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ASK DR ZOE

How do I avoid having bowel issues before my period?

JUST trying to go about daily life can feel difficult when you have a health problem that is always rearing its head — even if you are relatively prepared for it.

That’s what is facing our readers this week — flare-ups of pain and tummy troubles that happen every month without fail.

Dr Zoe Williams answers some common questions sent in by readers
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Dr Zoe Williams answers some common questions sent in by readersCredit: The Sun

Fortunately, these relatively common problems can be alleviated — by knowing what to do, and how to work with your body to ease   discomfort.

Which is what I’m here to help you do.

So here are my answers — and remember, if you’re struggling with pain, no matter how minor you may think it is, don’t be hesitant, ask for support!

Q) I HAVE serious osteoarthritis in my knees – how can I ease the pain?

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A) THE knees are among the joints most commonly affected by osteoarthritis. Symptoms of knee osteoarthritis include stiffness, swelling and pain, which can impact on a person’s ability to do certain things and their quality of life.

It may sound counterintuitive but in addition to pain-relieving medication, the main treatment for osteoarthritis of the knees is exercise.

And for some, knee replacement surgery is advised.

Non-impact exercise, such as stationary cycling or body-weight squats, can strengthen the muscles that support the knee joint and studies show this can lead to improvements in pain and function.

It’s important to build up the exercise gradually, and be aware that there may be a temporary increase in pain initially while your knees get used to it, so be prepared to increase your pain medication to help you get through this.

There are some helpful videos on the Chartered Society of Physiotherapists’ website. Search and also “knee pain exercises”.

Q) HOW do I avoid having bowel issues before my ­period?

A) BOWEL issues in the pre-menstrual period are very common. Some people experience constipation and others have loose stools or even diarrhoea.

It’s most likely due to the elevated levels of progesterone hormone at this time, which are responsible for the plethora of symptoms that can come with premenstrual syndrome (PMS).

The most common symptoms include: mood swings; feeling upset, anxious or irritable; tiredness or trouble sleeping; bloating or tummy pain; breast tenderness; headaches; spotty skin; greasy hair; changes in appetite; changes in sex drive.

Much like preparing for your period, I’d advise knowing that your bowel symptoms are coming and preparing for them, whether that be taking measures to avoid constipation or having loperamide to help alleviate diarrhoea.

There is also the option to take hormonal contraceptive pills to alleviate PMS symptoms. Speak to your GP about these.

Q) I AM at my wits’ end, I don’t know what to do. I suffer from vascular disease in both legs and I’m having a combination of knee (arthritis) and intermittent claudication pain (calf pain), and to make matters worse I can hardly walk due to tenderness and feel sore and burning feelings on the sole of my foot.

I have been to a podiatry specialist but my soles are so sore it made me cry.

My doctor prescribed Flexitol and Arjun cream but they were no help. What should I try?

A) Intermittent claudication is caused by narrowing or blockage of the femoral artery, the main artery taking blood to your leg.

This is usually due to hardening of the arteries (atherosclerosis).

It results in reduced blood supply in the leg, and cramp-like pain is usually experienced when walking up a hill, for ­example, because the muscles of the leg need additional blood at that time.

This pain usually eases after a couple of minutes of rest.

The risk factors are the same as those for heart disease and stroke, such as age over 50, smoking, diabetes, high blood pressure and high cholesterol.

Unfortunately, the blockage that causes the claudication will not clear itself, but exercise can help.

Exercise has been shown to more than double the distance someone can walk without getting pain.

Severe cases require a referral to the vascular surgeon who may consider procedures such as angioplasty, which stretches the artery, or bypass surgery, where a blood vessel from somewhere else in the body replaces a blocked portion of artery.

If you’re willing to give exercise a go, aim to walk at a brisk pace for ten minutes daily (or whatever you can manage).

The Active 10 app can help with this.

Over time, aim to increase either the pace or the amount of time you walk.

A good aim would be 30 minutes of continuous walking three to four times a week.

The “burning” pain in your feet could be due to nerve damage and if so, it is more likely to respond well to medication that can calm the nerves, such as gabapentin, amitriptyline or pregabalin.

I’d advise going back to see your GP about this as it could hinder your ability to get walking.

Q) I THINK I suffer from hyperventilating attacks. Should I tell my GP about it?

A) Yes, 100 per cent, you should tell your GP about it.

It might be worth keeping a diary of when you get the episodes of hyperventilation too, or you may already be aware of what some of the triggers are.

When we breathe, we inhale oxygen and exhale carbon dioxide. When we hyper­ventilate, which means that we breathe too rapidly, we actually get rid of too much carbon dioxide, which can cause unpleasant symptoms such as light-headedness or tingling in the fingers.

This is the reason why breathing into a paper bag can help, as it means you inhale some of the carbon dioxide back in.

You can also breathe into cupped hands or through pursed lips.

You can also try alternate nostril breathing.

This involves covering your mouth and alternating breathing through each nostril.

With your mouth covered, close the right nostril and breathe in through the left. Then alternate by closing the left nostril and breathing in through the right.

Repeat this pattern until your breathing has returned to normal.

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Hyperventilation most commonly results from anxiety, panic, nervousness, or stress, and your GP would be a great person to advise you on how you could get some ­support for these.

You can also self-refer if you prefer, by going to the NHS talking therapies webpage.

Covid’s impact on our periods

Q) IS it possible for Covid to affect your ­menstrual cycle?

A) One of the interesting things about ­Covid is how it affects us all differently and seems to be able to affect just about any system in the body.

So it is completely plausible and fair to say that it could temporarily affect our hormones too, and therefore our menstrual cycles. There have been many reported cases of menstrual cycles being affected by ­Covid infection and changes in menstrual cycle have also been reported ­following Covid vaccinations.

It is not known for certain whether the infection, or the immune response to the vaccine, is the actual cause of the changes, or whether these changes would have happened anyway and they coincided, timing-wise, with either the infection or the ­vaccination.

Menstrual cycle changes are common. It’s something we see in general practice all the time, and this was also the case long before the pandemic.

These changes can cause disturbance and distress, especially in people who are monitoring their periods for ­contraceptive or fertility purposes.

But the good news is that periods tend to return to normal, for most, after one or two cycles and there is no medical evidence of any impact on a woman’s fertility.

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