Is this pain in my gut down to IBS… or my recent back injury?

I am a long-term irritable bowel syndrome (IBS) sufferer but I had been able to manage the pain pretty well. However, earlier this year I injured my back while bending down. Now I have an almost continuous pain low down in the gut. I cannot work out whether this is gut or back related. Would a scan detect the source of my pain?

As IBS is a chronic condition it can be difficult to ascertain whether it is to blame for a new pain. The agony related to IBS is very specific in its character and recognisable by sufferers.

It usually causes a cramp-like pain that worsens after eating, and is affected – for better or for worse – by opening the bowels. This cramp-like pain is the tightening of muscles in the gut, often coming and going in waves.

Of course, people with IBS suffer a variety of aches, but a continuous pain in the gut would not be typical.

It would not be unusual to have abdominal pain caused by a back injury. The entire abdominal wall is held firm by muscles, and a back injury will put pressure on the muscles in the front. This can lead to abdominal sprains.

Another cause of pain in this area could be a hernia – a weakness in a muscular wall allowing the internal contents behind to push through. They are common in the abdomen and cause anything from a dull ache to ongoing agony.

To assess where the pain is coming from, a GP examination would be best. The abdomen and back would need to be looked at and tested for movements or postures that induce the pain.

Prior to any appointment it is useful to log a pain diary. This involves documenting when and how the pain comes as well as what was happening that day. This can be an invaluable tool for seeing when the pain woes arrive, which often helps medics with their diagnosis.

I’ve noticed that my right ankle has started to tilt, as if it needs propping up, when I walk. I am in my 50s, I walk a lot and am otherwise fit and not overweight. I tend to wear shoes with support but I’d like to stop it getting any worse. What do you recommend?

When an ankle feels unreliable, or like it is giving way, it is often a condition called ankle instability. Patients find they feel wobbly on that foot, especially if the floor is uneven or during sports. Some sufferers will notice swelling and occasionally feel pain.

An ankle often becomes unstable after a sprain – an over-pulling or tear of the ligaments, which are the tissues that support bones. In the ankle the ligaments hold everything in place, keeping it firm but mobile for all movements.

Instability is more likely in people who have repeated sprains on the same foot. A sprained ankle ligament is one of the most common sports injuries.

The diagnosis would usually be made by a GP or physiotherapist. An MRI may also be needed to assess for damage.

Physiotherapy is the first type of treatment for ankle instability, in an effort to strengthen the muscles and ligaments. Improving one’s balance as well as supportive shoes and orthotics within footwear can be vital. An ankle braces may be recommended, too – this holds the ankle in place and prevents further damage.

If it does not settle then surgery is an option, but most patients will not need this.

For the past two years I have had an extremely itchy back. I went to my local surgery and they had no answer – my skin is very clear with no obvious signs of irritation. Coincidentally, this has occurred since starting Covid vaccinations, and I wondered whether there may be a connection. Have you heard of anybody else suffering the same or, better, have any remedies? I am 80 years old.

Itchiness is very distressing and made even more so when no cause is found.

Skin infections, such as scabies, and dermatitis, such as eczema, are obvious culprits – as are allergies and irritations caused by washing detergents used on bed sheets and pyjamas, for instance.

Medications can cause itchiness without a visible rash and may even continue to do so once you stop taking them. Some sources include: blood pressure tablets, such as amlodipine or irbesartan; diabetes drugs metformin and gliclazide; gout medicine allopurinol; and painkillers including codeine. The GP can decide whether these should be stopped or swapped out.

Even if no cause is found, it is still important to have treatment to limit the distracting side effects. This may involve the use of antihistamines or creams. Loose cotton clothing limits irritation of the skin, too, as does keeping cool.

While itching is a common side effect of medication, it would certainly be less common in the long term. Since the Covid vaccinations are still relatively new, it would be worth reporting this to the side effect regulatory body via the MHRA yellow card scheme. A pharmacist or GP can help you do this, but it is also possible to do so online.

Fight gambling addiction – by tackling the stigma

Reports suggest that six out of ten adults in the UK who have experienced problems with gambling have never spoken to anyone about it. I find this incredibly worrying.

Gambling addiction is a serious health problem which affects almost 300,000 people in the UK, with another 3.5 million negatively impacted by someone else’s gambling problem.

People who have had a gambling addiction are twice as likely to develop depression and anxiety compared to those who do not. One in five problem gamblers admit to having had suicidal thoughts in the past year.

And yet gambling is often a hidden addiction, which is far easier to hide than alcohol or drug abuse. This makes it all the more dangerous.

The problem can affect anyone, and I know from my work that all sorts of people – men, women and all age groups – can fall victim to gambling.

We need to create a society where people feel comfortable admitting they have a problem. Only then can we ensure that everyone who needs treatment can get it.

I’d urge anyone who is struggling to talk to their GP or look at the Gambleaware website (begambleaware.org).

Don’t miss your vital smear test

I was shocked to hear that a third of women invited for a cervical cancer screening do not take up the offer.

The screening is designed to spot signs of the human papillomavirus (HPV) in the cervix, which is responsible for 99 per cent of cases of the cancer. If HPV is spotted then further tests will be carried out to see if there are any changes in the cells of the cervix, which could be early signs of cancer.

The NHS invites all women aged between 25 and 64 for the smear test every three to five years. The programme saves thousands of lives every year by catching the disease early enough to cure it. But it would appear that the number of women showing up for their screening has been slowly falling in recent years.

Make no mistake, missing this test could be the difference between life and death. If you are invited for cervical screening, I would urge you to go.