Why do I feel things going all the way down after I swallow?

I HAVE developed the uncomfortable sensation of feeling anything I swallow – food, or even tablets – ‘going down’ almost all the way into my stomach. It’s very odd. Any ideas what it could be?

THIS would fall into the category of a swallowing difficulty, and it absolutely should be checked out by your doctor.

Pain, regurgitating or feeling food is stuck or irritating the gullet on swallowing can be early signs of cancer of the oesophagus – it’s uncommon, so it’s important not to panic, but needs to be ruled out. Most commonly, changes of this type are caused by excess acid from the stomach escaping into the oesophagus, or gullet.

We call this gastric reflux, and it’s most often seen in people who are overweight, pregnant or eat too close to going to bed.

The reflux not only causes heartburn pain or indigestion, it can irritate the lining of the oesophagus and this could certainly cause changes to the sensation with swallowing and a feeling of food being stuck the whole way down.

This is called oesophagitis. Another common reason for both swallowing difficulty and acid reflux is a hiatus hernia.

This is when part of the stomach bulges through a weakness in the diaphragm, the muscle that separates the abdomen and chest.

It would be reasonable in someone who has had this symptom for a week or two to try an acid-reflux medicine such as omeprazole or lansoprazole to see if this lessens the sensation.

If it does persist for more than a month, seek a referral for an endoscopy, a test carried out under sedation during which a camera is inserted through the mouth, and down into the gullet. If these sensations are happening alongside unexplained weight loss or ongoing nausea or pain, it’s particularly important to get this test.

It’s not a pleasant procedure, but the endoscopy would differentiate between this being simply acid reflux, a hiatus hernia or worrying changes that could indicate cancer. I SUFFER from gout in my foot. Painkillers help, but I’m often left with pain in my big toe, which makes walking uncomfortable. How long will this last?

GOUT is an incredibly painful type of arthritis. It is caused by very high levels of a substance called urate in the blood.

We all have some urate but when the levels are very high in gout, crystals are formed which build up in joints. The crystals rub against the joint surfaces, causing the pain and swelling typical of an attack of gout. This can come on very suddenly.

A big toe is the most common place to be affected – patients say it feels hot and unbearably painful at times. When suffering an attack, anti-inflammatory tablets such as naproxen or ibuprofen are ideal and can be continued while pain lasts. If pain lingers, the tablets can be continued, dropping the dose down to once or twice a day, with meals.

Another drug called colchicine is also used for acute attacks and is effective at reducing the intense inflammation but can’t be used for lingering pain. Oral steroid tablets or an injection may be offered by your GP to curb any residual inflammation.

In the longer term, medicines called allopurinol and febuxostat can lower urate levels in the blood and prevent attacks.

Typically a gout attack would last a week, with the worst pain being in the first 48 hours, but it is really important to have an examination with a doctor if the pain persists for longer than this. AFTER an operation, I was given co-codamol, which made me constipated. I’m no long taking it, but now have haemorrhoids. My GP says there’s no need to do anything, but they’re getting worse. Can I get treatment on the NHS?

Codeine-based drugs, of which co-codamol is one, are notorious for causing constipation. And anything that causes constipation will put you at high risk of haemorrhoids.

Also known as piles, they are swollen, often inflamed, veins in the rectum. They can be triggered or exacerbated by the pressure that comes with the straining of constipation. Obesity, pregnancy and a poor, low-fibre diet are also linked.

Piles cause pain, bleeding, and itchiness – the bleeding is usually bright red. More often than not we treat them without surgery.

First and foremost, an examination is important, to rule out anything more serious. Haemorrhoids can be external and seen or felt as lumps around the anus, or internally within the rectum.

The first priority is avoiding constipation through your diet or by medication. A stool-softening diet would include plenty of fluids, dried fruit and fibre. There are many types of laxatives but stool-softening ones are necessary for haemorrhoids, such as docusate, which can be prescribed or bought.

This allows the veins to reduce and the swelling to go down. Steroid cream or suppositories can help reduce inflammation. They are usually used for a week and there are many types a GP can prescribe.

In conjunction with stool-softening this is usually the only treatment most people need.