Urinary tract infection (UTI) in children
of kidneys bladder and prostate

bladder urethra (the tube where urine leaves the body) kidneys

UTIs aren’t usually serious and can be treated with antibiotics if needed.

Speak to your GP if your child has symptoms of a UTI like: vomiting tiredness and lack of energy (lethargy) irritability not eating properly not gaining weight yellowing of the skin and whites of the eyes (jaundice) in very young children pain or a burning sensation when peeing needing to pee frequently deliberately holding in their pee a change in their normal toilet habits, like wetting themselves or wetting the bed unpleasant-smelling pee cloudy pee

Phone 111 or speak to a GP urgently if: You think a child has a urinary tract infection (UTI) and they: are under 3 have a very high temperature, or feel hot and shivery have a very low temperature below 36C are confused or drowsy have pain in the lower tummy or in the back, just under the ribs have blood in their pee


Speak to your GP if your child has symptoms of a UTI like: vomiting tiredness and lack of energy (lethargy) irritability not eating properly not gaining weight yellowing of the skin and whites of the eyes (jaundice) in very young children pain or a burning sensation when peeing needing to pee frequently deliberately holding in their pee a change in their normal toilet habits, like wetting themselves or wetting the bed unpleasant-smelling pee cloudy pee

Phone 111 or speak to a GP urgently if: You think a child has a urinary tract infection (UTI) and they: are under 3 have a very high temperature, or feel hot and shivery have a very low temperature below 36C are confused or drowsy have pain in the lower tummy or in the back, just under the ribs have blood in their pee


upper lower

An upper UTI means an infection of the kidneys or ureters. Ureters are the tubes connecting the kidneys to the bladder.

A lower UTI means an infection of the bladder (cystitis) or urethra. This is the tube that carries urine out of the body.

Symptoms

It’s very important to finish the prescribed course of antibiotics. This’ll prevent the infection from coming back.

Other treatments

If necessary, children can also take liquid paracetamol to help ease the symptoms of a UTI.

As a precaution, some children with a UTI may have to be treated in hospital. Your GP may advise you if this is necessary.

Don’t use non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen to treat a UTI. These can harm the kidneys. Aspirin should never be given to children under the age of 16.


If any symptoms do come back, tell your GP as soon as possible.

Causes

UTIs occur when the urinary tract becomes infected, usually by bacteria.

Bacteria from the gut can enter the urinary tract through the tube that carries pee out of the body (urethra). This may happen when a child:

wipes their bottom soils their nappy

Some children may be more likely to get UTIs due to problems emptying their bladder. This can be due to:

constipation dysfunctional elimination syndrome – a child ‘holds on’ to their pee, even though they have the urge to pee vesicoureteral reflux – urine leaks back up from the bladder into the ureters and kidney

Treatments

UTIs in children will often improve within 24 to 48 hours of treatment. A UTI won’t usually cause any long term problems.

Antibiotics

UTIs can usually be treated at home with antibiotics as long as the child is:

over 3 months not at risk of serious illness

The most suitable antibiotic depends on what type of UTI the child has.

Sometimes children can experience side effects whilst taking antibiotics. This can include feeling sick or having an upset stomach. These symptoms are usually mild and should stop once the antibiotics have finished.

It’s very important to finish the prescribed course of antibiotics. This’ll prevent the infection from coming back.

Other treatments

If necessary, children can also take liquid paracetamol to help ease the symptoms of a UTI.

As a precaution, some children with a UTI may have to be treated in hospital. Your GP may advise you if this is necessary.

Don’t use non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen to treat a UTI. These can harm the kidneys. Aspirin should never be given to children under the age of 16.

Preventions

It isn’t possible to prevent all childhood UTIs. But, there are some things you can do to reduce the risk of your child getting one.

Do encourage girls to wipe their bottom from front to back make sure children are well hydrated and go to the toilet regularly avoid nylon and other synthetic underwear – pick loose, cotton underwear avoid scented soaps or bubble baths – these can increase the risk of developing a UTI

Hives
of skin hair and nails

The rash may:

be raised be very itchy be on one part of the body spread over large areas range is size from a few millimetres to the size of a hand change in appearance within 24 hours

The image shows a hives rash on the side of the stomach. The rash is small, circular patches of pink on pale skin. https://dermnetnz.org/

More images of hives Image 1 Image 2 Image 3


be raised be very itchy be on one part of the body spread over large areas range is size from a few millimetres to the size of a hand change in appearance within 24 hours

The image shows a hives rash on the side of the stomach. The rash is small, circular patches of pink on pale skin. https://dermnetnz.org/

More images of hives Image 1 Image 2 Image 3


If your symptoms last a while (chronic urticaria), a doctor may arrange for tests to help work out the cause. They’ll also ask about anything that makes your symptoms worse.

Symptoms

The rash may:

be raised be very itchy be on one part of the body spread over large areas range is size from a few millimetres to the size of a hand change in appearance within 24 hours

The image shows a hives rash on the side of the stomach. The rash is small, circular patches of pink on pale skin. https://dermnetnz.org/

More images of hives Image 1 Image 2 Image 3


If your symptoms last a while (chronic urticaria), a doctor may arrange for tests to help work out the cause. They’ll also ask about anything that makes your symptoms worse.

Causes

Hives occur when histamine and other chemicals are released from under the skin’s surface. This causes the tissues to swell.

Histamine can be released for many reasons, including:

eating certain foods an insect bite or sting cold – including exposure to cold water or wind heat – including from exercise or eating spicy food emotional stress an infection like a cold having drinks like alcohol or caffeine taking medicines like non-steroidal anti-inflammatory drugs (NSAIDs) or antibiotics a reaction to environmental factors like pollen, dust mites or chemicals an allergic reaction to latex scratching or pressing on your skin – like wearing itchy or tight clothing a problem with your immune system water or sunlight (though this is rare)

If you can, try to work out what’s causing your hives. This can help to avoid them in the future.

Diagnoses

Hives can usually be diagnosed by examining the distinctive red rash. The pharmacist or GP may also ask you questions to find out what triggered your symptoms.

If your symptoms last a while (chronic urticaria), a doctor may arrange for tests to help work out the cause. They’ll also ask about anything that makes your symptoms worse.

Treatments

Most hives rashes don’t need treatment. The symptoms are usually mild and often get better within a few days.

If necessary, a pharmacist can give you advice about antihistamines to help treat hives.

Antihistamines may not be suitable for young children or if you’ve got a long term condition. You should discuss this with the pharmacist.

Find your nearest pharmacy


If hives are more severe, your doctor may prescribe:

steroid tablets (oral corticosteroids) antihistamines menthol cream to relieve itchiness

If hives don’t go away with treatment, a doctor may also refer you to a skin specialist (dermatologist).

Phone 999 or go to A&E if you: have swelling in your mouth, eyes, face, lips, tongue, throat, feet or hands are wheezing feel lightheaded or faint get tightness in your chest or throat have trouble breathing or talking have abdominal pain, nausea and vomiting You could be having a serious allergic reaction (anaphylaxis) and may need immediate treatment in hospital.

Speak to a GP if: the symptoms don’t improve after 2 days you’re worried about your child’s hives the rash is spreading the symptoms are severe hives keeps coming back (you may be allergic to something) you also have a high temperature and feel unwell you also have swelling under your skin (this might be angioedema) the symptoms cause distress the symptoms disrupt daily activities

Complications

Complications of hives can include:

angioedema – a deeper swelling of tissues psychological and emotional problems like stress and anxiety anaphylaxis – a severe allergic reaction that should be treated as a serious medical emergency

Vaginal cancer
of cancer, cancer types in adults

Vaginal cancer is a rare type of cancer that begins in the vagina.

