Ulcers leave me so down in the mouth

QI HAVE been suffering from mouth ulcers for the past five months and feel I’m living on Bonjela and mouthwash. I get them all around my mouth and on my tongue. I’ve been referred to hospital but the appointment isn’t for three months. Although I’m otherwise in good health, I’m quite worried. A MOUTH ulcers may seem like a minor ailment but can actually be incredibly distressing. The pain can severely impact on quality of life, as eating and drinking are significantly affected.

As many as 20 per cent of people suffer with the occasional single mouth ulcer and these are of no consequence. They are usually shallow and occur on the tongue or inside the lip or cheek. These small painful ulcers usually last no more than ten days and require no treatment.

We have a rule in medicine that any single mouth ulcer lasting longer than three weeks should be investigated in order to rule out a cancer of the mouth, but this would usually be an isolated ulcer that does not heal, rather than multiple lesions.

Multiple ongoing mouth ulcers are quite a different issue and certainly warrant further investigation. Initially it is worth taking blood tests to establish deficiencies of iron, B12 or folic acid that could be a root cause of significant tongue and mouth problems.

It is equally important to consider multiple chronic mouth ulcers as a symptom of bowel disease, as both coeliac disease and Crohn’s disease can first present as mouth ulcers.

Coeliac can be identified on specific blood tests and Crohn’s on a thorough history, examination and specialist opinion. A sudden-onset chronic issue in a previously healthy person does need proper assessment, and referral to a specialist certainly seems appropriate.

While waiting to see a specialist, always make another GP appointment if something has changed or you feel that perhaps an important symptom has been missed.

Q THREE years ago I had an operation to remove my prostate because of cancer. This seems to have been a success so far because my prostatespecific antigen (PSA) levels are zero. However, I now have a urine infection which has resisted five courses of antibiotics. At a recent hospital visit a registrar suggested that I drink at least three litres of water daily. I am not sure I’ll manage this. What can I do? A SURGERY to remove the prostate for cancer can lead to urinary problems in about one in five cases, as well as erectile dysfunction for almost twothirds of men. The former may manifest as incontinence or leakage of urine rather than recurrent infections. These are more likely when the bladder cannot empty properly, as urine is able to stagnate and bacteria can multiply. This typically occurs in men with an enlarged prostate, which puts pressure on the bladder, but would not seem likely if a prostate has been removed. A urologist’s opinion would be warranted to assess whether a complication such as scar tissue could be preventing the bladder from emptying properly.

After cancer, it is easy to assume all subsequent conditions are related. In fact, recurrent urine infections may be secondary to another urinary-system problem such as kidney stones or bladder disease, which need to be ruled out. It is unlikely that three litres of water a day will help.