Trigeminal neuralgia
of brain nerves and spinal cord

Trigeminal neuralgia is a sudden, severe facial pain, described as sharp, shooting or like an electric shock.

It usually occurs in sudden short attacks lasting from a few seconds to about two minutes, which stop just as abruptly.

In the vast majority of cases it affects part or all of one side of the face, with the pain most commonly felt in the lower part of the face. Very occasionally it affects both sides of the face, but not normally at the same time.

People with the condition may experience attacks of pain regularly for days, weeks or months at a time. In severe cases, attacks may occur hundreds of times a day.

It’s possible for the pain to improve or even disappear altogether for several months or years at a time (known as a period of remission), although these periods of remission tend to get shorter with time. Some people may then go on to develop a more continuous aching, throbbing and burning sensation, sometimes accompanied by the sharp attacks.

Typically, the attacks of pain are brought on by activities that involve lightly touching the face, such as washing, eating and brushing the teeth, but they can also be triggered by wind (even a slight breeze or air conditioning) or movement of the face or head. Sometimes, the pain can occur without any trigger whatsoever.

Living with trigeminal neuralgia can be very difficult and it can have a significant impact on a person’s quality of life, resulting in problems such as weight loss, isolation and depression.

Read more about the symptoms of trigeminal neuralgia

Symptoms

The main symptom of trigeminal neuralgia is sudden attacks of severe, sharp and shooting facial pain that last from a few seconds to about two minutes.

The pain is often described as an excruciating sensation, similar to an electric shock. The attacks can be so severe that you are unable to do anything during them, and the pain can sometimes bring you to your knees.

Trigeminal neuralgia usually only affects one side of your face. In rare cases it can affect both sides, although not at the same time. The pain can be in the teeth, the lower jaw, upper jaw, cheek and, less commonly, in the forehead or the eye.

You may feel aware of an impending attack of pain, though these usually come unexpectedly.

After the main, severe pain has subsided, you may experience a slight ache or burning feeling. There may also be a constant throbbing, aching or burning sensation between attacks.

You may have episodes of pain lasting regularly for days, weeks or months at a time. It is possible for the pain to then disappear completely and not recur for several months or years (a period known as “remission”). However, in severe cases, attacks may occur hundreds of times a day, and there may be no periods of remission.


Attacks of trigeminal neuralgia can be triggered by certain actions or movements, such as:

talking smiling chewing brushing your teeth washing your face a light touch shaving or putting on make-up swallowing kissing a cool breeze or air conditioning head movements vibrations, such as walking or a car journey

However, pain can occur spontaneously with no triggers whatsoever.

Causes

In the vast majority of cases, trigeminal neuralgia is caused by compression of the trigeminal nerve. This is the largest nerve inside the skull, which transmits sensations of pain and touch from your face, teeth and mouth to your brain.

This compression is usually caused by a nearby blood vessel pressing on part of the nerve inside the skull.

In rare cases, trigeminal neuralgia can occur as a result of damage to the trigeminal nerve, caused by an underlying condition such as multiple sclerosis (MS) or a tumour.

Read more about the causes of trigeminal neuralgia


Although the exact cause is not known, trigeminal neuralgia is often thought to be caused by compression of the trigeminal nerve or an underlying condition affecting this nerve.


Other reasons why the trigeminal nerve can become compressed or damaged include:

a tumour (a growth or lump) a cyst (fluid-filled sac) arteriovenous malformation (an abnormal tangle of arteries and veins) multiple sclerosis (MS) – a long-term condition that affects the central nervous system (the brain and spinal cord)

Diagnoses

As the pain caused by trigeminal neuralgia is often felt in the jaw, teeth or gums, it is common for people to visit their dentist initially, rather than their GP.

If you visit your dentist, they will ask you questions about your symptoms and investigate your facial pain using a dental X-ray and other means to look for other more common causes, such as a dental infection or cracked tooth. 

If the dentist cannot find a cause, it is important not to undergo unnecessary treatment such as a root canal filling or an extraction, even though you may be convinced that it is a tooth problem. If your dentist can’t find anything wrong, do not try to persuade them to remove a particular tooth, as this will not solve the problem.

Often, the diagnosis of trigeminal neuralgia is made by a dentist, but if you have already seen your dentist and they have not been able to find an obvious cause of your pain, visit your GP.

Treatments

You should see your GP if you experience frequent or persistent facial pain, particularly if standard painkillers such as paracetamol and ibuprofen do not help and a dentist has ruled out any dental causes.

Your GP will try to identify the problem by asking about your symptoms and ruling out conditions that could be responsible for your pain.

However, diagnosing trigeminal neuralgia can be difficult, and it can take a few years for a diagnosis to be confirmed.

Read more about diagnosing trigeminal neuralgia


Trigeminal neuralgia is usually a long-term condition, and the periods of remission often get shorter over time. However, most cases can be controlled to at least some degree with treatment.

The first treatment offered will usually be with an anticonvulsant medication (usually used to treat epilepsy) called carbamazepine. To be effective, this medication needs to be taken several times a day, with the dose gradually increased over the course of a few days or weeks so that high enough levels of the medication can build up in your bloodstream.

Unless your pain starts to diminish or disappears altogether, the medication is usually continued for as long as is necessary, sometimes for many years. If you are entering a period of remission and your pain goes away, stopping the medication should always be done slowly over days or weeks, unless you are advised otherwise by a doctor.

Carbamazepine was not originally designed to treat pain, but it can help relieve nerve pain by slowing down electrical impulses in the nerves and reducing their ability to transmit pain messages.

If this medication is ineffective, unsuitable or causes too many side effects, you may be referred to a specialist to discuss alternative medications or surgical procedures that may help.

There are a number of minor surgical procedures that can be used to treat trigeminal neuralgia – usually by damaging the nerve to stop it sending pain signals – but these are generally only effective for a few years.

Alternatively, your specialist may recommend having surgery to open up your skull and move away any blood vessels compressing the trigeminal nerve. Research suggests this operation offers the best results in terms of long-term pain relief, but it is a major operation and carries a risk of potentially serious complications, such as hearing loss, facial numbness or, very rarely, a stroke.

Read more about treating trigeminal neuralgia


You should see your GP if you experience frequent or persistent facial pain, particularly if standard painkillers such as paracetamol and ibuprofen do not help and a dentist has ruled out any dental causes.

Your GP will try to identify the problem by asking about your symptoms and ruling out conditions that could be responsible for your pain. Trigeminal neuralgia can be a difficult condition to diagnose, so it’s important to try to describe your symptoms as accurately and in as much detail as possible.

Read more about diagnosing trigeminal neuralgia


There are a number of treatments available that can offer some relief from the pain caused by trigeminal neuralgia.

Identifying triggers and avoiding them can also help.

Most people with trigeminal neuralgia will be prescribed medication to help control their pain, although surgery may be considered for the longer term in those cases where medication is ineffective or causes too many side effects.