Cancer that begins in the vagina is called primary vaginal cancer. Cancer that begins in another part of the body – such as the cervix, womb or ovaries – and spreads to the vagina is known as secondary vaginal cancer.

This topic is about primary vaginal cancer. There are separate topics on cervical cancer, ovarian cancer and womb cancer.

Symptoms

The most common symptom of vaginal cancer is abnormal vaginal bleeding. This includes:

bleeding between your normal periods, or after sex bleeding after the menopause (post-menopausal bleeding)

Other symptoms can include:

smelly or bloody vaginal discharge pain during sex pain when urinating needing to urinate more frequently than usual blood in your urine pelvic pain an itch or lump in your vagina

Speak to your GP if you experience any abnormal vaginal bleeding, changes in your usual pattern of periods (such as irregular periods or heavier periods than usual), or problems urinating.

While it’s highly unlikely that these symptoms are caused by vaginal cancer, they should still be investigated by your GP. Read more about diagnosing vaginal cancer.

Causes

The exact causes of vaginal cancer are unknown, but things that may increase your risk of developing it include:

being infected with a particularly persistent type of the human papilloma virus (HPV), which can be spread during sex your age – 7 out of every 10 cases of vaginal cancer affect women and anyone with a vagina over 60 a previous history of vaginal intraepithelial neoplasia (VAIN) or cervical intraepithelial neoplasia (CIN) – abnormal cells in the vagina or cervix that can sometimes become cancerous

As there is a possible link with HPV, it may be possible to reduce your risk of vaginal cancer by practising safe sex. 

The HPV vaccination, which is routinely offered to girls who are 12 to 13 years old, provides protection against 2 strains of HPV thought to be responsible for most cases of vaginal and cervical cancer.

Read more about the causes of vaginal cancer.


Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour.

The exact reason why this happens in cases of vaginal cancer is unknown, but certain things can increase your chances of developing the condition.

Diagnoses

To help diagnose vaginal cancer, your GP will ask you about your symptoms and may carry out a physical examination.

They may also refer you for blood tests to rule out other causes of your symptoms, such as infection.

If your GP cannot find an obvious cause of your symptoms, they will probably refer you to a gynaecologist for further testing. A gynaecologist is a specialist in treating conditions of the female reproductive system.

If your GP refers you urgently because they think you have cancer, you have the right to be seen by a specialist within 2 weeks.

The National Institute for Health and Care Excellence (NICE) recommends that GPs consider referring a woman who has an unexplained mass in or at the entrance to their vagina.

Treatments

Treatment for vaginal cancer depends on which part of your vagina is affected and how far the cancer has spread (known as the ‘stage’).

The main treatments for vaginal cancer are:

radiotherapy – radiation is used to destroy the cancerous cells surgery to remove the cancerous cells chemotherapy – medication is used to kill the cancerous cells; this is often used in combination with radiotherapy

These treatments can cause both short- and long-term side effects that should be discussed with your care team before treatment begins.

Read more about treating vaginal cancer


Treatment for vaginal cancer will depend on where the cancer is in your vagina and how far it has spread. Possible treatments include radiotherapy, surgery and chemotherapy.

When you are diagnosed with cancer, you will be cared for by a group of different healthcare professionals, known as a multidisciplinary team (MDT).

Your MDT will include a range of specialists, including surgeons, clinical oncologists (specialists in the non-surgical treatment of cancer), and specialist cancer nurses.

Your MDT will recommend a treatment plan they feel is most suitable for you, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.


Treatment for vaginal cancer can have a significant emotional impact, particularly for young women who experience an early menopause as a result of treatment.

The removal of some or all of the vagina can be traumatic for pre- and post-menopausal women alike, and some women feel less ‘womanly’ than they did before. It’s not uncommon to feel a sense of loss and bereavement after treatment. In some women, this may lead to depression.

You may find it helpful to talk to other women who have had similar treatment. Your GP or hospital staff may be able to recommend a suitable local support group. Charities can also help:

Macmillan Cancer Support has information on groups you can join and a support line that you can call for free on 0808 808 00 00 (Monday to Friday, 9am to 8pm) Cancer Research UK provides a free phone number that you can call on 0808 800 40 40 (Monday to Friday, 9am to 5pm)

If feelings of depression persist, speak to your GP about the treatment and support available.

Vaginal discharge
of sexual and reproductive

Vaginal discharge is nothing to worry about if it’s:

odourless (no unpleasant smell) clear or white thick and sticky slippery and wet

The amount of discharge you might experience can vary. You might experience heavier or more frequent discharge if you’re:

pregnant sexually active using contraception, such as the contraceptive pill

During ovulation, you’ll notice more slippery and wet discharge, which is normal.

Contact your GP or sexual health service if: You have vaginal discharge and: you experience pelvic pain you’re bleeding between periods or after sex you experience pain when peeing you feel itchy, sore or have blisters your vaginal discharge changes in colour, smell or texture

You should look out for anything that doesn’t seem normal for you. This can include discharge which is:

foul-smelling thick and white (like cottage cheese) green or yellow and frothy accompanied by pain or bleeding accompanied by itchiness, blister or sores

STIs that can cause vaginal discharge include:

chlamydia gonorrhoea genital herpes trichomonas

If you’re sexually active and you experience any abnormal discharge, contact your local sexual health clinic to get tested for STIs.

Vaginal discharge can also be caused by thrush or bacterial vaginosis.

You might be asked to visit your local sexual health clinic for a vaginal examination to ensure you get the correct treatment.


odourless (no unpleasant smell) clear or white thick and sticky slippery and wet

The amount of discharge you might experience can vary. You might experience heavier or more frequent discharge if you’re:

pregnant sexually active using contraception, such as the contraceptive pill

During ovulation, you’ll notice more slippery and wet discharge, which is normal.

Contact your GP or sexual health service if: You have vaginal discharge and: you experience pelvic pain you’re bleeding between periods or after sex you experience pain when peeing you feel itchy, sore or have blisters your vaginal discharge changes in colour, smell or texture

You should look out for anything that doesn’t seem normal for you. This can include discharge which is:

foul-smelling thick and white (like cottage cheese) green or yellow and frothy accompanied by pain or bleeding accompanied by itchiness, blister or sores

STIs that can cause vaginal discharge include:

chlamydia gonorrhoea genital herpes trichomonas

If you’re sexually active and you experience any abnormal discharge, contact your local sexual health clinic to get tested for STIs.

Vaginal discharge can also be caused by thrush or bacterial vaginosis.

You might be asked to visit your local sexual health clinic for a vaginal examination to ensure you get the correct treatment.


pregnant sexually active using contraception, such as the contraceptive pill

During ovulation, you’ll notice more slippery and wet discharge, which is normal.

Contact your GP or sexual health service if: You have vaginal discharge and: you experience pelvic pain you’re bleeding between periods or after sex you experience pain when peeing you feel itchy, sore or have blisters your vaginal discharge changes in colour, smell or texture

You should look out for anything that doesn’t seem normal for you. This can include discharge which is:

foul-smelling thick and white (like cottage cheese) green or yellow and frothy accompanied by pain or bleeding accompanied by itchiness, blister or sores

STIs that can cause vaginal discharge include:

chlamydia gonorrhoea genital herpes trichomonas

If you’re sexually active and you experience any abnormal discharge, contact your local sexual health clinic to get tested for STIs.

