Hopping could stop you having a nasty fall
MY WIFE, who has a balance disorder, had a fall at home recently, resulting in a broken leg. She has been on vertigo tablets for quite some time now, which have no effect. Could you advise on this? J. Aylen, Kent.
THAnK you for highlighting what is a very common but largely ignored problem. Every year more than 30 per cent of people over 65 have a fall, rising to 50 per cent in those over 80.
Falls can have a significant impact on quality of life, and yet the public is given far too little advice about how to minimise them.
They are nearly always the result of a combination of f actors such as weakness in the legs, early dementia, dizziness, anaemia, blood pressure problems, a history of stroke and taking psychotropic drugs such as antidepressants and tranquillisers.
Poor balance is clearly a key risk factor — our sense of balance depends on three systems: the input the brain receives from the eyes, the balance mechanisms of the inner ear, and on proprioception (the technical term for the body’s ability to sense the position of the joints).
All three systems decline as we age. There are also age-related conditions associated with f all s, i ncluding Parkinson’s disease, chronic musculoskeletal pain such as osteoarthritis, and diabetes (when nerves in the limbs fail to conduct impulses to the brain properly, a complication called peripheral neuropathy). Falls are more common in older women, in part due to muscle weakness, which i s more prevalent in women.
However, the risks can be reduced. In July, a French study involving 700 women (aged 75 to 85) who underwent a two-year programme of balance training found these exercises improved stability, mobility and confidence, and reduced the chance of falls by 20 per cent.
For a person of this age, s uch e xercises must always be taught and supervised, although once you are competent and safe there are some that can then be practised daily at home.
one example might be the socalled Captain Morgan, where you stand on one leg and flex the hip on the other side, raising your thigh so it is parallel to the floor. Hold the arms outstretched and maintain this posture for 30 seconds before switching to the other leg.
You could also try hopping. Earlier this month, researchers at Loughborough University found that two minutes of hopping a day may also help protect older people from hip fractures, by strengthening bones and reducing the risk of breakage in a fall.
Engaging i n such exercise regimens is neither appealing nor popular, but it’s well worth the trouble, and of far more value than any form of medication.
Your wife could well benefit from coming under the care of a physiotherapist for balance and equilibrium training. Even a regular Pilates class will help, improving the muscle strength in her abdomen, i mportant f or balance, and honing the reflexes i nvolved i n maintaining a good posture.
It must continue for at least a year, with a commitment to longterm daily exercises at home. I HAVE an embarrassing problem — my bowels sometimes turn to water or near- unstoppable diarrhoea. It also happens occasionally when urinating, if I break wind when doing so. I have frequent wind and bloating, which no amount of tablets (Nexium, Omeprazole etc) can solve.
I’ve also had frequent recurrences of polyps and am on my tenth colonoscopy. Problems processing food have been with me since childhood and, at the age of 70, I have developed acid reflux.
Name and address withheld. THE first thing to say is that any change in bowel habit from whatever is normal for that individual must be further investigated.
What you describe are occasional bouts of diarrhoea, although it’s unclear how long you’ve been troubled with this. Another important feature is whether there has been significant weight loss.
Looking back over the years in my own practice, two causes of your type of symptoms spring to mind. The first relates to chewing gum. An elderly female patient consulted me with a three-year history of acute and urgent watery diarrhoea whi c h frequently caught her short when driving to visit her family — a two-hour journey.
The symptom rarely assailed her at other times. A colonoscopy (viewing the entire length of the colon) and other investigations proved negative, so I reappraised her history, and the villain was eventually pinned down: chewing gum when driving.
MAnY sugar-free versi ons contain t he sweetener sorbitol, and this can act as a laxative. This is a known but not much publicised side- effect of foods with sorbitol and similar sweeteners such as mannitol and xylitol.
My patient stopped using gum and her symptoms vanished.
A second case was a man in his 50s who regularly experienced a bout of acute diarrhoea travelling to work. He was otherwise well.
As his dominant symptom was a change of bowel habit, a colonoscopy was mandatory. This revealed changes to the membrane lining the colon. He had microscopic colitis, a more benign form of inflammatory bowel disease than Crohn’s disease and ulcerative colitis, which can both have serious complications, including blood loss and a risk long-term of developing bowel cancer with colitis.
Microscopic colitis is found in about 10 per cent of patients undergoing investigations for non-bloody diarrhoea with no obvious cause. After medication to calm the inflammation, my patient’s symptoms cleared.
Your gastroenterologist will be checking for microscopic colitis, as well as Crohn’s disease and ulcerative colitis ( although if either of these was your problem you would almost certainly have been diagnosed at an earlier colonoscopy).
As for the role of the polyps, these are not usually associated with diarrhoea. It’s also difficult to see how acid reflux fits in.
If the colonoscopy is normal, it might be worth trying an effective probiotic for three months — given your history, it may be that your gut bacteria (microbiome) are at the root of this.
A probiotic can improve the mix of bacteria — I’d try Symprove, available without prescription. I would also recommend Professor Tim Spector’s book The Diet Myth; it includes some worthwhile ideas about improving your microbiome.