Crohn’s disease
of stomach liver and gastrointestinal tract, inflammatory bowel disease ibd

Inflammation can affect any part of the digestive system, from the mouth to the back passage. But it mostly occurs in the last section of the small intestine (ileum) or the large intestine (colon).

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


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

Symptoms

The symptoms of Crohn’s disease vary. They depend on which part of the digestive system is inflamed.

Common symptoms include:

recurring diarrhoea abdominal pain and cramping, which is usually worse after eating extreme tiredness (fatigue) unintended weight loss blood and mucus in your poo

You may have long periods without symptoms, or very mild symptoms. 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.

Less common symptoms include:

a high temperature (fever) of 38°C (100°F) or above feeling sick (nausea) being sick (vomiting) joint pain and swelling (arthritis) inflammation and irritation of the eyes (uveitis) areas of painful, red and swollen skin – most often the legs mouth ulcers anal pain and discharge due to perianal Crohn’s

Children with Crohn’s disease may grow at a slower rate than expected.

Speak to your GP practice if you have: diarrhoea for more than 7 days persistent abdominal pain unexplained weight loss blood in your poo concern about your child’s development

Causes

The exact cause of Crohn’s disease is unknown.

A combination of factors may be responsible, including:

genetics – genes you inherit from your parents a problem with the immune system (the body’s defence against infection and illness) – where it attacks healthy bacteria in the gut and causes inflammation environmental factors – like air pollution, medication or previous infections smoking – smokers are twice as likely to develop Crohn’s disease, and usually have more severe symptoms than non-smokers

Diagnoses

Your GP will usually ask you about:

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 any bowel conditions

Your GP may also carry out a tests to check your general health. For example, they may:

check your pulse check your blood pressure measure your height and weight measure your temperature examine your abdomen (tummy)

Your GP may also:

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

Referral to a specialist

You may be referred to a gastroenterologist. A gastroenterologist is a specialist in conditions of the digestive system. They might recommend more tests, such as:

gastroscopy – a thin flexible tube with a camera is put into your mouth to look at your food pipe and stomach 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 a colon capsule endoscopy (pill camera) X-ray or barium enema MRI scan or CT scan

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

Treatments

There’s currently no cure for Crohn’s disease, but treatment can improve the symptoms and keep the inflammation under control.

Your treatment will usually be provided by a range of healthcare professionals.

Once your symptoms are under control, you are likely to be offered treatment to help keep them under control. If your Crohn’s stays under control for a long time, you may choose to stop treatment. You may need to start again if your symptoms come back.

Steroid medication

The first treatment offered is usually steroids, such as prednisolone or budesonide (corticosteroids) to reduce inflammation quickly. Steroids are often effective in reducing your symptoms. But they can have significant side effects. So they’re not suitable for long-term use and your dose will slowly be reduced when your symptoms start to improve.

Medicines to suppress your immune system

Medicines to suppress your immune system (immunosuppressants) may be given alongside steroids if your symptoms flare up twice or more during 12 months, or return when your steroid dose is reduced.

Common types include azathioprine, mercaptopurine and methotrexate.

Biological therapies

If steroids and immunosuppressants don’t help or aren’t right for you, biological therapies may be used.

Biological therapies block particular chemicals involved in the immune response, which helps reduce inflammation. They’re made using living cells in a lab. They can be given as a drip or an injection. Treatment usually lasts at least 12 months. Your inflammatory bowel disease (IBD) team will be able to discuss these with you.

Common types are adalimumab, infliximab, ustekinumab or vedolizumab.

There’s a risk that these medicines may cause side effects, which can cause symptoms such as:

itchy skin a high temperature joint and muscle pain swelling of the hands or lips problems swallowing

You should seek immediate medical help if you experience these symptoms. Reactions can occur immediately after treatment or months later, even after treatment stops.

Surgery

Surgery to treat Crohn’s disease 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 Crohn’s disease

Surgery might involve widening narrow parts of your bowel, or removing parts of it (resection).

Resection involves removing the inflamed area of the intestine.

If you have a resection, you might have the healthy sections of bowel joined back together. Or you might have the end of your small bowel joined to the skin of your tummy (an ileostomy or stoma). In this case, poo comes out of the opening on your tummy and is collected in special bags that you wear. An ileostomy might be temporary, to give your bowel time to heal, or it might be permanent.

Your IBD team will tell you what surgery they recommend and let you know what to expect.

Diet and smoking

There is no evidence that a particular diet causes or triggers flare-ups of Crohn’s disease. But alongside medications, some changes to your diet may help control symptoms for some people.

Do 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

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. You can 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  taking a food supplement if you are struggling to get enough nutrients from your diet being referred to a dietitian

If you smoke, it is advised that you make every effort to stop smoking, especially if you need to have surgery.

If you smoke, smoking can make Crohn’s worse and is it important that you make every effort to stop smoking.

Complications

Over time, inflammation can damage sections of the digestive system. This can result in complications such as:

narrowing of the bowel (stricture) a channel developing between your bowel and your skin, another section of bowel or a body organ (fistula)

These problems usually need surgical treatment.

Croup
of lungs and airways

Croup is a childhood condition that affects the windpipe (trachea), the airways to the lungs (the bronchi) and the voice box (larynx).

Children with croup have a distinctive barking cough and will make a harsh sound, known as stridor, when they breathe in.

They may also have a hoarse voice and find it difficult to breathe because their airway is blocked.

Take your child to A&E or phone 999 if your child: has severe breathing difficulties has an increased breathing rate (they’re too breathless to feed or talk) or ‘silent chest’ (you’re unable to hear sounds of breathing) has a worsening cough or rasping sound shows distress and agitation has dark, blue-tinged or pale skin the skin around their ribs and chest appears to be pulled in and tight, making the bones of their chest and ribs more visible has abnormal drowsiness and sleepiness has an inability to drink fluids

Contact your GP or, if your GP’s closed, phone 111 if: is less than 3 months old and has a temperature of 38 °C or above is aged 3 months or older and has a temperature of 39 °C or above your child has a distinctive barking cough your child makes a harsh sound when they breathe in Croup can usually be diagnosed by a GP and treated at home.

