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bone marrow to work normally again. Chemotherapy is the main treatment for AML. Usually a combination of chemotherapy drugs is given, according to a treatment plan (often called a protocol or regimen). The treatment usually has different phases. Induction This phase involves intensive treatment, aimed at destroying as many leukaemia cells as possible. It usually involves 2 courses (cycles) of a combination of chemotherapy drugs. A bone marrow test is taken at the end of induction treatment to confirm whether or not the child still has leukaemia. When there is no evidence of leukaemia, the child’s condition is referred to as being in remission. Post-remission treatment When there are no signs of the leukaemia in the blood or bone marrow, further treatment is often given. This phase of the treatment aims to destroy any leukaemia cells that may be left and to help stop the AML from coming back. This treatment usually involves 2 more courses of chemotherapy. Bone marrow transplant This


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may be left and to help stop the AML from coming back. This treatment usually involves 2 more courses of chemotherapy. Bone marrow transplant This treatment is usually only used for children with AML that is likely to come back or has come back (recurred) following standard chemotherapy. Central nervous system (CNS) treatment AML may sometimes develop in the brain and spinal cord. This can be prevented by injecting chemotherapy drugs directly into the spinal fluid during a lumbar puncture (intrathecal chemotherapy). Intrathecal chemotherapy is usually given after each of the first 2 courses of chemotherapy. Sometimes a more intensive treatment is needed, and the intrathecal drugs are given more frequently until all the regular chemotherapy has been completed. Occasionally, radiotherapy to the brain is also necessary. Side effects of treatment Many cancer treatments will cause side effects. This is because while the treatments are killing the cancer cells, they can also damage some


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Many cancer treatments will cause side effects. This is because while the treatments are killing the cancer cells, they can also damage some normal cells. Some of the main side effects are: hair loss reduction in the number of blood cells produced by the bone marrow, which can cause anaemia (increased risk of bruising, bleeding and infection) loss of appetite and weight feeling sick (nausea) and being sick (vomiting) Most side effects are temporary, and there are ways of reducing them and supporting your child through them. Your child’s doctor or nurse will talk to you about side effects. Late side effects of treatment A small number of children may develop late side effects, sometimes many years later. These include possible problems with puberty and fertility, a change in the way the heart works, and a small increase in the risk of developing a second cancer in later life. Your child’s doctor or nurse will talk to you about any possible late side effects. Clinical trials Many


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of developing a second cancer in later life. Your child’s doctor or nurse will talk to you about any possible late side effects. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for AML. If appropriate, your child’s medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is often provided to help explain things. Taking part in a research trial is completely voluntary, and you’ll be given plenty of time to decide if it’s right for your child. Treatment guidelines Sometimes, clinical trials are not available for your child’s cancer. This may be because a recent trial has just finished, or because the cancer is very rare. In these cases, you can expect your doctors and nurses to offer


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may be because a recent trial has just finished, or because the cancer is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Children’s Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Many children with AML are cured. If the leukaemia comes back after initial treatment, it usually does so within the first 3 years. Most children with AML grow and develop normally. If you have specific concerns about your child’s condition and treatment, it’s best to discuss them with your child’s doctor, who knows the situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of


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can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Your child may have a variety of powerful emotions throughout their experience of cancer. Further information and advice if your child has cancer Source: Children's Cancer and Leukemia Group - Opens in new browser window Last updated: 09 October 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Other health sites Scottish Cancer Network: Cancer patient information Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS


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cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-teenagers-and-young-adults/acute-myeloid-leukaemia-teenagers-and-young-adults/


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Acute Myeloid Leukaemia in young adults | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Cancer Cancer types in teenagers and young adults Acute myeloid leukaemia: Teenagers and young adults Acute myeloid leukaemia: Teenagers and young adults Introduction Leukaemia, blood tests and bone marrow Tests for AML Treating AML Introduction This section is for teenagers and young adults and is about a type of cancer called acute myeloid leukaemia (AML). The other main type of leukaemia that can affect teenagers and young adults is acute lymphoblastic leukaemia. For information about AML in people of all ages, read our general AML section. Leukaemia is a cancer of the white blood cells. In leukaemia, the process for making new white blood cells gets out of control. Immature white blood cells (called blasts) keep being made and build up in the bone marrow


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for making new white blood cells gets out of control. Immature white blood cells (called blasts) keep being made and build up in the bone marrow until there isn’t enough room for the bone marrow to make healthy white blood cells, red blood cells and platelets. The body needs these cells to: help fight infection (white cells) carry oxygen from the lungs around the body (red blood cells) stop cuts bleeding by clotting blood (platelets) Symptoms Many of the symptoms of AML are caused by having fewer than normal healthy blood cells in the body. Symptoms can include: looking paler than usual and feeling tired – because of too few red blood cells (anaemia) bruises or bleeding – you may bruise more easily and it could take longer for bleeding to stop, if you have less blood clotting cells (platelets) than normal infections – because there are too few mature white blood cells to fight infection aches and pains in your bones swollen glands (lymph nodes) in your neck, under your arm or in your


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few mature white blood cells to fight infection aches and pains in your bones swollen glands (lymph nodes) in your neck, under your arm or in your groin feeling unwell and run down fever and sweats – you may have a high temperature without any obvious cause, such as an infection headaches and blurred vision – because of too many white blood cells breathlessness – because of too many white blood cells. Causes It’s not known exactly what causes AML. Research is going on to try to find out. We do know some things might increase the risk of AML: some genetic conditions, like Down’s Syndrome (a genetic condition is something you are born with) some non-cancerous conditions of the bone marrow, such as aplastic anaemia or myelodysplastic syndromes If you’re worried about AML If you think you might have any of the symptoms of AML, you should go to your GP. They’ll talk to you about your symptoms, examine you and can arrange tests or refer you to see a specialist. Remember that the symptoms


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to your GP. They’ll talk to you about your symptoms, examine you and can arrange tests or refer you to see a specialist. Remember that the symptoms can be caused by other things, but it’s important to go and get checked if you are worried. Leukaemia, blood tests and bone marrow To understand leukaemia, it can help to know a little about the blood and bone marrow. Leukaemia is a cancer of the white blood cells. All blood cells are made in the bone marrow, which is like a blood cell factory inside bones. A type of cell in the bone marrow, called a stem cell, can make any kind of blood cell your body needs. There are 3 main types of blood cells: white blood cells – which help fight infection red blood cells – which carry oxygen from the lungs around the body platelets – which clot blood to stop cuts bleeding The bone marrow normally makes millions of blood cells every day. To begin with, these new blood cells, called blasts, are not fully developed (they’re immature). The main job of


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millions of blood cells every day. To begin with, these new blood cells, called blasts, are not fully developed (they’re immature). The main job of blast cells is to make more blood cells like themselves. They can’t do any of the jobs that mature blood cells can do, like carrying oxygen or fighting infection. Blast cells normally stay inside the bone marrow until they’ve matured into fully-developed blood cells. Once blood cells are mature, they’re ready to do their jobs. They leave the bone marrow and go into the bloodstream, where they can be carried to wherever they’re needed. How leukaemia develops In leukaemia, the process for making new white blood cells gets out of control and immature white blood cells (blasts) keep being made. They build up in the bone marrow until there isn’t enough room for the bone marrow to make healthy white cells, red cells and platelets. Types of leukaemia Leukaemia is a cancer of the white blood cells. Healthy white blood cells are made from 2 types


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cells, red cells and platelets. Types of leukaemia Leukaemia is a cancer of the white blood cells. Healthy white blood cells are made from 2 types of blood cells: lymphoblasts that make lymphocytes myeloid cells (myeloblasts) that make other types of white blood cells such as neutrophils Leukaemias are named after the type of white blood cell that has become abnormal and started growing out of control. The most common types in teenagers and young adults are AML and ALL: acute myeloid leukaemia (AML) is leukaemia that starts from abnormal myeloid cells acute lymphoblastic leukaemia (ALL) is leukaemia that starts from abnormal lymphoblasts There are other types of leukaemia that are more common in older people. The information in this section is about ALL, but if you have a different type of leukaemia and want to know more, contact Macmillan Cancer Support. We also have more information about: symptoms and causes of AML having tests for AML being treated for AML If you’re looking for


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Cancer Support. We also have more information about: symptoms and causes of AML having tests for AML being treated for AML If you’re looking for information about ALL in people of all ages, read general AML section. Tests for AML You should speak to your GP as soon as possible if you think you have some of the symptoms of AML. But remember that the symptoms of AML can be caused by other things. Visiting your GP Your GP will examine you and arrange for you to have blood tests. There can be different reasons for your symptoms, so you’ll need to have a blood test to help diagnose acute myeloid leukaemia (AML). If you have AML, a blood test will usually find leukaemia cells and you’ll be referred to a specialist at the hospital. This specialist is called a haematologist and is a doctor who treats people with blood disorders. At the hospital The haematologist will examine you and ask you about your symptoms and any recent illnesses. They will also arrange for you to have some more tests.


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The haematologist will examine you and ask you about your symptoms and any recent illnesses. They will also arrange for you to have some more tests. These may include: blood tests – you’ll need more blood tests even if you’ve had some already to look at the changes in the leukaemia cells and help the doctors decide on the best treatment for you; these tests may be called cytogenetics and immunophenotyping bone marrow test – to count the numbers of leukaemia cells in the bone marrow and get send samples for cytogenetic and immunophenotyping testing lumbar puncture – a small sample of the fluid that surrounds your brain and spinal cord is taken to check for leukaemia cells chest X-ray – this may also be done to see if there are any swollen lymph nodes (glands) in your chest If you have AML, you might need a few more tests to check how your body is working in general. These could be blood tests, an ultrasound scan of the tummy (abdomen) to look at your liver, spleen and kidneys, or an


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body is working in general. These could be blood tests, an ultrasound scan of the tummy (abdomen) to look at your liver, spleen and kidneys, or an echocardiogram (which is an ultrasound of the heart). This may seem like a lot of tests, but they give the doctors important information that will help them give you the right treatment. Waiting for test results can be a scary time, but understanding a little about them – what will happen, how you’ll feel and when you’ll get the results – can help you cope. Thinking about how you feel and getting support from family, friends or your specialist nurse and doctor can also make it a bit easier. You could also talk to a cancer support specialist on the Macmillan Support Line. We also have more information about: symptoms and causes of AML being treated for AML leukaemia, blood cells and bone marrow If you’re looking for information about AML in people of all ages, read our general AML section. Treating AML The main treatment for acute myeloid


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If you’re looking for information about AML in people of all ages, read our general AML section. Treating AML The main treatment for acute myeloid leukaemia (AML) is chemotherapy. This means having anti-cancer drugs to destroy the leukaemia cells. You’ll also have drugs called steroids, which help the chemotherapy to work. The treatment for AML is pretty intensive at times and can cause unpleasant side effects. But you’ll be in hospital when you’re most likely to feel unwell, and the staff can help if things get tough. Don’t feel you have to be brave. Be honest about how you’re feeling with your doctors and nurses. They can give you medicines to help you feel better. There are different phases of treatment for AML: getting rid of the leukaemia – remission induction keeping the leukaemia away – consolidation and delayed intensification therapy central nervous system (CNS) therapy (mainly for teenagers under 16) Very often, treatment is given as part of a clinical trial or research


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therapy central nervous system (CNS) therapy (mainly for teenagers under 16) Very often, treatment is given as part of a clinical trial or research study, but it will be your decision whether to take part in the trial or not. Clinical trials help doctors to keep improving treatment for leukaemia. You usually start chemotherapy pretty quickly after finding out that you have AML. You’ll be in hospital for your treatment to begin with. If you’re 18 or younger, you’ll be treated in a specialist Principal Treatment Centre (PTC) for teenage and young adults (TYA). If you’re 19 or older, you’ll be offered the choice of having treatment at the PTC or another hospital closer to home called a TYA designated hospital. Most chemotherapy for AML is given into the bloodstream (intravenously). So you’ll have a ‘line’ put into one of your main veins to make it easier for you to have intravenous chemotherapy. There are different kinds of lines. You’ll also be given chemotherapy into the fluid around


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make it easier for you to have intravenous chemotherapy. There are different kinds of lines. You’ll also be given chemotherapy into the fluid around your spinal cord and brain. This is to get rid of any leukaemia cells that might be hiding there. This type of treatment is called central nervous system (CNS) therapy. Having chemotherapy can be hard, but the staff looking after you will give you medicines to help you cope with any side effects so you can stay strong enough to have treatment. And you’ll be given medicines to help you feel less sick and antibiotics to help prevent infections. There will probably be times when you feel rough and other times when you’ll feel better. You might also feel upset, down or irritable. Talking to someone you trust can help you cope with these feelings. Being in hospital for long periods can be frustrating, especially when you miss out on stuff happening at school, college, university or work or on things your friends are doing. You could try


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especially when you miss out on stuff happening at school, college, university or work or on things your friends are doing. You could try talking to your friends and family about this and see what they can do to help you. Getting rid of the leukaemia (remission induction) The first phase of your treatment is about getting rid of the leukaemia. You’ll be given chemotherapy to kill as many leukaemia cells as possible. Remission means there is no sign of leukaemia cells in your blood or bone marrow. You have chemotherapy over a few days, then you have a few weeks off so that your body can recover from any side effects. The days you have the chemotherapy and the rest period afterwards is called a cycle. You’ll usually have 4 cycles of chemotherapy overall with 2 courses in the induction phase. Some people might also need to have a bone marrow transplant. This normally happens after 2 cycles of chemotherapy. You’ll probably need to stay in hospital most of the time that you’re having


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marrow transplant. This normally happens after 2 cycles of chemotherapy. You’ll probably need to stay in hospital most of the time that you’re having remission induction. This is so that the doctors can check how things are going. Chemotherapy drugs Drugs you may have include: cytarabine (Ara-C) daunorubicin, doxorubicin or idarubicin etoposide thioguanine Side effects Different chemotherapy can cause different side effects. As well as the chemotherapy drugs, you’ll be given other drugs to: help prevent you from feeling sick or being sick help prevent infections protect your kidneys as sometimes when lots of leukaemia cells are destroyed at once it can cause kidney problems You’ll probably also need blood and platelet transfusions to top up the numbers of red cells and platelets in your blood. Chemotherapy can cause side effects. Most of them are short-term (temporary) and gradually disappear once treatment stops. The most common side effects are: being more at risk of infections


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of them are short-term (temporary) and gradually disappear once treatment stops. The most common side effects are: being more at risk of infections feeling sick hair loss a sore mouth Sometimes side effects can be long-term. For example, some chemotherapy treatments can affect fertility (your ability to have a baby). If you are a young man, you will be offered the chance to store sperm before chemotherapy is started. There may be other late effects of treatment and your specialist can talk to you about this. Remission induction is pretty intense treatment and you’ll probably feel a bit wiped out sometimes. You’ll need to stay in hospital for most of the time and you might not have the energy to do much. You might feel fed up, tearful or irritable. It’s normal to feel like this. It’s hard to be in hospital and you might worry about losing touch with your friends or falling behind at school or college. It can help to talk about this with a friend, doctor, nurse or counsellor. Keeping


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touch with your friends or falling behind at school or college. It can help to talk about this with a friend, doctor, nurse or counsellor. Keeping the leukaemia away (post-remission treatment) This phase of treatment is sometimes also called consolidation or intensification treatment. It’s given to prevent the leukaemia from returning (known as a relapse). When you’re in remission, it means the doctors can’t see any leukaemia cells in your blood or bone marrow samples under the microscope. But there may still be leukaemia cells hiding in your body, so further treatment is needed to get rid of these cells. You start post-remission treatment soon after you complete remission induction. You’ll usually have 2 courses of treatment. You might be given the same chemotherapy drugs you’ve had before (perhaps at similar or higher doses) or you might be given different chemotherapy drugs. When your doctors decide what chemotherapy treatment plan to give you, they will take into account: how well