Vaginal discharge can also be caused by thrush or bacterial vaginosis.

You might be asked to visit your local sexual health clinic for a vaginal examination to ensure you get the correct treatment.

Treatments

If you’re experiencing discharge that you don’t think has been caused by an STI, you can visit your local pharmacy for advice.

If you experience discharge and think there’s a chance it could be caused by an STI, you should contact your local sexual health clinic. If they think you need treatment or aftercare for anything that’s caused vaginal discharge, you’ll be given this for free.

Free treatment is available for:

vaginal infections such as bacterial vaginosis (BV) and thrush all STIs

Varicose eczema
of skin hair and nails

Varicose eczema is a long-term skin condition that affects the lower legs and is common in people with varicose veins.

It is also known as venous eczema, gravitational eczema and stasis eczema.

Symptoms

Like all types of eczema, the affected skin becomes:

itchy red and swollen dry and flaky  scaly or crusty

There may be periods when these symptoms improve and periods when they become more severe.

Your legs may become swollen, especially towards the end of the day or after long periods of standing. Varicose veins (swollen and enlarged veins) are often visible on the legs.

Some people also have other symptoms, such as:

brown discolouration of the skin red, tender and tight skin that can eventually become hardened (lipodermatosclerosis) small, white scars (atrophie blanche) pain eczema affecting other parts of the body

Left untreated, leg ulcers can develop. These are long-lasting wounds that form where the skin has become damaged.

Causes

Varicose eczema is caused by increased pressure in the leg veins.

When the small valves in the veins stop working properly, it’s difficult for blood to be pushed against gravity and it can leak backwards.

This increases the pressure in the veins, which can cause fluid to leak into the surrounding tissue. It is thought that varicose eczema may develop as a result of the immune system reacting to this fluid.

Varicose eczema is more common in people with varicose veins, as these are also often a sign that the leg veins aren’t working properly.

Read more about the causes of varicose eczema.


Varicose eczema is usually caused by increased pressure in your leg veins.

Inside your veins there are valves that let the blood through in one direction and prevent it flowing backwards.

Sometimes, the walls of the veins can become stretched and lose their elasticity, causing the valves to become weakened. If the valves do not function properly, blood may leak backwards.

This increases the pressure in your veins, which may cause fluid to leak into surrounding tissues. It is thought that varicose eczema may develop as a result of your immune system reacting to these fluids in the tissues under your skin.

This increase in pressure can also cause blood to collect in your veins, which become swollen and enlarged (varicose veins).

Diagnoses

See your GP if you have symptoms of varicose eczema. They can usually make a diagnosis by simply looking at the affected areas.

Your GP will also ask you questions to determine whether you have a problem with the flow of blood in your leg veins, as this is the main cause of varicose eczema.

To help make a diagnosis, your GP may want to know if you have a history of:

varicose veins – swollen and enlarged veins deep vein thrombosis (DVT) – a blood clot in one of the deep veins of your legs leg ulcers – areas of damaged skin that take several weeks to heal cellulitis – an infection of the deeper layers of the skin and underlying tissue surgery or injury to your legs

Your GP may also check the pulse in your feet and they may carry out an ankle brachial pressure index (ABPI) test to see if compression stockings are suitable for you. See the section on treating varicose eczema for more information about these.

The ABPI test involves comparing blood pressure readings taken from your ankles and upper arms. A significant difference in the readings suggests a problem with the flow of blood in your arteries – in which case, compression stockings may not be safe to use.

Treatments

See your GP if you have symptoms of varicose eczema. They will often be able to make a diagnosis simply by looking at the skin.

Read more about diagnosing varicose eczema.


Varicose eczema tends to be a long-term problem. However, treatments are available to help keep it under control.

For most people, treatment involves a combination of:

self-help measures – including ways to improve your circulation, such as keeping active and frequently raising your legs emollients – moisturisers applied to the skin to stop it becoming dry) topical corticosteroids – ointments and creams applied to the skin to help treat the eczema and relieve symptoms compression stockings – specially designed stockings, usually worn every day, that steadily squeeze your legs and help to improve your circulation

If these treatments don’t help, your GP may refer you to a dermatologist (skin specialist) in case there is another cause for your symptoms or if they are concerned you may also have a type of eczema called contact dermatitis.

If you also have varicose veins, you may be referred to a vascular specialist (a doctor or surgeon specialising in conditions affecting the blood vessels) who can talk to you about the treatment options for varicose veins.

Read more about treating varicose eczema.


Treatment for varicose eczema aims to improve the condition of your skin, treat your symptoms and help improve your circulation (blood flow).

For many people, this will involve long-term treatment with a combination of:

emollients (moisturisers)  topical corticosteroids compression stockings

There are also some self-help techniques that you can try. These treatment options are described in more detail below.

Lipodermatosclerosis (hardened, tight skin) is treated in a similar way to varicose eczema. If you have a venous leg ulcer, you can also read about treating venous leg ulcers.


If you have varicose veins, as well as varicose eczema, treating these may sometimes be helpful.

If your GP thinks treatment may be beneficial, they can refer you to a vascular surgeon, who can arrange for an ultrasound scan of your leg to find the faulty blood vessels. Treatment of your varicose veins can then be planned.

There are a number of treatments available that can improve the symptoms and appearance of varicose veins, including:

endothermal ablation – where energy from either high-frequency radio waves or lasers is used to seal the affected veins sclerotherapy – where a special foam is injected into your veins to seal them ligation and stripping – where affected veins are tied off and surgically removed

These procedures are usually performed in the day surgery department of a hospital.

Read more about treating varicose veins.

Venous leg ulcer
of skin hair and nails

A leg ulcer is a long-lasting (chronic) sore that takes more than 4 to 6 weeks to heal. They usually develop on the inside of the leg, just above the ankle.

The symptoms of a venous leg ulcer include pain, itching and swelling in the affected leg. There may also be discoloured or hardened skin around the ulcer, and the sore may produce a foul-smelling discharge.

See your GP if you think you have a leg ulcer, as it will need specialist treatment to help it heal.

Your GP will examine your leg and may carry out additional tests to rule out other conditions.

Read more about how a venous leg ulcer is diagnosed.

Symptoms

Venous leg ulcers are open, often painful, sores in the skin that take more than a month to heal. They usually develop on the inside of the leg, just above the ankle.

If you have a venous leg ulcer, you may also have:

swollen ankles (oedema) discolouration and darkening of the skin around the ulcer hardened skin around the ulcer, which may make your leg feel hard or even resemble the shape of an upside-down champagne bottle a heavy feeling in your legs aching or swelling in your legs red, flaky, scaly and itchy skin on your legs (varicose eczema) swollen and enlarged veins on your legs (varicose veins) an unpleasant and foul-smelling discharge from the ulcer


Swelling in the legs and ankles

Venous leg ulcers are often accompanied by swelling of your feet and ankles (oedema), which is caused by fluid. This can be controlled by compression bandages.

Keeping your leg elevated whenever possible, ideally with your toes at the same level as your eyes, will also help ease swelling. You should put a suitcase, sofa cushion or foam wedge under the bottom of your mattress, to help keep your legs raised while you sleep.