Read more about the symptoms of croup and diagnosing croup

Symptoms

A child can get croup at any time of the year, although it’s more likely to occur during late autumn or early winter.

This may be because there are more viruses, such as colds and flu, around at this time of year.

Typical symptoms of croup include: 

a bark-like cough a hoarse or croaky voice difficulty breathing a harsh grating sound when breathing in, called stridor

Stridor is often most noticeable when the child cries or coughs. But in more severe cases of croup it can also occur when the child is resting or sleeping.

Symptoms tend to be worse at night.

Some children have cold-like symptoms for a few days before developing croup symptoms.

These cold-like symptoms can include:

sore throat runny nose cough  high temperature (fever)

Although croup symptoms usually only last for a few days, they can occasionally last up to two weeks. 

Causes

Commonly, croup is caused by a virus. Several viruses can cause croup but in most cases it is the parainfluenza virus.

Read more about the causes of croup


Croup usually develops as the result of a viral infection. The infection causes the larynx (voice box) to become swollen and the trachea (windpipe) to become blocked, and may affect the tubes in the lungs (bronchi). It is sometimes called laryngo-tracheo-bronchitis


Less common causes of croup include:

inhaling a small object such as a peanut or a pen cap (inhaled foreign body) epiglottitis – inflammation of the epiglottis, (the flap at the base of the tongue that keeps food from going into the windpipe) an allergic reaction to substances such as pollen or dust mites inhalation of irritants, such as chemicals acid leaking back out of the stomach and into the throat (acid reflux)

Diagnoses

A GP can diagnose croup by studying your child’s symptoms, particularly the sound of their cough. They may also check your child’s temperature for a fever and ask whether they have recently had a cold or viral infection.

In some cases, a pulse oximetry test may be carried out. This involves clipping a sensor onto your child’s earlobe or finger to find out their oxygen levels.

The test does not hurt and should not distress your child, and determines whether your child is absorbing enough oxygen into their blood.

Your GP will decide whether your child needs to be admitted to hospital or whether their croup is safe to treat at home.

You should not try to check your child’s throat yourself, because it could trigger a spasm (sudden narrowing) of the airway. This could cause the airway to swell even more, making breathing even more difficult.

Treatments

Most cases of croup are mild and can be treated at home. Sitting your child upright and comforting them if they are distressed is important, because crying may make symptoms worse. Your child should also drink plenty of fluids to prevent dehydration.

A single dose of an oral corticosteroid medication called dexamethasone or prednisolone will usually also be prescribed to help reduce the swelling in the throat.

If your child has breathing problems they may need hospital treatment, such as adrenaline and oxygen through a mask.

Read more about treating croup


Croup can usually be diagnosed by a GP and mild cases can be treated at home.

Take your child to A&E or phone 999 if your child: has severe breathing difficulties has an increased breathing rate (they’re too breathless to feed or talk) or ‘silent chest’ (you’re unable to hear sounds of breathing) has a worsening cough or rasping sound shows distress and agitation has dark, blue-tinged or pale skin the skin around their ribs and chest appears to be pulled in and tight, making the bones of their chest and ribs more visible has abnormal drowsiness and sleepiness has an inability to drink fluids

You should take them to your nearest hospital’s accident and emergency department or dial 999 for an ambulance.

Some of these symptoms may indicate a potentially life-threatening underlying condition called epiglottitis (inflammation and swelling of the epiglottis).

The symptoms could also indicate tracheitis (inflammation of the windpipe), which also requires immediate medical attention.


Treatment of croup depends on how severe the symptoms are. Most cases are mild and can be managed at home.

However, if your child has severe croup, they will need to be admitted to hospital urgently.


If your GP thinks your child has mild croup, they will usually recommend managing it at home.

This will often involve using children’s paracetamol to ease any pain associated with the condition and may help lower your child’s temperature if they have a fever.

You should also ensure your child is well hydrated by encouraging them to drink plenty of fluids.

Comforting your child is also important because their symptoms may get worse if they are agitated or crying. If your child is distressed, sitting them upright on your lap will help to comfort and reassure them.

Your GP will usually prescribe a single dose of an oral corticosteroid medication called dexamethasone or prednisolone to help reduce swelling (inflammation) in your child’s throat. Side effects of these medications can include restlessness, vomiting, upset stomach and headache.

Steam treatment is not advised for the treatment of croup. There is no evidence that allowing your child to breathe in humid air, for example steam from a hot bath or shower in a closed room, will help.

You should seek urgent medical advice if you notice your child’s symptoms getting worse.


In severe cases of croup, treatment in hospital may be required.

Breathing problems, such as shortness of breath, are a major symptom of severe croup.

You should dial 999 immediately for an ambulance if your child is struggling to breathe.

If your child has severe croup, they may be given adrenaline through a nebuliser. This will help improve symptoms within 10 to 30 minutes and the effects should last for up to two hours. A nebuliser allows your child to breathe the medication as a mist.

If your child is very distressed and finding it difficult to breathe, they will be given oxygen through an oxygen mask.

As with milder cases of croup, oral dexamethasone or prednisolone will usually be given to help reduce any swelling in your child’s airways.

In rare cases croup may require hospitalisation, where a child may need intubation. During intubation, a tube is inserted either through a nostril or the mouth and passed down into the windpipe. This will help your child breathe more easily.

Intubation is usually performed under general anaesthetic. This means your child will be completely unconscious throughout the procedure so they do not experience pain or distress. 

Preventions

Croup is spread in a similar way to the common cold, so it is difficult to prevent.

Good hygiene is the main defence against croup, such as regularly washing hands and cleaning surfaces.

A number of your child’s routine vaccinations also protect against some of the infections that can cause croup. These include:

MMR – protection from measles, mumps and rubella DTaP/IPV/Hib – protection from diphtheria, tetanus, whooping cough, polio and Haemophilus influenzae type b

Complications

Most cases of croup clear up within 48 hours. However, in some cases symptoms can last for up to two weeks.