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be given different chemotherapy drugs. When your doctors decide what chemotherapy treatment plan to give you, they will take into account: how well your leukaemia responded to the first lot of treatment (remission induction) the results of the tests that were done when you were diagnosed The following drugs may be used to treat you: cytarabine (ara-C) methotrexate Central nervous system therapy (CNS) You usually won’t need this treatment if you’re 16 or over. But if you’re under 16, you’ll probably have it. CNS therapy is given to get rid of any leukaemia cells that might be in the brain or spinal cord. (The CNS or central nervous system is the name for the brain and spinal cord.) CNS therapy involves giving chemotherapy into the fluid, called cerebrospinal fluid or CSF, around the spinal cord and brain. It’s a bit like having a lumbar puncture but with chemotherapy added. A doctor puts a needle into the space between two small bones (vertebrae) near the bottom of your spine. Then


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puncture but with chemotherapy added. A doctor puts a needle into the space between two small bones (vertebrae) near the bottom of your spine. Then they inject chemotherapy into the CSF. The CSF will carry the chemotherapy around your CNS so it can reach any leukaemia cells that might be there. You’ll have a lumbar puncture before you start treatment to check for leukaemia cells in the CSF. If there is no sign of leukaemia cells, you’ll have 2 lots of CNS therapy, 1 after each cycle of remission induction therapy. If there are leukaemia cells in the CSF, you’ll have CNS therapy twice a week until all traces of leukaemia cells in your CSF have gone. You’ll then have 2 more lots of CNS therapy just to make sure. For CNS therapy for AML, you’ll have chemotherapy drugs called methotrexate and cytarabine and a steroid called hydrocortisone. Side effects The most common side effect is feeling sick but you can be given anti-sickness treatment to help this. Rarer side effects include a


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Side effects The most common side effect is feeling sick but you can be given anti-sickness treatment to help this. Rarer side effects include a headache, dizziness, tiredness or blurry vision for a few hours afterwards. We also have more information about: symptoms and causes of AML having tests for AML leukaemia, blood cells and bone marrow If you’re looking for information about AML in people of all ages, read our general AML section. Source: Macmillan - Opens in new browser window Last updated: 09 October 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Other health sites Scottish Cancer Network: Patient information Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy


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Network: Patient information Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/acute-pancreatitis/


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Acute pancreatitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Acute pancreatitis Acute pancreatitis About acute pancreatitis Symptoms of acute pancreatitis Causes of acute pancreatitis Diagnosing acute pancreatitis Treating acute pancreatitis Complications of acute pancreatitis Preventing acute pancreatitis About acute pancreatitis Acute pancreatitis is a serious condition where the pancreas becomes inflamed over a short period of time. The pancreas is a small organ located behind the stomach and below the ribcage. Most people with acute pancreatitis improve within a week and experience no further problems, but severe cases can have serious complications and can even be fatal. Acute pancreatitis is different to chronic pancreatitis, where the inflammation of the pancreas persists for many years. The


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and can even be fatal. Acute pancreatitis is different to chronic pancreatitis, where the inflammation of the pancreas persists for many years. The most common symptoms of acute pancreatitis include: suddenly getting severe pain in the centre of your abdomen (tummy) feeling or being sick diarrhoea Read more about the symptoms of acute pancreatitis and diagnosing acute pancreatitis. When to seek medical help Contact your GP immediately if you suddenly develop severe abdominal pain. If this isn’t possible, contact NHS 24’s 111 service or your local out-of-hours service for advice. Why it happens It’s thought that acute pancreatitis occurs when a problem develops with some of the enzymes (chemicals) in the pancreas, which causes them to try to digest the organ. Acute pancreatitis is most often linked to: gallstones – which accounts for around half of all cases alcohol consumption – which accounts for about a quarter of all cases By reducing your alcohol intake and altering your diet to


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half of all cases alcohol consumption – which accounts for about a quarter of all cases By reducing your alcohol intake and altering your diet to make gallstones less likely, you can help to reduce your chances of developing acute pancreatitis. Read more about the causes of acute pancreatitis and preventing acute pancreatitis. Who is affected? Acute pancreatitis is more common in middle-aged and elderly people, but it can affect people of any age. Men are more likely to develop alcohol-related pancreatitis, while women are more likely to develop it as a result of gallstones. How it’s treated Treatment for acute pancreatitis focuses on supporting the functions of the body until the inflammation has passed. This usually involves admission to hospital so you can be given fluids into a vein (intravenous fluids), as well as pain relief, nutritional support and oxygen through tubes into your nose. Most people with acute pancreatitis improve within a week and are well enough to leave


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nutritional support and oxygen through tubes into your nose. Most people with acute pancreatitis improve within a week and are well enough to leave hospital after 5 to 10 days. However, recovery takes longer in severe cases, as complications that require additional treatment may develop. Read more about treating acute pancreatitis. Complications About 4 out of 5 cases of acute pancreatitis improve quickly and don’t cause any serious further problems. However, 1 in 5 cases are severe and can result in life-threatening complications, such as multiple organ failure. In severe cases where complications develop, there’s a high risk of the condition being fatal. If a person survives the effects of severe acute pancreatitis, it’s likely to be several weeks or months before they’re well enough to leave hospital. Read more about the possible complications of acute pancreatitis. Symptoms of acute pancreatitis The main symptom of acute pancreatitis is a severe, dull pain around the top of your


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of acute pancreatitis. Symptoms of acute pancreatitis The main symptom of acute pancreatitis is a severe, dull pain around the top of your stomach that develops suddenly. This aching pain often gets steadily worse and can travel along your back or below your left shoulder blade. Eating or drinking may also make you feel worse very quickly, especially fatty foods. Leaning forward or curling into a ball may help to relieve the pain, but lying flat on your back often increases the pain. Acute pancreatitis caused by gallstones usually develops after eating a large meal. If the condition is caused by alcohol, the pain often develops 6 to 12 hours after drinking a significant amount of alcohol. Other symptoms Other symptoms of acute pancreatitis can include: nausea (feeling sick) or vomiting diarrhoea indigestion a high temperature (fever) of 38C (100.4F) or above jaundice – yellowing of the skin and the whites of the eyes tenderness or swelling of the abdomen (tummy) When to seek medical


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38C (100.4F) or above jaundice – yellowing of the skin and the whites of the eyes tenderness or swelling of the abdomen (tummy) When to seek medical advice Contact your GP immediately if you suddenly develop severe abdominal pain. If this isn’t possible, contact NHS 24 111 Service or your local out-of-hours service for advice. Causes of acute pancreatitis Most cases of acute pancreatitis are closely linked to gallstones or to alcohol consumption, although the exact cause isn’t always clear. Gallstones Gallstones are hard pieces of stone-like material that form in your gallbladder. They can trigger acute pancreatitis if they move out of the gallbladder and block the opening of the pancreas. The blockage can disrupt some of the enzymes (chemicals) produced by the pancreas. These enzymes are normally used to help digest food in your intestines, but they can start to digest the pancreas instead if the opening is blocked. However, not everyone with gallstones will develop acute


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intestines, but they can start to digest the pancreas instead if the opening is blocked. However, not everyone with gallstones will develop acute pancreatitis. Most gallstones don’t cause any problems. Alcohol consumption It’s not fully understood how alcohol causes the pancreas to become inflamed. One theory is that it interferes with the normal workings of the pancreas, causing the enzymes to start digesting it. Whatever the cause, there is a clear link between alcohol use and acute pancreatitis. A very large study found that people who regularly drank more than 35 units of alcohol a week were 4 times more likely to develop acute pancreatitis than people who never drank alcohol (35 units is the equivalent of drinking around 16 cans of strong lager or 4 bottles of wine a week). Binge drinking, which is drinking a lot of alcohol in a short period of time, is also thought to increase your risk of developing acute pancreatitis. Other causes Less common causes of acute pancreatitis


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a short period of time, is also thought to increase your risk of developing acute pancreatitis. Other causes Less common causes of acute pancreatitis include: accidental damage or injury to the pancreas – for example, during a procedure to remove gallstones or examine the pancreas certain types of medication, such as some antibiotics or chemotherapy medication – acute pancreatitis can be an unexpected side effect of these in a small number of people a viral infection – such as mumps or measles a complication of cystic fibrosis certain rare conditions – including hyperparathyroidism, Reye’s syndrome and Kawasaki disease Severe pancreatitis Little is known about why some people develop severe acute pancreatitis. Factors thought to increase your risk include: being 70 years of age or over being obese (a person is considered obese if they have a body mass index (BMI) of 30 or above) having 2 or more alcoholic drinks a day smoking Researchers have also discovered that people with a


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they have a body mass index (BMI) of 30 or above) having 2 or more alcoholic drinks a day smoking Researchers have also discovered that people with a specific genetic mutation, known as the MCP-1 mutation, are 8 times more likely to develop severe acute pancreatitis than the general population. A genetic mutation is where the instructions (DNA) found in all living cells become scrambled, resulting in a genetic disorder or a change in characteristics. Diagnosing acute pancreatitis Most cases of acute pancreatitis are diagnosed in hospital because of the risk of serious complications. The doctor in charge of your care will ask you about the history of your symptoms. They may also carry out a physical examination. If you have acute pancreatitis, certain areas of your abdomen will be very tender to touch. A blood test will be carried out to help confirm a diagnosis. This can detect signs of acute pancreatitis, such as a high level of 2 chemicals called lipase and amylase. At first, it can


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confirm a diagnosis. This can detect signs of acute pancreatitis, such as a high level of 2 chemicals called lipase and amylase. At first, it can be difficult to tell whether your acute pancreatitis is mild or severe. You’ll be monitored closely for signs of serious problems, such as organ failure. People with mild acute pancreatitis tend to improve within a week and experience either no further problems or problems that resolve within 48 hours. People with severe acute pancreatitis develop persistent serious problems. Further testing Several tests may be used to help determine the severity of your condition and assess your risk of developing more serious complications. You may have any of the following tests: a computerised tomography (CT) scan – where a series of X-rays are taken to build up a more detailed, 3D image of your pancreas a magnetic resonance imaging (MRI) scan – where strong magnetic fields and radio waves are used to produce a detailed image of the inside of your body


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magnetic resonance imaging (MRI) scan – where strong magnetic fields and radio waves are used to produce a detailed image of the inside of your body an ultrasound scan – where high-frequency sound waves are used to create an image of part of the inside of the body endoscopic retrograde cholangiopancreatography (ERCP) An ERCP uses a narrow, flexible tube known as an endoscope, which has a camera on one end. The endoscope will be passed through your mouth and towards your stomach. A special dye that shows up on X-rays is then injected through the endoscope into your bile and pancreatic ducts. After the dye has been injected, X-rays will be taken. This test can be useful in cases of gallbladder-associated acute pancreatitis, because it can pinpoint exactly where the gallstone is located. In some cases, it may be possible to pass surgical instruments down the endoscope, so the gallstone can be removed. Treating acute pancreatitis Acute pancreatitis is treated in hospital, where you’ll be


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down the endoscope, so the gallstone can be removed. Treating acute pancreatitis Acute pancreatitis is treated in hospital, where you’ll be closely monitored for signs of serious problems and given supportive treatment, such as fluids and oxygen. Many people are well enough to leave hospital after 5 to 10 days. In severe cases, complications can develop that require specific additional treatment and you’ll need to be admitted to a high dependency unit or intensive care unit (ICU). In these cases, recovery may take much longer, and the condition can be fatal. Read about the potential complications of acute pancreatitis for more information on severe cases. Fluids Your body can become dehydrated during an episode of acute pancreatitis, so fluids are provided through a tube connected to one of your veins (this is known as intravenous, or IV, fluid). In severe cases of acute pancreatitis, IV fluids can help to prevent a serious problem called hypovolemic shock, which occurs when a drop in


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fluid). In severe cases of acute pancreatitis, IV fluids can help to prevent a serious problem called hypovolemic shock, which occurs when a drop in your fluid levels lowers the amount of blood in your body. Nutritional support Although the diet of many people with mild acute pancreatitis isn’t restricted, some people are advised not to eat. This is because trying to digest solid food could place too much strain on your pancreas. Depending on the severity of the condition, you may not be able to eat solid foods for a few days or longer. If you need to avoid solid food, a feeding tube may be used to provide your body with nutrients. This is known as enteral feeding and often involves using a tube inserted into your stomach through your nose (nasogastric tube). Oxygen To ensure your vital organs have enough oxygen, it will usually be supplied through tubes into your nose. The tubes can be removed after a few days, once your condition is improving. In severe cases, ventilation equipment


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through tubes into your nose. The tubes can be removed after a few days, once your condition is improving. In severe cases, ventilation equipment may also be used to assist with your breathing. Painkillers Acute pancreatitis often causes severe abdominal (tummy) pain, so strong painkilling medication will probably be required, such as morphine. Some of the painkillers used can make you feel very drowsy. If you’re visiting someone who is in hospital with acute pancreatitis, don’t be alarmed or concerned if they appear drowsy or unresponsive. Treating the underlying cause Once the condition is under control, the underlying cause may need to be treated. Gallstones If a gallstone is responsible for the pancreatitis, you may need a procedure called endoscopic retrograde cholangiopancreatography (ERCP), or your gallbladder may need to be removed. Gallbladder removal surgery may be done while you’re in hospital, or it may be planned for several weeks’ time. Having your gallbladder removed


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Gallbladder removal surgery may be done while you’re in hospital, or it may be planned for several weeks’ time. Having your gallbladder removed should have no significant effect on your health, other than making it more difficult to digest certain foods, such as fatty or spicy foods. An ERCP procedure is an alternative treatment for gallstones. It involves using a narrow, flexible tube known as an endoscope, which has a camera on one end. X-rays guide the endoscope into your digestive system, and surgical instruments are passed down the endoscope to remove the gallstones. Alcohol consumption After recovering from acute pancreatitis, alcohol should be completely avoided if this was the cause of the condition. If you find this difficult, you’ll probably need additional treatment. Treatment options for alcohol dependence include: one-to-one counselling self-help groups – such as Alcoholics Anonymous a medication called acamprosate – which helps to reduce your alcohol cravings


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one-to-one counselling self-help groups – such as Alcoholics Anonymous a medication called acamprosate – which helps to reduce your alcohol cravings Complications of acute pancreatitis Although most people with acute pancreatitis recover without experiencing further problems, severe cases can have serious complications. Pseudocysts Pseudocysts are sacs of fluid that can develop on the surface of the pancreas. They’re a common complication of acute pancreatitis, thought to affect around 1 in 20 people with the condition. Pseudocysts usually develop 4 weeks after the symptoms of acute pancreatitis start. In many cases, they don’t cause any symptoms and are only detected during a computerised tomography (CT) scan. However, in some people, pseudocysts can cause bloating, indigestion and a dull abdominal (tummy) pain. If the pseudocysts are small and not causing any symptoms, there may be no need for further treatment, as they usually go away on their own. Treatment is usually recommended


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and not causing any symptoms, there may be no need for further treatment, as they usually go away on their own. Treatment is usually recommended if you’re experiencing symptoms or if the pseudocysts are large. Larger pseudocysts are at risk of bursting, which could cause internal bleeding or trigger an infection. Pseudocysts can be treated by draining the fluid out of the cyst by inserting a needle into it through your skin. This can also be done by carrying out an endoscopy, where a thin, flexible tube called an endoscope is passed down your throat, and tiny tools are used to drain away the fluid. Infected pancreatic necrosis In around 1 in 3 severe cases of acute pancreatitis, a serious complication called infected pancreatic necrosis occurs. In infected pancreatic necrosis, high levels of inflammation cause an interruption to the blood supply of your pancreas. Without a consistent supply of blood, some of the tissue of your pancreas will die. Necrosis is the medical term for the


