The Irish Mail on Sunday

Is this pain in my gut down to IBS ...or is it just my recent back injury?

- Ask Dr Ellie THE GP WHO’S ALWAYS HERE FOR YOU

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 invaluable for seeing when the pain does 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 brace 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. I am 80 years old.

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

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