It is extremely rare for a child to die from croup.

There are a number of conditions that can follow croup, such as pneumonia and middle ear infection.

Read more about the complications of croup.


Complications that develop as a result of croup are rare.


Although rare, other possible complications of croup can include middle ear infection and lymphadenitis, an infection of the glands of the immune system (lymph nodes).

Cystic fibrosis
of lungs and airways

Cystic fibrosis is an inherited condition in which the lungs and digestive system can become clogged with thick, sticky mucus.

It can cause problems with breathing and digestion from a young age. Over many years, the lungs become increasingly damaged and may eventually stop working properly.

Most cases of cystic fibrosis in the UK are now identified through screening tests carried out soon after birth. It’s estimated that 1 in every 2,500 babies born in the UK has cystic fibrosis.

A number of treatments are available to help reduce the problems caused by the condition, but unfortunately average life expectancy is reduced for people who have it.

Symptoms

Symptoms of cystic fibrosis tend to start in early childhood, although they can sometimes develop very soon after birth, or may not be obvious until adulthood.

Some of the main symptoms of cystic fibrosis can include:

recurring chest infections difficulty putting on weight frequent, wet-sounding coughs diarrhoea occasional wheezing and shortness of breath

People with the condition can also develop a number of related conditions, including diabetes, thin, weakened bones (osteoporosis) and liver problems.

Read more about the symptoms of cystic fibrosis


Cystic fibrosis can cause a range of problems. The lungs and digestive system are the main areas that are affected.

Symptoms tend to start in early childhood, but sometimes they can develop soon after birth and very occasionally they may not be obvious until adulthood.

Nowadays, cystic fibrosis is usually diagnosed before symptoms appear, through screening tests carried out soon after birth. Read more about screening for cystic fibrosis.

The main problems associated with cystic fibrosis are outlined below.

Causes

Cystic fibrosis is caused by a faulty gene that a child inherits from both of their parents.

The faulty gene means that some cells struggle to move salt and water across the cell wall. This, along with recurrent infections, can result in a build-up of thick, sticky mucus in the body’s tubes and passageways.

To be born with cystic fibrosis, a child has to inherit two copies of this faulty gene – one from each of their parents. Their parents will not usually have the condition themselves, because they will only carry one faulty gene and one that works normally.

If both parents carry the faulty gene, there’s a 25% chance that each child they have will be born with cystic fibrosis.

Read more about the causes of cystic fibrosis


Cystic fibrosis is caused by a faulty gene that a child inherits from both their parents.

The faulty gene means that some cells struggle to move salt and water across the cell wall. This, along with recurrent infections, can result in a build-up of thick, sticky mucus in the body’s tubes and passageways – particularly the lungs and digestive system.

The condition is present from birth and cannot be caught from someone else who has it.

Diagnoses

Most cases of cystic fibrosis are now detected soon after birth through the newborn blood spot test.

This involves collecting a drop of blood from the baby’s heel and testing it for abnormalities that could indicate cystic fibrosis.

More tests will be needed to confirm the diagnosis, such as:

a sweat test – to measure the amount of salt in sweat, as the sweat of someone with cystic fibrosis has higher levels of salt than normal a genetic test – where a sample of blood or saliva is checked for the faulty gene that causes cystic fibrosis

These tests can also be carried out in older children and adults with symptoms of cystic fibrosis who haven’t been screened previously.

If you have a family history of cystic fibrosis, you can be tested to determine if you’re at risk of having a child with the condition by checking if you’re a “carrier” of the faulty gene that causes it.

Read more about how cystic fibrosis is diagnosed


Tests can be carried out to diagnose cystic fibrosis at any age.

Most cases are now detected soon after birth through newborn screening, but older children and adults with symptoms of cystic fibrosis who weren’t screened can also have tests to check for the condition.

Tests to find out if you are a ‘carrier’ of the faulty gene responsible for cystic fibrosis may also be recommended for some people.


Tests to confirm a diagnosis will be carried out if screening suggests that your child may have cystic fibrosis, or your doctor thinks you could have the condition and you haven’t been screened previously.

Two main tests can be used to diagnose cystic fibrosis:

sweat test – a test to measure the amount of salt in sweat, as the sweat of someone with cystic fibrosis has higher levels of salt than normal genetic test – where a sample of blood or saliva is checked for the faulty gene that causes cystic fibrosis

The sweat test is most commonly used, although genetic testing may be done if the sweat test result is inconclusive or to identify the specific genetic fault that’s causing the condition.


Testing to find out if you carry the faulty gene that causes cystic fibrosis may be useful if:

you have a close relative, such as a child, sibling or parent, who’s a known carrier you have a close relative with cystic fibrosis your partner is known to carry the cystic fibrosis gene

This can be done using a blood test, or occasionally a special mouthwash, to collect a sample of cells. The sample is then sent to a laboratory so it can be checked for the faulty gene.

Finding out whether you’re a carrier of the faulty gene can help determine if you’re at risk of having a child with cystic fibrosis. A genetic counsellor will explain the results of the test to you and discuss the implications and options available for future pregnancies.

Treatments

There’s currently no cure for cystic fibrosis, but a number of treatments are available to help control the symptoms, prevent complications, and make the condition easier to live with.

Possible treatments include:

antibiotics to prevent and treat chest infections medicines to make the mucus in the lungs thinner and easier to cough up medicines to widen the airways and reduce inflammation special techniques and devices to help clear mucus from the lungs medicines that help the person absorb food better following a special diet and taking supplements to prevent malnutrition

A lung transplant may eventually be needed if the lungs become greatly damaged.

Read more about treating cystic fibrosis


There’s currently no cure for cystic fibrosis, but it’s possible to help control the symptoms, prevent or reduce complications, and make the condition easier to live with.

A person with cystic fibrosis will be supported by a team of healthcare professionals at a specialist cystic fibrosis centre. A care plan will be drawn up that’s tailored to their individual needs.