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supply of your pancreas. Without a consistent supply of blood, some of the tissue of your pancreas will die. Necrosis is the medical term for the death of tissue. The dead tissue is extremely vulnerable to infection from bacteria. Once an infection has occurred, it can quickly spread into the blood (blood poisoning) and cause multiple organ failure. If left untreated, infected pancreatic necrosis is almost always fatal. Infected pancreatic necrosis usually develops 2 to 6 weeks after the symptoms of acute pancreatitis starts. Symptoms include increased abdominal pain and a high temperature. The infection is treated with injections of antibiotics, and the dead tissue needs to be removed to prevent the infection returning. In some cases, it may be possible to drain away the dead tissue using a thin tube called a catheter, which is placed through the skin. Alternatively, laparoscopic surgery (keyhole surgery) can be used. A small cut is made in your back and an endoscope is inserted to


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through the skin. Alternatively, laparoscopic surgery (keyhole surgery) can be used. A small cut is made in your back and an endoscope is inserted to wash away any dead tissue. If laparoscopic surgery isn’t possible, a cut can be made in your abdomen to allow the dead tissue to be removed. Infected pancreatic necrosis is a very serious complication. Even with the highest standards of medical care, the risk of dying from organ failure is estimated to be around 1 in 5. Systemic inflammatory response syndrome (SIRS) Another common complication of severe acute pancreatitis is systemic inflammatory response syndrome (SIRS). SIRS develops in an estimated 1 in 10 severe cases of acute pancreatitis. In SIRS, the inflammation affecting the pancreas spreads throughout the body, which can cause one or more organs to fail. It usually develops during the first week after the symptoms start, with most cases developing on the same day. Symptoms of SIRS include: a rise in body temperature to above


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the first week after the symptoms start, with most cases developing on the same day. Symptoms of SIRS include: a rise in body temperature to above 38C (100.4F) or a fall in body temperature to below 36C (96.8F) a rapid heartbeat of more than 90 beats a minute an unusually fast breathing rate (more than 20 breaths a minute) There’s currently no cure for SIRS, so treatment involves trying to support the body’s functions until the inflammation has passed. The outcome depends on how many organs fail. The higher the number of organs affected, the greater the risk of death. Chronic pancreatitis If you have repeated episodes of acute pancreatitis, the damage to your pancreas may lead to chronic pancreatitis. Chronic pancreatitis is a long-term condition that can have a serious impact on your quality of life. Preventing acute pancreatitis As acute pancreatitis is often caused by gallstones or excessive alcohol consumption, a healthy lifestyle can reduce your chances of developing the


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As acute pancreatitis is often caused by gallstones or excessive alcohol consumption, a healthy lifestyle can reduce your chances of developing the condition. Gallstones The most effective way of preventing gallstones is eating a healthy, balanced diet that includes plenty of fresh fruit and vegetables (at least 5 portions a day). Your diet should also include wholegrains, found in wholemeal bread, oats and brown rice. This helps lower the amount of cholesterol in your body. There is also evidence that regularly eating nuts, such as peanuts or cashews, can help reduce your risk of developing gallstones. Because of the role cholesterol appears to play in the formation of gallstones, it’s advisable to avoid eating too many fatty foods with a high cholesterol content. Foods high in cholesterol include: meat pies sausages and fatty cuts of meat butter and lard cakes and biscuits Being overweight also increases your chances of developing gallstones, so maintaining a healthy weight by


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of meat butter and lard cakes and biscuits Being overweight also increases your chances of developing gallstones, so maintaining a healthy weight by eating a balanced diet and taking plenty of regular exercise can also help reduce your risk of developing the condition. Read more information and advice about exercise, healthy eating and losing weight. Alcohol Limiting the amount of alcohol you drink can help prevent your pancreas being damaged, and reduce your risk of developing acute pancreatitis. It can also lower your chances of developing other serious conditions, such as liver cancer. Read the pages on drinking and alcohol for more information and advice. Source: NHS 24 - Opens in new browser window Last updated: 26 March 2025 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters


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personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Also on NHS inform Food and nutrition Gallstones Chronic pancreatitis Other health sites Lab Tests Online UK: lipase test British Liver Trust NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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Addison's disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Glands Addison’s disease Addison’s disease About Addison’s disease Symptoms of Addison’s disease Causes of Addison’s disease Diagnosing Addison’s disease Treating Addison’s disease About Addison’s disease Addison’s disease (also known as primary adrenal insufficiency or hypoadrenalism) is a rare disorder of the adrenal glands. The adrenal glands are 2 small glands that sit on top of the kidneys. They produce essential hormones: cortisol, aldosterone and adrenaline. In Addison’s disease, the adrenal gland is damaged, and not enough cortisol and aldosterone are produced. About 8,400 people in the UK have Addison’s disease. It can affect people of any age. It’s most common between the ages of 30 and 50. It’s also more common in women than men. Early-stage symptoms of Addison’s disease


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people of any age. It’s most common between the ages of 30 and 50. It’s also more common in women than men. Early-stage symptoms of Addison’s disease are similar to other more common health conditions, such as depression or flu. You may experience: fatigue (lack of energy or motivation) muscle weakness low mood loss of appetite and unintentional weight loss increased thirst Over time, these problems may become more severe and you may experience further symptoms, such as dizziness, fainting, cramps and exhaustion. You may also develop small areas of darkened skin, or darkened lips or gums. Although these symptoms aren’t always caused by Addison’s disease, you should see your GP, so they can be investigated. Read more about the symptoms of Addison’s disease and diagnosing Addison’s disease Why it happens The condition is usually the result of a problem with the immune system, which causes it to attack the outer layer of the adrenal gland (the adrenal cortex), disrupting the production


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of a problem with the immune system, which causes it to attack the outer layer of the adrenal gland (the adrenal cortex), disrupting the production of steroid hormones aldosterone and cortisol. It’s not clear why this happens, but it’s responsible for 70% to 90% of cases in the UK. Other potential causes include conditions that can damage the adrenal glands, such as tuberculosis (TB), although this is uncommon in the UK. Read more about the causes of Addison’s disease Treating Addison’s disease Addison’s disease is treated with medication to replace the missing hormones. You’ll need to take the medication for the rest of your life. With treatment, symptoms of Addison’s disease can largely be controlled. Most people with the condition live a normal lifespan and are able to live an active life, with few limitations. However, many people with Addison’s disease also find they must learn to manage bouts of fatigue and there may be associated health conditions, such as diabetes or an


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with Addison’s disease also find they must learn to manage bouts of fatigue and there may be associated health conditions, such as diabetes or an underactive thyroid. People with Addison’s disease must be aware of the risk of a sudden worsening of symptoms, called an adrenal crisis. This can happen when the levels of cortisol in your body fall significantly due to not taking your medicines, or during another illness. An adrenal crisis is a medical emergency and warning signs include severe nausea, confusion, fever, headache and weakness. If left untreated, it can be fatal. If you or someone you know has Addison’s disease and is experiencing severe symptoms, phone 999 for an ambulance. Read more about treating Addison’s disease Information about you If you have Addison’s disease, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this


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National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register Symptoms of Addison’s disease Addison’s disease can be difficult to detect at first, because early symptoms are similar to symptoms of many other health conditions. Initial symptoms of Addison’s disease can include: fatigue (lack of energy or motivation) lethargy (abnormal drowsiness or tiredness) muscle weakness low mood (mild depression) or irritability loss of appetite and unintentional weight loss the need to urinate frequently increased thirst craving for salty foods Dehydration can also be an early sign of Addison’s disease. It’s caused by lack of the hormone aldosterone in your body, which is used to regulate the balance of salt and water. Later symptoms Further symptoms of Addison’s disease tend to develop gradually over months or years.


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used to regulate the balance of salt and water. Later symptoms Further symptoms of Addison’s disease tend to develop gradually over months or years. However, additional stress, caused by another illness or an accident, for example, may cause your symptoms to suddenly get worse. You may go on to develop: low blood pressure when you stand up, which can cause dizziness and fainting feeling sick (nausea) vomiting diarrhoea abdominal, joint or back pain muscle cramps chronic exhaustion, which may cause depression brownish discolouration of the skin, lips and gums (hyperpigmentation), particularly in the creases on your palms, on scars or on pressure points, such as your knuckles or knees a reduced libido (lack of interest in sex), particularly in women Some women may also have irregular periods or miss some periods completely. Children with Addison’s disease may experience puberty later than usual. Some people with Addison’s disease also develop low blood sugar (hypoglycaemia). This can


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Addison’s disease may experience puberty later than usual. Some people with Addison’s disease also develop low blood sugar (hypoglycaemia). This can cause symptoms such as difficulty concentrating, confusion, anxiety and even unconsciousness (particularly in children). If you’re experiencing symptoms of Addison’s disease, see your GP so they can diagnose or rule out the condition. These symptoms will usually improve with appropriate treatment. Read more about diagnosing Addison’s disease and treating Addison’s disease Adrenal crisis If Addison’s disease is left untreated, the levels of hormones produced by the adrenal gland gradually decrease in the body. This causes your symptoms to get progressively worse and eventually lead to a life-threatening situation called an adrenal or Addisonian crisis. During an adrenal crisis, the symptoms of Addison’s disease appear quickly and severely. This could happen when you’re already experiencing initial symptoms or without any symptoms at all.


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of Addison’s disease appear quickly and severely. This could happen when you’re already experiencing initial symptoms or without any symptoms at all. Signs of an adrenal crisis include: severe dehydration pale, cold, clammy skin sweating rapid, shallow breathing dizziness severe vomiting and diarrhoea severe muscle weakness headache severe drowsiness or loss of consciousness An adrenal crisis is a medical emergency. If left untreated, it can be fatal. If you think you or someone you know with Addison’s disease is having an adrenal crisis, phone 999 for an ambulance. If an adrenal crisis isn’t treated, it can lead to a coma and death. There’s also a risk your brain won’t get enough oxygen if treatment is delayed, which can cause permanent disability. Causes of Addison’s disease Addison’s disease develops when the outer layer of your adrenal glands (your adrenal cortex) is damaged, reducing the levels of hormones it produces. Problems with the immune system In the UK, a problem with the


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glands (your adrenal cortex) is damaged, reducing the levels of hormones it produces. Problems with the immune system In the UK, a problem with the immune system is the most common cause of Addison’s disease, accounting for 70% to 90% of cases. The immune system is your body’s defence against infection and disease. If you’re ill, your immune system produces antibodies (a special type of protein that destroys disease-carrying organisms and toxins). These antibodies attack the cause of the illness. However, if you develop a problem with your immune system, it can start to attack your own healthy tissues and organs. This is known as an autoimmune disorder. Addison’s disease can develop if your immune system attacks your adrenal glands and severely damages your adrenal cortex. When 90% of the adrenal cortex is destroyed, your adrenal glands won’t be able to produce enough of the steroid hormones cortisol and aldosterone. Once levels of these start decreasing, you’ll experience symptoms of


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be able to produce enough of the steroid hormones cortisol and aldosterone. Once levels of these start decreasing, you’ll experience symptoms of Addison’s disease. It’s not clear why some people develop this problem with their immune system, although it can run in families. Genetics Research has shown that some people with certain genes are more likely to develop autoimmune disorders. It’s not clear how these genes lead to Addison’s disease and similar conditions, but it does mean your risk of developing Addison’s disease is increased if you or a close family member have another autoimmune condition, such as: vitiligo – a chronic (long-term) condition that causes pale, white patches to develop on the skin type 1 diabetes – a chronic condition caused by too much glucose in the blood underactive thyroid gland (hypothyroidism) Other causes Tuberculosis (TB) is the most common cause of Addison’s disease worldwide, but is rare in the UK. TB is a bacterial infection that mostly affects the


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Tuberculosis (TB) is the most common cause of Addison’s disease worldwide, but is rare in the UK. TB is a bacterial infection that mostly affects the lungs, but can also spread to other parts of your body. It can cause Addison’s disease if it damages your adrenal glands. Other possible causes of Addison’s disease include: infections – such as those linked to AIDS, or fungal infections a haemorrhage – very heavy bleeding into the adrenal glands, sometimes associated with meningitis or other types of severe sepsis cancer – if cancer cells from elsewhere in your body spread to your adrenal glands amyloidosis – a disease where amyloid, a protein produced by your bone marrow cells, builds up in your adrenal glands and damages them surgical removal of both adrenal glands (adrenalectomy) – for example, to remove a tumour adrenoleukodystrophy (ALD) – a rare, life-limiting, inherited condition affecting the adrenal glands and nerve cells in the brain that most often affects young boys certain


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– a rare, life-limiting, inherited condition affecting the adrenal glands and nerve cells in the brain that most often affects young boys certain treatments needed for Cushing’s syndrome – a collection of symptoms caused by very high levels of cortisol in the body Diagnosing Addison’s disease To help diagnose Addison’s disease, your GP will first ask about your symptoms and review your medical history. They’re also likely to ask if anyone in your family has an autoimmune disorder (a condition caused by a problem with their immune system). Your GP will examine your skin for any evidence of brownish discolouration (hyperpigmentation), particularly in certain areas, such as: where skin creases on your palm in your elbow crease on any scars your lips and gums However, hyperpigmentation doesn’t occur in all cases of Addison’s disease. You’ll also be tested for low blood pressure (hypotension) while you’re lying down and again shortly after you stand up. This is to see whether you have


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also be tested for low blood pressure (hypotension) while you’re lying down and again shortly after you stand up. This is to see whether you have postural or orthostatic hypotension (low blood pressure when you change position). Blood tests If Addison’s disease is suspected, blood tests will be carried out to measure the levels of sodium, potassium and cortisol in your body. A low sodium, high potassium or low cortisol level may indicate Addison’s disease. You may need to see a hospital hormone specialist (endocrinologist) for your blood to be tested for the following: a low level of the hormone aldosterone a high level of adrenocorticotrophic hormone (ACTH) a low level of glucose (sugar used for energy) positive adrenal antibodies (antibodies designed to attack the adrenal gland) Any of these could be a sign of Addison’s disease. Synacthen stimulation test If cortisol in your blood is low, or your symptoms strongly suggest Addison’s disease, you’ll need to have a synacthen


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Synacthen stimulation test If cortisol in your blood is low, or your symptoms strongly suggest Addison’s disease, you’ll need to have a synacthen stimulation test to confirm the diagnosis. Your GP may refer you to an endocrinology unit (a unit that specialises in the study of hormones) for the test. How urgently you’re referred depends on how severe your symptoms are. Synacthen is a man-made (synthetic) copy of the adrenocorticotrophic hormone (ACTH). ACTH is naturally produced by the pituitary gland (a pea-sized gland below the brain) to encourage the adrenal glands to release the hormones cortisol and aldosterone. When synacthen is administered, the adrenal glands should respond in the same way as they would to ACTH, and release cortisol and other steroid hormones into the blood. A blood sample will be taken and tested for cortisol, before an injection of synacthen is given into your arm. After 30 and 60 minutes, a further blood sample will be taken for cortisol measurement. If the


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an injection of synacthen is given into your arm. After 30 and 60 minutes, a further blood sample will be taken for cortisol measurement. If the ACTH level is high, but the cortisol and aldosterone levels are low, it’s usually confirmation of Addison’s disease. Thyroid function test As well as a synacthen stimulation test, your thyroid gland may also be tested to see if it’s working properly. Your thyroid gland is found in your neck. It produces hormones that control your body’s growth and metabolism. People with Addison’s disease often have an underactive thyroid gland (hypothyroidism), where the thyroid gland does not produce enough hormones. By testing the levels of certain hormones in your blood, your endocrinologist (a specialist in hormone conditions) can determine whether you have hypothyroidism. Scans In some cases, your specialist may refer you for a scan of your adrenal glands. This could be a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan.


