FROM a dribble to a sudden urge to dash to the loo, incontinence can strike anywhere at any time.
There are two main types.
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Stress incontinence is when you leak because the bladder is under pressure, such as when you laugh or sneeze.
Urge incontinence is when you suddenly need to go because the muscles in the bladder are overactive.
A misconception is that it only happens to older people or pregnant women.
While pregnancy, childbirth and menopause make it more likely, the reality is it can affect any of us at any age.
We are about to go into World Continence Week.
If you suffer, then your GP can advise you.
Pelvic floor exercises can reduce leaks and help prevent incontinence.
To feel your pelvic floor muscles, imagine you are passing urine and stopping the flow mid-stream – that tug of the muscles is your pelvic floor.
Now imagine you’re stopping wind to find your posterior pelvic floor.
To exercise those muscles, sit comfortably and do a long squeeze, followed by ten short squeezes and repeat ten times.
Aim to do these at least three times a day.
Here’s a selection of what readers have been asking me this week.
‘Eczema hell is driving Dad insane’
Q: MY dad is 80 and in the last few months has got eczema.
His skin is unbelievably dry and itchy, driving him insane.
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He has tried loads of creams but nothing seems to work. Any suggestions?
A: Eczema is a condition where the skin becomes inflamed, leading to dryness, thickened skin, sometimes redness and intense itching.
It happens due to a combination of genetic and environmental factors, which cause the skin’s barrier to weaken and become more prone to irritation.
As we age, the skin is less able to maintain hydration and becomes thinner.
Asteatotic eczema is a type that is more common in older people when the skin becomes very dry, rough and scaly, and sometimes resembles little slabs of crazy paving.
It usually affects the shins but sometimes affects other areas such as the thighs, arms, tummy and back.
Avoid sitting close to a fire or radiators, where the air is warm and dry, and have short, warm showers – not hot, as this can dry the skin out further.
Have a bowl of water in each room to try to keep the air in the home moist.
For all types of eczema, the first-line and most important treatment is emollients to prevent moisture loss from the skin.
They also plug gaps in the skin’s weak barrier to prevent dust or other allergens getting in.
Your father should use fragrance-free emollient-based moisturisers formulated for sensitive/eczema-prone skin.
Emollients come as lotions, creams and ointments.
Ointments are the thickest and do the best job, if tolerable.
Emollients with added ingredients such as glycerin or ceramides can help the skin retain moisture.
They should be applied at least twice a day in all affected areas and can also be used as a soap substitute because soaps dry the skin.
Limit exposure to harsh soaps and household cleaners and opt for hypoallergenic or fragrance-free products wherever possible.
If over-the-counter treatments haven’t provided relief, I encourage your father to schedule an appointment with his GP to consider steroid creams and calcineurin inhibitors.
‘HYPOTENSION WOE’
Q: SUFFER from severe hypotension (blood pressure 56/39) linked to Sjogren’s syndrome.
My GP only offers me steroids for this problem and I feel reluctant to take them because they are not a cure.
Can you advise on any other ways to stop my blood pressure from falling so dramatically, because it makes me feel very ill when it happens?
A: Sjogren’s syndrome is a chronic autoimmune condition where the immune system mistakenly attacks your own moisture-producing glands, such as the ones that deliver saliva and tears.
This attack leads to the hallmark symptoms of dry mouth and eyes.
Sjogren’s syndrome can affect the autonomic nervous system (ANS), which helps to regulate various involuntary functions in the body, including heart rate and blood pressure.
In some individuals with Sjogren’s syndrome, the dysfunction of the ANS can result in hypotension.
Sjogren’s syndrome is also associated with various other complications, such as inflammation of blood vessels (vasculitis) or of the heart muscle (myocarditis), which can also cause hypotension.
It currently does not have a known cure, so the treatment aims instead at symptom management and prevention of complications.
To address hypotension, consider upping your fluid intake, using compression stockings/socks and avoiding triggers such as alcohol, excessive heat and prolonged standing.