A range of treatments may be used and sometimes treatment in hospital will be needed. Regular appointments to monitor the condition will also be recommended.

Some of the main treatments for cystic fibrosis include:


People with cystic fibrosis can have a number of other problems that may benefit from treatment.

For example:

exercise can help keep bones and joints healthy, and is recommended for everyone with cystic fibrosis – any sport or exercise is usually good, but if you’re not sure about a particular activity, you should ask your physiotherapist for advice medicines called bisphosphonates can help treat weak and brittle bones that may occur as a result of cystic fibrosis if the person doesn’t get enough vitaminD and calcium (from their diet and/or from supplements) insulin medication and a special diet may help someone with diabetes caused by cystic fibrosis control their blood sugar levels

Cystitis
of kidneys bladder and prostate

Cystitis is inflammation of the bladder, usually caused by a bladder infection.

It’s a common type of urinary tract infection (UTI), particularly in women, and is usually more of a nuisance than a cause for serious concern. Mild cases will often get better by themselves within a few days.

However, some people experience episodes of cystitis frequently and may need regular or long-term treatment.

There’s also a chance that cystitis could lead to a more serious kidney infection in some cases, so it’s important to seek professional advice if your symptoms don’t improve.

Symptoms

The main symptoms of cystitis include:

pain, burning or stinging when you pee needing to pee more often and urgently than normal urine that’s dark, cloudy or strong smelling pain low down in your tummy feeling generally unwell, achy, sick and tired

Possible symptoms in young children include a high temperature (fever) of 38C (100.4F) or above, weakness, irritability, reduced appetite and vomiting.

Read more about the symptoms of cystitis


Cystitis can cause problems with peeing and make you feel unwell.


Cystitis in adults can cause:

pain, burning or stinging when you pee needing to pee more often and urgently than normal feeling like you need to pee again soon after going to the toilet urine that’s dark, cloudy or strong-smelling pain low down in your tummy feeling generally unwell, achy, sick and tired blood in your urine

In adults, cystitis doesn’t usually cause a high temperature (fever). If you have a temperature of 38C (100.4F) or above and pain in your lower back or sides, it may be a sign of a kidney infection.


It can be difficult to tell whether a child has cystitis, because the symptoms can be vague and young children cannot easily communicate how they feel.

Possible symptoms of cystitis in young children may include:

a high temperature (fever) of 38C (100.4F) or above weakness and tiredness irritability  reduced appetite vomiting

Children with cystitis can sometimes also have symptoms usually found in adults, such as pain when peeing, peeing more often than normal and pain in their tummy.

Causes

Most cases are thought to occur when bacteria that live harmlessly in the bowel or on the skin get into the bladder through the urethra (tube that carries urine out of your body).

It’s not always clear how this happens, but it can be caused by:

having sex wiping your bottom after going to the toilet – particularly if you wipe from back to front inserting a tampon or urinary catheter (a thin tube inserted into the urethra to drain the bladder) using a diaphragm for contraception

Women may get cystitis more often than men because their anus (back passage) is closer to their urethra, and their urethra is much shorter, which means bacteria may be able to get into the bladder more easily.

Read more about the causes of cystitis


Cystitis is usually caused by a bacterial infection, although it sometimes happens when the bladder is irritated or damaged for another reason.


Cystitis can also be caused by damage or irritation to the urethra and bladder.

This can be the result of:

friction from sex chemical irritants, such as those in perfumed soap or bubble bath damage caused by a catheter or surgery on your bladder radiotherapy to your pelvis or treatment with certain chemotherapy medicines a woman’s genitals having been deliberately cut or changed for cultural, religious and social reasons (an illegal practice called female genital mutilation or FGM)

Cystitis has also been linked to recreational use of the drug ketamine.

Treatments

Speak to your pharmacist if you think you may have cystitis or symptoms of a urine infection. Women who have had cystitis before don’t necessarily need to see their GP if the condition returns, as mild cases often get better without treatment. You can try the self-help measures, or ask your pharmacist for advice.

Pharmacy First Scotland: Urinary infection treatment from your pharmacyWomen over 16 with symptoms of a mild urinary infection can get advice and treatment directly from their pharmacist through the Pharmacy First Scotland service. Your pharmacist may be able to provide you with treatment to clear the infection, although there may be situations where they will recommend you see your GP. Find your local pharmacy on Scotland’s Service directory.Search for a pharmacy near you

You should see your GP if:

your symptoms don’t start to improve within a few days you get cystitis frequently you have severe symptoms, such as blood in your urine you’re pregnant and have symptoms of cystitis you’re a man and have symptoms of cystitis your child has symptoms of cystitis

Your GP should be able to diagnose the problem by asking about your symptoms. They may test a sample of your urine for bacteria to help confirm the diagnosis.


If you see your pharmacist with symptoms of cystitis you can be treated under the Pharmacy First Scotland service. If you are female over 16 with signs of a mild urine infection, the pharmacist may offer you a course of antibiotics to treat the infection where appropriate. These should start to have an effect within a day or two.

If you’ve had cystitis before and don’t feel you need to see your pharmacist or GP, you may want to treat your symptoms at home.

Until you’re feeling better, it may help to:

take paracetamol or ibuprofen drink plenty of water hold a hot water bottle on your tummy or between your thighs avoid having sex

Some people find it helpful to try over-the-counter products that reduce the acidity of their urine (such as sodium bicarbonate or potassium citrate), but there’s a lack of evidence to suggest they’re effective.

If you keep getting cystitis, your GP may give you an antibiotic prescription to take to a pharmacy whenever you develop symptoms, without needing to see your doctor first. Your GP can also prescribe a low dose of antibiotics for you to take continuously over several months if necessary.

Read more about treating cystitis


You should see your GP if you or your child have symptoms of cystitis for the first time.

Cystitis isn’t usually a cause for serious concern, but the symptoms can be similar to several other conditions, so it’s important to get a proper diagnosis.