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may refer you for a scan of your adrenal glands. This could be a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan. Diagnosis during an adrenal crisis If Addison’s disease is left untreated, it eventually leads to an adrenal crisis. This is where the symptoms of Addison’s disease appear quickly and severely. During an adrenal crisis, there’s not enough time to perform a synacthen stimulation test to confirm Addison’s disease. If possible, blood will be taken and tested for any of the abnormalities listed above. While you’re waiting for the results, treatment may be started with steroid injections, and fluids containing salt and glucose. Read more about treating Addison’s disease Driving If you’re diagnosed with Addison’s disease and have a bus, coach or lorry licence, it’s your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA). Read about driving and Addison’s disease on the GOV.UK website. Treating Addison’s disease If you have


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Driver and Vehicle Licensing Agency (DVLA). Read about driving and Addison’s disease on the GOV.UK website. Treating Addison’s disease If you have Addison’s disease, you’ll need to take daily medication to replace the lost hormones. This should help you to live an active life, although many people find they still need to manage their fatigue. In some cases, the underlying causes of Addison’s disease can be treated. For example, tuberculosis (TB) is treated with a course of antibiotics over a period of at least 6 months. However, most cases are caused by a problem with the immune system that can’t be cured. Medication for Addison’s disease Treatment usually involves corticosteroid (steroid) replacement therapy for life. Corticosteroid medication is used to replace the hormones cortisol and aldosterone that your body no longer produces. It’s usually taken in tablet form 2 or 3 times a day. In most cases, a medication called hydrocortisone is used to replace the cortisol. Other possible


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usually taken in tablet form 2 or 3 times a day. In most cases, a medication called hydrocortisone is used to replace the cortisol. Other possible medicines are prednisolone or dexamethasone, though these are less commonly used. Aldosterone is replaced with a medication called fludrocortisone. Your GP may also ask you to add extra salt to your daily diet, although if you’re taking enough fludrocortisone medicine this may not be necessary. Unlike most people, if you feel the urge to eat something salty, then you should eat it. In general, the medications used for Addison’s disease don’t have side effects, unless your dose is too high. If you take a higher dose than necessary for a long time, there’s a risk of problems such as weakened bones (osteoporosis), mood swings and difficulty sleeping (insomnia). Living with Addison’s disease Many people with Addison’s disease find that taking their medication enables them to continue with their normal diet and exercise routines. However, bouts


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people with Addison’s disease find that taking their medication enables them to continue with their normal diet and exercise routines. However, bouts of fatigue are also common, and it can take some time to learn how to manage these periods of low energy. Some people find that needing to take regular doses of medication is restrictive and affects their daily life or emotional health. Missing a dose of medication, or taking it late, can also lead to exhaustion or insomnia. Some people can develop associated health conditions, such as diabetes or an underactive thyroid, which require extra treatment and management. You’ll usually need to have appointments with an endocrinologist every 6 to 12 months, so they can review your progress and adjust your medication dose, if necessary. Your GP can provide support and repeat prescriptions in between these visits. Failing to take your medication could lead to a serious condition called an adrenal crisis, so you must: remember to collect your


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these visits. Failing to take your medication could lead to a serious condition called an adrenal crisis, so you must: remember to collect your repeat prescriptions keep spare medication as necessary – for example, in the car or at work, and always carry some spare medication with you take your medication every day at the right time pack extra medication if you are going away – usually double what you would normally need, plus your injection kit (see below) carry your medication in your hand luggage if you are travelling by plane, with a note from your doctor explaining why it is necessary You could also inform close friends or colleagues of your condition. Tell them about the signs of adrenal crisis and what they should do if you experience one. Medical alert bracelets It’s also a good idea to wear a medical alert bracelet or necklace that informs people you have Addison’s disease. After a serious accident, such as a car crash, a healthy person produces more cortisol. This helps you


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informs people you have Addison’s disease. After a serious accident, such as a car crash, a healthy person produces more cortisol. This helps you cope with the stressful situation and additional strain on your body that results from serious injury. As your body cannot produce cortisol, you’ll need a hydrocortisone injection to replace it and prevent an adrenal crisis. Wearing a medical alert bracelet will inform any medical staff treating you about your condition, and what medication you require. Medical alert bracelets or necklaces are pieces of jewellery engraved with your medical condition and an emergency contact number. They are available from a number of retailers. Ask your GP if there’s one they recommend, or go to the MedicAlert website. If you need to stay in hospital, the healthcare professionals responsible for your care will also need to know you need steroid replacement medication throughout your stay. It’s important to note that this advice still applies if you’re not


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also need to know you need steroid replacement medication throughout your stay. It’s important to note that this advice still applies if you’re not supposed to eat or drink (nil by mouth) for any reason. Adjusting your medication At certain times, your medication may need to be adjusted to take into account any additional strain on your body. For example, you may need to increase the dosage of your medication if you experience any of the following: an illness or infection – particularly if you have a high temperature of 37.5C (99.5F) an accident, such as a car crash an operation, dental or medical procedure (such as a tooth filling or endoscopy) you’re taking part in strenuous exercise not usually part of your daily life This will help your body cope with the additional stress. Your endocrinologist will monitor your dosage and advise about any changes. Over time, as you get used to the condition and learn what can trigger your symptoms, you may learn how to adjust your medication


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about any changes. Over time, as you get used to the condition and learn what can trigger your symptoms, you may learn how to adjust your medication yourself. However, always consult your GP or specialist if you’re unsure. Emergency treatment You and a partner or family member may be trained to administer an injection of hydrocortisone in an emergency. This could be necessary if you go into shock after an injury, or if you experience vomiting or diarrhoea and are unable to keep down oral medication. This may occur if you’re pregnant and have morning sickness. Your endocrinologist will discuss with you when an injection might be necessary. If you need to administer emergency hydrocortisone, always phone your GP immediately afterwards. Check what out-of-hours services are available in your local area, in case the emergency is outside normal working hours. You can also register yourself with your local ambulance service, so they have a record of your requirement for a steroid injection


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working hours. You can also register yourself with your local ambulance service, so they have a record of your requirement for a steroid injection or tablets, if you need their assistance. Treating adrenal crisis Adrenal crisis, or Addisonian crisis, needs urgent medical attention. Phone 999 for an ambulance if you or someone you know are experiencing adrenal crisis. Signs of an adrenal crisis include: severe dehydration pale, cold, clammy skin sweating rapid, shallow breathing dizziness severe vomiting and diarrhoea severe muscle weakness headache severe drowsiness or loss of consciousness In hospital, you’ll be given lots of fluid through a vein in your arm to rehydrate you. This will contain a mixture of salts and sugars (sodium, glucose and dextrose) to replace those that your body is lacking. You’ll also be injected with hydrocortisone to replace the missing cortisol hormone. Any underlying causes of the adrenal crisis, such as an infection, will also be treated. Source: NHS 24 -


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to replace the missing cortisol hormone. Any underlying causes of the adrenal crisis, such as an infection, will also be treated. Source: NHS 24 - Opens in new browser window Last updated: 20 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Also on NHS inform Underactive thyroid NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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https://www.nhsinform.scot/healthy-living/womens-health/girls-and-young-women-puberty-to-around-25/periods-and-menstrual-health/adenomyosis/


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Adenomyosis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Healthy living Women's health Girls and young women (puberty to around 25) Periods and menstrual health Adenomyosis Adenomyosis العربية | 简体中文 | Polski | ਪੰਜਾਬੀ | اردو | British Sign Language (BSL) | Easy Read Adenomyosis is a condition that causes the lining of the womb (the endometrium) to bury into the muscular wall of the womb. It can affect the whole womb or just one part of the womb. Adenomyosis is not a life-threatening condition, but the symptoms can have a big impact on your day-to-day life so it’s important to get the support you need. Symptoms It’s possible to have adenomyosis and have no symptoms. Symptoms you might experience include: heavy periods that last for a long time severe period pain a feeling of pressure in your tummy bloating (your tummy sticks out more than normal) Symptom questionnaire


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last for a long time severe period pain a feeling of pressure in your tummy bloating (your tummy sticks out more than normal) Symptom questionnaire You can use our menstrual health symptom questionnaire (PDF, 421KB) to keep a note of your symptoms and how you’re feeling. You can print it and talk about it with your healthcare professional to help them understand the different symptoms you’re experiencing. Complete the symptom questionnaire Causes It’s not known exactly why adenomyosis happens. Adenomyosis is not an infection and it’s not contagious. It is benign (not cancerous). Diagnosis When you see your doctor about your symptoms, they’ll carry out what is called a pelvic examination. They’ll look at your vulva, vagina and cervix (the opening between the vagina and the womb) to see if there is something that could be causing your symptoms. Sometimes other tests might be needed. Your doctor will discuss this with you and you can ask any questions that you might have. As this is an


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Sometimes other tests might be needed. Your doctor will discuss this with you and you can ask any questions that you might have. As this is an intimate examination, the doctor who performs it will have another person (chaperone) present. You can ask for a female doctor to carry it out. If there isn’t a female doctor available, you can ask if there’s a female health professional who could carry out the examination. You might be referred to a specialist who’ll carry out more tests. This might include an ultrasound or an MRI, which will allow a doctor to look at your womb. This can also help rule out any other health conditions. Treatment Depending on your symptoms, there are different options to treat adenomyosis, including: anti-inflammatory medication to help relieve mild pain treatment during your period to help reduce the amount of menstrual blood loss hormone therapy such as the contraceptive pill, to help control heavy or painful periods a hysterectomy (removal of the womb) – this


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blood loss hormone therapy such as the contraceptive pill, to help control heavy or painful periods a hysterectomy (removal of the womb) – this would only be considered in extreme cases, where other treatments do not work and if you do not wish to become pregnant Your doctor will discuss this with you and you can ask any questions that you might have. Source: Scottish Government - Opens in new browser window Last updated: 11 April 2025 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats العربية | 简体中文 | Polski | ਪੰਜਾਬੀ | اردو | British Sign Language (BSL) | Easy Read العربية | 简体中文 | Polski | ਪੰਜਾਬੀ | اردو | British Sign Language (BSL) | Easy Read Add this page to Info For Me Also on NHS inform Five steps to mental wellbeing Get help with


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ਪੰਜਾਬੀ | اردو | British Sign Language (BSL) | Easy Read Add this page to Info For Me Also on NHS inform Five steps to mental wellbeing Get help with your mental health Self-help tool: Periods and mental wellbeing Other health sites Endometriosis UK: adenomyosis and endometriosis Wellbeing of Women: Period Symptom Checker NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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https://www.nhsinform.scot/ready-steady-baby/pregnancy/looking-after-yourself-and-your-baby/alcohol-and-pregnancy/


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Alcohol and pregnancy | Ready Steady Baby! 0 Ready Steady Baby Pregnancy Health problems in pregnancy Looking after yourself and your baby Preparing for parenthood Relationships and wellbeing in pregnancy Your antenatal care Your baby’s development Labour and birth After the birth Assisted birth Getting ready for the birth Giving birth Labour Meeting your new baby Early parenthood Caring for your new baby Getting to know your baby Going home If your baby’s ill Your growing family Your wellbeing after the birth Other languages and formats Back Ready Steady Baby! Home Ready Steady Baby Pregnancy Looking after yourself and your baby Alcohol and pregnancy There’s no known safe limit of drinking during pregnancy. Some people will tell you that having the odd drink when you’re pregnant is okay. The safest option is to stop drinking when you’re trying to get pregnant or as soon as you know you’re pregnant. How alcohol can harm your baby Your baby’s developing all the way through your


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you’re trying to get pregnant or as soon as you know you’re pregnant. How alcohol can harm your baby Your baby’s developing all the way through your pregnancy. Alcohol can be harmful at any stage. Drinking alcohol: damages your baby’s developing cells which can affect how their brain and organs develop and how they look makes it more likely you’ll have a miscarriage, or your baby will be born early or underweight can cause fetal alcohol spectrum disorder Even small amounts of alcohol can cross over from your body into your baby. The exact level of alcohol exposure that can lead to harm is not known with certainty, but the more you drink, the greater the possible harm. Drinking a lot in a single occasion (sometimes called binge drinking) is especially harmful Fetal alcohol spectrum disorder (FASD) If you drink while pregnant your baby could develop fetal alcohol spectrum disorder (FASD). This is a term used to describe a range of alcohol-related birth defects. About 3 in every 100


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could develop fetal alcohol spectrum disorder (FASD). This is a term used to describe a range of alcohol-related birth defects. About 3 in every 100 children and young people in the UK have FASD, but it’s preventable by avoiding alcohol when pregnant or planning a pregnancy. FASD may not always be detected at birth but can cause problems later in life, including: problems with hyperactivity, impulsivity, and attention learning and behavioural difficulties experiencing difficulty in social interaction, personal care, making sense of the world, and staying safe sensory difficulties such as being sensitive to, and distressed by, certain patterns of light, sound, or touch vulnerability to victimisation and bullying Now’s the time to stop drinking Lots of pregnancies aren’t planned, so you might not have known you were pregnant for a while and may have drunk alcohol in that time. The first and most important thing you can do now is to stop drinking alcohol completely. When you go to your


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may have drunk alcohol in that time. The first and most important thing you can do now is to stop drinking alcohol completely. When you go to your first antenatal appointment, your midwife will ask you whether you drink alcohol and if so how much. Be honest with your midwife or GP if you have been drinking during pregnancy – you can speak safely and openly to them. There are lots of organisations available to provide information, help and support. Sometimes drinking alcohol can be a response to other problems in your life, including money worries or mental health problems. Getting help with other issues may make it easier to cut down or stop drinking. Read more about the support to available to help with the cost of living Read advice about dealing with low mood, anxiety, phobias and stress Stopping drinking when pregnant For lots of women, stopping drinking when pregnant can be difficult – sometimes harder than they thought. The social pressure to have a drink can be huge and can


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women, stopping drinking when pregnant can be difficult – sometimes harder than they thought. The social pressure to have a drink can be huge and can make it harder to say no. With the right support and a bit of planning, you can do it. Talking to your midwife is the first step towards getting the right support for you and your baby. Support your partner Dads and partners can support a healthy, alcohol-free pregnancy by: not drinking alcohol around their partner trying activities that don’t involve alcohol – you could go swimming or go for a walk trying non-alcoholic alternatives such as mocktails, smoothies, and flavoured and fizzy water If you need help and support, visit Scotland’s Service Directory or our where to get help page. Further information, other languages and alternative formats Translations and alternative formats of this information are available from Public Health Scotland. If you need a different language or format, please contact phs.otherformats@phs.scot. Arabic


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information are available from Public Health Scotland. If you need a different language or format, please contact phs.otherformats@phs.scot. Arabic Ready Steady Baby Easy Read (English) Ready Steady Baby Polish Ready Steady Baby Simplified Chinese (Mandarin) Ready Steady Baby Ukrainian Ready Steady Baby Source: Public Health Scotland - Opens in new browser window Last updated: 13 January 2025 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Also on NHS inform Alcohol Other health sites NOFAS: Alcohol and pregnancy Find local alcohol services Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of


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https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/alcohol-related-liver-disease/


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Alcohol-related liver disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Alcohol-related liver disease Alcohol-related liver disease About alcohol-related liver disease Symptoms of alcohol-related liver disease Causes of alcohol-related liver disease Diagnosing alcohol-related liver disease Treating alcohol-related liver disease Complications of alcohol-related liver disease About alcohol-related liver disease Alcohol-related liver disease (ARLD) refers to liver damage caused by excess alcohol intake. There are several stages of severity and a range of associated symptoms. ARLD doesn’t usually cause any symptoms until the liver has been severely damaged. When this happens, symptoms can include: feeling sick weight loss loss of appetite yellowing of the eyes and skin (jaundice) swelling in the ankles