Tuberculosis (TB)
of infections and poisoning

Tuberculosis (TB) is a bacterial infection spread through inhaling tiny droplets from the coughs or sneezes of an infected person.

It is a serious condition, but can be cured with proper treatment.

TB mainly affects the lungs. However, it can affect any part of the body, including the glands, bones and nervous system.

Symptoms

Typical symptoms of TB include:

a persistent cough that lasts more than three weeks and usually brings up phlegm, which may be bloody weight loss night sweats high temperature (fever) tiredness and fatigue loss of appetite new swellings that haven’t gone away after a few weeks

You should see a GP if you have a cough that lasts more than three weeks or if you cough up blood.

Read more about the symptoms of TB and diagnosing TB


The symptoms of tuberculosis (TB) depend on where the infection occurs.

TB usually develops slowly. Your symptoms might not begin until months or even years after you were initially infected.

In some cases the infection doesn’t cause any symptoms, which is known as latent TB. It’s called active TB if you have symptoms. You should contact your GP if you or your child have symptoms of TB.

Read about the causes of tuberculosis for more information about latent and active TB.


General symptoms of TB include:

lack of appetite and weight loss a high temperature (fever) night sweats extreme tiredness or fatigue

These symptoms can have many different causes, however, and are not always a sign of TB.


TB can also cause additional symptoms depending on which part of the body is infected.

Pulmonary TB

Most infections affect the lungs, which can cause:

a persistent cough that lasts more than 3 weeks and usually brings up phlegm, which may be bloody breathlessness that gradually gets worse

This is known as pulmonary TB.

Extrapulmonary TB

Less commonly, TB infections develop in areas outside the lungs, such as the lymph nodes (small glands that form part of the immune system), the bones and joints, the digestive system, the bladder and reproductive system, and the nervous system (brain and nerves).

This is known as extrapulmonary TB.

Symptoms of extrapulmonary TB vary, but can include:

persistently swollen glands abdominal (tummy) pain pain and loss of movement in an affected bone or joint confusion a persistent headache seizures (fits)

Extrapulmonary TB is more common in people with a weakened immune system, such as those with HIV.

Causes

TB is caused by a bacterium called Mycobacterium tuberculosis.

TB that affects the lungs is the most contagious type, but it usually only spreads after prolonged exposure to someone with the illness. For example, it often spreads within a family who live in the same house.

In most healthy people, the immune system (the body’s natural defence against infection and illness) kills the bacteria, and you have no symptoms.

Sometimes the immune system cannot kill the bacteria, but manages to prevent it spreading in the body. This means you will not have any symptoms, but the bacteria will remain in your body. This is known as ‘latent TB’. 

If the immune system fails to kill or contain the infection, it can spread within the lungs or other parts of the body and symptoms will develop within a few weeks or months. This is known as ‘active TB’.

Latent TB could develop into an active TB infection at a later date, particularly if your immune system becomes weakened.

Read more about the causes of TB


Tuberculosis (TB) is caused by a type of bacterium called Mycobacterium tuberculosis.

The condition is spread when a person with an active TB infection in their lungs coughs or sneezes and someone else inhales the expelled droplets, which contain TB bacteria.

Although it is spread in a similar way to a cold or the flu, TB is not as contagious. You would usually have to spend prolonged periods in close contact with an infected person to catch the infection yourself.

For example, TB infections usually spread between family members who live in the same house. It would be highly unlikely to become infected by sitting next to an infected person on a bus or train.

Not everyone with TB is infectious. Generally, children with TB or people with TB that occurs outside the lungs (extrapulmonary TB) do not spread the infection.

Diagnoses

Several tests are used to diagnose tuberculosis (TB), depending on the type of TB suspected.

Your GP may refer you to a TB specialist for testing and treatment if they think you have TB.

Treatments

With treatment, TB can usually be cured. Most people will need a course of antibiotics, usually for 6 months.

Several different antibiotics are used. This is because some forms of TB are resistant to certain antibiotics. If you are infected with a drug-resistant form of TB, treatment with 6 or more different medications may be needed.

If you are in close contact with someone who has TB, tests may be carried out to see if you are also infected. These can include a chest X-ray, blood tests, and a skin test called the Mantoux test.

Read more about treating TB


Treatment for tuberculosis (TB) will usually involve a long course of antibiotics lasting several months.

While TB is a serious condition that can be fatal if left untreated, deaths are rare if treatment is completed.

For most people, a hospital admission during treatment is not necessary.

Preventions

If you are diagnosed with pulmonary TB, you will be contagious up to about 2 to 3 weeks into your course of treatment.

You will not normally need to be isolated during this time, but it’s important to take some basic precautions to stop TB spreading to your family and friends. You should:

stay away from work, school or college until your TB treatment team advises you it is safe to return  always cover your mouth – preferably with a disposable tissue – when coughing, sneezing or laughing carefully dispose of any used tissues in a sealed plastic bag  open windows when possible to ensure a good supply of fresh air in the areas where you spend time do not sleep in the same room as other people, as you could cough or sneeze in your sleep without realising it

Type 1 diabetes
of diabetes

Diabetes is a lifelong condition that causes a person’s blood glucose (sugar) level to become too high.

The hormone insulin – produced by the pancreas – is responsible for controlling the amount of glucose in the blood.

There are two main types of diabetes:

Type 1 – where the pancreas doesn’t produce any insulin Type 2 – where the pancreas doesn’t produce enough insulin or the body’s cells don’t react to insulin

This topic is about type 1 diabetes.

Read more about type 2 diabetes

Another type of diabetes, known as gestational diabetes, occurs in some pregnant women and tends to disappear following birth.

It’s very important for diabetes to be diagnosed as soon as possible, because it will get progressively worse if left untreated.

You should therefore visit your GP if you have symptoms, which include feeling thirsty, passing urine more often than usual and losing weight unexpectedly (see the list below for more diabetes symptoms).

Symptoms

The symptoms of diabetes occur because the lack of insulin means that glucose is high but isn’t used by your muscles as fuel for energy.

When blood glucose is high, glucose is lost in your urine and you may become dehydrated.

Typical symptoms include:

feeling very thirsty passing urine more often than usual, particularly at night feeling very tired all the time weight loss and loss of muscle bulk persistent infections such as thrush

The symptoms of type 1 diabetes usually develop very quickly in young people (over a few hours or days). In adults, the symptoms often take longer to develop (a few days or weeks).

Read more about the symptoms of type 1 diabetes


The symptoms of type 1 diabetes should disappear when you start taking insulin and you get the condition under control.

The main symptoms of diabetes are:

feeling very thirsty urinating more frequently than usual, particularly at night feeling very tired weight loss and loss of muscle bulk itchiness around the genital area, or regular bouts of thrush (a yeast infection) blurred vision caused by the lens of your eye changing shape

Vomiting or heavy, deep breathing can also occur at a later stage. This is a dangerous sign and requires immediate admission to hospital for treatment.