If you’re a woman who has had cystitis before, you don’t necessarily need to see your GP again. Cystitis is very common in women and mild cases often get better on their own. Speak to a pharmacist if you need any advice about treating cystitis.

However, you should see your GP if your symptoms are severe or don’t start to get better in a few days, you get cystitis frequently, or you’re pregnant.

Children and men should always be seen by a GP if they have symptoms of cystitis, as the condition is less common and could be more serious in these groups.


Mild cystitis will usually clear up on its own within a few days, although sometimes you may need to take antibiotics.

See your GP for advice and treatment if:

you have symptoms of cystitis for the first time your symptoms don’t start to improve within a few days you get cystitis frequently you have severe symptoms, such as blood in your urine you’re pregnant and have symptoms of cystitis you’re a man and have symptoms of cystitis your child has symptoms of cystitis

Women who have had cystitis before don’t necessarily need to see their GP if the condition returns, as mild cases often get better without antibiotics. You can try the self-help measures or ask your pharmacist for advice.

Preventions

If you get cystitis frequently, there are some things you can try that may stop it coming back. However, it’s not clear how effective most of these measures are.

These measures include:

not using perfumed bubble bath, soap or talcum powder around your genitals – use plain, unperfumed varieties having a shower, rather than a bath – this avoids exposing your genitals to the chemicals in your cleaning products for too long going to the toilet as soon as you need to pee and always emptying your bladder fully staying well hydrated – drinking plenty of fluids may help to stop bacteria multiplying in your bladder  always wiping your bottom from front to back when you go to the toilet emptying your bladder as soon as possible after having sex contraception instead wearing underwear made from cotton, rather than synthetic material such as nylon, and not wearing tight jeans and trousers

Drinking cranberry juice has traditionally been recommended as a way of reducing your chances of getting cystitis. However, large studies have suggested it doesn’t make a significant difference.

Deafblindness
of eyes

Deafblindness is a combination of sight and hearing loss that affects a person’s ability to communicate, access information and get around.

It’s also sometimes called ‘dual sensory loss’ or ‘multi-sensory impairment’.

A deafblind person won’t usually be totally deaf and totally blind, but both senses will be reduced enough to cause significant difficulties in everyday life.

These problems can occur even if hearing loss and vision loss are mild, as the 2 senses work together and 1 would usually help compensate for loss of the other.

Symptoms

A person who’s deafblind won’t usually be totally deaf and totally blind, but both senses will be reduced enough to cause difficulties with everyday activities.

The hearing and/or vision problems may be present from birth, but in many cases one or both problems develop gradually as a person gets older and they may not notice it themselves at first.

If someone you know has a combination of the signs mentioned below, it’s possible they have some degree of deafblindness and should seek medical advice.

Causes

There are many potential causes of deafblindness. Some babies are born deafblind, but in many cases the hearing and/or vision loss occurs later in life.

Causes of deafblindness include:

age-related hearing loss genetic conditions, such as Usher syndrome an infection picked up during pregnancy, such as rubella (German measles) cerebral palsy – a problem with the brain and nervous system that mainly affects movement and co-ordination eye problems associated with increasing age, such as cataracts

Read more about the causes of deafblindness

Living with deafblindness

A range of care and support services is available to help deafblind people.

Each deafblind person will have a different level of hearing and sight loss, which means they’ll have their own individual care needs.

The general aims of care for a deafblind person are to:

preserve and maximise any remaining sight or hearing the person has – this could involve treating underlying conditions like cataracts, wearing glasses or using a hearing aid teach alternative methods of communication – such as hand on hand signing or braille help retain or develop as much independence as possible – for example, by training the person to use a long cane, a guide dog or offering a communicator guide

Your local authority should arrange an assessment to determine exactly what care and support is needed.

Read more about managing deafblindness


There are many possible causes of deafblindness. The condition can either be present at birth or develop later in life.

Diagnoses

Deafblindness may be detected soon after a baby is born, or after tests carried out later in life.

Speak to your GP if you have any concerns about your or your child’s hearing and/or vision at any point.

If you’re worried about a family member or friend, try to encourage them to speak to their GP.


In most cases, deafblindness develops as a person gets older. It can happen gradually, so you may not notice that your vision and/or hearing are getting worse at first.

It’s therefore important to have routine eye tests to check for any problems. Adults should normally have their eyes tested every two years.

You can request a hearing test at your GP surgery at any point if you think you may be losing your hearing.

A person may be diagnosed with deafblindness if tests show they have both hearing and vision problems.

Their hearing and vision should continue to be regularly assessed even after they’ve been diagnosed, as the level of care and support they need will depend on how severely each sense is affected.

Find your local optometry practice

Treatments

Some conditions that affect hearing and vision can be treated using medication or surgery. For example:

cataracts can often be treated by surgically implanting an artificial lens in the eye glaucoma can often be treated using eye drops or laser surgery – read more about treating glaucoma diabetic retinopathy can be treated in the early stages using laser surgery

Some causes of temporary hearing loss are also treatable, such as a build-up of earwax or middle ear infections.

Deep vein thrombosis
of blood and lymph

Deep vein thrombosis (DVT) is a blood clot that develops within a deep vein in the body, usually in the leg.

Blood clots that develop in a vein are also known as venous thrombosis.

DVT usually occurs in a deep leg vein, a larger vein that runs through the muscles of the calf and the thigh. It can also occur in the pelvis or abdomen.

It can cause pain and swelling in the leg and may lead to complications such as pulmonary embolism. 

DVT and pulmonary embolism together are known as venous thromboembolism (VTE).

Symptoms

In some cases, there may be no symptoms of DVT. If symptoms do occur they can include:

pain, swelling and tenderness in one of your legs (usually your calf or thigh) a heavy ache in the affected area warm skin in the area of the clot red skin, particularly at the back of your leg below the knee

DVT usually (although not always) affects one leg. The pain may be worse when you bend your foot upward towards your knee.