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When this happens, symptoms can include: feeling sick weight loss loss of appetite yellowing of the eyes and skin (jaundice) swelling in the ankles and tummy confusion or drowsiness vomiting blood or passing blood in your stools This means ARLD is frequently diagnosed during tests for other conditions, or at a stage of advanced liver damage. If you regularly drink alcohol to excess, tell your GP so they can check if your liver is damaged. Read more about: symptoms of ARLD diagnosing ARLD Alcohol and the liver With the exception of the brain, the liver is the most complex organ in the body. Its functions include: filtering toxins from the blood aiding digestion of food regulating blood sugar and cholesterol levels helping fight infection and disease The liver is very resilient and capable of regenerating itself. Each time your liver filters alcohol, some of the liver cells die. The liver can develop new cells, but prolonged alcohol misuse (drinking too much) over many years can reduce


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alcohol, some of the liver cells die. The liver can develop new cells, but prolonged alcohol misuse (drinking too much) over many years can reduce its ability to regenerate. This can result in serious and permanent damage to your liver. ARLD is very common in the UK – the number of people with the condition has been increasing over the last few decades as a result of increasing levels of alcohol misuse. Read more about the causes of ARLD. Stages of ARLD There are 3 main stages of ARLD, although there’s often an overlap between each stage. These stages are explained below. Alcoholic fatty liver disease Drinking a large amount of alcohol, even for just a few days, can lead to a build-up of fats in the liver. This is called alcoholic fatty liver disease, and is the first stage of ARLD. Fatty liver disease rarely causes any symptoms, but it’s an important warning sign that you’re drinking at a harmful level. Fatty liver disease is reversible. If you stop drinking alcohol for 2 weeks, your


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an important warning sign that you’re drinking at a harmful level. Fatty liver disease is reversible. If you stop drinking alcohol for 2 weeks, your liver should return to normal. Alcoholic hepatitis Alcoholic hepatitis – which is unrelated to infectious hepatitis – is a potentially serious condition that can be caused by alcohol misuse over a longer period. When this develops, it may be the first time a person is aware they’re damaging their liver through alcohol. Less commonly, alcoholic hepatitis can occur if you drink a large amount of alcohol in a short period of time (binge drinking). The liver damage associated with mild alcoholic hepatitis is usually reversible if you stop drinking permanently. Severe alcoholic hepatitis, however, is a serious and life-threatening illness. Many people die from the condition each year in the UK, and some people only find out they have liver damage when their condition reaches this stage. Cirrhosis Cirrhosis is a stage of ARLD where the liver


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and some people only find out they have liver damage when their condition reaches this stage. Cirrhosis Cirrhosis is a stage of ARLD where the liver has become significantly scarred. Even at this stage, there may not be any obvious symptoms. It’s generally not reversible, but stopping drinking alcohol immediately can prevent further damage and significantly increase your life expectancy. A person who has alcohol-related cirrhosis and doesn’t stop drinking has a less than 50% chance of living for at least 5 more years. How ARLD is treated There’s currently no specific medical treatment for ARLD. The main treatment is to stop drinking, preferably for the rest of your life. This reduces the risk of further damage to your liver and gives it the best chance of recovering. If a person is dependent on alcohol, stopping drinking can be very difficult. However, support, advice and medical treatment may be available through local alcohol support services. A liver transplant may be required in


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However, support, advice and medical treatment may be available through local alcohol support services. A liver transplant may be required in severe cases where the liver has stopped functioning and doesn’t improve when you stop drinking alcohol. You’ll only be considered for a liver transplant if you’ve developed complications of cirrhosis, despite having stopped drinking. All liver transplant units require a person to not drink alcohol while awaiting the transplant, and for the rest of their life. Read more about treating ARLD. Complications Death rates linked to ARLD have risen considerably over the last few decades. Alcohol is now one of the most common causes of death in the UK, along with smoking and high blood pressure. Life-threatening complications of ARLD include: internal (variceal) bleeding build-up of toxins in the brain (encephalopathy) fluid accumulation in the abdomen (ascites) with associated kidney failure liver cancer Read more about the complications of ARLD.


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(encephalopathy) fluid accumulation in the abdomen (ascites) with associated kidney failure liver cancer Read more about the complications of ARLD. Preventing ARLD The most effective way to prevent ARLD is to stop drinking alcohol or stick to the low-risk drinking guidelines. Even if you’ve been a heavy drinker for many years, reducing or stopping your alcohol intake will have important short- and long-term benefits for your liver and overall health. Read our drinking and alcohol pages for more information and advice. Symptoms of alcohol-related liver disease In many cases, people with alcohol-related liver disease (ARLD) don’t have any noticeable symptoms until their liver is badly damaged. Early symptoms If you do experience early symptoms of ARLD, these are often quite vague, such as: abdominal pain loss of appetite fatigue feeling sick diarrhoea feeling generally unwell Advanced symptoms As the liver becomes more severely damaged, more obvious and serious symptoms can develop,


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sick diarrhoea feeling generally unwell Advanced symptoms As the liver becomes more severely damaged, more obvious and serious symptoms can develop, such as: yellowing of the skin and whites of the eyes (jaundice) swelling in the legs, ankles and feet, due to a build-up of fluid (oedema) swelling in your abdomen, due to a build-up of fluid known as ascites a high temperature (fever) and shivering attacks very itchy skin hair loss unusually curved fingertips and nails (clubbed fingers) blotchy red palms significant weight loss weakness and muscle wasting confusion and memory problems, trouble sleeping (insomnia) and changes in your personality due to a build-up of toxins in the brain vomiting blood and black, tarry stools due to internal bleeding a tendency to bleed and bruise more easily, such as frequent nosebleeds and bleeding gums increased sensitivity to alcohol and drugs (because the liver can’t process them) When to seek medical advice ARLD doesn’t often cause symptoms until


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increased sensitivity to alcohol and drugs (because the liver can’t process them) When to seek medical advice ARLD doesn’t often cause symptoms until it’s reached an advanced stage. If you misuse alcohol, you may have liver damage, even though you have none of these symptoms. Read about alcohol misuse (drinking too much). Contact your GP for advice if you have a history of regular alcohol misuse. A good way to assess your history and pattern of drinking is to use a short test known as the CAGE test, which consists of 4 questions: Have you ever thought you should cut down on your drinking? Have people annoyed you by criticising your drinking? Have you ever felt guilty about your drinking? Have you ever drunk an ‘eye-opener’, which means: have you ever drunk alcohol first thing in the morning to get over a hangover and steady your nerves? If you answer yes to 1 or more of the questions, you may have an alcohol problem and are advised to see your GP. See your GP as soon as possible if


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If you answer yes to 1 or more of the questions, you may have an alcohol problem and are advised to see your GP. See your GP as soon as possible if you have symptoms of advanced ARLD. Read more about how ARLD is diagnosed. Causes of alcohol-related liver disease Alcohol-related liver disease (ARLD) is caused by drinking too much alcohol. The more you drink above the recommended limits, the higher your risk of developing ARLD. There are 2 ways alcohol misuse (drinking too much) can cause ARLD. These are: drinking a large amount of alcohol in a short amount of time (binge drinking) can cause fatty liver disease and, less commonly, alcoholic hepatitis drinking more than the recommended limits of alcohol over many years can cause hepatitis and cirrhosis, the more serious types of ARLD Evidence suggests people who regularly drink more than the recommended maximum amounts are most at risk of developing ARLD. Read more about alcohol units and how to calculate them. Additional factors As well


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recommended maximum amounts are most at risk of developing ARLD. Read more about alcohol units and how to calculate them. Additional factors As well as drinking excessive amounts of alcohol, other factors can increase your chances of developing ARLD. These include: being overweight or obese being female – women appear to be more vulnerable than men to the harmful effects of alcohol having a pre-existing liver condition, such as hepatitis C genetics – alcohol dependence and problems processing alcohol often run in families Diagnosing alcohol-related liver disease Alcohol-related liver disease (ARLD) is often first suspected when tests for other medical conditions show a damaged liver. This is because the condition causes few obvious symptoms in the early stages. If a doctor suspects ARLD, they’ll usually arrange a blood test to check how well your liver is working. They may also ask about your alcohol consumption. It’s important to be totally honest about how much and how often you


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well your liver is working. They may also ask about your alcohol consumption. It’s important to be totally honest about how much and how often you drink alcohol to avoid further unnecessary testing. This could lead to a delay in the treatment you need. Blood tests Blood tests used to assess the liver are known as liver function tests. However, liver function tests can be normal at many stages of liver disease. Blood tests can also detect if you have low levels of certain substances, such as a protein called serum albumin, which is made by the liver. A low level of serum albumin suggests your liver isn’t functioning properly. A blood test may also look for signs of abnormal blood clotting, which can indicate significant liver damage. Lab Tests Online has more information on liver function tests. Further testing If your symptoms or liver function test suggest an advanced form of ARLD – either alcoholic hepatitis or cirrhosis – you may need further tests. Imaging tests Scans may be


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function test suggest an advanced form of ARLD – either alcoholic hepatitis or cirrhosis – you may need further tests. Imaging tests Scans may be needed to produce detailed images of your liver. This may include: an ultrasound scan a computerised tomography (CT) scan a magnetic resonance imaging (MRI) scan Some scans may also measure the stiffness of the liver, which is a good indication of whether your liver is scarred. Liver biopsy During a liver biopsy, a fine needle is inserted into your body (usually between your ribs). A small sample of liver cells is taken and sent to a laboratory to be examined under a microscope. The biopsy is usually carried out under local anaesthetic, either as a day case or with an overnight stay in hospital. Specialist doctors will examine the liver biopsy tissue under the microscope to determine the degree of scarring in the liver and the cause of the damage. Endoscopy An endoscope is a long, thin, flexible tube with a light and a video camera at one


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of scarring in the liver and the cause of the damage. Endoscopy An endoscope is a long, thin, flexible tube with a light and a video camera at one end. During an endoscopy, the instrument is passed down your oesophagus (the long tube that carries food from the throat to the stomach) and into your stomach. Pictures of your oesophagus and stomach are transmitted to an external screen. The doctor will be looking for swollen veins (varices), which are a sign of cirrhosis. Treating alcohol-related liver disease Successful treatment for alcohol-related liver disease (ARLD) often depends on whether someone is willing to stop drinking alcohol and make changes to their lifestyle. Stopping drinking alcohol Treatment for ARLD involves stopping drinking alcohol. This is known as abstinence, which can be vital, depending on what stage the condition is at. If you have fatty liver disease, the damage may be reversed if you abstain from alcohol for at least 2 weeks. After this point, it’s usually


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is at. If you have fatty liver disease, the damage may be reversed if you abstain from alcohol for at least 2 weeks. After this point, it’s usually safe to start drinking again if you stick to the NHS guidelines on alcohol consumption. If you have a more serious form of ARLD – alcoholic hepatitis or cirrhosis – life-long abstinence is recommended. This is because stopping drinking is the only way to prevent your liver damage getting worse and potentially stop you dying of liver disease. Stopping drinking isn’t easy, especially as an estimated 70% of people with ARLD have an alcohol dependency problem. Nevertheless, if you have alcohol-related cirrhosis or alcoholic hepatitis and don’t stop drinking, no medical or surgical treatment can prevent liver failure. Withdrawal symptoms If you’re abstaining from alcohol, you may suffer withdrawal symptoms. These will be at their worst for the first 48 hours, but should start to improve as your body adjusts to being without alcohol. This


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symptoms. These will be at their worst for the first 48 hours, but should start to improve as your body adjusts to being without alcohol. This usually takes 3 to 7 days from the time of your last drink. Many people initially experience disturbed sleep when abstaining from alcohol, but in most cases their sleep pattern returns to normal within a month. In some cases, you may be advised to reduce your alcohol intake in a gradual and planned way to help avoid withdrawal problems. You may also be offered a medication called a benzodiazepine and psychological therapy, such as cognitive behavioural therapy (CBT), to help you through the withdrawal process. Some people need to stay in hospital or a specialist rehabilitation clinic during the initial withdrawal phases, so their progress can be closely monitored. If you’re staying at home, you’ll regularly see a nurse or other health professional. You might see them at home, at your GP surgery or at a specialist NHS service. Preventing


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you’ll regularly see a nurse or other health professional. You might see them at home, at your GP surgery or at a specialist NHS service. Preventing relapses Once you’ve stopped drinking, you may need further treatment to help ensure you don’t start drinking again. The first treatment usually offered is psychological therapy. This involves seeing a therapist to talk about your thoughts and feelings, and how these affect your behaviour and wellbeing. If psychological therapy alone isn’t effective, you may also need medication to help you abstain from alcohol, such as: acamprosate naltrexone disulfiram Read our page on treating alcohol misuse for more information on the treatments offered. Self-help groups Many people with alcohol dependence find it useful to attend self-help groups to help them stop drinking. One of the most well-known is Alcoholics Anonymous, but there are many other groups that can help. Read the alcohol support page for more information about the help available.


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is Alcoholics Anonymous, but there are many other groups that can help. Read the alcohol support page for more information about the help available. Diet and nutrition Malnutrition is common in people with ARLD, so it’s important to eat a balanced diet to help ensure you get all the nutrients you need. Avoiding salty foods and not adding salt to foods you eat can reduce your risk of developing swelling in your legs, feet and abdomen (tummy) caused by a build-up of fluid. The damage to your liver can also mean it’s unable to store glycogen – a carbohydrate that provides short-term energy. When this happens, the body uses its own muscle tissue to provide energy between meals, which leads to muscle wasting and weakness. Therefore, you may need extra energy and protein in your diet. Healthy snacking between meals can top up your calories and protein. It may also be helpful to eat 3 or 4 small meals a day, rather than 1 or 2 large meals. Your GP can advise you on a suitable diet or, in


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and protein. It may also be helpful to eat 3 or 4 small meals a day, rather than 1 or 2 large meals. Your GP can advise you on a suitable diet or, in some cases, refer you to a dietitian. In the most serious cases of malnutrition, nutrients may need to be provided through a feeding tube inserted through the nose and into the stomach. Medication for symptoms The use of medication to directly treat ARLD is controversial. Many experts have argued there’s limited evidence for its effectiveness. For people with severe alcoholic hepatitis, treatment in hospital may be necessary. Specific treatment with corticosteroids or pentoxifylline medication may be used to reduce inflammation of the liver in some people with this condition. Nutritional support is also an important part of treatment in these cases. Other medications that have been used to treat liver damage include: anabolic steroids (a more powerful type of steroid medication) ropylthiouracil (a type of medicine originally designed to


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treat liver damage include: anabolic steroids (a more powerful type of steroid medication) ropylthiouracil (a type of medicine originally designed to treat overactive thyroid glands) However, there’s a lack of good evidence that these help and they’re no longer used for severe alcoholic hepatitis. Liver transplants In the most serious cases of ARLD, the liver loses its ability to function, leading to liver failure. A liver transplant is currently the only way to cure irreversible liver failure. A liver transplant may be considered if: you develop progressive liver failure, despite not drinking alcohol you’re otherwise well enough to survive such an operation you commit to not drinking alcohol for the rest of your life Complications of alcohol-related liver disease A number of serious complications can develop if you have alcohol-related liver disease (ARLD). Portal hypertension and varices Portal hypertension is a common complication of cirrhosis and, less commonly, alcoholic


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liver disease (ARLD). Portal hypertension and varices Portal hypertension is a common complication of cirrhosis and, less commonly, alcoholic hepatitis. It occurs when the blood pressure inside your liver has risen to a potentially serious level. When the liver becomes severely scarred, it’s harder for blood to move through it. This leads to an increase in the pressure of blood around the intestines. The blood must also find a new way to return to your heart. It does this by opening up new blood vessels, usually along the lining of your stomach or oesophagus (the long tube that carries food from the throat to the stomach). These new blood vessels are known as varices. If the blood pressure rises to a certain level, it can become too high for the varices to cope with, causing the walls of the varices to split and bleed. This can cause long-term bleeding, which can lead to anaemia. Alternatively, the bleeding can be rapid and massive, causing you to vomit blood and pass stools that are