Causes

Type 1 diabetes is an autoimmune condition, where the immune system (the body’s natural defence against infection and illness) mistakes the cells in your pancreas as harmful and attacks them.

Without insulin, your body will break down its own fat and muscle, resulting in weight loss. This can lead to a serious short-term condition called diabetic ketoacidosis. This is when the bloodstream becomes acidic, you develop dangerous levels of ketones in your blood stream and become severely dehydrated.

This results in the body being unable to produce insulin, which is required to move glucose out of the blood and into your cells to be used for energy. This is called Type 1 diabetes.

Read more about the causes of type 1 diabetes


Type 1 diabetes occurs when the body is unable to produce insulin. Insulin is a hormone that’s needed to control the amount of glucose (sugar) in your blood.

When you eat, your digestive system breaks down food and passes its nutrients – including glucose – into your bloodstream.

The pancreas (a small gland behind your stomach) usually produces insulin, which transfers any glucose out of your blood and into your cells, where it’s converted to energy.

However, if you have type 1 diabetes, your pancreas is unable to produce any insulin (see below). This means that glucose can’t be moved out of your bloodstream and into your cells.

Diagnoses

If you experience the symptoms of diabetes, you should visit your GP as soon as possible. They’ll ask about your symptoms and may request a urine and blood test.


Your urine sample will be tested to see whether it contains glucose. Urine doesn’t usually contain glucose, but if you have diabetes, some glucose can overflow through the kidneys and into the urine. Your urine may also be tested for ketones (chemicals) that indicate type 1 diabetes.

The GP may do a finger prick blood test for glucose and ketones. A sample will be sent to the laboratory to confirm the diagnosis. These results will be discussed with the specialist diabetes service if there is concern you have Type 1 Diabetes.


If you have type 1 diabetes, you should be invited to have your your eyes screened at once a year to check for diabetic retinopathy.

Retinopathy is an eye condition where the small blood vessels in your eye become damaged. It can occur if your blood glucose level is too high for a long time (hyperglycaemia). If it isn’t treated, retinopathy can eventually cause sight loss.

Read more about diabetic eye screening

Treatments

It’s important that diabetes is diagnosed as early as possible. If left untreated, type-1 diabetes is a life-threatening condition. It’s essential that treatment is started early.

Diabetes can’t be cured, but treatment aims to keep your blood glucose levels as normal as possible and control your symptoms, to prevent health problems developing later in life.

If you’re diagnosed with diabetes, you’ll be referred to a diabetes care team for specialist treatment and monitoring.

As your body can’t produce insulin, you’ll need regular insulin injections to keep your glucose levels normal. You’ll be taught how to do this and how to match the insulin you inject to the food (carbohydrate) you eat, taking into account your blood glucose level and how much exercise you do.

Insulin injections come in several different forms, with each working slightly differently. You’ll most likely need a combination of different insulin preparations.

Insulin is given to some patients by a continuous infusion of fast (rapid) acting insulin (pump therapy). This is where a small device constantly pumps insulin (at a rate you control) into your bloodstream through a plastic tube (cannula) that’s inserted under the skin with a needle.

There are alternatives to insulin injections and pumps, but they’re only suitable for a small number of patients. They are:

islet cell transplantation – where healthy insulin-producing cells from the pancreas of a deceased donor are implanted into the pancreas of someone with type 1 diabetes a complete pancreas transplant – this is still relatively rare and only a few centres of excellence offer this.

Read more about diagnosing diabetes and treating type 1 diabetes


You should seek urgent medical attention if you have diabetes and develop:

a loss of appetite nausea or vomiting a high temperature stomach pain fruity smelling breath – which may smell like pear drops or nail varnish (some people can smell this themselves)



Hypoglycaemia can occur when your blood glucose level becomes very low. It’s likely that you’ll develop hypoglycaemia from time to time.

Mild hypoglycaemia (or a “hypo”) can make you feel shaky, weak and hungry, and can be controlled by eating or drinking something sugary, such as:

200ml pure fruit juice 5 to 7 Dextrose tablets 4 to 5 Glucotabs 60ml Glucojuice 5 jelly babies

You may also be able to take pure glucose, in the form of a tablet or fluid, if you need to control the symptoms of a hypo quickly.

If you develop severe hypoglycaemia, you can become drowsy and confused, and you may even lose consciousness. If this occurs, you’ll need assistance from another person who may be able to give you a glucose gel rubbed into your cheeks or an injection of glucagon into your muscle. Glucagon is a hormone that quickly increases your blood glucose levels.

Your diabetes care team may show several of your family members and close friends how to inject glucagon or give you glucose gel, should you need it.

Once you begin to come round, you’ll need to eat something sugary when you’re alert enough to do so. If you lose consciousness as a result of hypoglycaemia, there’s a risk that it could happen again within a few hours. You’ll need to rest afterwards and have someone with you to ensure that you eat some food to replace the glucose stores in your body.

If the glucagon injection into your muscle doesn’t work, and you’re still drowsy or unconscious 10 minutes after the injection, you’ll need urgent medical attention.

You’ll need to have an injection of dextrose straight into a vein, which must be given by a trained healthcare professional.

If you have type 1 diabetes, it’s recommended that you carry identification with you so that people are aware of the problem if you become hypoglycaemic.

If significant hypoglycaemia is a regular problem or you have lost your awareness of hypoglycaemia your health care team may consider using a continuous glucose monitor (CGM).


Hyperglycaemia can occur when your blood glucose levels become too high. It can happen for several reasons, such as eating too much, being unwell or not taking enough insulin.

If you develop hyperglycaemia, you may need to adjust your diet or your insulin dose to keep your glucose levels normal. Your diabetes care team can advise you about the best way to do this.

If hyperglycaemia isn’t treated, it can lead to a condition called diabetic ketoacidosis, where the body begins to break down fats for energy instead of glucose, resulting in a build-up of ketones (acids) in your blood.

Diabetic ketoacidosis is very serious and, if not addressed quickly, it can lead to unconsciousness and, eventually, death.

The signs of diabetic ketoacidosis include:

frequently passing urine thirst tiredness and lethargy (lack of energy) blurry vision abdominal (stomach) pain nausea and vomiting deep breathing smell of ketones on breath (described as smelling like pear drops) collapse and unconsciousness

Read more about the symptoms of diabetic ketoacidosis

Your healthcare team will educate you on how to decrease your risk of ketoacidosis by testing your own blood for ketones using blood ketone sticks if you’re unwell.

If you develop diabetic ketoacidosis, you’ll need urgent hospital treatment. You’ll be given insulin directly into a vein (intravenously). You may also need other fluids given by a drip if you’re dehydrated, including salt solution and potassium.


Type 1 diabetes can lead to long-term complications. If you have the condition, you have an increased risk of developing heart disease, stroke, eye and kidney disease. To reduce the chance of this, you may be advised to take:

anti-hypertensive medicines to control high blood pressure a statin – such as simvastatin – to reduce high cholesterol levels low-dose aspirin to prevent stroke angiotensin-converting enzyme (ACE) inhibitor – such as enalapril, lisinopril or ramipril if you have the early signs of diabetic kidney disease

Diabetic kidney disease is identified by the presence of small amounts of a protein called albumin in your urine. It’s often reversible if treated early enough.