You should also keep as active as possible and aim to continue with your normal activities. Regular exercise, such as a daily walk, will help reduce leg swelling. However, you should avoid standing or sitting still with your feet down. You should elevate your feet at least every hour.

Itchy skin

Some people with venous leg ulcers develop rashes with scaly and itchy skin.

This is often due to varicose eczema, which can be treated with a moisturiser (emollient) and occasionally a mild corticosteroid cream or ointment. In rare cases, you may need to be referred to a dermatologist (skin specialist) for treatment.

Itchy skin can also sometimes be caused by an allergic reaction to the dressings or creams applied by your nurse. If this happens, you may need to be tested for allergies.

It’s important to avoid scratching your legs if they feel itchy, because this damages the skin and may lead to further ulcers.

Causes

A venous leg ulcer is the most common type of leg ulcer, accounting for over 90% of all cases.

Venous leg ulcers can develop after a minor injury, where persistently high pressure in the veins of the legs has damaged the skin.

Read more about the causes of venous leg ulcers.


A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins. If this happens, pressure inside the veins increases.

This constant high pressure can gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a knock or scratch.

Unless you have treatment to improve the circulation in your legs, the ulcer may not heal.

Read more about treating venous leg ulcers.

Diagnoses

See your GP if you think you have a venous leg ulcer. The ulcer is unlikely to heal without specialist treatment.

Diagnosis is largely based on your symptoms and examination of your affected leg, although additional tests may be required.

Treatments

Most venous leg ulcers heal within 3 to 4 months if they’re treated by a healthcare professional trained in compression therapy for leg ulcers. However, some ulcers may take longer to heal, and a very small number never heal.

Treatment usually involves:

cleaning and dressing the wound using compression, such as bandages or stockings, to improve the flow of blood in the legs

Antibiotics may also be used if the ulcer becomes infected, but they don’t help ulcers to heal.

However, unless the underlying cause of the ulcer is addressed, there’s a high risk of a venous leg ulcer recurring after treatment. Underlying causes could include immobility, obesity, previous DVT, or varicose veins.

Read more about treating venous leg ulcers.


Contact your GP if you think you’ve developed a venous leg ulcer. They’re unlikely to get better on their own, as they usually require specialist medical treatment.

You should also contact your GP or leg ulcer specialist if you’ve been diagnosed with a venous leg ulcer and have symptoms that suggest it could be infected.

Read more about how venous leg ulcers are treated.


With appropriate treatment, most venous leg ulcers heal within 3 to 4 months.

Treatment should always be carried out by a healthcare professional trained in compression therapy for leg ulcers. Usually, this will be a practice or district nurse.


Swelling in the legs and ankles

Venous leg ulcers are often accompanied by swelling of your feet and ankles (oedema), which is caused by fluid. This can be controlled by compression bandages.

Keeping your leg elevated whenever possible, ideally with your toes at the same level as your eyes, will also help ease swelling. You should put a suitcase, sofa cushion or foam wedge under the bottom of your mattress, to help keep your legs raised while you sleep.

You should also keep as active as possible and aim to continue with your normal activities. Regular exercise, such as a daily walk, will help reduce leg swelling. However, you should avoid standing or sitting still with your feet down. You should elevate your feet at least every hour.

Itchy skin

Some people with venous leg ulcers develop rashes with scaly and itchy skin.

This is often due to varicose eczema, which can be treated with a moisturiser (emollient) and occasionally a mild corticosteroid cream or ointment. In rare cases, you may need to be referred to a dermatologist (skin specialist) for treatment.

Itchy skin can also sometimes be caused by an allergic reaction to the dressings or creams applied by your nurse. If this happens, you may need to be tested for allergies.

It’s important to avoid scratching your legs if they feel itchy, because this damages the skin and may lead to further ulcers.


To help your ulcer heal more quickly, follow the advice below:

Try to keep active by walking regularly. Sitting and standing still without elevating your legs can make venous leg ulcers and swelling worse Whenever you’re sitting or lying down, keep your affected leg elevated – with your toes level with your eyes Regularly exercise your legs by moving your feet up and down, and rotating them at the ankles. This can help encourage better circulation If you’re overweight, try to reduce your weight with a healthy diet and regular exercise Stop smoking  Moderate your alcohol consumption Be careful not to injure your affected leg, and wear comfortable, well-fitting footwear

You may also find it helpful to attend a local healthy leg club, such as those provided by the Lindsay Leg Club Foundation, for support and advice.


An ulcer sometimes produces a large amount of discharge and becomes more painful. There may also be redness around the ulcer. These symptoms and feeling unwell are signs of infection.

If your ulcer becomes infected, it should be cleaned and dressed as usual.

You should also elevate your leg most of the time and you’ll be prescribed a 7-day course of antibiotics.

The aim of antibiotic treatment is to clear the infection. However, antibiotics don’t heal ulcers and should only be used in short courses to treat infected ulcers.


Treating severe varicose veins may help prevent leg swelling or ulcers. This may involve a procedure where a catheter (a thin, flexible tube) is inserted into the affected veins with high-frequency radio waves or lasers used to seal them.

Alternatively, you may need surgery to repair the damage to your leg veins, or to remove the affected veins altogether.

Read more about treating varicose veins.

Preventions

There are several ways to help prevent a venous leg ulcer in people at risk, such as: 

wearing compression stockings losing weight if you’re overweight exercising regularly elevating your leg when possible

This is particularly important if you’ve previously had a leg ulcer – once a leg has suffered a venous ulcer, you’re at risk of further ulcers developing within months or years.

Read more about preventing venous leg ulcers.


You can help reduce your risk of developing a venous leg ulcer in several ways, such as wearing a compression stocking, losing weight and taking care of your skin.

People most at risk of developing a venous leg ulcer are those who have previously had a leg ulcer.

Vertigo
of ears nose and throat

Vertigo is a symptom, rather than a condition itself. It’s the sensation that you, or the environment around you, is moving or spinning.

This feeling may be barely noticeable, or it may be so severe that you find it difficult to keep your balance and do everyday tasks.

Attacks of vertigo can develop suddenly and last for a few seconds, or they may last much longer. If you have severe vertigo, your symptoms may be constant and last for several days, making normal life very difficult.

Other symptoms associated with vertigo may include:

loss of balance – which can make it difficult to stand or walk feeling sick or being sick dizziness

Causes

Vertigo is commonly caused by a problem with the way balance works in the inner ear, although it can also be caused by problems in certain parts of the brain.

Causes of vertigo may include:

benign paroxysmal positional vertigo (BPPV) – where certain head movements trigger vertigo migraines – severe headaches labyrinthitis – an inner ear infection vestibular neuronitis – inflammation of the vestibular nerve, which runs into the inner ear and sends messages to the brain that help to control balance

Depending on the condition causing vertigo, you may experience additional symptoms, such as a high temperature, ringing in your ears (tinnitus) and hearing loss.

Read more about the causes of vertigo


Vertigo is a symptom of several different conditions. There are two types of vertigo, known as peripheral and central, depending on the cause.


If the cause of your vertigo is unknown, you may be admitted to hospital if:

you have severe nausea and vomiting, and can’t keep fluids down your vertigo comes on suddenly and wasn’t caused by you changing position you possibly have central vertigo you have sudden hearing loss, but it’s not thought to be Ménière’s disease

Alternatively, you may be referred to a specialist, such as:

a neurologist – a specialist in treating conditions that affect the nervous system an ENT specialist – a specialist in conditions that affect the ear, nose or throat an audiovestibular physician – a specialist in hearing and balance disorders

While waiting to see a specialist, you may be treated with medication. 