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bleeding, which can lead to anaemia. Alternatively, the bleeding can be rapid and massive, causing you to vomit blood and pass stools that are very dark or tar-like. Split varices can be treated by using an endoscope to locate the varices. A tiny band can then be used to seal the base of the varices. Ascites A person with portal hypertension may also develop a build-up of fluid in their abdomen (tummy) and around the intestines. This fluid is known as ascites. Initially, this can be treated with water tablets (diuretics). If the problem progresses, many litres of fluid can build up, which needs to be drained. This is a procedure known as paracentesis and involves a long, thin tube being placed into the fluid through the skin under local anaesthetic. One of the problems associated with the development of ascites is the risk of infection in the fluid (spontaneous bacterial peritonitis). This is a potentially very serious complication and is linked to an increased risk of kidney failure


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the fluid (spontaneous bacterial peritonitis). This is a potentially very serious complication and is linked to an increased risk of kidney failure and death. Hepatic encephalopathy One of the most important functions of the liver is to remove toxins from your blood. If the liver is unable to do this due to hepatitis or cirrhosis, the levels of toxins in the blood increase. A high level of toxins in the blood due to liver damage is known as hepatic encephalopathy. Symptoms of hepatic encephalopathy include: agitation confusion disorientation muscle stiffness muscle tremors difficulty speaking in very serious cases, a coma Hepatic encephalopathy may require hospital admission. In hospital, body functions are supported and medication is used to remove toxins from the blood. Liver cancer Liver damage due to heavy drinking over many years can also increase your risk of developing liver cancer. Over the past few decades, rates of liver cancer in the UK have risen sharply due to increased


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also increase your risk of developing liver cancer. Over the past few decades, rates of liver cancer in the UK have risen sharply due to increased levels of alcohol misuse. It’s estimated that, every year, 3-5% of people with cirrhosis will develop liver cancer. Source: NHS 24 - Opens in new browser window Last updated: 29 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Also on NHS inform Cirrhosis Liver transplant Other health sites Lab Tests Online: liver function test British Liver Trust NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS


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Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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Allergic rhinitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Ears, nose and throat Allergic rhinitis Allergic rhinitis Allergic rhinitis is inflammation (redness and swelling) of the inside of the nose. It’s caused by an allergen, such as pollen, dust, mould, or flakes of skin from certain animals. It’s a very common condition. For most people it’s easy to treat with medicines from a pharmacist. Symptoms of allergic rhinitis Allergic rhinitis usually causes cold-like symptoms, such as: sneezing itchiness a blocked or runny nose These symptoms usually start soon after coming into contact with something you’re allergic to. Some people only get allergic rhinitis seasonally because they’re allergic to things like tree or grass pollen. Other people get allergic rhinitis all year round. When to get medical advice Speak to your GP practice if: you


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to things like tree or grass pollen. Other people get allergic rhinitis all year round. When to get medical advice Speak to your GP practice if: you have allergic rhinitis and your symptoms get worse you also have asthma and it’s getting worse your symptoms are affecting your sleep and everyday life you’re not sure what’s causing your symptoms treatments from a pharmacist are not working Diagnosing allergic rhinitis Your GP will usually be able to diagnose allergic rhinitis from your symptoms and any triggers you may have noticed. If the cause of your condition is uncertain, you may be referred for allergy testing. Treatment for allergic rhinitis Treatment for allergic rhinitis depends on how severe your symptoms are. Things you can do to help your symptoms If you have mild allergic rhinitis, you can often treat the symptoms yourself. Do take over-the-counter medications, such as antihistamines clean your nasal passages with a salt water solution avoid triggers if you can Always read


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take over-the-counter medications, such as antihistamines clean your nasal passages with a salt water solution avoid triggers if you can Always read the leaflet that comes with your medicine before taking it. Follow the recommended dosage instructions. If you’re not sure which treatments are suitable for you or your child, speak to a pharmacist for advice. How to clean your nose with a homemade salt water solution Boil a pint of water, then leave it to cool. Mix 1 teaspoon of salt and 1 teaspoon of bicarbonate of soda into the water. Wash your hands. Stand over a sink, cup the palm of 1 hand and pour a small amount of the solution into it. Sniff the water into 1 nostril at a time. Breathe through your mouth and allow the water to pour back into the sink. Try not to let the water go down the back of your throat. Repeat the first 5 steps up to 3 times a day until your nose feels more comfortable. You do not need to use all of the solution, but make a fresh solution each time you clean


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up to 3 times a day until your nose feels more comfortable. You do not need to use all of the solution, but make a fresh solution each time you clean your nose. Medication Medication won’t cure your allergy, but it can be used to treat the symptoms. Speak to your GP practice if your symptoms do not improve 2 weeks after starting medicine. They may prescribe a stronger medication such as a nasal spray containing corticosteroids. What causes allergic rhinitis? Allergic rhinitis is caused by breathing in tiny particles that you’re allergic to. The most common allergens in the air that cause rhinitis are: house dust mites pollen and spores flakes of animal skin wood dust flour dust latex You’re more likely to develop an allergy if there’s a history of allergies in your family. Complications of allergic rhinitis Allergic rhinitis can lead to complications in some cases. These include: nasal polyps – abnormal but non-cancerous (benign) growths inside the nose and sinuses sinusitis –


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to complications in some cases. These include: nasal polyps – abnormal but non-cancerous (benign) growths inside the nose and sinuses sinusitis – inflammation that blocks the sinuses so mucus cannot drain into your nose as usual blockage of the middle ear – due to a build-up of fluid behind the eardrum These problems can often be treated with medication. Surgery is sometimes needed in severe or long-term cases. Source: ENT Scotland - Opens in new browser window Last updated: 10 May 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Also on NHS inform Self-help guide: Hay fever Allergies Sinusitis Other health sites Allergy UK: hay fever NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info


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Other health sites Allergy UK: hay fever NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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Allergies | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Immune system Allergies Allergies About allergies Symptoms of allergies Testing for allergies Treating allergies Preventing an allergic reaction About allergies An allergy is a reaction the body has to a particular food or substance. Allergies are very common. They’re thought to affect more than 1 in 4 people in the UK at some point in their lives. They are particularly common in children. Some allergies go away as a child gets older, although many are lifelong. Adults can develop allergies to things they weren’t previously allergic to. Having an allergy can be a nuisance and affect your everyday activities, but most allergic reactions are mild and can be largely kept under control. Severe reactions can occasionally occur, but these are uncommon. Common allergies Substances that cause


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mild and can be largely kept under control. Severe reactions can occasionally occur, but these are uncommon. Common allergies Substances that cause allergic reactions are called allergens. The more common allergens include: grass and tree pollen – an allergy to these is known as hay fever (allergic rhinitis) dust mites animal dander (tiny flakes of skin or hair) food – particularly nuts, fruit, shellfish, eggs and cow’s milk insect bites and stings medication – including ibuprofen, aspirin, and certain antibiotics latex – used to make some gloves and condoms mould – these can release small particles into the air that you can breathe in household chemicals – including those in detergents and hair dyes Most of these allergens are generally harmless to people who aren’t allergic to them. Symptoms of an allergic reaction Allergic reactions usually happen quickly within a few minutes of exposure to an allergen. They can cause: sneezing a runny or blocked nose red, itchy, watery eyes


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usually happen quickly within a few minutes of exposure to an allergen. They can cause: sneezing a runny or blocked nose red, itchy, watery eyes wheezing and coughing a red, itchy rash worsening of asthma or eczema symptoms Most allergic reactions are mild, but occasionally a severe reaction called anaphylaxis or anaphylactic shock can occur. This is a medical emergency and needs urgent treatment. Read more about the symptoms of allergies. When to get professional advice Pharmacy First Scotland: Allergies treatment from your pharmacyIf you have allergies you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotland’s Service Directory.Search for a pharmacy near you Getting help for allergies If your pharmacist thinks you might have a mild allergy, they can offer advice and treatment to help manage the condition. See your pharmacist if you think you or your child might have had an allergic reaction to something. The symptoms of an allergic reaction can


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See your pharmacist if you think you or your child might have had an allergic reaction to something. The symptoms of an allergic reaction can also be caused by other conditions. Your pharmacist can help determine whether it’s likely you have an allergy. If your allergy is particularly severe or it’s not clear what you’re allergic to, the pharmacist may advise you see your GP who may refer you to an allergy specialist for testing and advice about treatment. Read more about allergy testing. How to manage an allergy In many cases, the most effective way of managing an allergy is to avoid the allergen that causes the reaction whenever possible. For example, if you have a food allergy, you should check a food’s ingredients list for allergens before eating it. The Food Standards Agency has more information about food allergen labelling. There are also several medications available to help control symptoms of allergic reactions, including: antihistamines – these can be taken when you notice


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are also several medications available to help control symptoms of allergic reactions, including: antihistamines – these can be taken when you notice the symptoms of a reaction, or before being exposed to an allergen to stop a reaction occurring decongestants – tablets, capsules, nasal sprays or liquids that can be used as a short-term treatment for a blocked nose lotions and creams, such as moisturising creams (emollients) – these can reduce skin redness and itchiness steroid medication – sprays, drops, creams, inhalers and tablets that can help reduce redness and swelling caused by an allergic reaction For some people with very severe allergies, a treatment called immunotherapy may be recommended. This involves being exposed to the allergen in a controlled way over a number of years, so your body gets used to it and doesn’t react to it so severely. Read more about treating an allergy and avoiding allergic reactions. What causes allergies? Allergies occur when the body’s immune


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to it so severely. Read more about treating an allergy and avoiding allergic reactions. What causes allergies? Allergies occur when the body’s immune system reacts to a particular substance as though it’s harmful. It’s not clear why this happens, but most people affected have a family history of allergies or have closely related conditions such as asthma or eczema. The number of people with allergies is increasing every year. The reasons for this are not understood, but one of the main theories is it’s the result of living in a cleaner, germ-free environment, which reduces the number of germs our immune system has to deal with. It’s thought this may cause it to overreact when it comes into contact with harmless substances. Symptoms of allergies Symptoms of an allergic reaction usually develop within a few minutes of being exposed to something you’re allergic to, although occasionally they can develop gradually over a few hours. Although allergic reactions can be a nuisance and hamper


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you’re allergic to, although occasionally they can develop gradually over a few hours. Although allergic reactions can be a nuisance and hamper your normal activities, most are mild. Very occasionally, a severe reaction called anaphylaxis can occur. Main allergy symptoms Common symptoms of an allergic reaction include: sneezing and an itchy, runny or blocked nose (allergic rhinitis) itchy, red, watering eyes (conjunctivitis) wheezing, chest tightness, shortness of breath and a cough a raised, itchy, red rash (hives) swollen lips, tongue, eyes or face tummy pain, feeling sick, vomiting or diarrhoea dry, red and cracked skin The symptoms vary depending on what you’re allergic to and how you come into contact with it. For example, you may have a runny nose if exposed to pollen, develop a rash if you have a skin allergy, or feel sick if you eat something you’re allergic to. See your pharmacist if you or your child might have had an allergic reaction to something. They can help determine


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eat something you’re allergic to. See your pharmacist if you or your child might have had an allergic reaction to something. They can help determine whether the symptoms are caused by an allergy or another condition. Read more about diagnosing allergies. Severe allergic reaction (anaphylaxis) In rare cases, an allergy can lead to a severe allergic reaction, called anaphylaxis or anaphylactic shock, which can be life-threatening. This affects the whole body and usually develops within minutes of exposure to something you’re allergic to. Signs of anaphylaxis include any of the symptoms above, as well as: swelling of the throat and mouth difficulty breathing lightheadedness confusion blue skin or lips collapsing and losing consciousness Anaphylaxis is a medical emergency that requires immediate treatment. Read more about anaphylaxis for information about what to do if it occurs. Testing for allergies If you think you have an allergy, tell your pharmacist about the symptoms you’re having,


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about what to do if it occurs. Testing for allergies If you think you have an allergy, tell your pharmacist about the symptoms you’re having, when they happen, how often they occur and if anything seems to trigger them. Your pharmacist can offer advice and treatment for mild allergies with a clear cause. If your allergy is more severe or it’s not obvious what you’re allergic to, your pharmacist may advise you to see your GP as you may need referred for allergy testing at a specialist allergy clinic. The tests that may be carried out are described below. Skin prick testing Skin prick testing is one of the most common allergy tests. It involves putting a drop of liquid onto your forearm that contains a substance you may be allergic to. The skin under the drop is then gently pricked with a needle. If you are allergic to the substance, an itchy, red bump will appear within 15 minutes. Skin prick testing is painless and very safe. Make sure you don’t take antihistamines before the test, as


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red bump will appear within 15 minutes. Skin prick testing is painless and very safe. Make sure you don’t take antihistamines before the test, as they can interfere with the results. Blood tests Blood tests may be used instead of, or alongside, skin prick tests to help diagnose common allergies. A sample of your blood is removed and analysed for specific antibodies produced by your immune system in response to an allergen. Patch tests Patch tests are used to investigate a type of eczema known as contact dermatitis, which can be caused by your skin being exposed to an allergen. A small amount of the suspected allergen is added to special metal discs, which are then taped to your skin for 48 hours and monitored for a reaction. Elimination diet If you have a suspected food allergy, you may be advised to avoid eating a particular food to see if your symptoms improve. After a few weeks, you may then be asked to eat the food again to check if you have another reaction. Don’t attempt to do


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if your symptoms improve. After a few weeks, you may then be asked to eat the food again to check if you have another reaction. Don’t attempt to do this yourself without discussing it with a qualified healthcare professional. Challenge testing In a few cases, a test called a food challenge may also be used to diagnose a food allergy. During the test, you’re given the food you think you’re allergic to in gradually increasing amounts, to see how you react under close supervision. This test is riskier than other forms of testing, as it could cause a severe reaction, but is the most accurate way to diagnose food allergies. And challenge testing is always carried out in a clinic where a severe reaction can be treated if it does develop. Treating allergies The treatment for an allergy depends on what you’re allergic to. In many cases your pharmacist will be able to offer advice and treatment. They’ll advise you about taking steps to avoid exposure to the substance you’re allergic to, and


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will be able to offer advice and treatment. They’ll advise you about taking steps to avoid exposure to the substance you’re allergic to, and can recommend medication to control your symptoms. Avoiding exposure to allergens The best way to keep your symptoms under control is often to avoid the things you’re allergic to, although this isn’t always practical. For example, you may be able to help manage: food allergies by being careful about what you eat animal allergies by keeping pets outside as much as possible and washing them regularly mould allergies by keeping your home dry and well-ventilated, and dealing with any damp and condensation hay fever by staying indoors and avoiding grassy areas when the pollen count is high dust mite allergies by using allergy-proof duvets and pillows, and fitting wooden floors rather than carpets Read more about preventing allergic reactions. Allergy medications Medications for mild allergies are available from pharmacies on the Pharmacy First


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Read more about preventing allergic reactions. Allergy medications Medications for mild allergies are available from pharmacies on the Pharmacy First Scotland service without a prescription, but always ask your pharmacist for advice before starting any new medicine, as they’re not suitable for everyone. Antihistamines Antihistamines are the main medicines for allergies. They can be used: as and when you notice the symptoms of an allergic reaction to prevent allergic reactions – for example, you may take them in the morning if you have hay fever and you know the pollen count is high that day Antihistamines can be taken as tablets, capsules, creams, liquids, eye drops or nasal sprays, depending on which part of your body is affected by your allergy. Decongestants Decongestants can be used as a short-term treatment for a blocked nose caused by an allergic reaction. They can be taken as tablets, capsules, nasal sprays or liquids. Don’t use them for more than a week at a time, as using