Complications

If diabetes is left untreated, it can cause a number of different health problems. Large amounts of glucose can damage blood vessels, nerves and organs.

Having a consistently raised glucose level that doesn’t cause any symptoms can have damaging effects in the long term.

There is also complications that can arise if your insulin is not balanced with your food intake and exercise. Your diabetes team will work with you to manage your insulin correctly.

Read more about the complications of type 1 diabetes


If diabetes isn’t treated, it can lead to a number of different health problems. High glucose levels can damage blood vessels, nerves and organs.

A consistently raised glucose level that doesn’t cause any symptoms can have damaging effects in the long term.

Type 2 diabetes
of diabetes

Diabetes is usually a lifelong condition that causes a person’s blood glucose (sugar) level to become too high.

The hormone insulin – produced by the pancreas – is responsible for controlling the amount of glucose in the blood

There are two main types of diabetes:

type 1 – where the pancreas doesn’t produce any insulin type 2 – where the pancreas doesn’t produce enough insulin or the body’s cells don’t react to insulin

This topic is about type 2 diabetes.

Read more about type 1 diabetes

Another type of diabetes, known as gestational diabetes, occurs in some pregnant women and tends to disappear after birth.

Symptoms

The symptoms of diabetes occur because the lack of insulin means glucose stays in the blood and isn’t used as fuel for energy.

Your body tries to reduce blood glucose levels by getting rid of the excess glucose in your urine.

Typical symptoms include:

feeling very thirsty passing urine more often than usual, particularly at night feeling very tired weight loss and loss of muscle bulk slow to heal cuts or ulcers frequent vaginal or penile thrush blurred vision

Read more about the symptoms of type 2 diabetes

It’s very important for diabetes to be diagnosed as soon as possible as it will get progressively worse if left untreated.


The symptoms of diabetes include feeling very thirsty, passing more urine than usual, and feeling tired all the time.

The symptoms occur because some or all of the glucose stays in your blood and isn’t used as fuel for energy. Your body tries to get rid of the excess glucose in your urine.

The main symptoms of type 2 diabetes are:

urinating more often than usual, particularly at night feeling very thirsty feeling very tired unexplained weight loss itchiness around the genital area, or regular bouts of thrush (a yeast infection) cuts or wounds that heal slowly blurred vision – caused by the lens of the eye becoming dry

The signs and symptoms of type 1 diabetes are usually obvious and develop very quickly, often over a few weeks.

These signs and symptoms aren’t always as obvious, however, and it’s often diagnosed during a routine check-up.

This is because they are often mild and develop gradually over a number of years. This means you may have type 2 diabetes for many years without realising it.

Early diagnosis and treatment for type 2 diabetes is very important as it may reduce your risk of developing complications later on.

Causes

Type 2 diabetes occurs when the body doesn’t produce enough insulin to function properly, or the body’s cells don’t react to insulin. This means glucose stays in the blood and isn’t used as fuel for energy.

Type 2 diabetes is often associated with obesity and tends to be diagnosed in older people. Due to increased obesity, type 2 diabetes is now being seen in young people and all ages. It’s far more common than type 1 diabetes.

Read about the causes and risk factors for type 2 diabetes


Type 2 diabetes occurs when the pancreas doesn’t produce enough insulin to maintain a normal blood glucose level, or the body is unable to use the insulin that is produced (insulin resistance).

The pancreas is a large gland behind the stomach that produces the hormone insulin. Insulin moves glucose from your blood into your cells, where it’s converted into energy.

In type 2 diabetes, there are several reasons why the pancreas doesn’t produce enough insulin.

Diagnoses

If you have type 2 diabetes, you should be invited to have your eyes screened once a year to check for diabetic retinopathy.

Diabetic retinopathy is an eye condition where the small blood vessels in your eye become damaged.

It can occur if your blood glucose level is too high for a long period of time (hyperglycaemia). Left untreated, retinopathy can eventually lead to sight loss.

Read more about diabetic eye screening

People with diabetes should also see their optician every two years for a regular eye test. Diabetic eye screening is specifically for diabetic retinopathy and can’t be relied upon for other conditions.

Treatments

Type 2 diabetes is treated with changes in your diet and depending on the response of your blood glucose levels, sometimes tablets and insulin. Early in the course of type 2 diabetes, planned weight loss can even reverse the disease.

Read more about the treatment of type 2 diabetes



If glucose-lowering tablets aren’t effective in controlling your blood glucose levels, you may need to have insulin treatment.

This can be taken instead of or alongside your tablets, depending on the dose and the way you take it.

Insulin comes in several different preparations, and each works slightly differently. Your treatment may include a combination of these different insulin preparations.


If you have type 2 diabetes that’s controlled using insulin or certain types of tablets (e.g. sulfonylurea), you may experience episodes of hypoglycaemia.

Hypoglycaemia is where your blood glucose levels become very low.

Mild hypoglycaemia (a “hypo”) can make you feel shaky, weak and hungry, but it can usually be controlled by eating or drinking something sugary.

If you have a hypo, you should initially have a form of carbohydrate that will act quickly, such as a sugary drink or glucose tablets.

This should be followed by a longer-acting carbohydrate, such as a cereal bar, sandwich or piece of fruit.

In most cases, these measures will be enough to raise your blood glucose level to normal. You should aim for a hypo to be treated and to recheck your blood glucose level within 15 minutes.

If blood glucose still less than 4mmol/l then repeat the treatment using a fast acting carbohydrate. When your blood glucose returns to normal then have your longer acting carbohydrate.

If you develop severe hypoglycaemia, you may become drowsy and confused, and you may even lose consciousness.

If this occurs, you may need to have an injection of glucagon into your muscle or glucose into a vein. Glucagon is a hormone that quickly increases your blood glucose levels.

You may require input from a health care professional. If the glucagon is not successful, you may require an injection of dextrose into your vein.

Your diabetes care team can advise you on how to avoid a hypo and what to do if you have one.


If you have type 2 diabetes, your risk of developing heart disease, stroke, foot problems, eye and kidney disease is increased.

To reduce your risk of developing other serious health conditions, you may be advised to take other medicines, including:

anti-hypertensive medicines to control high blood pressure a statin, such as simvastatin or atorvastatin, to reduce high cholesterol low-dose aspirin to prevent a stroke an angiotensin-converting enzyme (ACE) inhibitor, such as enalapril, lisinopril or ramipril, if you have the early signs of diabetic kidney disease

Diabetic kidney disease is identified by the presence of small amounts of albumin (a protein) in your urine. If treated early enough, it may be reversible.

Preventions

If you’re at risk of type 2 diabetes, you may be able to prevent it developing by making lifestyle changes.

