small bowel joined to the skin of your tummy (an ileostomy or stoma). In this case, poo comes out of the opening on your tummy and is collected in special bags that you wear. An ileostomy might be temporary, to give your bowel time to heal, or it might be permanent. Your IBD team will tell you what surgery they recommend and let you know what to expect. Diet and smoking There is no evidence that a particular diet causes or triggers flare-ups of Crohns disease. But alongside medications, some changes to your diet may help control symptoms for some people. Do eat 5 to 6 small meals rather than 3 main meals try to eat a healthy, varied diet that includes a wide variety of fruit, vegetables, nuts, seeds, proteins and wholegrains drink plenty of water Do not make major changes to your diet without talking to your IBD team and make sure you are still getting all the nutrients you need. You can speak to your IBD team about: keeping a food diary to find out if any particular foods affect your symptoms removing trigger foods from your diet taking a food supplement if you are struggling to get enough nutrients from your diet being referred to a dietitian If you smoke, it is advised that you make every effort to stop smoking , especially if you need to have surgery. If you smoke, smoking can make Crohns worse and is it important that you make every effort to stop smoking . Fertility and pregnancy A womans chance of becoming pregnant isnt usually affected by Crohns disease. However, surgery for Crohns disease might affect your fertility. Most women with Crohns disease will have a normal pregnancy and a healthy baby. But if youre pregnant or planning a pregnancy you should discuss it with your IBD team. This is because they may need to change your medication. If youre having a flare-up of Crohns disease you may also be advised to avoid getting pregnant until its under control. Complications Over time, inflammation can damage sections of the digestive system. This can result in complications such as: narrowing of the bowel (stricture) a channel developing between your bowel and your skin, another section of bowel or a body organ (fistula) These problems usually need surgical treatment. Information about you If you have Crohns disease, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register Source: Scottish Government - Opens in new browser window Last updated: 25 January 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. [email protected] Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Ulcerative colitis Inflammatory bowel disease (IBD) Other health sites Crohn's & Colitis UK: Crohn's Disease Crohn's & Colitis UK: Symptoms Crohn's & Colitis UK: Tests and investigations Crohn's & Colitis UK: Fistulas Crohn's & Colitis UK: Stoma Crohn's & Colitis UK: Smoking Crohn's & Colitis UK: Treatments Crohn's & Colitis UK: Reproductive health Chron's & Colitis UK: Getting a diagnosis Chron's & Colitis UK: Joints Chron's & Colitis UK: Pregnancy and breastfeeding NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852"