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by an allergic reaction. They can be taken as tablets, capsules, nasal sprays or liquids. Don’t use them for more than a week at a time, as using them for long periods can make your symptoms worse. Lotions and creams Red and itchy skin caused by an allergic reaction can sometimes be treated with over-the-counter creams and lotions, such as: emollients (moisturising creams) to keep the skin moist and protect it from allergens calamine lotion to reduce itchiness steroids to reduce inflammation (see below) Steroids Steroid medications can help reduce inflammation caused by an allergic reaction. They’re available as: nasal sprays and eye drops for an inflamed nose and eyes creams for eczema and contact dermatitis inhalers for asthma tablets for hives (urticaria) Sprays, drops and weak steroid creams are available without a prescription. Stronger creams, inhalers and tablets are available on prescription from your GP. Immunotherapy (desensitisation) Immunotherapy may be an option for a


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creams, inhalers and tablets are available on prescription from your GP. Immunotherapy (desensitisation) Immunotherapy may be an option for a small number of people with certain severe and persistent allergies who are unable to control their symptoms using the measures above. The treatment involves being given occasional small doses of the allergen – either as an injection, or as drops or tablets under the tongue – over the course of several years. The injection can only be performed in a specialist clinic under the supervision of a doctor, as there is a small risk of a severe reaction. The drops or tablets can usually be taken at home. The aim of treatment is to help your body get used to the allergen so it doesn’t react to it so severely. This won’t necessarily cure your allergy, but it will make it milder and mean you can take less medication. Treating severe allergic reactions (anaphylaxis) Some people with severe allergies may experience life-threatening reactions, known as


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medication. Treating severe allergic reactions (anaphylaxis) Some people with severe allergies may experience life-threatening reactions, known as anaphylaxis or anaphylactic shock. If you’re at risk of this, you’ll be given special injectors containing a medicine called adrenaline to use in an emergency. If you develop symptoms of anaphylaxis, such as difficulty breathing, you should inject yourself in the outer thigh before seeking emergency medical help. Read more about the treating anaphylaxis. Preventing an allergic reaction The best way to prevent an allergic reaction is to avoid the substance that you’re allergic to, although this isn’t always easy or practical. Below is some practical advice that should help you avoid the most common allergens. House dust mites One of the biggest causes of allergies are dust mites, which are tiny insects found in household dust. You can limit the number of mites in your home by: choosing wood or hard vinyl floor coverings instead of a carpet


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insects found in household dust. You can limit the number of mites in your home by: choosing wood or hard vinyl floor coverings instead of a carpet fitting roller blinds that can be easily wiped clean choosing leather, plastic or vinyl furniture instead of upholstered furniture cleaning cushions, soft toys, curtains and upholstered furniture regularly, either by washing (at a high temperature) or vacuuming using tested allergy-proof covers on mattresses, duvets and pillows using a vacuum cleaner fitted with a HEPA (high-efficiency particulate air) filter, because it can trap more dust mites than ordinary vacuum cleaners regularly wiping surfaces with a damp, clean cloth – avoid dry dusting, as this can spread dust into the air Concentrate your efforts of controlling dust mites in the areas of your home where you spend the most time, such as the bedroom and living room. You can find more information on indoor allergies in the home on the Allergy UK website. Pets It’s not the pet fur


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as the bedroom and living room. You can find more information on indoor allergies in the home on the Allergy UK website. Pets It’s not the pet fur that causes an allergic reaction. Instead, it’s flakes of their dead skin, saliva and dried urine. If you can’t permanently remove a pet from the house, you could try: keeping pets outside as much as possible, or limiting them to a particular area of the house, preferably an area without carpet not allowing pets in bedrooms washing pets at least once a week regularly grooming pets outside regularly washing all bedding and soft furnishings on which a pet has lain using an air filter in rooms where you spend most of your time increase ventilation with fans, air-conditioning or by opening windows If you’re visiting a friend or relative with a pet, ask them not to dust or vacuum on the day you’re visiting, as this will stir up the allergens into the air. Taking an antihistamine medicine about an hour before entering a pet-inhabited house can


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visiting, as this will stir up the allergens into the air. Taking an antihistamine medicine about an hour before entering a pet-inhabited house can also help reduce your symptoms. The Allergy UK website has more information about domestic pet allergies. Mould spores Tiny particles released by moulds can cause an allergic reaction in some people. You can help prevent this by: keeping your home dry and well-ventilated removing any indoor pot plants from your home not drying clothes indoors, store clothes in damp cupboards or packing clothes too tightly in wardrobes dealing with any damp and condensation in your home avoiding damp buildings, damp woods and rotten leaves, cut grass and compost heaps Food allergies By law, food manufacturers must clearly label any foods that contain something that’s known to cause allergic reactions in some people. By carefully checking the label for the list of ingredients, you should be able to avoid an allergic reaction. People with food allergies most


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By carefully checking the label for the list of ingredients, you should be able to avoid an allergic reaction. People with food allergies most often experience an allergic reaction while eating out at a restaurant. You can avoid this by: not relying on the menu description alone (remember, many sauces or dressings could contain allergens) communicating clearly with the waiting staff and asking for their advice avoiding places where there’s a chance that different types of food could come into contact with each other, such as buffets or bakeries let restaurant staff you know your dietary requirements, including how severe your food allergy or intolerance is always check what allergens are in the dish even if you have eaten it before, as recipes and ingredients can change Remember, simple dishes are less likely to contain “hidden” ingredients. If you’re not sure about a dish, don’t risk it Read more about living with a food allergy and advice from the Food Standards Agency on food


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If you’re not sure about a dish, don’t risk it Read more about living with a food allergy and advice from the Food Standards Agency on food allergen labelling. Hay fever Pollen allergies – more commonly known as hay fever – are caused when trees and grasses release pollen into the air. Doctors often call hay fever allergic rhinitis. Different plants pollinate at different times of the year, so the months that you get hay fever will depend on what sort of pollen(s) you are allergic to. Typically, people are affected during spring (trees) and summer (grasses). To help keep your hay fever under control, you can: check weather reports for the pollen count and stay indoors when it’s high, if possible avoid drying clothes and bedding outside when the pollen count is high wear wraparound sunglasses to protect your eyes keep doors and windows shut when possible shower and change your clothes after being outside avoid grassy areas, such as parks and fields – particularly in the early morning,


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when possible shower and change your clothes after being outside avoid grassy areas, such as parks and fields – particularly in the early morning, evening or night, when the pollen count is highest if you have a lawn, try asking someone else to cut the grass for you Insect bites and stings If you’ve ever suffered a bad reaction to an insect bite or sting, it’s important to take precautions to minimise your risk. When you’re outdoors, particularly in the summer, you could: cover exposed skin wear shoes apply insect repellent avoid wearing strong perfumes or fragrances, as these can attract insects Read more about preventing insect bites and stings. Preventing severe allergies (anaphylaxis) If you’re at risk of experiencing a severe allergic reaction (anaphylaxis), make sure you carry two adrenaline auto-injectors with you everywhere. Wearing a MedicAlert or Medi-Tag medallion or bracelet can make others aware of your allergy in an emergency. Consider telling your teachers, work


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Wearing a MedicAlert or Medi-Tag medallion or bracelet can make others aware of your allergy in an emergency. Consider telling your teachers, work colleagues and friends, so they can give you your adrenaline injection in an emergency, while waiting for an ambulance. Read more about preventing anaphylaxis. Source: NHS 24 - Opens in new browser window Last updated: 21 February 2025 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Also on NHS inform Self-help guide: Hay fever Allergic rhinitis Anaphylaxis Food allergy Other health sites Allergy UK Anaphylaxis Campaign Search for a pharmacy near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms


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you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/dementia/types-of-dementia/alzheimers-disease/


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Alzheimer's disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Dementia Types of dementia Alzheimer’s disease Alzheimer’s disease Dementia is an umbrella term for a range of conditions that affect different brain functions, including memory. Alzheimer’s disease is the most common type of dementia. Alzheimer’s disease is most common in people over 65. But, people under 65 can also develop it. Alzheimer’s affects slightly more women than men. Symptoms of Alzheimer’s disease Alzheimer’s disease is a progressive condition. This means the symptoms develop gradually and become more severe over time. The first sign of Alzheimer’s disease is usually minor memory problems. For example, a loss of interest and enjoyment in day-to-day activities. It’s also common to forget about recent conversations, events or the names of


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For example, a loss of interest and enjoyment in day-to-day activities. It’s also common to forget about recent conversations, events or the names of places. As the condition develops, memory problems become more severe. Other symptoms of Alzheimer’s disease Other changes caused by Alzheimer’s disease that could cause you concern include: confusion, disorientation and getting lost in familiar places difficulty planning or making decisions problems with speech and language problems moving around without help difficulty performing self-care tasks stress and distress hallucinations (seeing or hearing things that aren’t there) delusions (believing things that are untrue) low mood or anxiety Causes of Alzheimer’s disease Alzheimer’s disease is thought to be caused by the build up of amyloid and tau. These are substances found inside the brain. Amyloid and tau build up and form tiny structures called plaques and tangles. These make it harder for the brain to work properly. Over time,


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brain. Amyloid and tau build up and form tiny structures called plaques and tangles. These make it harder for the brain to work properly. Over time, Alzheimer’s disease causes parts of the brain to get smaller. It also reduces chemicals in the brain that are used to send messages around the brain. Eventually, the brain struggles to cope with the damage. This can lead to problems with memory and thinking. Over time, damage also spreads to different areas of the brain. The first areas affected are the ones that are responsible for memories. Risk factors for Alzheimer’s disease The exact cause of Alzheimer’s disease is unknown. But, many things could increase your risk of developing the condition. These include: increasing age having had a severe head injury in the past in very rare cases, a family history of the condition When to speak to a healthcare professional If you’re worried about your memory or think you may have dementia, you should speak to your GP. If you’re worried about


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to a healthcare professional If you’re worried about your memory or think you may have dementia, you should speak to your GP. If you’re worried about someone else, you should encourage them to make an appointment at their GP practice. You could suggest that you’ll go with them. More advice if you’re worried about dementia Diagnosing Alzheimer’s disease Memory problems are not only caused by dementia. They can also be caused by depression, stress, medications or other health problems. Your GP can carry out some simple checks to try to find out what the cause may be. They can refer you to a specialist for more tests, if necessary. Treatment for Alzheimer’s disease There’s currently no cure for Alzheimer’s disease. But, there are treatments that can help manage the symptoms. Your GP or healthcare professional can discuss the best treatment options for you. There are things you can do to live well for as long as possible with dementia. Read more about living well with dementia Your future


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for you. There are things you can do to live well for as long as possible with dementia. Read more about living well with dementia 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 help, like: 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 Source: Scottish Government - Opens in new browser window Last updated: 22 January 2025 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Also on NHS inform About


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conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Also on NHS inform About dementia Other health sites Alzheimer Scotland: Genetics and dementia NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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Anal cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Anal cancer Anal cancer Anal cancer is a rare type of cancer that affects the very end of the large bowel. Symptoms of anal cancer The symptoms of anal cancer are often similar to more common and less serious conditions affecting the anus, such as piles (haemorrhoids) and anal fissures (small tears or sores). Symptoms of anal cancer can include: bleeding from the bottom (rectal bleeding) itching and pain around the anus small lumps around the anus a discharge of mucus from the anus loss of bowel control (bowel incontinence) However, some people with anal cancer don’t have any symptoms. Speak to your GP if you develop any of the above symptoms. While they’re unlikely to be caused by anal cancer, it’s best to get them checked out. Diagnosing anal cancer Your GP


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any of the above symptoms. While they’re unlikely to be caused by anal cancer, it’s best to get them checked out. Diagnosing anal cancer Your GP will usually ask about your symptoms and carry out some examinations. They may feel your tummy and carry out a rectal examination. This involves your doctor inserting a gloved finger into your bottom so they can feel any abnormalities. Your GP will refer you to hospital if they think further tests are necessary. The National Institute for Health and Care Excellence (NICE) recommends in its 2015 guidelines that GPs should consider referring someone with an unexplained anal lump or anal ulcer. The person should receive an appointment within 2 weeks. If you’re referred to hospital, a number of different tests may be carried out to check for anal cancer and rule out other conditions. Some of the tests you may have include a: sigmoidoscopy – where a thin, flexible tube with a small camera and light is inserted into your bottom to check for any


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tests you may have include a: sigmoidoscopy – where a thin, flexible tube with a small camera and light is inserted into your bottom to check for any abnormalities proctoscopy – where the inside of your rectum is examined using a hollow tube-like instrument (proctoscope) with a light on the end biopsy – where a small tissue sample is removed from your anus during a sigmoidoscopy or proctoscopy so it can be examined in a laboratory under a microscope If these tests suggest you have anal cancer, you may have some scans to check whether the cancer has spread. Once these are complete, your doctors will be able to ‘stage’ the cancer. This means giving it a score to describe how large it is and how far it has spread. You can read more about the stages of anal cancer on the Cancer Research UK website. How anal cancer is treated If you’re diagnosed with anal cancer, you’ll be cared for by a multidisciplinary team. This is a team of different specialists who work together to provide the best


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with anal cancer, you’ll be cared for by a multidisciplinary team. This is a team of different specialists who work together to provide the best treatment and care. The main treatments used for anal cancer are: chemoradiation – a combination of chemotherapy and radiotherapy surgery – to remove a tumour or a larger section of bowel In cases where the cancer has spread and can’t be cured, chemotherapy alone may be considered to help relieve symptoms. This is known as palliative care. Chemoradiation Chemoradiation is a treatment that combines chemotherapy (cancer-killing medication) and radiotherapy (where radiation is used to kill cancer cells). It’s currently the most effective treatment for anal cancer. You don’t usually need to stay in hospital when you’re having chemoradiation. Chemotherapy for anal cancer is usually given in 2 cycles, each lasting 4 to 5 days, with a 4-week gap between the cycles. In many cases, part of the chemotherapy is delivered through a small tube called a


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each lasting 4 to 5 days, with a 4-week gap between the cycles. In many cases, part of the chemotherapy is delivered through a small tube called a peripherally inserted central catheter (PICC) in your arm, which can stay in place until your treatment has finished. The tube means you don’t need to stay in hospital during each of the cycles of chemotherapy. However, you’ll be attached to a small plastic pump, which you take home with you. A few hospitals now offer tablet chemotherapy for anal cancer, which avoids the need for the pump and PICC. Read more about how chemotherapy is carried out Radiotherapy is usually given in short sessions, once a day from Monday to Friday, with a break at weekends. This is usually carried out for 5 to 6 weeks. To prepare for radiotherapy, additional scans will be required. Read more about how radiotherapy is carried out Both chemotherapy and radiotherapy often cause significant side effects, including: tiredness sore skin around the anus sore skin


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is carried out Both chemotherapy and radiotherapy often cause significant side effects, including: tiredness sore skin around the anus sore skin around the penis and scrotum in men or vulva in women hair loss – limited hair loss from the head, but total loss from the pubic area feeling sick diarrhoea These side effects are usually temporary, but there’s also a risk of longer-term problems, such as infertility. If you’re concerned about the potential side effects of treatment, you should discuss this with your care team before treatment begins. Other possible long-term side effects can include: bowel control problems long-term (chronic) diarrhoea erectile dysfunction vaginal pain when having sex dry and itchy skin around the groin and anus bleeding from the anus, rectum, vagina or bladder Tell your doctor if you develop any of these symptoms so they can be investigated and treated. Surgery Surgery is a less common treatment option for anal cancer. It’s usually only considered if the