These include:

losing weight if you’re overweight, and maintaining a healthy weight eating a healthy, balanced diet stopping smoking if you smoke drinking alcohol in moderation taking plenty of regular exercise

Complications

Diabetes can cause serious long-term health problems. It’s the most common cause of vision loss and blindness in people of working age.

Everyone with diabetes aged 12 or over should be invited to have their eyes screened once a year for diabetic retinopathy.

Diabetes is also responsible for most cases of kidney failure and lower limb amputation, other than accidents.

Read more about the complications of type 2 diabetes


If diabetes isn’t treated, it can lead to a number of other health problems.

High glucose levels can damage blood vessels, nerves and organs.

Even a mildly raised glucose level that doesn’t cause any symptoms can have long-term damaging effects.

Trichomonas infection
of sexual and reproductive

It infects the genitals and may also lead to infection in the:

vagina urethra (the passage carrying urine from the bladder) prostate gland


vagina urethra (the passage carrying urine from the bladder) prostate gland


having unprotected vaginal, anal or oral sex (sex without a condom) sharing sex toys that aren’t washed or covered with a new condom each time they’re used

Symptoms

Almost half of all people with trichomonas infection will have no symptoms.

If you do develop symptoms you may experience:

a yellow or green discharge from the vagina or penis, which can sometimes have an unpleasant, ‘fishy’ smell genital itching and soreness which can lead to infections of the urethra (the passage that carries pee from the bladder) and infection of the prostate gland pain or a burning sensation when peeing

Some women may also experience pain or discomfort during sex.

Diagnoses

If you think you have trichomonas infection, make an appointment with your GP or local sexual health services. Testing for trichomonas may not be offered in all sexual health clinics.

Testing is quick and straightforward. There are 2 main ways the sample can be collected:

using a swab – a small cotton bud is gently wiped over the area that might be infected, such as inside the vagina or penis peeing into a container – this should ideally be done at least 1 or 2 hours after you last peed

Most sexual health clinics can look at the sample straightaway under the microscope and see the parasite. In some clinics and at your GP, the swab needs to be sent away to a lab to make the diagnosis.

The test is more accurate from vagina samples. It’s less accurate from penile and urine samples.

Treatments

Antibiotics will get rid of the infection. You should avoid having sex until 1 week after you and your partner(s) have been treated.

If your infection is untreated you may pass it onto other sexual partners.

Transverse myelitis
of brain nerves and spinal cord

The scars or lesions interrupt the communication between the nerves in the spinal cord and the rest of the body.

‘Transverse’ refers to the swelling being across the width of the spinal cord. It’s also sometimes used to describe swelling that only affects part of the width of the spinal cord.


‘Transverse’ refers to the swelling being across the width of the spinal cord. It’s also sometimes used to describe swelling that only affects part of the width of the spinal cord.

Symptoms

The symptoms of transverse myelitis can include:

muscle weakness in the legs, and sometimes the arms mobility problems unusual sensations and numbness bladder problems bowel problems sexual problems pain

Transverse myelitis can happen to anyone at any time in their life. In most cases there might only be one episode of symptoms, but sometimes it can happen repeatedly. Transverse myelitis can be the first sign of MS or another condition.

Causes

There are several different causes of transverse myelitis. Sometimes a cause isn’t found, and this is called idiopathic transverse myelitis.

Autoimmune disease Sometimes transverse myelitis is caused by an autoimmune reaction. In autoimmune diseases, the immune system mistakes the body’s own tissue as dangerous and attacks it. This causes swelling that results in damage to the myelin sheath. This includes: MS-like swelling neuromyelitis optica (NMO) myelin oligodendrocyte antibody (MOG) associated myelitis sarcoidosis Sjögrens syndrome lupus

Viral infection Sometimes transverse myelitis is caused indirectly by a viral infection, although often the virus responsible isn’t identified. Transverse myelitis often develops after a viral infection like: echovirus enterovirus Epstien-Barr hepatitis A herpes simplex HIV rubella influenza (flu) rubella aricella zoster (the virus that causes chicken pox and shingles)

Bacterial infection Bacterial infections such as syphilis might also lead to transverse myelitis.

Cancer Some cancers might trigger an unusual immune response that can lead to transverse myelitis.

Diagnoses

If your GP thinks you could have transverse myelitis, you should see a neurologist (a specialist in conditions of the nervous system) for a specialist assessment.

Some of the tests you may need to confirm transverse myelitis are:

neurological examination magnetic resonance imaging (MRI) scan lumbar puncture blood tests

Sometimes your neurologist will do other tests to look for conditions that cause transverse myelitis. This might include CT scans.

Treatments

Sometimes transverse myelitis requires no treatment as it will improve on its own. Sometimes patients may require treatment for their symptoms, the swelling, or the underlying cause.

Treatment for transverse myelitis symptoms

There are different treatments available for transverse myelitis symptoms.

Muscle weakness Physiotherapy can help improve strength, and the muscle spasms and stiffness that may sometimes develop. Techniques such as stretching exercises can help if your movement is restricted. If your muscle spasms are more severe, you may be prescribed a medicine that can relax your muscles. This will usually be either baclofen, gabapentin or tizanidine. These medicines all have side effects. You might experience dizziness, weakness, nausea and diarrhoea. Discuss which of these would be best for you with your healthcare professional.

Mobility problems Mobility problems are often the result of muscle spasms and spasticity. Muscle weakness, or problems with balance can also cause mobility problems. If you have problems with mobility, your healthcare professional might suggest: an exercise programme supervised by a physiotherapist mobility aids, such as a walking stick, or a wheelchair home adaptations such as stair lifts or railings An occupational therapist can carry out an assessment of your home and suggest adaptations.

Treatment of the inflammation (swelling) Sometimes your neurologist might offer treatment with steroids. This can help with some types of transverse myelitis. Steroids are only given for a short period of time to avoid possible steroid side effects. The side effects could include reflux and stomach irritation, worsening infection, mood swings, and difficulty sleeping.

Bladder problems Medication might help if you have an overactive bladder or need to pee frequently during the night. If you find it difficult to empty your bladder, advice from a continence nurse or physiotherapist can help. Hand-held external stimulators can help some people to start peeing or to empty the bladder. Sometimes a catheter can empty the bladder when needed. You might be taught how to do intermittent self catheterisation (ISC). In rare cases, people with transverse myelitis may need a long-term catheter to keep the bladder emptying safely. You might be referred to a continence adviser or urologist, for specialist treatment and advice. Read more about treating urinary incontinence.

Bowel problems It might be possible to treat mild to moderate constipation by changing your diet or taking laxatives. More severe constipation may need to be treated with suppositories, which are inserted into your bottom, or an enema. During an enema, liquid medication is rinsed through your bottom and large bowel, which softens and flushes out your stools. Anti diarrhoea medication or pelvic floor exercises might help bowel incontinence.

