How to beat the health problems no one likes to talk about: From piles to itchy bottoms and constant peeing in the night - and the VERY surprising diet changes that could help...

From an upset tummy and excess upwind to urine infections and piles, location are galore problems affecting ‘down there’ that we conscionable don’t consciousness comfortable talking about.

But nan consequence is that superior conditions spell undiagnosed – aliases group miss retired connected curen that could help.

We asked nan experts astir everything that tin spell incorrect pinch your bowels and individual plumbing – and what to do erstwhile it does.

WHAT’S NORMAL – AND WHAT’S NOT WHEN IT COMES TO BOWEL MOVEMENTS?

‘Anything from respective times a week to 3 times a time is successful nan normal range,’ says Dr Simon Smale, a advisor gastroenterologist astatine Manchester University NHS Foundation Trust.

‘It’s besides astir whether nan stool is easy to pass, aliases you person to strain.’

Severe chronic constipation, little than 3 bowel movements a week aliases trouble passing stools, affects up to 2 cardinal group successful nan UK.

For a one-off section wherever you person an evident logic for your constipation, specified arsenic a infirmary enactment aliases a long-haul flight, it’s good to return an over-the-counter remedy specified arsenic senna (a herbal laxative made from pods of nan Cassia character which stimulates nan gut), says Dr Smale.

‘But you should not return these long-term. Constipation should beryllium prevented by a patient diet, drinking plentifulness of fluids and exercise.’

People who person constipation arsenic a consequence of irritable bowel syndrome (IBS) shouldn’t usage senna, arsenic they tin build up a tolerance and truthful request to return much and much to get nan aforesaid effect.

Between 15 and 30 per cent of patients pinch chronic constipation person a information called slow-transit constipation, wherever their gut doesn’t move discarded astatine nan normal rate.

The proposal to eat much fibre whitethorn make nan problem worse, says Professor Julian Walters, a advisor gastroenterologist astatine Imperial College Healthcare NHS Trust.

‘Bran is simply a poorly tolerated root of fibre and tin make symptom and bloating worse successful immoderate constipated people.

‘So if you find fibre makes things worse, you whitethorn request to spot a gastroenterologist.’

RED FLAG: See your expert if you person unexplained weight loss, a family history of colon aliases ovarian cancer, rectal bleeding and symptoms that aftermath you astatine night.

‘I besides return much announcement if a personification complete 50 comes to spot maine pinch caller gut symptoms,’ says Dr Smale.

THOSE LITTLE RUMBLES – WHEN IS IT A WORRY?

WIND 

Passing upwind is simply a normal bodily usability – connected average, we walk upwind 15 times a day; but up to 40 times a time is considered normal, according to nan experts.

Flatus (gas) is simply a operation of swallowed aerial – from chewing gum, sucking sweets and eating and drinking astatine nan aforesaid clip – and state produced by germs successful nan gut.

The main gases are nitrogen, oxygen, c dioxide, hydrogen and methane, which person nary odour.

Smelly upwind is owed to a compound called sulphur – from our fare successful cruciferous veg and reddish nutrient – which is surgery down by your gut germs into a state called hydrogen sulphide, which smells for illustration rotten eggs.

Excess upwind tin beryllium caused by fare products that impact nan equilibrium of our gut bacteria, specified arsenic sugar-free chewing gum, because of nan artificial sweeteners; arsenic good arsenic laxatives; consequence juice and foods containing nan sweetener fructose; and narcotics specified arsenic non-steroidal anti-inflammatory narcotics (NSAIDs) utilized to dainty arthritis.

It tin besides beryllium a denotation of bowel conditions including IBS, coeliac illness and lactose intolerance.

You tin research pinch your fare to trim down connected immoderate of nan astir wind-inducing foods.

These are now mostly recognised arsenic being rich | successful FODMAPS (fermentable oligosaccharides, disaccharides, monosaccharides and polyols), types of sweetener recovered successful a wide scope of foods and drinks.

According to St Mark’s Hospital website, a master tertiary bowel infirmary successful Harrow, to trim upwind accumulation debar these foods: beans, peas, lentils and different pulses, bran cereal, cabbage, cauliflower, carrots and broccoli, radishes, eggs, shellfish, beverage and beverage products, muesli, overgarment murphy skins, leeks, parsnips, onions and dried fruits.

Caffeine tin besides summation bowel movements, perchance because of its stimulating effect connected nan colon muscles, and nutrient much wind.

‘Your doctors whitethorn want to analyse whether your upwind is simply a denotation of IBS, lactose intolerance aliases coeliac illness if you person different symptoms that propose this,’ says Professor Walters.

‘They whitethorn besides prescribe nan anti-spasmodic spasmonal aliases colpermin [containing peppermint oil] to relieve cramps.’

RUMBLING 

That embarrassing rumbling, gurgling sound your tummy makes has a aesculapian sanction – borborygmi.

Rest assured it will sound louder to you than anyone else.

It’s caused by nan activity of gas, nutrient and liquid successful nan intestines arsenic nan muscles propel them down done nan gut – called peristalsis.

Until precocious it’s been considered normal but researchers astatine nan University of Western Australia person invented an acoustic loop that listens to and records gut noises and they’ve recovered a nexus betwixt noisy rumblings and immoderate gut diseases.

‘It whitethorn beryllium a motion of incomplete digestion of nutrient and a build-up of state if accompanied by different symptoms specified arsenic bloating, symptom and diarrhoea,’ says Professor Walters.

This whitethorn beryllium a denotation of conditions specified arsenic lactose intolerance aliases coeliac disease, an autoimmune guidance to nan protein, gluten.

Borborygmi doesn’t mostly request treatment, but if location are different symptoms specified arsenic bloating, symptom and diarrhoea, spot a doctor.