Diagnoses

Your GP will ask about your symptoms and carry out some simple tests to help them make an accurate diagnosis.

In some cases, you may be referred for some further tests.


Depending on your symptoms, your GP may refer you to a hospital or specialist for further tests.

Hearing tests

If you have tinnitus (ringing in your ears) or hearing loss, your GP may refer you to an ear, nose and throat (ENT) specialist, who can carry out some hearing tests.

These may include:

an audiometry test – a machine called an audiometer produces sounds of different volume and pitch. You listen to the sounds through headphones and signal when you hear a sound, either by raising your hand or pressing a button. tuning fork test – a tuning fork produces sound waves at a fixed pitch when it’s gently tapped. The tester will tap the tuning fork before holding it at each side of your head.

Read more about how hearing tests are carried out.

Videonystagmography 

Videonystagmography (VNG) is sometimes used to check for signs of nystagmus in more detail. Nystagmus can indicate a problem with the organs that help you to balance.

During this test, special goggles are placed over your eyes and you’ll be asked to look at various still and moving targets. The goggles are fitted with a video camera to record the movements of your eyes.

Electronystagmography may also be used, where electrodes are placed around the eye instead of goggles.

Caloric testing

A caloric test involves running warm or cool water or air into your ear for about 30 seconds. The change in temperature stimulates the balance organ in the ear, allowing the specialist to check how well it’s working.

This test isn’t painful, although it’s normal to feel dizzy during the test. This can sometimes continue for a few minutes afterwards.

Posturography

A machine to test your balance may be used to give valuable information about how you are using your vision, proprioception (sensations from your feet and joints) and the input from your ear to maintain balance. This may help to plan your rehabilitation and monitor your treatment.

Scans

In some cases, a scan of your head may be used to look for the cause of your vertigo, such as an acoustic neuroma (a non-cancerous brain tumour).

Usually, either a magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan is used. An MRI scan uses a strong magnetic field and radio waves to produce a detailed image of the inside of your head, whereas a CT scan uses a series of detailed X-rays to create an image.

Treatments

Some cases of vertigo improve over time, without treatment. However, some people have repeated episodes for many months, or even years, such as those with Ménière’s disease.

There are specific treatments for some causes of vertigo. A series of simple head movements (known as the Epley manoeuvre) is used to treat BPPV.

Medicines, such as prochlorperazine and some antihistamines, can help in the early stages or most cases of vertigo.

Many people with vertigo also benefit from vestibular rehabilitation training (VRT), which is a series of exercises for people with dizziness and balance problems.

Read more about treating vertigo


Treatment for vertigo depends on the cause and severity of your symptoms.

During a vertigo attack, lying still in a quiet, darkened room may help to ease any symptoms of nausea and reduce the sensation of spinning. You may be advised to take medication.

You should also try to avoid stressful situations, as anxiety can make the symptoms of vertigo worse.

Read more about what to do if you’re struggling with stress

Vitamin B12 or folate deficiency anaemia
of nutritional

Vitamin B12 or B9 (commonly called folate) deficiency anaemia occurs when a lack of vitamin B12 or folate causes the body to produce abnormally large red blood cells that can’t function properly.

Red blood cells carry oxygen around the body using a substance called haemoglobin.

Anaemia is the general term for having either fewer red blood cells than normal or having an abnormally low amount of haemoglobin in each red blood cell.

There are several different types of anaemia, and each one has a different cause. For example, iron deficiency anaemia, which occurs when the body doesn’t contain enough iron.

Symptoms

Vitamin B12 and folate perform several important functions in the body, including keeping the nervous system healthy.

A deficiency in either of these vitamins can cause a wide range of problems, including:

extreme tiredness a lack of energy pins and needles (paraesthesia) a sore and red tongue mouth ulcers muscle weakness disturbed vision psychological problems, which may include depression and confusion  problems with memory, understanding and judgement

Some of these problems can also occur if you have a deficiency in vitamin B12 or folate, but don’t have anaemia.

Read about the symptoms of vitamin B12 or folate deficiency anaemia


Vitamin B12 or folate deficiency anaemia can cause a wide range of symptoms. These usually develop gradually but can worsen if the condition goes untreated.

Anaemia is where you have fewer red blood cells than normal or you have an abnormally low amount of a substance called haemoglobin in each red blood cell. General symptoms of anaemia may include:

extreme tiredness (fatigue) lack of energy (lethargy) breathlessness feeling faint headaches pale skin noticeable heartbeats (palpitations) hearing sounds coming from inside the body, rather than from an outside source (tinnitus) loss of appetite and weight loss


If you have anaemia caused by a vitamin B12 deficiency, you may have other symptoms in addition to those listed above, such as:

a pale yellow tinge to your skin a sore and red tongue (glossitis) mouth ulcers pins and needles (paraesthesia) changes in the way that you walk and move around disturbed vision irritability depression changes in the way you think, feel and behave a decline in your mental abilities, such as memory, understanding and judgement (dementia)

Some of these symptoms can also occur in people who have a vitamin B12 deficiency, but have not developed anaemia.


Additional symptoms in people with anaemia caused by a folate deficiency can include:

symptoms related to anaemia reduced sense of taste diarrhoea numbness and tingling in the feet and hands muscle weakness depression

Causes

There are a number of problems that can lead to a vitamin B12 or folate deficiency, including:

pernicious anaemia – where your immune system attacks healthy cells in your stomach, preventing your body from absorbing vitamin B12 from the food you eat; this is the most common cause of vitamin B12 deficiency in the UK a lack of these vitamins in your diet – this is uncommon, but can occur if you have a vegan diet, follow a fad diet or have a generally poor diet for a long time medication – certain medications, including anticonvulsants and proton pump inhibitors (PPIs), can affect how much of these vitamins your body absorbs 

Both vitamin B12 deficiency and folate deficiency are more common in older people, affecting around 1 in 10 people aged 75 or over, and 1 in 20 people aged 65 to 74.

Read about the causes of vitamin B12 or folate deficiency anaemia


Vitamin B12 or folate deficiency anaemia occurs when a lack of either of these vitamins affects the body’s ability to produce fully functioning red blood cells.

Red blood cells carry oxygen around the body. Most people with vitamin B12 or folate deficiency anaemia have underdeveloped red blood cells that are larger than normal. The medical term for this is “megaloblastic anaemia”.

A vitamin B12 or folate deficiency can be the result of a variety of problems, some of which are described below.


Pernicious anaemia

Pernicious anaemia is the most common cause of vitamin B12 deficiency in the UK.

Pernicious anaemia is an autoimmune condition that affects your stomach. An autoimmune condition means your immune system (the body’s natural defence system that protects against illness and infection) attacks your body’s healthy cells.

In your stomach, vitamin B12 is combined with a protein called intrinsic factor. This mix of vitamin B12 and intrinsic factor is then absorbed into the body in part of the gut called the distal ileum.

Pernicious anaemia causes your immune system to attack the cells in your stomach that produce the intrinsic factor, which means your body is unable to absorb vitamin B12.

The exact cause of pernicious anaemia is unknown, but the condition is more common in women around 60 years of age, people with a family history of the condition and those with another autoimmune condition, such as Addison’s disease or vitiligo.

Diet

Some people can develop a vitamin B12 deficiency as a result of not getting enough vitamin B12 from their diet.