Sexual problems If you experience problems with less interest in sex or difficulty reaching orgasm, relationship counselling or seeing a sex therapist might help. If you have transverse myelitis and find it hard to get or maintain an erection (erectile dysfunction) you may be prescribed medication to increase the blood flow to the penis.

Musculoskeletal pain A physiotherapist might be able to help with this pain by suggesting exercises or better seating positions. If your pain is more severe, you may be prescribed painkillers. Or, you might have a transcutaneous electrical nerve stimulation (TENS) machine that stimulates your nerves.

Neuropathic pain Neuropathic pain is caused by damage to your nerves and is usually sharp and stabbing. It can also occur in the form of extreme skin sensitivity, or a burning sensation. This type of pain can be treated using neuropathic painkillers.

Other treatments

You may be offered other treatments depending on the cause of your transverse myelitis. Your neurologist will discuss your options with you.

Ulcerative colitis
of stomach liver and gastrointestinal tract, inflammatory bowel disease ibd

Your colon is your large intestine (bowel). Your rectum is the end of your bowel, where poo is stored.

If you have ulcerative colitis, you get swelling, inflammation and ulcers in the lining of your large bowel. They can bleed and produce pus.

Ulcerative colitis can affect people of all ages, but it’s usually diagnosed between the age of 15 and 40.


If you have ulcerative colitis, you get swelling, inflammation and ulcers in the lining of your large bowel. They can bleed and produce pus.

Ulcerative colitis can affect people of all ages, but it’s usually diagnosed between the age of 15 and 40.


Ulcerative colitis can affect people of all ages, but it’s usually diagnosed between the age of 15 and 40.

Symptoms

The main symptoms of ulcerative colitis are:

recurring diarrhoea, which may contain blood, mucus or pus abdominal pain needing to poo often

You may also experience:

extreme tiredness (fatigue) loss of appetite weight loss

Some people also get symptoms in other parts of their body. For example, some people develop:

painful and swollen joints (arthritis) mouth ulcers areas of painful, red and swollen skin irritated and red eyes

Speak to your GP practice if: you have symptoms of ulcerative colitis and you haven’t been diagnosed with the condition

Symptoms of a flare-up

Some people may go for weeks or months with very mild symptoms, or none at all. This is known as remission. This may be followed by periods where the symptoms are particularly troublesome. These are known as flare-ups or relapses.

Symptoms of flare-ups vary from person-to-person. They may include:

diarrhoea 6 or more times a day blood or mucus in your poo severe abdominal pain symptoms in other parts of your body

Severe ulcerative colitis can also cause symptoms like:

shortness of breath a fast or irregular heartbeat a high temperature (fever) blood in your poo becoming more obvious

Speak to your inflammatory bowel disease (IBD) team if: you have ulcerative colitis and think you’re having a flare-up

Causes

The exact cause of ulcerative colitis is unknown.

A combination of factors may be responsible, including:

problems with your immune system – where the immune system mistakenly attacks the lining of your large bowel, making it inflamed genetics – genes you inherit from your family environmental factors – like air pollution, medication and viruses or bacteria in your gut

Diagnoses

To help diagnose ulcerative colitis, your GP will ask about your:

your pattern of symptoms your diet any recent travel – for example, you may have developed travellers’ diarrhoea whether you’re taking any medication, including any over-the-counter medicines whether anyone else in your family has a bowel condition any health problems you’ve had in the past

Your GP may also:

examine your abdomen (tummy) ask for a stool (poo) sample and use a qFIT test to check for blood and mucus, infection or inflammation via a faecal calprotectin test arrange blood tests to check for inflammation or anaemia

Additional tests for ulcerative colitis

If your GP thinks that you have ulcerative colitis you may be referred to hospital for more tests. These could include:

colonoscopy – a thin, flexible tube with a camera is put into your bottom to look at the whole of your large bowel sigmoidoscopy – a thin, flexible tube with a camera is put into your bottom to look at the end of your large bowel X-ray MRI scan or computerised tomography (CT)

You will be told what tests you need and what you need to do to prepare for them.

Treatments

Treatment for ulcerative colitis aims to relieve and prevent symptoms.

Your treatment will depend on how severe your symptoms are and how often they flare up. Mild flare-ups can be usually be treated at home. But severe flare-ups usually need treatment in hospital to reduce the risk of complications.

Treatment will usually be provided by a range of healthcare professionals.

Medication

Most people will get medication to treat symptoms of ulcerative colitis. This includes medications like:

aminosalicylates (ASAs) – often the first treatment option, used to get and keep inflammation under control and can be given rectally as well as orally corticosteroids – used to get inflammation under control quickly, but not suitable for long-term use

If you have lots of flare-ups or aminosalicylates do not keep your inflammation under control, you may need other treatments, such as:

immunosuppressants like azathioprine or mercaptopurine – used to reduce the activity of the immune system biologic medicines, like adalimumab, infliximab, golimumab, ustekinumab or vedolizumab other advanced medicines like filgotinib, ozanimod, tofacitinib and upadacitinib

Surgery

Surgery to treat ulcerative colitis may be an option if:

you choose to have surgery instead of taking medications that may cause side effects medications don’t control your symptoms your quality of life is severely affected by your condition you have serious complications of ulcerative colitis

Surgery for ulcerative colitis involves removing part or all of your large bowel (known as a colectomy). This means the small intestine must be used to pass waste products out of your body instead.

During the surgery, your small intestine will either be:

joined to the surface of your tummy (known as an ileostomy or a colostomy) – after this type of surgery, poo comes out of the opening on your tummy and is collected in special bags that you wear joined directly to your rectum (the end of your large bowel), so your poo comes out of your bottom as usual used to create an internal pouch that’s connected to your bottom (known as an ileo-anal pouch or J-pouch) – this means your poo can pass through your bottom as usual

Diet

There’s no evidence that a particular diet causes ulcerative colitis. But alongside medications, some changes to your diet may help control symptoms for some people.

You could:

eat 5 to 6 small meals rather than 3 main meals try to eat a healthy, varied diet that includes a wide variety of fruit, vegetables, nuts, seeds, proteins and wholegrains drink plenty of water

You could also speak to your IBD team about:

keeping a food diary to find out if any particular foods affect your symptoms removing trigger foods from your diet – but do not make major changes to your diet without talking to your IBD team and make sure you are still getting all the nutrients you need taking a food supplement if you are struggling to get enough nutrients from your diet being referred to a dietitian

Managing stress

Stress doesn’t cause ulcerative colitis. But, managing stress may reduce how often you get symptoms.

To help manage stress, you could:

exercise – speak to your IBD team about a suitable exercise plan try relaxation techniques like yoga, medication and breathing exercises talk to others – Crohn’s & Colitis UK has details of local support groups speak to your GP if you think you may have depression

Complications

If you have ulcerative colitis, you may be at an increased risk of developing other problems. This can include:

osteoporosis poor growth and development in children and young people

More serious and rare complications can include:

primary sclerosing cholangitis (PSC) – inflammation in the bile ducts, which can lead to liver damage narrowing’s in the bowel (strictures) that may become blocked or make it difficult for poo to pass through toxic megacolon – severe inflammation in the colon may lead to trapped gas so the colon becomes very enlarged and can rupture a higher risk of getting bowel cancer a higher risk of getting blood clots in your legs or lungs

Underactive thyroid
of glands

An underactive thyroid gland (hypothyroidism) is where your thyroid gland doesn’t produce enough hormones.