THE DIET THAT COULD BANISH BLOATING FOR GOOD 

People pinch IBS tin strengthen a bid of embarrassing gut symptoms including diarrhoea, constipation, bloating, symptom successful nan rectum, needing to walk stools urgently and achy tummy cramps.

They whitethorn besides suffer large gurgle noises and excessive wind.

But it is not a straightforward diagnosis.

‘IBS is nan sanction fixed to a longstanding information that consists of predominant abdominal symptom and bowel symptoms that isn’t explained by immoderate different diseases,’ explains Alison Reid, main executive of nan IBS Network charity.

‘It has nary azygous circumstantial origin and nary 1 effective treatment.’

‘We cognize that immoderate group create symptoms aft nutrient poisoning (about 10 per cent), aliases a people of powerful antibiotics, aliases arsenic a denotation of a traumatic aliases stressful arena aliases bid of events . It’s important to spot your GP truthful that tests tin norm retired different conditions which person akin overlapping symptoms.

‘These see humor tests for anaemia and C-reactive macromolecule [a marker for infection aliases inflammation].

‘Other tests see an antibody trial for coeliac disease, faecal calproctectin (for inflammatory bowel disease, specified arsenic ulcerative colitis) and faecal occult humor (for bowel cancer).

If these are negative, and considering a patient’s aesculapian history, nan GP whitethorn past diagnose IBS.

If you do person IBS, there’s nary one-size-fits-all curen – it’s a mobility of trying different ones until you find thing that useful for you.

One newer thought that whitethorn thief is nan low-FODMAP diet.

FODMAPS are types of sweetener recovered successful a wide scope of foods and drinks that are thought to origin problems because they are poorly absorbed successful nan mini intestine and truthful participate nan colon, wherever they are fermented by bacteria, causing bloating, upwind and diarrhoea.

Most group are capable to tolerate FODMAPS – they will still person immoderate wind, but not symptom arsenic group successful IBS have.

Researchers person shown that avoiding foods precocious successful FODMAPS (and, successful susceptible individuals, beverage and dairy products arsenic good arsenic bread, which besides contains FODMAPS), tin amended IBS symptoms successful up to 73 per cent of cases.

The six FODMAPS identified arsenic nan astir apt to origin problems see fructans-oligosaccharides recovered successful wheat, rye, onions, ail and artichokes; glactooligosaccherides recovered successful legumes; lactose recovered successful milk; fructose successful honey, apples, pears, watermelon and mango; sorbitol recovered successful apples, pears, chromatic fruits and sugar-free mints; and mannitol recovered successful mushrooms, cauliflower and sugar-free mints.

Research published successful 2017 successful nan diary Gastroenterology by King’s College London, which compared nan low-FODMAP fare pinch a normal diet, showed it to beryllium an effective curen for IBS.

Kevin Whelan, a professor of dietetics astatine King’s College London, and nan lead researcher, says: ‘A batch of nan dietary proposal fixed to IBS patients successful nan past astir managing their symptoms done fare has been very deed and miss, and has been beautiful overmuch untested.

‘Our investigation has shown that pursuing a low-FODMAP fare tin resoluteness IBS symptoms successful betwixt 50 and 75 per cent of patients.

‘It was peculiarly successful successful helping to resoluteness flatulence, bloating and abdominal symptom symptoms.’

Professor Whelan said that successful a follow-up study 12 months aft patients tried nan diet, they gradually reintroduced FODMAP foods and nan majority’s IBS symptoms did not return.

‘We urge group attack nan fare successful 3 stages; removing these foods from their diet, achieving solution of symptoms and past slow and systematically reintroducing definite foods 1 by one,’ says Professor Whelan.

But he stresses that because it’s a restrictive diet, group pinch IBS must get proposal from a dietitian earlier starting it to guarantee they will still get each nan nutrients they need.

IS YOUR ‘IBS’ ACTUALLY A CONDITION CALLED ‘BAD’?

Professor Walters estimates that up to a 3rd of group (at slightest 1 million) told they person IBS pinch diarrhoea arsenic nan main denotation really person a information called bile acerb diarrhoea (or BAD).

‘It tin origin up to 10 watery stools a day, flatulence, urgency and achy abdominal cramps,’ he says.

It’s caused erstwhile bile acids produced by nan liver are not processed properly, truthful excess bile passes into nan colon, stimulating salts and h2o secretion, and starring to watery diarrhoea.

There is simply a trial for it - nan SeHCAT trial - wherever nan retention and nonaccomplishment of bile acids is measured complete 7 days.

A diligent swallows a capsule containing bile acerb and a mini magnitude of radioactive tracer. This allows scans taken a week isolated to show really nan assemblage is processing nan bile acid.

BAD tin beryllium treated pinch medicine specified arsenic colestyramine and colesvelam.

‘But excessively galore group are conscionable told that they person IBS and are not offered a test’, says Professor Walters.

He suggests asking for a trial if you person persistent, predominant watery diarrhoea.

OR A SIGN OF TOO MUCH BACTERIA IN YOUR GUT?

IBS-type symptoms tin besides beryllium caused by mini intestinal bacterial overgrowth (SIBO).

This is wherever colon germs migrate into nan mini intestine, starring to intermittent loose stools, diarrhoea and constipation.

It besides causes precocious levels of hydrogen and methane gas, and sometimes hydrogen sulphide gas, which whitethorn lead to burping.

SIBO is diagnosed pinch a activity trial measuring nan magnitude of hydrogen and methane that you respire retired complete a three-hour play aft drinking a substance of lactulose (a non-digestible sugar) and water. It tin beryllium treated pinch antibiotics.

Microscopic colitis whitethorn besides origin IBS-type symptoms, successful this lawsuit a type of terrible watery diarrhoea.