A diet that includes meat, fish and dairy products usually provides enough vitamin B12, but people who don’t regularly eat these foods – such as those following a vegan diet or who have a generally very poor diet – can become deficient.

Stores of vitamin B12 in the body can last around two to four years without being replenished, so it can take a long time for any problems to develop after a dietary change.

Conditions affecting the stomach

Some stomach conditions or stomach operations can prevent the absorption of enough vitamin B12.

For example, a gastrectomy (a surgical procedure where part of your stomach is removed) increases your risk of developing a vitamin B12 deficiency.

Conditions affecting the intestines

Some conditions that affect your intestines can also stop you from absorbing the necessary amount of vitamin B12.

For example, Crohn’s disease (a long-term condition that causes inflammation of the lining of the digestive system) can sometimes mean your body doesn’t get enough vitamin B12.

Medication

Some types of medicine can lead to a reduction in the amount of vitamin B12 in your body.

For example, proton pump inhibitors (PPIs) – a medication sometimes used to treat indigestion – can make a vitamin B12 deficiency worse. PPIs inhibit the production of stomach acid, which is needed to release vitamin B12 from the food you eat.

Your GP will be aware of medicines that can affect your vitamin B12 levels and will monitor you if necessary.

Functional vitamin B12 deficiency

Some people can experience problems related to a vitamin B12 deficiency, despite appearing to have normal levels of vitamin B12 in their blood.

This can occur due to a problem known as functional vitamin B12 deficiency – where there’s a problem with the proteins that help transport vitamin B12 between cells. This results in neurological complications involving the spinal cord.


Folate dissolves in water, which means your body is unable to store it for long periods of time. Your body’s store of folate is usually enough to last four months. This means you need folate in your daily diet to ensure your body has sufficient stores of the vitamin.

Like vitamin B12 deficiency anaemia, folate deficiency anaemia can develop for a number of reasons. Some are described below.

Diet

Good sources of folate include broccoli, Brussels sprouts, asparagus, peas, chickpeas and brown rice. If you don’t regularly eat these types of foods, you may develop a folate deficiency.

Folate deficiency caused by a lack of dietary folate is more common in people who have a generally unbalanced and unhealthy diet, people who regularly misuse alcohol and people following a fad diet that doesn’t involve eating good sources of folate.

Malabsorption

Sometimes your body may be unable to absorb folate as effectively as it should. This is usually due to an underlying condition affecting your digestive system, such as coeliac disease.

Excessive urination

You may lose folate from your body if you urinate frequently. This can be caused by an underlying condition that affects one of your organs, such as:

congestive heart failure – where the heart is unable to pump enough blood around the body acute liver damage – often caused by drinking excessive amounts of alcohol long-term dialysis – where a machine that replicates the kidney function is used to filter waste products from the blood

Medication

Some types of medicine reduce the amount of folate in your body, or make the folate harder to absorb.

These include some anticonvulsants (medication used to treat epilepsy), colestyramine, sulfasalazine and methotrexate.

Your GP will be aware of medicines that can affect your folate levels and will monitor you if necessary.

Other causes

Your body sometimes requires more folate than normal. This can cause folate deficiency if you can’t meet your body’s demands for the vitamin.

Your body may need more folate than usual if you:

are pregnant (see below) have cancer have a blood disorder – such as sickle cell anaemia (an inherited blood disorder which causes red blood cells to develop abnormally) are fighting an infection or health condition that causes inflammation (redness and swelling)

Premature babies (born before the 37th week of pregnancy) are also more likely to develop a folate deficiency, because their developing bodies require higher amounts of folate than normal.

Pregnancy

If you’re pregnant or trying to get pregnant, it’s recommended that you take a 400 microgram folic acid tablet every day until you’re 12 weeks pregnant. This will ensure that both you and your baby have enough folate and help your baby grow and develop.

Folic acid tablets are available with a prescription from your GP, or you can buy them over the counter from pharmacies, large supermarkets and health food stores.

If you’re pregnant and have another condition that may increase your body’s need for folate, such as those mentioned above, your GP will monitor you closely to prevent you from becoming anaemic.

In some cases, you may need a higher dose of folic acid. For example, if you have diabetes, you should take a 5 milligrams (5mg or 5,000 micrograms) supplement of folic acid instead of the standard 0.4 milligrams (0.4mg or 400 micrograms).

Read more about vitamins and minerals in pregnancy


If your symptoms and blood test results suggest a vitamin B12 or folate deficiency, your GP may arrange further tests. If the cause can be identified, it will help to determine the most appropriate treatment.

For example, you may have additional blood tests to check for a condition called pernicious anaemia. This is an autoimmune condition (where your immune system produces antibodies to attack healthy cells), which means you’re unable to absorb vitamin B12 from the food you eat.

Tests for pernicious anaemia aren’t always conclusive, but they can often give your GP a good idea of whether you have the condition.

Diagnoses

A diagnosis of vitamin B12 or folate deficiency anaemia can often be made by your GP based on your symptoms and the results of blood tests.


Different types of blood tests can be carried out to help identify people with a possible vitamin B12 or folate deficiency. These tests check:

whether you have a lower level of haemoglobin (a substance that transports oxygen) than normal whether your red blood cells are larger than normal the level of vitamin B12 in your blood the level of folate in your blood

However, some people can have problems with their normal levels of these vitamins or may have low levels despite having no symptoms. This is why it’s important for your symptoms to be taken into account when a diagnosis is made.

A particular drawback of testing vitamin B12 levels is that the current widely-used blood test only measures the total amount of vitamin B12 in your blood.

This means it measures forms of vitamin B12 that are “active” and can be used by your body, as well as the “inactive” forms, which can’t. If a significant amount of the vitamin B12 in your blood is “inactive”, a blood test may show that you have normal B12 levels, even though your body can’t use much of it.

There are some types of blood test that may help determine if the vitamin B12 in your blood can be used by your body, but these aren’t yet widely available.

Treatments

See your GP if you think you may have a vitamin B12 or folate deficiency. These conditions can often be diagnosed based on your symptoms and the results of a blood test.

It’s important for vitamin B12 or folate deficiency anaemia to be diagnosed and treated as soon as possible because, although many of the symptoms improve with treatment, some problems caused by the condition can be irreversible.

Read about diagnosing vitamin B12 or folate deficiency anaemia


Most cases of vitamin B12 and folate deficiency can be easily treated with injections or tablets to replace the missing vitamins.

Vitamin B12 supplements are usually given by injection at first. Then, depending on whether your B12 deficiency is related to your diet, you’ll either require B12 tablets between meals or regular injections. These treatments may be needed for the rest of your life.

Folic acid tablets are used to restore folate levels. These usually need to be taken for four months.

In some cases, improving your diet can help treat the condition and prevent it recurring. Vitamin B12 is found in meat, fish, eggs, dairy products, yeast extract (such as Marmite) and specially fortified foods. The best sources of folate include green vegetables such as broccoli, Brussels sprouts and peas.

Read about treating vitamin B12 or folate deficiency


See your GP if you’re experiencing symptoms of vitamin B12 or folate deficiency anaemia. These conditions can often be diagnosed based on your symptoms and the results of a blood test.

Read more about diagnosing vitamin B12 or folate deficiency anaemia

It’s important for vitamin B12 or folate deficiency anaemia to be diagnosed and treated as soon as possible. Although many of the symptoms improve with treatment, some problems caused by the condition can be irreversible if left untreated. The longer the condition goes untreated, the higher the chance of permanent damage.