Common signs of an underactive thyroid are tiredness, weight gain and feeling depressed.

An underactive thyroid can often be successfully treated by taking daily hormone tablets to replace the hormones your thyroid isn’t making.

There’s no way of preventing an underactive thyroid. Most cases are caused either by the immune system attacking the thyroid gland and damaging it, or by damage to the thyroid that occurs during some treatments for an overactive thyroid or thyroid cancer.

Read more about the causes of an underactive thyroid

Symptoms

Many symptoms of an underactive thyroid (hypothyroidism) are the same as those of other conditions, so it can easily be confused for something else.

Symptoms usually develop slowly and you may not realise you have a medical problem for several years.

Common symptoms include:

tiredness being sensitive to cold weight gain constipation depression slow movements and thoughts muscle aches and weakness muscle cramps dry and scaly skin brittle hair and nails loss of libido (sex drive) pain, numbness and a tingling sensation in the hand and fingers (carpal tunnel syndrome) irregular periods or heavy periods

Elderly people with an underactive thyroid may develop memory problems and depression. Children may experience slower growth and development. Teenagers may start puberty earlier than normal.

If you have any of these symptoms, see your GP and ask to be tested for an underactive thyroid.

Read more about getting tested for an underactive thyroid

Causes

An underactive thyroid (hypothyroidism) is when your thyroid gland doesn’t produce enough of the hormone thyroxine (also called T4).

Most cases of an underactive thyroid are caused by the immune system attacking the thyroid gland and damaging it, or by damage that occurs as a result of treatments for thyroid cancer or an overactive thyroid.


Worldwide, a lack of dietary iodine is a common cause of an underactive thyroid, because the body needs iodine to make thyroxine. However, iodine deficiency is uncommon in the UK.

Babies are sometimes born with an underactive thyroid because the thyroid gland doesn’t develop properly in the womb. This is called congenital hypothyroidism and is uncommon, affecting around 1 in 3,000 babies. It’s usually picked up during routine screening soon after birth.

A problem with the pituitary gland could lead to an underactive thyroid. The pituitary gland sits at the base of the brain and regulates the thyroid. Therefore, damage to the pituitary gland may lead to an underactive thyroid.

An underactive thyroid has also been linked to some viral infections or some medications used to treat other conditions, such as:

lithium – a medication sometimes used to treat certain mental health conditions, including depression and bipolar disorder amiodarone – a medication sometimes used to treat irregular heartbeats (arrhythmias) interferons – a class of medication sometimes used to treat certain types of cancer and hepatitis C

Speak to your GP or specialist if you’re concerned that a medication you’re taking may be affecting your thyroid hormone levels.

Diagnoses

It’s very important that an underactive thyroid (hypothyroidism) is diagnosed as soon as possible.

Low levels of thyroid-producing hormones, such as triiodothyronine (T3) and thyroxine (T4), can change the way the body processes fat.

This can cause high cholesterol and atherosclerosis (clogging of the arteries), which can potentially lead to serious heart-related problems, such as angina and heart attack.

Therefore, you should see your GP and ask for a blood test if you repeatedly have symptoms of an underactive thyroid.


A blood test measuring your hormone levels is the only accurate way to find out whether there’s a problem.

The test, called a thyroid function test, looks at levels of thyroid-stimulating hormone (TSH) and thyroxine (T4) in the blood.

A high level of TSH and a low level of T4 in the blood could mean you have an underactive thyroid.

If your test results show raised TSH but normal T4, you may be at risk of developing an underactive thyroid in the future.

Your GP may recommend that you have a repeat blood test every so often to see whether you eventually develop an underactive thyroid.

Blood tests are also sometimes used for other measurements, such as checking the level of a hormone called triiodothyronine (T3). However, this isn’t routine, because T3 levels can often remain normal, even if you have a significantly underactive thyroid.

The Lab Tests Online UK website has more information about the different types of thyroid function tests.

Treatments

Symptoms of an underactive thyroid are often similar to those of other conditions, and they usually develop slowly, so you may not notice them for years.

You should see your GP and ask to be tested for an underactive thyroid if you have symptoms including:

tiredness weight gain depression  being sensitive to the cold dry skin and hair muscle aches

The only accurate way of finding out whether you have a thyroid problem is to have a thyroid function test, where a sample of blood is tested to measure your hormone levels.

Read more about testing for an underactive thyroid


Treatment for an underactive thyroid involves taking daily hormone replacement tablets, called levothyroxine, to raise your thyroxine levels. You’ll usually need treatment for the rest of your life. However, with proper treatment, you should be able to lead a normal, healthy life.

If an underactive thyroid isn’t treated, it can lead to complications, including heart disease, goitre, pregnancy problems and a life-threatening condition called myxoedema coma (although this is very rare).

Read more about treating an underactive thyroid and the complications of an underactive thyroid


It’s unlikely that you’d have many of the later symptoms of an underactive thyroid, because the condition is often identified before more serious symptoms appear.

Later symptoms of an underactive thyroid include:

a low-pitched and hoarse voice a puffy-looking face thinned or partly missing eyebrows a slow heart rate hearing loss anaemia


An underactive thyroid can also occur as a side effect or complication of previous treatment to the thyroid gland, such as surgery or a treatment called radioactive iodine therapy.

These treatments are sometimes used for an overactive thyroid (where the thyroid gland produces too much hormone) or thyroid cancer.


An underactive thyroid (hypothyroidism) is usually treated by taking daily hormone replacement tablets called levothyroxine.

Levothyroxine replaces the thyroxine hormone, which your thyroid doesn’t make enough of.

You’ll initially have regular blood tests until the correct dose of levothyroxine is reached. This can take a little while to get right.

You may start on a low dose of levothyroxine, which may be increased gradually, depending on how your body responds. Some people start to feel better soon after beginning treatment, while others don’t notice an improvement in their symptoms for several months

Once you’re taking the correct dose, you’ll usually have a blood test once a year to monitor your hormone levels.

If blood tests suggest you may have an underactive thyroid, but you don’t have any symptoms or they’re very mild, you may not need any treatment. In these cases, your GP will usually monitor your hormone levels every few months and prescribe levothyroxine if you develop symptoms.

Complications

Several complications can occur if you have an underactive thyroid that isn’t treated.


If an underactive thyroid isn’t treated during pregnancy, there’s a risk of problems occurring. These include:

pre-eclampsia – which can cause high blood pressure and fluid retention in the mother and growth problems in the baby anaemia in the mother an underactive thyroid in the baby birth defects bleeding after birth problems with the baby’s physical and mental development premature birth or a low birthweight stillbirth or miscarriage

These problems can usually be avoided with treatment under the guidance of a specialist in hormone disorders (an endocrinologist). Therefore, tell your GP if you have an underactive thyroid and you’re pregnant or trying to get pregnant.

