From back pain to UTIs and weight loss – Dr Zoe Williams answers your questions
HOW often have you felt a twinge in your back and blamed your sciatica?
This nerve is a real problem area for lots of people, causing shooting pains and numbness.
If you keep finding yourself clutching your lower back in agony, or worrying about a slipped disc, rest assured, you’re not alone and it should heal fairly quickly, as I tell one reader this week.
As always, however common a health problem is, no question is too “silly” or “small” — just drop me a line.
I’m here to help.
Here are some of the letters I have received this week.
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Q) Can you advise me about spine trouble? Mine is so painful. I hate scans, and they say sciatica can’t be operated on.
A) Spine trouble is a broad subject, as there are a number of issues people may have with the spine. You mention sciatica, so let’s focus on that.
Sciatica is a common condition that I see in general practice all the time. It’s caused by irritation to the sciatic nerve.
The sciatic nerve is the longest nerve in the body. It starts in the lower back, travels through your hip and goes all the way down to the foot.
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It is most commonly irritated by pressure from a bulging disc in the spine.
If the disc, which sits between the vertebra gets squashed, some of its jelly-like contents can bulge out into the space where the sciatic nerve sits. This is sometimes referred to as a “slipped disc”.
So while the problem is at the level of the lower back, people often feel symptoms lower down, in the buttock, leg and foot.
This is because the nerve isn’t able to tell where exactly it is being compressed, so symptoms may be along its whole length.
Most commonly people experience “nerve-type” pain, with a stabbing, burning or shooting nature, sometimes people have “pins and needles”, numbness or weakness.
There is a good video on the NHS website explaining what it is. See and scroll to the bottom.
In most cases symptoms resolve on their own over about six weeks, and you’ll likely benefit from painkillers during this period.
It’s important to keep moving — an exercise video is available on the NHS website, just search “exercises for sciatica”.
In some cases further treatment is required, including surgery, but this wouldn’t be the right option for everyone.
There are alternatives such as painkilling injections, and other procedures which use radiofrequency waves to block nerves.
An MRI scan gives the best view of what is happening with the nerves in the body.
Always seek medical attention immediately if you have back pain associated with loss of control of your bladder or bowels, inability to fully empty your bladder, or progressive weakness of both legs.
Q) How can you lose weight while you are pregnant?
A) It is quite common to lose a small amount of weight in the first trimester, especially with severe morning sickness.
This small unintentional weight loss in early pregnancy will not harm the baby. Intentional weight loss is not usually recommended.
Weight gain in pregnancy is normal and varies greatly, though is mostly between 10kg and 12.5kg, most of which is put on after week 20. It’s widely known that we need to eat a little more while pregnant, but only around 200 calories a day.
The advice for women who are overweight or have obesity is that with proper nutrition guidance, it is safe and feasible to restrict weight gain, or even aim to maintain their pre-pregnancy weight.
Pregnancy is a unique opportunity to establish new and healthier habits.
Healthy eating and physical activity will benefit both mother and baby.
If the pregnant person doesn’t usually exercise, then start out with about 15 minutes of continuous exercise, three times per week, increasing gradually towards 30-minute sessions every day. Healthy exercise includes swimming and pregnancy yoga.
Actual weight loss in pregnancy should only be the aim in those who have received individualised medical advice and are receiving support to do so safely.
This is only likely to be the case when the pregnant person has severe obesity or poorly controlled diabetes, and the weight loss is likely to mitigate some of the risks associated with these conditions.
Q) Why would I keep getting urinary tract infections (UTIs) when I’ve been on eight antibiotics this past two months, and my bloods are OK?
Recurrent urinary tract infections (UTIs) are becoming more and more common. A major reason for this is the global antimicrobial resistance crisis.
UTIs are generally becoming harder to treat as the bacteria become resistant to antibiotics.
While repeated infections tend to be caused by the same type of bacteria, some UTIs, like yours, now manage to survive multiple rounds of antibiotic treatment.
There are a few things women can do to reduce our risk of UTIs, such as urinating immediately after sex and wiping from front to back after going to the toilet.
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The next steps will depend on your personal details and full medical history.
However, it is likely that some investigations are required, including urine cultures, a blood test and a scan of your kidneys.
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‘Odd feeling in my throat’
Q) FOR months I have felt like something is stuck in my throat. I’ve had gastroscopy done and a stool sample taken. The results came back negative.
I’ve been prescribed Lansoprazole and Gaviscon but neither helped. I’m awaiting an appointment where I will have an examination done via my nostrils. I can still eat and drink well. What’s going on?
A) The sensation of “something stuck in the throat” is often named globus. Globus can be caused by many things, such as an increased tension of muscles or irritation in the throat.
One common cause is excess stomach acid and reflux of it into the oesophagus. This can cause burning to the lining of the oesophagus, and the associated swelling can give the symptom of globus.
It seems your doctors have considered this, hence the medications that reduce stomach acid and the camera test.
The stool test was likely to identify the presence of Helicobacter pylori. This is a type of bacteria that is present in many of us and causes no issues, so can be left alone, but it can increase the production of stomach acid, so in those with symptoms it is best to eradicate it with antibiotics.
A nasendoscopy is a camera inserted via the nostril and this can look at the back of the throat and voicebox, to identify any inflammation, injury or structural cause.
Sometimes these tests find nothing, and actually one of the commonest causes of globus is stress and anxiety.