This is caused by changes successful inflammatory cells successful nan colon visible only nether a microscope: these trim nan magnitude of h2o absorbed from nan stool, starring to predominant watery motions.

It tin beryllium diagnosed pinch biopsies taken during a colonoscopy. It tin beryllium treated pinch a supplier called budesonide, a type of steroid, usually for 3 months, but sometimes it takes a fewer years to settee nan symptoms.

10 things you didn't cognize tin upset your gut 

When it comes to a troublesome tummy, we tin beryllium speedy to constituent nan digit astatine well-known culprits specified arsenic wheat aliases dairy products — pinch immoderate group cutting specified foods retired entirely.

But eliminating full nutrient groups from your fare is seldom what doctors advise, unless a circumstantial allergy aliases auto-immune condition, specified arsenic coeliac disease, is diagnosed. And erstwhile it comes to irritable bowel syndrome-type symptoms specified arsenic bloating, abdominal symptom and constipation, location are galore little evident triggers.

Here, we uncover nan apical gut saboteurs. Some of them whitethorn astonishment you …

1. Apples

Yes, of people consequence is portion of a patient diet, but nan National Institute for Health and Care Excellence (NICE) has recommended IBS patients limit consequence to 3 portions a day.

Apples are a peculiar problem for 2 reasons, explains Dr Steven Mann, a advisor gastroenterologist astatine nan Royal Free Hospital successful London.

‘Some group are fructose-intolerant, which intends they don’t digest good nan sweetener successful fruit. Apples are peculiarly precocious successful this consequence sugar.’

Apples besides incorporate sugars known arsenic fermentable oligosaccharides, disaccharides, monosaccharides and polyols (collectively known arsenic Fodmaps), which are poorly absorbed successful immoderate people’s mini intestine and truthful ferment, triggering symptoms.

A debased Fodmap fare is often suggested for group pinch IBS (see backmost page). Other fruits that person a precocious Fodmap contented are chromatic fruits specified arsenic apricots and prunes.

2. Mayonnaise

Hormones released successful consequence to nan precocious saturated fat contented successful mayonnaise whitethorn lead to a hold successful nan emptying of nan tummy and activity of nutrient done nan bowel, explains Dr Mann. This tin origin uncomfortable feelings of bloating.

3. Branflakes

This is thing of a paradox, since we’re often told that high-fibre foods specified arsenic bran are bully for nan bowel.

‘For those pinch IBS issues, specified arsenic bloating, bran tin aggravate nan condition,’ says Dr Mann. This is because adding a bulking supplier successful nan shape of fibre gives nan bowel moreover much activity to do, which tin make symptoms specified arsenic constipation worse. Kevin Whelan, professor of dietetics astatine Kings College, London, says nan fibre communicative is simply a analyzable one.

‘In nan Eighties and Nineties we were telling IBS patients to eat much fibre, but now we cognize it’s not arsenic elemental arsenic that. It depends connected what type of fibre it is.’

NICE recommends that group pinch IBS should beryllium discouraged from eating insoluble fibre (which intends it cannot beryllium absorbed by nan body), including bran.

Nice says that if much fibre successful nan fare is needed, it should beryllium soluble fibre (which tin beryllium absorbed) specified arsenic oats aliases ispaghula powder (made from nan husks of plants and contained successful products specified arsenic Fybogel).

So effort switching that greeting vessel of bran cereal for oat-based porridge. Watch retired for muesli, though, arsenic it tin incorporate a batch of high-Fodmap dried fruit.

4. Reheated pasta

Reheated carbohydrates, specified arsenic pasta and potatoes, incorporate what’s known arsenic resistant starch, which is harder for nan gut to break down, says Dr Mann.

That’s because erstwhile pasta is cooked and cooled, it becomes resistant to nan normal enzymes successful our gut that break carbohydrates — truthful nan gut efficaciously has to dainty it for illustration fibre, which tin worsen IBS symptoms.

Reheated pasta whitethorn beryllium worse than acold pasta — investigation has shown that nan starch successful acold pasta becomes moreover much ‘resistant’ erstwhile heated up again.

5. Coffee 

The British Dietetic Association recommends drinking nary much than 2 mugs of caffein- ated drinks a time if you suffer from IBS. 

Consultant gastroenterologist Dr Simon Smale says group pinch patient gut usability tin astir apt portion more, but those pinch IBS should purpose to support wrong recommended limits. ‘Obviously beverage contains caffeine, too, but java is overmuch stronger — particularly java shop double espressos.

Caffeine tin origin problems because it stimulates compartment messengers which summation gut motility — truthful it loosens your bowel movements and tin besides lead to a emotion of fullness.’

6. Vegan diets

Going meat-free and dairy-free has go a trendy measurement of boosting your all-round health. But while a fare based wholly connected plants mightiness sound very virtuous, it whitethorn not beryllium truthful saintly for your gut.

‘Vegans are a very wide religion and I would opportunity that much of them eat healthily and astir apt unrecorded longer,’ says Dr Smale.

‘But vegans pinch IBS person to beryllium observant not to eat excessively galore beans and grains, consequence and vegetables containing Fodmaps arsenic they tin origin bloating, symptom and diarrhoea.’

Offending vegetables see onions, garlic, artichokes, mushrooms and cauliflower.

7. Alcohol

‘Booze tin decidedly beryllium a trigger for IBS symptoms arsenic it has an effect connected gut motility,’ explains Dr Smale. ‘Drinking beer, for instance, whitethorn consequence successful you having looser stools.’

And while it’s evident that fizzy alcoholic drinks specified arsenic lager and Prosecco are much apt to time off you bloated, fizz isn’t nan only booze facet bothering your gut.

‘Spirits pinch precocious concentrations of alcohol, specified arsenic gin and vodka, tin hold gastric emptying which tin consequence successful symptom aliases bloating,’ adds Dr Smale.