Tilt-training or leg exercises might also help you.
A type of steroid known as fludro-cortisone is the first line of treatment but you are right that steroids do have extensive potential side-effects.
Some other drugs, with UK licences for use for other conditions, are sometimes prescribed “off-label” in order to treat postural hypotension.
But you may need to be referred to see a rheumatologist for these to be considered as a suitable treatment for your condition.
TIP OF THE WEEK
SHOULD you bother having cold showers?
Well, some research says it can support the immune system over time.
So if you are prone to the sniffles, finish each shower with a 30-second blast of cold water and see if it helps.
Q: MY granddaughter goes dizzy, pale and almost passes out after sitting on her knees for a few minutes.
It was identified because she kneels down for her mum to do her hair for school.
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She has been to see her GP who thought it could be hormonal.
Blood tests showed nothing.
She is sporty and while running cross country recently, her teacher told her to drop out as she was hyper-ventilating.
We are beginning to wonder if it is related to blood pressure or her heart.
A: For some people, kneeling causes the body to respond in unexpected ways.
Your grand-daughter may be experiencing vasovagal syncope, where kneeling stimulates the vagus nerve, resulting in a sudden decrease in heart rate and blood pressure.
Studies have found that position changes from sitting to kneeling to standing in church can cause fainting.
But usually, it’s the standing that causes the biggest drop in blood pressure.
Although the initial blood tests were normal, it would be a good idea to schedule another GP appointment for further evaluation of her blood pressure and heart function, especially if this is of concern to you – just to be on the safe side.
Meanwhile, it could be helpful to monitor her blood pressure in different positions, including standing and kneeling, to detect any significant changes.
Keep a journal of her symptoms, including their timing and severity as this may help with diagnosis.
I also recommend that your granddaughter avoid prolonged periods of kneeling, and to sit on a chair for her hair to be done and lie down if she feels dizzy.
Regarding her physical activity, if she’s feeling perfectly fine when doing sport there’s no reason for her to stop.
However, she should listen to her body and her teachers and take it easy if necessary.
SARNIES AND WRAPS BLAMED AS E.COLI OUTBREAK BITES
LOTS of sandwiches, wraps and salads have been pulled from supermarket shelves amid an E.coli outbreak that has seen more than 200 cases so far.
Some 42 per cent of those affected have been admitted to hospital, as health chiefs scramble to identify the exact source of the bug.
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Due to the wide geographic spread of cases, the UK Health Security Agency believes it is linked to nationally distributed food items.
More than 60 products have now been recalled from chains including Asda, Sainsbury’s, Aldi, Morrisons, Co-op and Boots over fears they may contain the bacteria.
Information on all food items affected can be found on the Food Safety Agency website (food.gov.uk).
Symptoms of E.coli include diarrhoea, stomach cramps and fever and can last up to two weeks.
The elderly, young children and those with a weaker immune system are more vulnerable to suffering a worse illness.
All the cases recorded in the outbreak this month involve Shiga toxin-producing E.coli O145 (Stec).
About half of these Stec cases develop bloody diarrhoea. In serious cases, the infection can damage organs, such as the kidneys.
Stamping out the spread of the infection requires control measures at all stages of the food chain.
But there are some things you can do at home, too . . .
- nCook all foods thoroughly, particularly minced meat products, such as burgers and meatballs, until the colour is the same all the way through and no blood runs from them.
- nStore uncooked meat at the bottom of the fridge to prevent juices dripping on to ready-to-eat foods below.
- n Wash pre-prepared bags of salad, as well as fruits and vegetables, before eating, and clean surfaces with a disinfectant.
- Only leave cooked foods, meat and dairy products out at room temperature for a short time.
- The UKHSA also advises people to regularly wash their hands with soap and water (not antibacterial gels), particularly before preparing food and eating it and after using the toilet.
- If you are unwell, do not prepare food for others and avoid hospital or care home visits. Do not return to work, school or nursery until 48 hours after your symptoms have stopped.