If you think you have deep vein thrombosis ask for an urgent GP appointment or call 111

Phone 999 or go to A&E if you have symptoms of DVT like: pain and swelling of the leg, along with either breathlessness or chest pain

Causes

Each year, DVT affects around 1 person in every 1,000 in the UK.

Anyone can develop DVT, but it becomes more common over the age of 40. As well as age, there are also some other risk factors, including:

having a history of DVT or pulmonary embolism having a family history of blood clots being inactive for long periods – such as after an operation or during a long journey blood vessel damage – a damaged blood vessel wall can result in the formation of a blood clot having certain conditions or treatments that cause your blood to clot more easily than normal – such as cancer (including chemotherapy and radiotherapy treatment), heart and lung disease, thrombophilia and Hughes syndrome being pregnant – your blood also clots more easily during pregnancy being overweight or obese

The combined contraceptive pill and hormone replacement therapy (HRT) both contain the female hormone oestrogen, which causes the blood to clot more easily. If you’re taking either of these, your risk of developing DVT is slightly increased.

Read more about the causes of DVT


Deep vein thrombosis (DVT) sometimes occurs for no apparent reason.

However, the risk of developing DVT is increased in certain circumstances.


Your risk of getting DVT is also increased if you or a close relative have previously had DVT and:

you’re overweight or obese you smoke you’re dehydrated you’re over 60 – particularly if you have a condition that restricts your mobility

Diagnoses

See your GP as soon as possible if you think you may have DVT – for example, if you have pain, swelling and a heavy ache in your leg. They’ll ask you about your symptoms and medical history.

D-dimer test

It can be difficult to diagnose DVT from symptoms alone. Your GP may advise that you have a specialised blood test called a D-dimer test.

This test detects pieces of blood clot that have been broken down and are loose in your bloodstream. The larger the number of fragments found, the more likely it is that you have a blood clot in your vein.

However, the D-dimer test isn’t always reliable because blood clot fragments can increase after an operation, injury or during pregnancy. Additional tests, such as an ultrasound scan, will need to be carried out to confirm DVT.

Ultrasound scan

An ultrasound scan can be used to detect clots in your veins. A special type of ultrasound called a Doppler ultrasound can also be used to find out how fast the blood is flowing through a blood vessel. This helps doctors identify when blood flow is slowed or blocked, which could be caused by a blood clot.

Venogram

A venogram may be used if the results of a D-dimer test and ultrasound scan can’t confirm a diagnosis of DVT.

During a venogram, a liquid called a contrast dye is injected into a vein in your foot. The dye travels up the leg and can be detected by X-ray, which will highlight a gap in the blood vessel where a clot is stopping the flow of blood.

Treatments

Treatment for DVT usually involves taking anticoagulant medicines. These reduce the blood’s ability to clot and stop existing clots getting bigger.

Heparin and warfarin are 2 types of anticoagulant often used to treat DVT. Heparin is usually prescribed first because it works immediately to prevent further clotting. After initial treatment, you may also need to take warfarin to prevent another blood clot forming.

A number of anticoagulants, known as directly acting oral anticoagulants (DOACs), may also be used to treat conditions such as DVT. These medications include rivaroxaban and apixaban, and they’ve been shown to be as effective as heparin and warfarin with less serious side effects.

You’ll also be prescribed compression stockings to wear every day, which will improve your symptoms and help prevent complications.

Read more about treating DVT


If you have deep vein thrombosis (DVT), you’ll need to take a medicine called an anticoagulant.


You may need to continue to take anticoagulant medicine and wear compression stockings when you leave hospital.

Before you leave, your healthcare team should advise you about how to use your treatment, how long to continue using it for, and who to contact if you experience any problems.

Preventions

If you need to go into hospital for surgery, a member of your care team will assess your risk of developing a blood clot while you’re there.

If you’re at risk of developing DVT, there are a number of things you can do to prevent a blood clot occurring, both before you go into hospital. These include temporarily stopping taking the combined contraceptive pill, and while you’re in hospital, such as wearing compression stockings.

When you leave hospital, your care team may also make some recommendations to help prevent DVT returning or complications developing. These may include:

not smoking eating a healthy, balanced diet taking regular exercise  maintaining a healthy weight or losing weight if you’re obese

There’s no evidence to suggest that taking aspirin reduces your risk of developing DVT.

See your GP before embarking on long-distance travel if you’re at risk of getting a DVT, or if you’ve had a DVT in the past.

When taking a long-distance journey (6 hours or more) by plane, train or car, you should take steps to avoid getting DVT. Drink plenty of water, perform simple leg exercises and take regular, short walking breaks.

Read more about preventing DVT


If you’re admitted to hospital or planning to go into hospital for surgery, your risk of developing a blood clot while you’re there will be assessed.

Surgery and some medical treatments can increase your risk of developing DVT – see causes of DVT for more information.

If you’re thought to be at risk of developing DVT, your healthcare team can take a number of measures to prevent a blood clot forming.

Complications

The 2 main complications of deep vein thrombosis (DVT) are pulmonary embolism and post-thrombotic syndrome.

Dehydration
of nutritional

Dehydration occurs when your body loses more fluid than you take in.

When the normal water content of your body is reduced, it upsets the balance of minerals (salts and sugar) in your body, which affects the way it functions.

Water makes up over two-thirds of the healthy human body. It lubricates the joints and eyes, aids digestion, flushes out waste and toxins, and keeps the skin healthy.

Some of the early warning signs of dehydration include:

feeling thirsty and lightheaded a dry mouth tiredness having dark coloured, strong-smelling urine passing urine less often than usual

A baby may be dehydrated if they:

have a sunken soft spot (fontanelle) on their head have few or no tears when they cry have fewer wet nappies are drowsy

The body is affected even when you lose a small amount of fluid.

Read more about the symptoms of dehydration

Symptoms

Dehydration can be mild, moderate or severe, depending on how much of your body weight is lost through fluids.

Two early signs of dehydration are thirst and dark-coloured urine. This is the body’s way of trying to increase water intake and decrease water loss.