8. Sugar-free mints

Peppermint lipid capsules are a communal remedy for IBS — but sugar-free mint sweets tin person nan other effect. These often incorporate aggravating Fodmaps specified arsenic nan sweeteners sorbitol and mannitol, which tin exacerbate IBS; nan aforesaid is existent of sugar-free gum.

Chewing gum tin besides lend to upwind and burping, arsenic chewing it intends you’ll return successful excess air.

9. Junk food

We each person trillions of germs surviving successful our gut and nan equilibrium of nan different types is an area of awesome liking erstwhile it comes to IBS research.

As good arsenic ‘friendly’ bacteria, immoderate types successful our courage are linked pinch accrued inflammation, according to Tim Spector, professor of familial epidemiology astatine King’s College London and caput of nan Great British Gut Project, and this could lend to IBS.

According to Professor Spector, chemicals known arsenic emulsifiers (which thief operation ingredients together successful immoderate foods) are particularly bad for this — sidesplitting disconnected much adjuvant germs strains and allowing nan unhealthy ones to flourish. Some investigation has suggested a junk-food fare tin halve nan number of adjuvant germs successful nan gut successful conscionable 10 days.

10. Gluten

A well-known trigger of gut problems, gluten is simply a macromolecule recovered successful wheat, barley and rye (and truthful is successful astir bread, cakes, biscuits and pasta).

It utilized to beryllium thought that gluten caused problems only successful group pinch coeliac disease, but it’s much analyzable than that.

‘There are 2 types of problem,’ explains Dr Smale.

‘Some group will create coeliac illness — an autoimmune upset wherever nan assemblage produces antibodies to gluten and damages nan gut, causing bloating and diarrhoea. This tin beryllium diagnosed via a humor trial and biopsy, and symptoms subside if nan diligent avoids gluten.

‘But location is different information — wherever group person nan aforesaid symptoms but trial antagonistic for markers successful nan humor trial and gut harm successful nan biopsies — called non-coeliac gluten sensitivity.

‘These patients whitethorn respond to a gluten-free diet, but coeliac illness needs to beryllium excluded first.’

WHY YOU NEED TO TALK ABOUT YOUR PILES...

Piles, aliases haemorrhoids, are often described arsenic looking for illustration a bunch of grapes - they are swollen humor vessels that tin bent extracurricular nan anus aliases stay within.

Internal haemorrhoids usually don’t origin immoderate symptom arsenic location are nary nervus fibres successful this area. But if they protrude, they tin beryllium itchy and achy and sometimes bleed aliases ooze mucus.

Most cases will beryllium dealt pinch by GPs and only astir 10 per cent of haemorrhoids request surgery.

It’s important not to beryllium embarrassed astir seeking help, says Professor Walters.

‘People virtually dice from embarrassment because they disregard rectal bleeding aliases humor successful their stools arsenic piles aliases are reluctant to picture their stools to their doctor. But we woody pinch these problems each day,’ he says.

‘It’s important to get immoderate caller problems checked out, but location whitethorn besides beryllium effective treatments disposable for symptoms that person been persistent.’

You’re much astatine consequence of piles if you’re overweight, walk agelong periods sitting down, suffer a semipermanent cough aliases extended vomiting bouts, regularly assistance dense objects aliases are conscionable getting older.

Lifestyle steps to debar constipation tin thief by preventing straining, advises Professor Walters.

‘You should besides make clip for a regular bowel activity truthful you are not ignoring nan impulse to walk a stool (the stools are softer past and easier to get out), and your GP whitethorn reappraisal immoderate narcotics that whitethorn person constipating effects, specified arsenic immoderate antacids, painkillers specified arsenic those containing codeine, arsenic good arsenic antidepressants and sedating antihistamines.’

The symptom and itching of piles tin beryllium relieved by over-the-counter creams containing section anaesthetic and zinc oxide, specified arsenic Anusol (£4.85 for 23g), to shrink nan haemorrhoid and soothe symptom and itching.

Suppositories tin supply effective symptom alleviation for haemorrhoids wrong nan anal canal. Germoloids Suppositories (£8.29 for 24) incorporate a section anaesthetic to numb symptom and zinc oxide to soothe itching and shrink piles.

PERSISTENT PILES

Sometimes piles tin go ulcerated aliases tegument tags tin develop, making nan area difficult to clean.

In uncommon cases, soul haemorrhoids tin go engorged and humor clots develop. In these cases, you will request to beryllium referred to a specialist.

There are various procedures disposable connected nan NHS.

These see room to trim disconnected nan haemorrhoid aliases attaching an elastic set astir it to trim disconnected nan humor proviso truthful it drops off.

Another action is injection sclerotherapy, wherever symptom relieving lipid is injected into nan rectum lining to harden nan haemorrhoid truthful it forms scar tissue.

Haemorrhoid artery ligation - which uses ultrasound to find nan humor alloy supplying nan haemorrhoid and stitches it to extremity humor travel - is besides effective and little painful, but it requires a wide anaesthetic and a week’s recovery.

One newer action for soul haemorrhoids is nan Rafaelo procedure, wherever a mini probe uses power wave power to shrivel nan pile.

INCONTINENCE

Although seldom talked about, urinary incontinence affects millions of group successful nan UK.

As galore arsenic 64 per cent of women pinch accent incontinence did not activity thief from a doctor, according to a awesome study published successful 2021 successful nan diary BMC Urology.

Yet location are treatments that are highly effective.

There are various types of incontinence, pinch different causes and truthful different solutions. But nan cardinal is you don’t person to unrecorded pinch it.

STRESS THAT’S NO LAUGHING MATTER

Small leakages of urine erstwhile you cough aliases laughter is known arsenic accent incontinence.

It happens erstwhile nan bladder cervix cannot stay closed nether beingness stress, specified arsenic from exertion/effort.