The treatment for vitamin B12 or folate deficiency anaemia depends on what’s causing the condition. Most people can be easily treated with injections or tablets to replace the missing vitamins.


Vitamin B12 deficiency anaemia is usually treated with injections of vitamin B12, in a form called hydroxocobalamin.

At first, you’ll have these injections every other day for two weeks, or until your symptoms have stopped improving. Your GP or nurse will give the injections.

After this initial period, your treatment will depend on whether the cause of your vitamin B12 deficiency is related to your diet. The most common cause of vitamin B12 deficiency in the UK is pernicious anaemia, which isn’t related to your diet.

Read more about the causes of vitamin B12 or folate deficiency

Diet-related

If your vitamin B12 deficiency is caused by a lack of the vitamin in your diet, you may be prescribed vitamin B12 tablets to take every day between meals. Alternatively, you may need to have an injection of hydroxocobalamin twice a year.

People who find it difficult to get enough vitamin B12 in their diets, such as those following a vegan diet, may need vitamin B12 tablets for life.

Although it’s less common, people with vitamin B12 deficiency caused by a prolonged poor diet may be advised to stop taking the tablets once their vitamin B12 levels have returned to normal and their diet has improved.

Good sources of vitamin B12 include:

meat salmon and cod milk and other dairy products eggs

If you’re a vegetarian and vegan, or are looking for alternatives to meat and dairy products, there are other foods that contain vitamin B12, such as yeast extract (including Marmite), as well as some fortified breakfast cereals and soy products.

Check the nutrition labels while food shopping to see how much vitamin B12 different foods contain.

Not diet-related

If your vitamin B12 deficiency isn’t caused by a lack of vitamin B12 in your diet, you’ll usually need to have an injection of hydroxocobalamin every three months for the rest of your life.

If you’ve had neurological symptoms (symptoms that affect your nervous system, such as numbness or tingling in your hands and feet) caused by a vitamin B12 deficiency, you’ll be referred to a haematologist, and you may need to have injections every two months. Your haematologist will advise on how long you need to keep taking the injections.

For injections of vitamin B12 given in the UK, hydroxocobalamin is preferred to an alternative called cyanocobalamin. This is because hydroxocobalamin stays in the body for longer.

If you need regular injections of vitamin B12, cyanocobalamin would need to be given once a month, whereas hydroxocobalamin can be given every three months.

Cyanocobalamin injections aren’t routinely available on the NHS. However, if you need replacement tablets of vitamin B12, these will be cyanocobalamin.


To treat folate deficiency anaemia, your GP will usually prescribe daily folic acid tablets to build up your folate levels. They may also give you dietary advice so you can increase your folate intake.

Good sources of folate include:

broccoli Brussels sprouts asparagus peas chickpeas brown rice

Most people need to take folic acid tablets for about four months. However, if the underlying cause of your folate deficiency anaemia continues, you may have to take folic acid tablets for longer – possibly for life.

Before you start taking folic acid, your GP will check your vitamin B12 levels to make sure they’re normal. This is because folic acid treatment can sometimes improve your symptoms so much that it masks an underlying vitamin B12 deficiency.

If a vitamin B12 deficiency isn’t detected and treated, it could affect your nervous system.

Complications

Although it’s uncommon, vitamin B12 or folate deficiency (with or without anaemia) can lead to complications, particularly if you’ve been deficient in vitamin B12 or folate for some time.

Potential complications can include:

problems with the nervous system temporary infertility heart conditions pregnancy complications and birth defects

Adults with severe anaemia are also at risk of developing heart failure.

Some complications improve with appropriate treatment, but others – such as problems with the nervous system – can be permanent. 

Read about the complications of vitamin B12 or folate deficiency anaemia


As most cases of vitamin B12 deficiency or folate deficiency can be easily and effectively treated, complications are rare.

However, complications can occasionally develop, particularly if you’ve been deficient in either vitamin for some time.


All types of anaemia, regardless of the cause, can lead to heart and lung complications as the heart struggles to pump oxygen to the vital organs.

Adults with severe anaemia are at risk of developing:

an abnormally fast heart beat (tachycardia) heart failure – where the heart fails to pump enough blood around the body at the right pressure

Complications of vitamin B12 deficiency

A lack of vitamin B12 (with or without anaemia) can cause the following complications:

Neurological changes

A lack of vitamin B12 can cause neurological problems (issues affecting your nervous system), such as:

vision problems memory loss pins and needles (paraesthesia) loss of physical coordination (ataxia), which can affect your whole body and cause difficulty speaking or walking damage to parts of the nervous system (peripheral neuropathy), particularly in the legs

If neurological problems do develop, they may be irreversible.

Infertility

Vitamin B12 deficiency can sometimes lead to temporary infertility (an inability to conceive). This usually improves with appropriate vitamin B12 treatment.

Stomach cancer

If you have a vitamin B12 deficiency caused by pernicious anaemia (a condition where your immune system attacks healthy cells in your stomach), your risk of developing stomach cancer is increased.

Neural tube defects

If you’re pregnant, not having enough vitamin B12 can increase the risk of your baby developing a serious birth defect known as a neural tube defect. The neural tube is a narrow channel that eventually forms the brain and spinal cord. 

Examples of neural tube defects include:

spina bifida – where the baby’s spine doesn’t develop properly anencephaly – where a baby is born without parts of the brain and skull encephalocele – where a membrane or skin-covered sac containing part of the brain pushes out of a hole in the skull


A lack of folate (with or without anaemia) can also cause complications, some of which are outlined below.

Infertility

As with a lack of vitamin B12, a folate deficiency can also affect your fertility. However, this is only temporary and can usually be reversed with folate supplements.

Cardiovascular disease

Research has shown a lack of folate in your body may increase your risk of cardiovascular disease (CVD).

CVD is a general term that describes a disease of the heart or blood vessels, such as coronary heart disease (CHD).

Cancer

Research has shown that folate deficiency can increase your risk of some cancers, such as colon cancer.

Problems in childbirth

A lack of folate during pregnancy may increase the risk of the baby being born prematurely (before the 37th week of pregnancy) or having a low birthweight.

The risk of placental abruption may also be increased. This is a serious condition where the placenta starts to come away from the inside of the womb wall, causing tummy (abdominal) pain and bleeding from the vagina.

Neural tube defects

As with a vitamin B12 deficiency, a lack of folate can also affect an unborn baby’s growth and development in the womb (uterus). This increases the risk of neural tube defects such as spina bifida developing in the unborn baby.

Vomiting in adults
of stomach liver and gastrointestinal tract

Vomiting is the body’s way of getting rid of harmful substances from the stomach, or it may be a reaction to something that has irritated the gut. 

One of the most common causes of vomiting in adults is gastroenteritis. This is an infection of the gut usually caused by bacteria or a virus. It’ll normally improve within a few days. 

Vomiting can occasionally be a sign of something more serious, such as appendicitis.  

There is a separate page on vomiting in children and babies. 


One of the most common causes of vomiting in adults is gastroenteritis. This is an infection of the gut usually caused by bacteria or a virus. It’ll normally improve within a few days. 

Vomiting can occasionally be a sign of something more serious, such as appendicitis.  

There is a separate page on vomiting in children and babies. 


Vomiting can occasionally be a sign of something more serious, such as appendicitis.  