Other symptoms may include:

dizziness or light-headedness headache  tiredness dry mouth, lips and eyes passing small amounts of urine infrequently (less than three or four times a day)

Dehydration can also lead to a loss of strength and stamina. It’s a main cause of heat exhaustion.

You should be able to reverse dehydration at this stage by drinking more fluids.

If dehydration is ongoing (chronic), it can affect your kidney function and increase the risk of kidney stones. It can also lead to muscle damage and constipation.

Causes

Dehydration is usually caused by not drinking enough fluid to replace what we lose. The climate, the amount of physical exercise you are doing (particularly in hot weather) and your diet can contribute to dehydration.

You can also become dehydrated as a result of an illness, such as persistent vomiting and diarrhoea, or sweating from a fever.

Read more about the causes of dehydration


Dehydration is caused by not drinking enough fluid or by losing more fluid than you take in. Fluid is lost through sweat, tears, vomiting, urine or diarrhoea.

The severity of dehydration can depend on a number of factors, such as climate, level of physical activity and diet.

There are several causes of dehydration, which are described below.

Treatments

See your GP if your symptoms continue, despite drinking plenty of fluids, or if you think your baby or toddler is dehydrated.

If your GP suspects dehydration, you may have a blood test or a urine test to check the balance of salts (sodium and potassium) in your body.

Contact your GP, out-of-hours service or NHS 24 111 service straight away if you have any of the following symptoms:

extreme thirst feeling unusually tired (lethargic) or confused not passing urine for eight hours rapid heartbeat dizziness when you stand up that doesn’t go away after a few seconds

You should also contact your GP if your baby has had six or more episodes of diarrhoea in the past 24 hours, or if they have vomited three times or more in the past 24 hours. 


See your GP if your symptoms continue despite drinking fluids, or if you suspect that your baby or toddler is dehydrated.

You should also contact your GP if your baby has had six or more episodes of diarrhoea in the past 24 hours, or if they have vomited three times or more in the past 24 hours.

If dehydration is suspected, you may be given a blood test or a urine test to check the balance of salts (sodium and potassium) in your body.


The best way to treat dehydration is to rehydrate the body by drinking plenty of fluids, such as water, diluted squash or diluted fruit juice.

A sweet drink can help to replace lost sugar, and a salty snack can help to replace lost salt.

Preventions

You should drink plenty of fluids to avoid becoming dehydrated.

Most of the time, you can prevent dehydration by drinking water regularly throughout the day. Be guided by your thirst, but be aware that in hot weather, when exercising and during illness, you should drink more.

Mild dehydration can be relieved by drinking more water and diluted fruit squash. If necessary, you can purchase oral rehydration solutions (ORS) from a pharmacy. As a guide, passing pale or clear-coloured urine (wee) is a good sign that you’re well hydrated.

Dementia
of

Dementia with Lewy bodies
of brain nerves and spinal cord

Dementia with Lewy bodies, also known as Lewy body dementia, is a common form of dementia estimated to affect more than 100,000 people in the UK.

The term “dementia” describes a loss of mental ability (cognitive impairment) associated with gradual death of brain cells. It’s rare in anyone younger than 65.

Symptoms usually develop gradually and become more severe over the course of several years.

Symptoms

People with dementia with Lewy bodies not only experience problems with memory and judgement, like those with Alzheimer’s disease, but are also likely to have difficulties with concentration and visual perception (recognising objects and making judgements about where they are in space).

They may experience:

slowed movement, stiff limbs, and tremors recurrent visual hallucinations (seeing things that aren’t there) sleep disturbances, including sleepiness during the day fainting, unsteadiness, and falls

People with the condition tend to swing from a state of alertness to drowsiness or staring into space. These extreme changes may be unpredictable and happen from hour to hour or day to day.

Read more about the symptoms of dementia with Lewy bodies


The symptoms of dementia with Lewy bodies usually develop gradually and become more severe over the course of a few years.

Like other forms of dementia, the condition causes problems with:

thinking speed language understanding judgement memory (although significant memory loss may not occur until later on)

People with dementia with Lewy bodies may also have other symptoms that can help distinguish it from other types of dementia, such as:

extreme swings between alertness and confusion or drowsiness, which may happen unexpectedly and change from hour to hour or day to day slow movement, stiff limbs, and tremors (as seen in Parkinson’s disease), which cause shuffling when walking seeing or hearing things that aren’t real (hallucinations), which can range from pleasant to distressing fainting, unsteadiness, and falls  sleep disturbances, which can cause talking in your sleep or acting out dreams loss of facial expression difficulty swallowing (dysphagia) depression 

These symptoms can make daily activities very difficult and can lead to further health problems, such as injuries from falls, and chest infections caused by accidentally inhaling food instead of swallowing it. 

Causes

Dementia with Lewy bodies is caused by deposits of an abnormal protein called Lewy bodies inside brain cells. These deposits, which are also found in people with Parkinson’s disease, build up in areas of the brain responsible for things such as memory and muscle movement.

It’s not clear why the deposits develop and how exactly they damage the brain, but it’s thought they disrupt the brain’s normal functions by interfering with chemical signals transmitted from one brain cell to another.

Dementia with Lewy bodies usually occurs in people with no family history of the condition, although there have been reports of rare cases that seem to run in families.

Diagnoses

If you think you may have early symptoms of dementia, it’s a good idea to see your GP. If you’re worried about someone else, encourage them to make an appointment, and perhaps suggest that you go along with them.

Your GP can do some simple checks to see if there is chance you could have dementia, and they can refer you to a memory clinic or another specialist clinic if necessary.

At one of these clinics, you will be asked about your symptoms and have a physical check-up and memory test. You may also have blood tests and brain scans.

The results of these checks and tests will give your doctor a good idea as to whether your symptoms are caused by dementia with Lewy bodies, another type of dementia, or something else entirely.

Read more about how dementia with Lewy bodies is diagnosed


Confirming a diagnosis of dementia can be difficult, particularly when the condition is in its early stages. This is because many of the symptoms of dementia can also be caused by other conditions.