‘In women, this tin hap aft childbirth, erstwhile nan cervix gets stretched during delivery, aliases because nan pelvic level muscles are weakened, causing nan cervix to sag,’ says Mike Bowen, a advisor obstetrician and gynaecologist based successful Oxford.

In men, removal of nan prostate gland (prostatectomy) ‘may origin accent urinary leakage’, says Giles Hellawell, a advisor urological surgeon astatine The London Clinic. This effect only beryllium impermanent — though men whitethorn person to deterioration pads while it settles down.

To diagnose nan type of incontinence, a master tin execute a bladder accent test, which is usually done pinch nan diligent lying down: fluid is inserted into nan bladder utilizing a bladed conduit — you’ll beryllium asked to cough and nan expert will cheque for fluid loss. The trial whitethorn beryllium repeated opinionated up.

There is besides a pad trial which involves wearing an absorbent pad for a play of time. It will beryllium weighed afterwards to activity retired really overmuch urine you person mislaid without going to nan loo.

SOLUTION: Pelvic level exercises are very effective astatine helping to alleviate accent incontinence.

A reappraisal of studies published successful 2010 recovered up to a 70 per cent betterment successful symptoms of accent incontinence successful women aft appropriately performed exercises (see below).

For accent incontinence that persists, and earnestly affects value of life, location are surgical options.

Supportive slings, besides known arsenic transvaginal slings aliases hostility free vaginal portion (TVT), which support soul organs and ‘lift’ nan bladder cervix and urethra were wide utilized until a region connected nan room was introduced successful 2018, and subsequently a study by Baroness Cumberlege successful 2020 officially recognised nan surgical mesh had caused harm to ‘tens of thousands’ of women.

This followed concerns astir nan worldly successful nan slings shredding and cutting into nan bladder and adjacent tissue.

More than 92,000 women had vaginal mesh implants from 2007 to 2015 successful England, and a 2012 Government study recovered that astir 15 per cent knowledgeable complications.

There is simply a newer sling process known arsenic a trans-obturator portion (or TOT) — disposable connected nan NHS and privately — which supports nan urethra utilizing a tension-free portion slung betwixt nan 2 obturator foramens (holes successful nan pubis bones of nan pelvis which let transition of nerves and humor vessels). Unlike nan TVT operation, nan portion isn’t thought to spell adjacent to nan bladder to support it successful its correct position.

NEED TO RUSH TO THE LOO

If you consciousness a near-constant request to urinate aliases consciousness arsenic though you can’t ‘hold on’ erstwhile you do request to go, this is apt to beryllium impulse incontinence (unlike accent incontinence, erstwhile nan pelvic level muscles are excessively anemic to forestall urination).

Urge incontinence is doubly arsenic communal among women and is caused by harm to nerves successful nan bladder aliases muscle, bladder stones, infection aliases bladder inflammation.

But successful astir cases, nary origin tin beryllium found.

Leakage occurs because nan bladder muscles compression aliases statement astatine nan incorrect times, not conscionable erstwhile your bladder is full.

Overactive bladder, erstwhile nan bladder muscles statement excessively often, is 1 origin of impulse incontinence.

It creates an uncomfortable emotion of wanting to urinate each nan time.

Some men suffer overactive bladder and travel problems because of an enlarging prostate, which tin artifact nan urethra — nan conduit that carries urine from nan body.

‘The bladder is having to summation nan unit to support flow,’ says Mr Hellawell. ‘Eventually it becomes unstable, starring to overactivity.’

It whitethorn beryllium diagnosed done urodyanamic testing, which includes noting if personification tin extremity urine travel mid-stream, aliases utilizing sensors to cheque unit wrong nan bladder and measuring nervus activity.

Unlike pinch accent incontinence, location are supplier treatments for impulse incontinence and an overactive bladder.

For instance, anticholinergic narcotics tin thief by dulling nan autonomic, aliases involuntary, tense strategy that controls nan functioning of organs specified arsenic nan bladder, heart, lungs and genitals.

‘But nan side-effects of these medications are not great,’ says Mr Hellawell.

‘Not only will they lessen nan bladder contractions, they will besides lessen bowel contractions, starring to constipation.’

Anticholinergic narcotics tin besides impact nan lacrimal glands down nan eyes and nan salivary glands, causing barren eyes and mouth.

They return 12 weeks to return afloat effect — and while nan thought is to return nan narcotics for life, patients are improbable to want to return them agelong term.

A newer medicine drug, called mirabegron (brand sanction Betmiga) useful by relaxing nan bladder and allowing it to expand.

Injecting Botox into nan bladder musculus has besides been recovered to beryllium effective - it paralyses nan muscles (for up to respective months) and is now wide disposable connected nan NHS, but nan process does request to beryllium repeated.

A CONSTANT TRICKLE - USUALLY IN MEN

Overflow incontinence is caused erstwhile nan bladder ne'er afloat empties and mini amounts dribble retired each nan time, alternatively than only erstwhile nan bladder is nether stress.

People pinch this type of incontinence whitethorn not ever consciousness that their bladder is full.

It is much communal successful older men and is often owed to an enlarged prostate.

Women tin suffer from this type of incontinence too, erstwhile nan urethra is blocked by prolapsed organs aliases kidney stones.

It is often diagnosed erstwhile personification has predominant bladder infections caused by a back-up of urine, which grows bacteria.

To diagnose it, you whitethorn beryllium asked to spell to nan loo and wholly quiet your bladder earlier a expert past scans nan bladder to measure nan residual - if a ample magnitude aliases urine remains it whitethorn propose that nan bladder isn’t moving properly.

Men pinch an enlarged prostate whitethorn beryllium prescribed narcotics called alpha adrenergic agonists, specified arsenic clonidine, which trim contractions of nan bladder and nan impulse to walk water.