There is a separate page on vomiting in children and babies. 

Symptoms

Phone 999 or go to A&E if: You’re vomiting and you also have: sudden, severe abdominal (tummy) pain severe chest pain blood in your vomit or what looks like coffee granules have green or yellow-green vomit a stiff neck and high temperature (fever) a sudden, severe headache that’s unlike any headache you’ve had before  swallowed something poisonous, or think you may have  have a stiff neck and pain when looking at bright lights

Speak to your GP if: you’ve been vomiting repeatedly for more than a day or two you’re unable to keep down any fluids because you’re vomiting repeatedly  you have signs of severe dehydration, such as confusion, a rapid heartbeat, sunken eyes and passing little or no urine you’ve lost a lot of weight since you became ill you experience episodes of vomiting frequently  you’re worried about your vomiting and are feeling very unwell you have diabetes and have been vomiting a lot, particularly if you take insulin as it can affect your blood sugar level 


Motion sickness

Nausea and vomiting when travelling could be a sign of motion sickness.

You can try:

looking at the horizon distracting yourself by listening to music

Appendicitis

As well as vomiting, appendicitis can cause severe pain in your abdomen (tummy). You should phone 999 for an ambulance if you experience pain that suddenly becomes worse and spreads across your abdomen. These are signs that you appendix may have burst.

If you have appendicitis, you will often need surgery to remove your appendix.

Other causes of vomiting in adults

Vomiting in adults can also be caused by a number of other things, including:

certain medicines, such as antibiotics and opioid painkillers  drinking too much alcohol  kidney infections and kidney stones  a blockage in your bowel, which may be caused by a hernia or gallstones chemotherapy or radiotherapy acute cholecystitis (inflammation of the gallbladder) 

Causes

Gastroenteritis 

If you have diarrhoea as well as vomiting, it’s likely you have gastroenteritis. This is one of the most common causes of vomiting in adults. 

It’s often caused by: 

a virus, like norovirus food poisoning caused by bacteria in contaminated food 

Your immune system will usually fight off the infection after a few days. 

Pregnancy

Pregnant women often experience nausea and vomiting, particularly during the early stages of pregnancy. This is often called morning sickness but it can happen at any time of the day.

Migraines

If you have recurrent episodes of vomiting along with intense, throbbing headaches that last for a few hours to days at a time, you may be experiencing migraines. 

Pain relief, such as paracetamol and ibuprofen, can sometimes help control the pain. Your GP can prescribe anti-sickness medicine to help prevent vomiting. 

Labyrinthitis 

If you also feel dizzy, or feel like you’re spinning (vertigo), you may have an inner ear infection called labyrinthitis. 

Labyrinthitis will usually improve over a few days. Your GP can prescribe medication to reduce your symptoms if needed. 

Motion sickness

Nausea and vomiting when travelling could be a sign of motion sickness.

You can try:

looking at the horizon distracting yourself by listening to music

Appendicitis

As well as vomiting, appendicitis can cause severe pain in your abdomen (tummy). You should phone 999 for an ambulance if you experience pain that suddenly becomes worse and spreads across your abdomen. These are signs that you appendix may have burst.

If you have appendicitis, you will often need surgery to remove your appendix.

Other causes of vomiting in adults

Vomiting in adults can also be caused by a number of other things, including:

certain medicines, such as antibiotics and opioid painkillers  drinking too much alcohol  kidney infections and kidney stones  a blockage in your bowel, which may be caused by a hernia or gallstones chemotherapy or radiotherapy acute cholecystitis (inflammation of the gallbladder) 

Vulval cancer
of cancer, cancer types in adults

Cancer of the vulva is a rare type of cancer that affects women and anyone with a vulva.

The vulva is a woman’s external genitals. It includes the lips surrounding the vagina (labia minora and labia majora), the clitoris (sexual organ that helps reach sexual climax), and the Bartholin’s glands (2 small glands each side of the vagina).

Most of those affected by vulval cancer are older women and anyone with a vulva over the age of 65. The condition is rare in women and anyone with a vulva under 50 who have not yet gone through the menopause.

Symptoms

Symptoms of vulval cancer can include:

a persistent itch in the vulva pain, soreness or tenderness in the vulva raised and thickened patches of skin that can be red, white or dark a lump or wart-like growth on the vulva bleeding from the vulva or blood-stained vaginal discharge between periods an open sore in the vulva a burning pain when passing urine a mole on the vulva that changes shape or colour

Speak to your GP if you notice any changes in the usual appearance of your vulva. While it’s highly unlikely to be the result of cancer, these changes should be investigated.

Read more about diagnosing vulval cancer.

Causes

The exact cause of vulval cancer is unclear, but your risk of developing the condition is increased by the following factors:

increasing age vulval intraepithelial neoplasia (VIN) – where the cells in the vulva are abnormal and at risk of turning cancerous persistent infection with certain versions of the human papilloma virus (HPV) skin conditions affecting the vulva, such as lichen sclerosus smoking

You may be able to reduce your risk of vulval cancer by stopping smoking and taking steps to reduce the chances of picking up an HPV infection.

Read more about the causes of vulval cancer.


Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour.

The exact reason why this happens in cases of vulval cancer is unknown, but certain things can increase your chances of developing the condition.

These include:

increasing age vulval intraepithelial neoplasia (VIN) human papilloma virus (HPV) infection skin conditions that can affect the vulva, such as lichen sclerosus smoking

Diagnoses

Speak to your GP if you notice any changes in the normal appearance of your vulva.

Your GP will ask you about your symptoms, look at your medical history, and examine your vulva to look for any lumps or unusual areas of skin.

If you would prefer to be examined by a female doctor or you would like a nurse present during the examination, it may help to let your GP practice know in advance of your appointment.

Treatments

The main treatment for vulval cancer is surgery to remove the cancerous tissue from the vulva and any lymph nodes containing cancerous cells.

Some people may also have radiotherapy (where radiation is used to destroy cancer cells) or chemotherapy (where medication is used to kill cancer cells), or both.

Radiotherapy and chemotherapy may be used without surgery if you’re not well enough to have an operation, or if the cancer has spread and it isn’t possible to remove it all.

Read more about treating vulval cancer.


Treatment for vulval cancer depends on factors such as how far the cancer has spread, your general health, and personal wishes.

The main options are surgery, radiotherapy and chemotherapy. Many women and anyone with a vulva with vulval cancer have a combination of these treatments.

If your cancer is at an early stage, it’s often possible to get rid of it completely. However, this may not be possible if the cancer has spread.

Even after successful treatment, there is up to a 1 in 3 chance of the cancer returning at some point later on, so you’ll need regular follow-up appointments to check for this.


Most hospitals use multidisciplinary teams (MDTs) to treat vulval cancer. MDTs are teams of specialists that work together to make decisions about the best way to proceed with your treatment.

Members of your MDT will probably include a specialist surgeon, a specialist in the non-surgical treatment of cancer (clinical oncologist) and a specialist cancer nurse.

Deciding which treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.

Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions you would like to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.

Preventions

It’s not thought to be possible to prevent vulval cancer completely, but you may be able to reduce your risk by:

practising safer sex – using a condom during sex can offer some protection against HPV attending cervical screening appointments – cervical screening can detect HPV and pre-cancerous conditions such as VIN stopping smoking

The HPV vaccination may also reduce your chances of developing vulval cancer. This is offered to all girls who are 12 to 13 years old as part of their routine childhood immunisation programme.