For dementia with Lewy bodies to be diagnosed correctly, you will have a number of tests and assessments, including:

an assessment of your symptoms – for example, whether you have typical symptoms of dementia with Lewy bodies a full assessment of your mental abilities a physical examination a review of the medication you are taking a range of tests, including blood tests, to rule out other possible causes of your symptoms, such as a vitamin B12 deficiency brain scans, such as a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan, which can check for signs of a stroke, brain tumour or brain shrinkage – a single photon emission CT (SPECT) scan, which looks at the dopamine system in the brain, can also sometimes help

Some of these tests can be carried out by your GP. Some will be carried out by other specialists, such as a neurologist (an expert in treating conditions that affect the brain and nervous system), an elderly care physician, or a psychiatrist with experience of treating dementia.

Treatments

There’s currently no cure for dementia with Lewy bodies, but treatments can help manage the symptoms.

First of all, your future health and social care needs will need to be assessed and a care plan drawn up.

This is a way of ensuring you receive the right treatment for your needs. It involves identifying areas where you may need some assistance, such as:

what support you or your carer need for you to remain as independent as possible whether there are any changes that need to be made to your home to make it easier to live in whether you need any financial assistance

Read more about care plans


In addition to medication, there are a number of therapies and practical measures that can help make everyday living easier for someone with dementia. These include:

occupational therapy to identify problem areas in everyday life, such as getting dressed, and help work out practical solutions speech and language therapy to help improve any communication or swallowing problems physiotherapy to help with movement difficulties psychological treatments, such as cognitive stimulation, to help improve memory, problem-solving skills and language ability relaxation techniques, such as massage, and music or dance therapy home modifications, such as removing loose carpets and potential trip hazards, ensuring the home is well lit, and adding grab bars and handrails checking for problems with vision and hearing that could be contributing to hallucinations

Read more about living well with dementia

Dental abscess
of mouth

An abscess at the end of a tooth is called a periapical abscess. An abscess in the gum is called a periodontal abscess.

Dental abscesses are often painful, but aren’t always. In either case, they should be looked at by a dentist.

It’s important to get help as soon as possible, because abscesses don’t go away on their own. They can sometimes spread to other parts of the body and make you ill.


Dental abscesses are often painful, but aren’t always. In either case, they should be looked at by a dentist.

It’s important to get help as soon as possible, because abscesses don’t go away on their own. They can sometimes spread to other parts of the body and make you ill.


It’s important to get help as soon as possible, because abscesses don’t go away on their own. They can sometimes spread to other parts of the body and make you ill.

Symptoms

Symptoms of an abscess in your tooth or gum may include:

an intense, throbbing pain in the affected tooth or gum that may come on suddenly and gets gradually worse pain that spreads to your ear, jaw and neck on the same side as the affected tooth or gum pain that’s worse when lying down, which may disturb your sleep redness and swelling in your face a tender, discoloured and/or loose tooth shiny, red and swollen gums sensitivity to hot or cold food and drink bad breath and/or an unpleasant taste in your mouth

If the infection spreads, you may also develop a high temperature (fever) and feel generally unwell. In severe cases, you may find it hard to fully open your mouth and have difficulty swallowing or breathing.


While you’re waiting to see a dentist, painkillers can help control your pain.

Ibuprofen is the preferred painkiller for dental abscesses, but if you’re unable to take it for medical reasons, you can take paracetamol instead. Aspirin shouldn’t be given to children under 16.

If one painkiller doesn’t relieve the pain, taking both paracetamol and ibuprofen at the doses shown in the medicine leaflet may help. This is safe for adults, but not for children under 16.

It may also help to:

avoid hot or cold food and drink if it makes the pain worse try eating cool, soft foods if possible, using the opposite side of your mouth use a soft toothbrush and temporarily avoid flossing around the affected tooth

These measures can help relieve your symptoms temporarily, but you shouldn’t use them to delay getting help from a dentist.

Causes

Your mouth is full of bacteria, which form a sticky film on your teeth called plaque.

If you don’t keep your teeth clean, acids produced by the bacteria in plaque can damage your teeth and gums, leading to tooth decay or gum disease.

The following can increase your chances of developing a dental abscess:

poor oral hygiene – plaque can build-up on your teeth if you don’t floss and brush your teeth regularly consuming lots of sugary or starchy food and drink – these can encourage the growth of bacteria in plaque and may lead to decay that can result in an abscess an injury or previous surgery to your teeth or gums – bacteria can get into any damaged parts of the teeth or gums having a weakened immune system – this includes people with certain underlying health conditions, such as diabetes, and those having treatment, including steroid medication or chemotherapy 

Treatments

Dental abscesses are treated by removing the source of the infection and draining away the pus.

Depending on the location of the abscess and how severe the infection is, possible treatments include:

removing the affected tooth (extraction) – this may be necessary if root canal treatment isn’t possible root canal treatment – a procedure to remove the abscess from the root of an affected tooth before filling and sealing it incision and drainage – where a small cut (incision) is made in the gum to drain the abscess (this is usually only a temporary solution and further treatment may be needed)

Local anaesthetic will usually be used to numb your mouth for these procedures. More extensive operations may be carried out under general anaesthetic (where you’re asleep).

Antibiotics aren’t routinely prescribed for dental abscesses, but may be used if the infection spreads or is particularly severe.

Preventions

You can reduce your risk of developing dental abscesses by keeping your teeth and gums as healthy as possible.

To do this, you should:

use floss or an interdental brush at least once a day to clean between your teeth and under the gum line brush your teeth with a fluoride toothpaste twice a day – spending at least two minutes each time avoid rinsing your mouth with water or mouthwash after brushing because this washes the protective toothpaste away – just spit out any excess toothpaste cut down on sugary and starchy food and drinks – particularly between meals or shortly before going to bed visit your dentist regularly – your dentist can suggest how often you should have a check-up, based on your oral health 

Read more on how to keep your teeth clean and dental check-ups.