Other types of drugs, alpha blockers (such arsenic tamsulosin and alfuzosin), tin besides beryllium prescribed to relax nan musculus successful nan prostate, taking nan unit disconnected nan urethra.

Many herbal and different replacement remedies tin beryllium recovered online, but location is nary beardown grounds to show immoderate is effective for an enlarged prostate.

Some men deterioration absorbent pads aliases usage a urinary sheath, worn for illustration a condom pinch a conduit starring to a bag.

PEEING TOO OFTEN AT NIGHT

For some men and women complete 50, getting up to pee erstwhile a nighttime is normal, and doubly a nighttime complete 65.

In men, an enlarged prostate aliases (more rarely) prostate crab tin beryllium a cause.

But because it happens to men and women, each nan blasted for ‘nocturia’ — needing to spell astatine nighttime — can’t beryllium laid connected nan prostate: disturbed slumber patterns and medications including humor unit narcotics tin each play a part.

It is, says Mr Hellawell, important to cheque that nan rumor isn’t an undiscovered cardiac problem, which tin origin fluid retention.

Lifestyle tin play a part.

‘I person patients who person a mates of beardown coffees aliases teas past thing,’ he says.

Caffeine is simply a anemic diuretic and is besides known to lend to bladder ‘instability’ - triggering a request for predominant aliases urgent weeing.

TOP TIPS:

Eat little salt. Cutting your intake by a 4th has been shown to halve nocturnal visits to nan loo, perchance arsenic excessively overmuch brackish intends nan kidneys nutrient much urine.

Stop going to nan loo ‘just successful case’ - complete clip this tin really weaken nan bladder arsenic its muscles aren’t stretched, truthful you’ll request to spell moreover more.

Sit connected nan loo alternatively than guidelines if you person an enlarged prostate. This tin thief pinch urine flow, perchance because muscles astir nan bladder are much relaxed.

HOW TO CURE THOSE PAINFUL URINE INFECTIONS

Cystitis, inflammation of nan bladder, is 1 of nan astir communal types of urinary tract infection (UTI) and affects much than 90 per cent of women.

It is typically caused by germs invading nan bladder wall, explains Con Kelleher, an obstetrician and gynaecologist astatine Guy’s and St Thomas’ NHS Foundation Trust.

Pain erstwhile urinating aliases passing frequent, mini amounts of urine are signs of cystitis. So, too, is humor successful nan urine — but it tin bespeak different problems specified arsenic bladder cancer, too, truthful ever talk to your GP.

It’s acold much communal among women than men.

‘The anus is person to nan urethra [the tract that carries urine from nan bladder retired of nan body] successful women and nan urethra is shorter,’ explains Dr Kelleher.

‘This makes it much apt that germs will invade.’

‘UTIs should not beryllium ignored since they tin lead to much superior complications specified arsenic kidney infection arsenic nan germs recreation up from nan bladder,’ adds Emma Gould, a caregiver pinch a typical liking successful urology and head of nan Women’s Health Clinic.

For mild cystitis, drinking plentifulness of h2o tin thief flush retired bacteria.

Although galore group judge that cranberry juice tin help, caller investigation recovered nary grounds that nan fruit, taken arsenic capsules, made immoderate quality to germs successful urine.

The antibiotic trimethoprim is nan main curen and useful successful 80 per cent of infections.

Adults pinch UTIs which are not responding to curen should person their urine tested to place nan germs causing nan problem truthful they tin beryllium targeted pinch nan astir effective drugs.

Professor James Malone-Lee, based astatine University College Hospital, advocates, for immoderate patients, high-dose, semipermanent curen pinch highly targeted antibiotics, mixed pinch an antiseptic medicine called Hiprex, prescribed by a specialist.

Wearing cleanable fabric underwear, avoiding perfumed products and bedewed wipes (which tin beryllium irritating), and wiping front-to-back tin thief if you’ve sewage a UTI.

Always passing urine astatine bedtime and aft activity — during which germs tin transportation to nan urethra — tin besides thief forestall these infections.

PROLAPSE: WHAT REALLY DOES WORK?

WHAT IS IT?

Half of women complete 50 will person immoderate grade of prolapse, according to nan Royal College of Obstetricians and Gynaecologists The worst cases tin make those affected consciousness arsenic if their insides are virtually falling out.

But immoderate are excessively insignificant moreover to origin symptoms and are discovered during an introspection for thing else.

‘The ligaments and muscles that dress up nan pelvic level commencement to stretch, and nan organs successful nan abdomen gaffe down,’ says Dr Bowen.

‘Menopausal women are astatine consequence arsenic musculus reside deteriorates and oestrogen levels fall, which origin nan wall of nan pussy to go bladed and little capable to support itself.’

TYPES OF PROLAPSE

UTERO-VAGINAL: The uterus protrudes into nan pussy and successful immoderate cases slips out. Up to 30 per cent of women who person had children create a utero-vaginal prolapse later successful life. They are communal successful postmenopausal and overweight women arsenic nan weight puts unit connected nan abdomen.

BLADDER: The bladder pushes into nan pussy and ‘this tin create a “reservoir” of urine that cannot beryllium emptied which tin lead to irritation, spasms and incontinence,’ says Dr Bowen. It tin besides consequence successful leaking erstwhile a female laughs aliases coughs.

RECTOCELE: This occurs erstwhile a loop of nan bowel presses into nan vagina, creating an S-bend wherever faeces tin collect.

‘In immoderate cases, women find it difficult to quiet their bowels,’ explains Dr Bowen.

Rectocele mostly occurs successful women who person undergone a hysterectomy.

TREATMENTS

Losing weight tin thief to lessen nan unit connected nan abdominal area. Physiotherapy tin trim nan symptoms of immoderate pelvic organ prolapse. Your expert tin mention you.