Urinary incontinence
of kidneys bladder and prostate

Urinary incontinence can affect anyone. It tends to be more common in women.

Further information about urinary incontinence in women

Although it’s common, it shouldn’t be thought of as normal. There are things you can do to reduce the chance of this happening and improve your symptoms.


Further information about urinary incontinence in women

Although it’s common, it shouldn’t be thought of as normal. There are things you can do to reduce the chance of this happening and improve your symptoms.


Although it’s common, it shouldn’t be thought of as normal. There are things you can do to reduce the chance of this happening and improve your symptoms.

Symptoms

Causes

The causes of urinary incontinence depend on the type.

Certain things can increase the chances of urinary incontinence developing, including:

being overweight a family history of incontinence getting older – but incontinence doesn’t happen just because you’ve aged if you’re a woman, pregnancy and vaginal birth if you’re a man, having surgery to remove the prostate gland

Diagnoses

Your GP will ask you some questions to understand what may be causing the incontinence and how bad it is.

They may also:

try to rule out other things that could be causing your symptoms, such as a urinary tract infection suggest you keep a diary of how much fluid you drink and how often you have to pee carry out a pelvic examination (in women) or rectal examination (in men) – as this is an intimate examination, there may be another person (chaperone) present refer you to a specialist, usually a physiotherapist

Treatments

Speak to your GP practice if: You have any symptoms of urinary incontinence, such as: peeing by accident feeling a sudden need to pee and are unable to stop it


Treatments which do not involve taking medication or having surgery are usually tried first. These include:

treating the underlying cause, if urinary incontinence is caused by another condition lifestyle changes – such as reducing your caffeine intake, changing how much you drink, and maintaining a healthy weight pelvic floor muscle training – your healthcare professional will explain how to do these exercises bladder training – techniques to increase the length of time between feeling the need to go to the toilet and peeing

Incontinence products (like pads or pants) aren’t a treatment for urinary incontinence. But you might find them helpful while you are waiting for assessment or for a treatment to start working.

If these treatments don’t work for you, your doctor may suggest trying other treatments, like medication or surgery. This will depend on the cause and type of incontinence you are experiencing.

It’s ok to ask any questions about your care to help you get the information you might need.

Preventions

There are things you can do that may help reduce the chance of urinary incontinence in the future.

Do strengthen you pelvic floor muscles with simple pelvic floor exercises stay active maintain a healthy weight avoid or cut down on alcohol and caffeinated drinks, such as coffee, tea and some fizzy drinks

Urinary tract infection (UTI)
of kidneys bladder and prostate

Anyone can get them, but they’re particularly common in women. Some women experience them regularly (called recurrent UTIs). 

UTIs can be painful and uncomfortable, but usually pass within a few days and can be treated with antibiotics. 

This page is about UTIs in adults. There is a separate page about UTIs in children.




UTIs can be painful and uncomfortable, but usually pass within a few days and can be treated with antibiotics. 

This page is about UTIs in adults. There is a separate page about UTIs in children.




This page is about UTIs in adults. There is a separate page about UTIs in children.

Symptoms

Lower UTIs

Infections of the bladder (cystitis) or urethra (tube that carries urine out of the body) are known as lower UTIs. These can cause: 

a need to pee more often than usual  pain or discomfort when peeing  sudden urges to pee  feeling as though you’re unable to empty your bladder fully  pain low down in your tummy  urine that’s cloudy, foul-smelling or contains blood  feeling generally unwell, achy and tired

You can speak to your pharmacist for advice and treatment on lower UTIs. 

Lower UTIs are common and aren’t usually a cause for major concern.  

Find your nearest pharmacy

Upper UTIs

Infections of the kidneys or ureters (tubes connecting the kidneys to the bladder) are known as upper UTIs. These can cause the same symptoms as lower UTIs and also: 

a high temperature (fever) of 38ºC (100.4ºF) or above  pain in your sides or back  shivering and chills  feeling and being sick  confusion  agitation or restlessness 

Upper UTIs can be serious if left untreated, as they could damage the kidneys or spread to the bloodstream. 

Speak to your GP urgently if: You think you, your child or someone you care for may have a urinary tract infection (UTI) and: have a very high temperature, or feel hot and shivery  have a low temperature below 36°C are confused or drowsy  have pain in the lower tummy or in the back, just under the ribs can see blood in your pee If your GP is closed, phone 111. These symptoms could mean you have a kidney infection, which can be serious if it’s not treated as it could cause sepsis.

Speak to your GP if: you have symptoms of an upper UTI your child has symptoms of a UTI the symptoms are severe or getting worse the symptoms haven’t started to improve after a few days  you get UTIs frequently  your symptoms come back after treatment

Your GP team can: 

rule out other possible causes of your symptoms by testing a sample of your urine  prescribe antibiotics if you have an infection 

Causes

UTIs occur when the urinary tract becomes infected, usually by bacteria. In most cases, bacteria from the gut enter the urinary tract through the urethra. 

This may happen when wiping your bottom or having sex. But often it’s not clear why it happens.

The following may increase your risk of getting a UTI:

conditions that obstruct your urinary tract, such as kidney stones  difficulty emptying your bladder fully  using a contraceptive diaphragm or condoms coated in spermicide  diabetes a weak immune system – for example from chemotherapy or HIV a urinary catheter (a tube in your bladder used to drain urine) an enlarged prostate gland in men 

Women may be more likely to get UTIs because their urethra is shorter than a man’s and is closer to their anus (back passage). 

Treatments

UTIs are normally treated with a short term course of antibiotics.

Most women are given a 3-day course of antibiotic capsules or tablets. Men, pregnant women and people with more serious symptoms may need a slightly longer course. 

Your symptoms will normally pass within 3 to 5 days of starting treatment. Make sure you complete the whole course of antibiotics that you’ve been prescribed, even if you’re feeling better. 

Over-the-counter pain relief such as paracetamol can help with any pain. Drinking plenty of fluids may also help you feel better. 

Return to your GP if your symptoms don’t improve, get worse, or come back after treatment. 

Preventions

There are some things you can do to try to prevent UTIs. 

Do go to the toilet as soon as you need to peealways empty your bladder fullystay well hydratedwipe your bottom from front to back when you go to the toiletpee as soon as possible after having sexhave a shower rather than a bathwear underwear made from cotton, rather than synthetic material such as nylonavoid tight jeans and trousers

Don’t do not use perfumed bubble bath, soap or talcum powder around your genitals – use plain, unperfumed ones insteaddo not use a diaphragm or condoms with spermicidal lubricant on them – try another type of contraception

Speak to your GP if these measures don’t work. 

Drinking cranberry juice or using probiotics aren’t proven to reduce your chances of getting UTIs.