Ring-shaped pessaries tin adhd support wrong nan vagina. They are worn each nan clip and request to beryllium replaced each six months.

Surgery whitethorn beryllium offered for terrible uterine prolapse.

One action is synthetic mesh to support nan pelvic floor, but this has been linked to semipermanent side-effects and is now only utilized arsenic a past resort.

The method has been efficaciously paused by nan Independent Medicines and Medical Devices Safety Review since 2018 because of issues pinch superior complications. See your expert if you person chronic constipation, arsenic semipermanent straining contributes to prolapse.

‘MALE’ CYSTITIS

Although men tin get cystitis, much communal is prostatitis — inflammation of nan prostate gland which affects half of men and is sometimes called ‘male cystitis’.

Symptoms see symptom erstwhile urinating, predominant urination and nan urgent request to walk water, cloudiness aliases humor successful nan urine and symptom successful nan abdomen, groin aliases little back.

Sometimes it causes intersexual problems specified arsenic debased libido and erectile dysfunction.

Prostatitis is diagnosed by ruling retired different conditions that could beryllium causing symptoms, specified arsenic cancer.

A expert whitethorn springiness you a beingness examination, bid urine and humor tests and sometimes a scan of your urinary tract and prostate to cheque for underlying issues.

In little than 10 per cent of cases it tin beryllium down to bacterial infection and origin symptoms specified arsenic fever, chills, musculus aches and associated pain, arsenic good arsenic symptom successful nan perineum (the area down nan penis) and guidelines of nan penis, and trouble passing urine.

Professor Christopher Eden, a urological surgeon astatine London Bridge Hospital, says nan quinolone people of antibiotics are astir effective astatine entering nan prostate gland.

‘You often find that GPs prescribe nan incorrect sort, specified arsenic trimethoprim, penicillin and nitrofurantoin which won’t person overmuch effect,’ he says.

The astir communal type of prostatitis is not caused by germs astatine all.

‘Most experts judge this is caused erstwhile scar insubstantial forms astir nan nervus endings wrong nan prostate aft a bacterial infection has resolved — this tin stimulate nerves which past nonstop signals to nan encephalon pinch nan mendacious accusation that location is inflammation,’ says Professor Eden.

New grounds suggests it whitethorn beryllium down to musculus spasms successful nan pelvic floor. Treatment includes alpha blockers, which tin thief by relaxing nan bladder cervix and nan musculus fibres wrong nan prostate.

Some patients look to use from Cialis, utilized to dainty erectile dysfunction, successful doses of 5mg per time which tin besides amended intersexual function.

Botox injections into nan prostate person been utilized to trim musculus spasms. Prostate massage and beingness therapy to relax nan pelvic level muscles has been shown to help.

Frequent activity and masturbation are sometimes cited arsenic ways to trim nan symptom of prostatitis.

Professor Eden says that this is astir apt a myth, ‘but immoderate men do opportunity that it helps’.

‘For men pinch terrible symptoms, surgical removal of nan prostate is worthy considering arsenic a past resort,’ he adds.

MEN NEED TO DO PELVIC FLOOR EXERCISES, TOO

Pelvic level exercises aren’t conscionable for women — for men they tin thief pinch erectile dysfunction and incontinence too.

Sit comfortably and ideate trying to extremity nan travel of urine mid-stream aliases forestall passing upwind by squeezing wrong and pulling upwards — nan muscles you tin consciousness moving are nan pelvic floor.

Lift and compression nan muscles astir your backmost passage. Then assistance and compression nan muscles astir your urethra, breathing normally.

Men should spot nan penis dip downwards and scrotum assistance upwards.

A female tin cheque by inserting a thumb into nan pussy — you should consciousness a gentle squeeze. Hold some contractions for 1 2nd and past relax.

Repeat 5 to 10 times, aliases until your muscles get tired. This is called a accelerated twitch exercise.

Next effort slow twitch exercises — clasp nan contractions for 5 to 10 seconds, and past relax for nan aforesaid time. Aim for 10 each clip and summation nan magnitude of contractions each time. Aim to do some accelerated and slow exercises 3 times a day.

PROSTATES: WHAT EVERY MAN NEEDS TO KNOW

When it comes to men’s ‘plumbing’ issues, nan culprit successful galore cases is nan prostate, nan gland which produces nan fluid that mixes pinch sperm to create semen.

In a portion of inarguably mediocre design, nan walnut-sized prostate, which is positioned beneath nan bladder, is wrapped astir nan urethra, nan conduit that carries urine retired of nan assemblage done nan penis.

That statement useful conscionable good erstwhile men are successful their prime.

But arsenic men turn older, nan prostate gradually enlarges, placing expanding unit connected nan urethra and interfering pinch nan travel of urine.

That, says advisor urological surgeon Giles Hellawell, is erstwhile siren bells commencement ringing for astir men.

‘Of course, prostate crab is nan first point that goes done their minds,’ he says — trouble urinating, aliases needing to urinate much often are communal symptoms of prostate cancer.

‘But nan first point I opportunity to patients is that astir half of men complete nan property of 50 person immoderate grade of prostatic enlargement — a benign information — and rather a precocious proportionality of those will person immoderate simplification successful flow.’

In fact, astir men who spell to spot their GP person been spooked by symptoms caused by a harmlessly enlarged prostate.

They mightiness person mediocre travel of urine — what erstwhile was a stream successful flood becomes a specified stream.

Or, if they person tolerated mediocre travel for a number of years, they whitethorn person started to acquisition secondary effects connected nan bladder, specified arsenic urinary wave — having to spell to nan loo a batch — aliases urgency, a sudden, overwhelming impulse to go.

But for many, says Mr Hellawell, nan trigger to spell and sojourn nan GP is having regularly to get up erstwhile aliases doubly during nan nighttime to pee.

The first measurement to test is nan GP conducting a beingness introspection of nan prostate; nan adjacent measurement is simply a humor trial to cheque for levels of a macromolecule called prostate circumstantial antigen, aliases PSA.

This is produced by cancerous cells successful nan prostate, but besides by normal ones, and PSA levels emergence people arsenic men turn older.

As a result, a raised PSA level is conscionable an denotation that further tests mightiness beryllium necessary, says Mr Hellawell.

The PSA throws up ‘false positives’ and galore men pinch an elevated reference do not person prostate cancer.

Conversely, though little often, immoderate men pinch a debased PSA reference do beryllium to person nan condition. So ‘increasingly we don’t trust conscionable connected that’, he says.

‘In my NHS believe we ever do an MRI scan of nan prostate erstwhile nan diligent has travel successful pinch elevated PSA earlier deciding whether to do a biopsy.’

Prostate crab ‘affects much than 300,000 men successful nan UK and kills 1 man each 45 minutes’, says Ali Rooke, elder master caregiver astatine Prostate Cancer UK.

‘However, it’s a illness which tin beryllium successfully treated, if caught early enough.

In galore cases, prostate crab doesn’t person immoderate symptoms astatine all, particularly successful its early stages.

‘Therefore, being alert of your consequence is important and is simply a man’s champion statement of defence,’ she says.

Men complete 50, achromatic men, aliases men pinch a begetter aliases relative who has had nan illness each look a higher-than-average risk.

If you autumn into 1 of these high-risk groups, aliases person noticed immoderate changes successful your waterworks, it’s important to person a speech pinch your GP astir your risk.

Anyone pinch concerns astir prostate crab tin interaction Prostate Cancer UK’s master nurses connected 0800 074 83 83.

If crab has been ruled out, a benign enlarged prostate tin beryllium treated.

This tin mean manner changes — cutting down connected caffeine, which irritates nan bladder, and alcohol, mostly drinking little successful nan evening — and learning to ‘double void’: peeing, waiting a fewer seconds, and peeing again.

Some men pinch enlarged prostate create overflow incontinence — wherever they leak urine (see above).

In cases of ‘chronic urine’, successful which peeing is really difficult, a man whitethorn person to regularly insert a catheter via nan penis to drain nan bladder.

When crab is found, aliases successful immoderate cases of a severely enlarged but benign prostate, a prostatectomy, successful which portion aliases each of nan prostate is removed, will beryllium carried out. This tin lead to different problems.

The problem is that nan prostate ‘is not a greatly located organ: it’s very adjacent to nan bladder and nan voluntary sphincter, which allows you to relax and person a wee.

‘If 1 is going to surgically region it you person to beryllium careful,’ says Mr Hellawell.

Even then, pursuing a modular prostatectomy nan consequence of incontinence is astir 5 per cent aliases higher. Sometimes this is only temporary.

‘We usually hold 12 to 18 months aft nan cognition to spot what nan eventual baseline incontinence levels will be, and luckily successful nan mostly of patients it does improve,’ explains Mr Hellawell.

During this clip men whitethorn person to deterioration pads.

If location is nary improvement, much room tin beryllium carried out.

This includes nan insertion of an soul urethral sling, a synthetic mesh positioned to springiness nan urethra immoderate support.

Still a comparatively caller innovation, utilized successful men and women, location are nary semipermanent results for this operation, which usually involves 2 nights successful hospital.

But successful nan short-term location is simply a occurrence complaint of astir 80 per cent — pinch occurrence defined arsenic being capable to extremity utilizing pads aliases seeing urinary leakage reduced by half.

For terrible cases of incontinence, an artificial urinary sphincter tin beryllium fitted to switch nan weakened ringing of musculus that contracts to forestall urine leaving nan bladder.

The artificial device, which is filled pinch fluid to compress nan urethra, is operated by a mini manus pump concealed successful nan scrotum.

Patients aged 70 aliases older are much apt to beryllium fixed radiotherapy to trim nan size of an enlarged prostate alternatively than extremist surgery.

There is small grounds to show 1 process is amended than nan other, but pinch older patients location is much be aware astir giving anaesthetics and undergoing a lengthy operation.

WHEN YOU FIND A LUMP

Understandably, galore men go worried erstwhile they find a lump successful their scrotum — but only 4 successful 100 are apt to beryllium cancerous. Frequently what they person recovered is simply a harmless testicular cyst, says Mr Hellawell.

By nan property of 50, betwixt 15 and 20 per cent of men tin expect to person a testicular cyst of immoderate kind, a lump they tin consciousness astatine nan apical of 1 of their testicles.

Cysts are situated successful nan epididymis, a duct that carries sperm from nan testes, and which is often tender successful its ain right.

‘Typically, personification has a somewhat tender epididymis, which tin hap from a spot of inflammation, and they analyse it and find a lump,’ says Mr Hellawell.

‘But it’s not really successful nan testes, it’s successful nan spot above.’

A cyst is champion near alone, says Mr Hellawell.

It seldom causes symptom aliases discomfort and removing it is not without imaginable consequences: ‘The testes area is not a awesome spot to run connected because nan consequence of infection is truthful high,’ he says.

To reassure a man his lump is harmless, ‘we would almost automatically get an ultrasound scan, surely up to nan property of 40 and astir apt beyond’.

This tin besides prime up hernias and hydrocele testis — a build-up of fluid astir nan testes.

‘Men should get to cognize really they usually look and feel, which tin thief you spot if thing changes,’ says Fiona Osgun, Cancer Research UK’s elder wellness accusation officer.

Any lump, swelling, alteration successful firmness aliases texture of nan testicles, aliases a emotion of heaviness aliases symptom successful nan testicles aliases scrotum should beryllium checked retired by a doctor.