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so they can be investigated and treated. Surgery Surgery is a less common treatment option for anal cancer. It’s usually only considered if the tumour is small and can be easily removed, or if chemoradiation hasn’t worked. If the tumour is very small and clearly defined, it may be cut out during a procedure called a local excision. This is a relatively simple procedure, carried out under general anaesthetic, that usually only requires a stay in hospital of a few days. If chemoradiation has been unsuccessful or the cancer has returned after treatment, a more complex operation called an abdominoperineal resection may be recommended. As with a local excision, this operation is carried out under general anaesthetic. An abdominoperineal resection involves removing your anus, rectum, part of the colon, some surrounding muscle tissue, and sometimes some of the surrounding lymph nodes (small glands that form part of the immune system) to reduce the risk of the cancer returning. You’ll usually


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some of the surrounding lymph nodes (small glands that form part of the immune system) to reduce the risk of the cancer returning. You’ll usually need to stay in hospital for up to 10 days after this type of surgery. During the operation, a permanent colostomy will also be formed to allow you to pass stools. This is where a section of the large intestine is diverted through an opening made in the abdomen called a stoma. The stoma is attached to a special pouch that will collect your stools after the operation. Before and after the operation, you’ll see a specialist nurse who can offer support and advice to help you adapt to life with a colostomy. Adjusting to life with a colostomy can be challenging, but most people become accustomed to it over time. Read more about living with a colostomy Follow-up After your course of treatment ends, you’ll need to have regular follow-up appointments to monitor your recovery and check for any signs of the cancer returning. To start with, these


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you’ll need to have regular follow-up appointments to monitor your recovery and check for any signs of the cancer returning. To start with, these appointments will be every few weeks or months, but they’ll gradually become less frequent over time. What causes anal cancer? The exact cause of anal cancer is unknown, although a number of factors can increase your risk of developing the condition. These include: infection with human papilloma virus (HPV) – a common and usually harmless group of viruses spread through sexual contact, which can affect the moist membranes lining your body having anal sex or lots of sexual partners – possibly because this increases your risk of developing HPV having a history of cervical, vaginal or vulval cancer smoking having a weakened immune system – for example, if you have HIV Your risk of developing anal cancer increases as you get older, with half of all cases diagnosed in people aged 65 or over. The condition is also slightly more common in women


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cancer increases as you get older, with half of all cases diagnosed in people aged 65 or over. The condition is also slightly more common in women than men. Further information about anal cancer Cancer Research UK: Anal cancer Macmillan Cancer Support: Anal cancer Source: NHS 24 - Opens in new browser window Last updated: 09 January 2025 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Other health sites Bowel Cancer UK Scottish Cancer Network: Patient information Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other


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Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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Angina | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Cardiovascular disease Heart disease Angina Angina About angina Treating angina About angina Angina is chest pain which occurs when the blood supply to the heart becomes restricted because of narrowing or blockages in the blood vessels around the heart. Symptoms of angina The main symptom of angina is chest pain. This can: feel like a dull pain, ache, ‘heavy’ or ‘tight’ feeling in your chest spread to your arms, neck, jaw or back be triggered by physical exertion Angina itself is not life threatening, but prolonged chest pain can be a symptom of a heart attack. Phone 999 immediately if: You or someone else has symptoms like: central chest pain or discomfort in the chest that doesn’t go away – it may feel like pressure, tightness or squeezing pain that radiates down the left arm, or both arms,


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discomfort in the chest that doesn’t go away – it may feel like pressure, tightness or squeezing pain that radiates down the left arm, or both arms, or to the neck, jaw, back or stomach unconsciousness seizures or fitting difficulty breathing (snoring or rasping) chest pain alongside breathlessness, nausea and sweating Speak to your GP practice if you: do not have a diagnosis of angina and experience chest pain on exercise that eases after a few minutes of resting have an angina diagnosis and your symptoms are becoming more frequent or occur at rest If your GP practice is closed, phone 111. Diagnosing angina To diagnose angina, you will be assessed and you may need to have several tests. You will also be asked some questions about: the symptoms you experienced if there were any triggers for the pain your family’s medical history lifestyle risk factors (like smoking, for example) Tests for angina You might also be given some tests to determine if you already have heart disease or


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risk factors (like smoking, for example) Tests for angina You might also be given some tests to determine if you already have heart disease or you’re at risk of it. measuring your weight measuring blood pressure taking blood to check cholesterol levels, diabetes or anaemia If it’s thought that you have angina, you might be referred to the hospital for some more tests. These might include: electrocardiogram (ECG) – measures the rhythms and electrical activity of the heart exercise tolerance test (ETT) – measures the activity of the heart during exercise myocardial perfusion scan (MPS or MYoview) – measures how well blood is reaching the heart coronary angiography – shows whether your coronary arteries are narrow and how severe any blockages are blood tests – help to identify increased enzyme levels (troponin) which are released when the heart is damaged Types of angina The 2 main types of angina are stable angina and unstable angina. Stable angina is more common. Attacks are more


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the heart is damaged Types of angina The 2 main types of angina are stable angina and unstable angina. Stable angina is more common. Attacks are more likely to have a trigger (like physical activity or stress). Symptoms of stable angina usually only last for a few minutes after exercise or stress. They can improve with rest and by taking a medication called Glyceryl trinitrate (GTN). Attacks of unstable angina can be unpredictable and develop without any clear triggers. They might also last longer and continue even when resting. Sometimes, when chest pain occurs suddenly, it’s unclear if it’s due to unstable angina or a heart attack. Until tests confirm the diagnosis, doctors sometimes call this Acute Coronary Syndrome (ACS). Treating angina There are various ways to treat and manage angina. Stable angina If you have stable angina you may be given medicine to: prevent and treat angina attacks reduce your risk of a heart attack Preventing and treating angina attacks Nitrates You may be


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be given medicine to: prevent and treat angina attacks reduce your risk of a heart attack Preventing and treating angina attacks Nitrates You may be given nitrates if you have stable angina. These work by relaxing the muscles in the blood vessels so that blood can pass through more easily. You might be given nitrates as: slow release tablets a fast acting spray or tablet Glyceryl trinitrate (GTN) is usually given in a fast acting spray or tablets. You should keep this with you at all times. If you experience an episode of angina you can use the spray or tablet under your tongue. The pain should then ease within a few minutes. You can repeat the dose after 5 minutes if the pain has not gone away. If the pain has still not gone 5 minutes after you take the second dose you should call an ambulance. Beta blockers Beta blockers work mainly by slowing down the heart. Calcium channel blockers Calcium channel blockers relax the arteries, increasing blood supply to the heart muscle. If you


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by slowing down the heart. Calcium channel blockers Calcium channel blockers relax the arteries, increasing blood supply to the heart muscle. If you cannot have beta blockers or calcium channel blockers, you may be given another medicine. Your doctor will discuss this with you. Reducing your risk of a heart attack or stroke To reduce your risk of more serious cardiovascular problems, your doctor might give you: a low dose of aspirin to prevent blood clots statins to reduce your cholesterol (blood fats) level ACE inhibitors to reduce your blood pressure Unstable angina Worsening angina symptoms over a short period of time can be a sign of a more acute coronary syndrome and you should seek urgent medical advice by phoning 999. If you have unstable angina (where symptoms develop unpredictably), you’ll need certain medicines. These will prevent blood clots and reduce your risk of having a heart attack. You may be given: low-dose aspirin clopidogrel Ticagrelor Surgery may be recommended if


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blood clots and reduce your risk of having a heart attack. You may be given: low-dose aspirin clopidogrel Ticagrelor Surgery may be recommended if you continue to have angina attacks despite medical treatment. It may also be recommended if tests show that you’re at a high risk of having a heart attack. Surgery for angina There are 2 types of procedures that are used to treat angina. These are a: coronary artery bypass graft (CABG) percutaneous coronary intervention (PCI) The best option for you depends on your circumstances. You should discuss the different options with your doctor. It’s likely that you will need to continue taking some medicines after surgery. Coronary artery bypass graft (CABG) A CABG is where a section of a blood vessel is taken from another part of the body. This is then used to re-route the flow of blood past a blocked or narrow section of artery. Percutaneous coronary intervention (PCI) PCI is where a narrowed section of artery is widened using a balloon and a


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or narrow section of artery. Percutaneous coronary intervention (PCI) PCI is where a narrowed section of artery is widened using a balloon and a tiny tube called a stent. It’s also known as a coronary angioplasty. Source: Scottish Government - Opens in new browser window Last updated: 19 November 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Other health sites Breathlessness intervention service British Heart Foundation: Angina Chest Heart and Stroke Scotland: Angina NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/leg-and-foot-problems-and-conditions/ankle-avulsion-fracture/


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Ankle avulsion fracture | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Leg and foot problems and conditions Ankle avulsion fracture Ankle avulsion fracture Your ankle avulsion fracture or 5th metatarsal fracture may be referred to as a fracture, break or crack. These terms all mean the same thing. When you have a fracture, it’s not just the bone that’s affected. You’ll also have injured some of the soft tissues around it. Soft tissues include the: muscles ligaments tendons nerves Recovery times Most of the healing happens between 4 to 6 weeks after the fracture. It’s normal to have aches and discomfort beyond this. This often happens when you try activities you haven’t done for a while. It’s also normal for the area to be more sensitive for several months after the injury. What can affect your recovery? There are some


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for a while. It’s also normal for the area to be more sensitive for several months after the injury. What can affect your recovery? There are some things that may affect your recovery. Smoking Smoking affects all of your tissues and slows facture healing times. In some people, it can stop healing altogether. Stopping smoking as your fracture heals will help to ensure the best recovery. Get help to stop smoking. General Health Some medical conditions, like diabetes, may slow down the healing process. Eating a healthy diet and keeping yourself active will help your recovery. Medication Some medications can slow down fracture healing. If you have concerns about your medication talk to a healthcare professional. Anti-inflammatory medication, like Ibuprofen or Naproxen, has been shown to delay healing. What to expect after an ankle avulsion or 5th Metatarsal Fracture This type of fracture is a minor fracture. It’s often treated in the same way as a strain or sprain. Some people may be


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or 5th Metatarsal Fracture This type of fracture is a minor fracture. It’s often treated in the same way as a strain or sprain. Some people may be fitted with a boot or plaster. Some might be given crutches. Walking on your foot can help your recovery but may be uncomfortable at first. Help and instructions for using crutches. Pain after a fracture It’s normal to have some discomfort in the areas around your fracture, including: other soft tissues nearby joints areas that have been immobilised Pain can change from day to day and it doesn’t always depend on what you’re doing. It’s common to have pain at rest. It’s normal to have some pain even when your fracture has healed. Some people also experience discomfort in the fracture site during colder weather. Your local pharmacy can give you advice on managing pain after a fracture. Find your local pharmacyUse Scotland’s Service Directory to find your local pharmacy.Pharmacies Swelling Swelling is the start of healing. It’s normal to have


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local pharmacyUse Scotland’s Service Directory to find your local pharmacy.Pharmacies Swelling Swelling is the start of healing. It’s normal to have it near the fracture first. It often spreads down your leg. The amount of swelling changes with: your position your activity the time of day Even when your fracture has healed, it’s normal to have some swelling. This can last for several months. How can I help swelling? Having a lot of swelling can become uncomfortable or limit your movement. However, there are some things you can do to help the swelling. You can: raise your foot above your heart when you’re resting – you can do this by supporting it with pillows keep the other joints in your leg moving normally avoid too much rest and too much activity massage the swelling from your foot towards your groin Bruising It’s normal to have bruising after a fracture. Bruising can be widespread and may appear a long way from your fracture. It can be very purple to start with and may change


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after a fracture. Bruising can be widespread and may appear a long way from your fracture. It can be very purple to start with and may change colour as you recover. Getting back to normal activities In general, you should gradually pace yourself back to your activities as you feel able. Driving You should contact your insurance provider before driving as your injury may affect your insurance. Once you’re out of your moonboot or cast the general advice is you must be able to safely perform an emergency stop or manoeuvre. You should always be in full control of your vehicle. Work Your return to work will depend on the type of work you do and your employer. You might be able to discuss a phased return to work or changed duties. You don’t need to see a healthcare professional to return to work. Daily activities Keep doing any activities you’re able to, as your pain allows. Over time, gradually increase what you do. Reduced flexibility and strength might make things more difficult to start


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able to, as your pain allows. Over time, gradually increase what you do. Reduced flexibility and strength might make things more difficult to start with. This will get better as you slowly build up to all your usual activities. Mood Frustration or low mood after an injury is normal. As you get back to normal life this should get better. Falls Loss of confidence is common after a fracture. Advice about preventing falls. Bone scanning You may be sent a letter inviting you for a scan of your bone density after a fracture. It’s routine to be assessed for any further risk of fracture, especially if you: are over the age of 50 have increased risk factors for fracture Rehabilitation plan There are things you can do to help your recovery after an ankle fracture. 0 to 2 weeks after your injury In the weeks just after your injury, you should: weight bear as much as you’re able to manage your pain and swelling increase movement in your foot and ankle with gentle exercises 2 to 6 weeks after your


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bear as much as you’re able to manage your pain and swelling increase movement in your foot and ankle with gentle exercises 2 to 6 weeks after your injury Between 2 to 6 weeks after your injury, you should: bear weight fully through your leg start balance exercises 6 to 12 weeks after your injury Between 6 to 12 weeks, you can: return to full function resume normal day to day activity return to higher impact activity Help and support If your ankle function hasn’t improved within 6 weeks of following this advice, it’s a good idea to talk to a healthcare professional about your symptoms. Gentle exercises Practise gentle foot and ankle exercises to build up strength and movement. Find out about exercises for the ankle Stop these exercises if they make your symptoms worse, or they cause new pain. Source: NHS 24 MSK Clinical Advisory Group - Opens in new browser window Last updated: 07 February 2025 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been


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Opens in new browser window Last updated: 07 February 2025 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/leg-and-foot-problems-and-conditions/ankle-sprain/


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https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/neck-and-back-problems-and-conditions/ankylosing-spondylitis/


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Ankylosing spondylitis (AS) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Neck and back problems and conditions Ankylosing spondylitis Ankylosing spondylitis Ankylosing spondylitis is a long-term (chronic) condition. The spine, or other areas of the body, become inflamed causing part of the spine to join up (fuse) and lose flexibility (ankylosis). Ankylosing spondylitis usually starts to develop in teenagers or young adults. Though most symptoms and diagnoses happen in people’s 20s. Causes of ankylosing spondylitis It’s not known exactly what causes ankylosing spondylitis. Studies have shown there’s a link between it and a gene known as HLA-B27. Having this gene does not necessarily mean you will develop ankylosing spondylitis. It’s estimated that 8% of people carry the HLA-B27 gene, but most do not have ankylosing


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necessarily mean you will develop ankylosing spondylitis. It’s estimated that 8% of people carry the HLA-B27 gene, but most do not have ankylosing spondylitis. Symptoms of ankylosing spondylitis The symptoms of ankylosing spondylitis can vary from person to person. They can develop slowly over several months or years. The main symptoms include: arthritis – causing pain, tenderness and swelling in the joints enthesitis – painful inflammation where a bone is joined to a tendon or ligament, commonly in the heel, ribs or elbow pain and swelling in other parts of the body – like the hips, knees and ribs fatigue – severe tiredness that doesn’t improve with sleep or rest pain in your lower back in the early morning morning stiffness that lasts at least 30 minutes and then eases through the day or with activity pain that doesn’t improve or gets worse with rest waking up regularly during the night because of the pain pain in the area around your buttocks Contact your GP if: you have lower back


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with rest waking up regularly during the night because of the pain pain in the area around your buttocks Contact your GP if: you have lower back pain for more than 3 months you have morning stiffness greater than 30 mins and are age 40 or below you have back pain that gets better with exercise and worse at rest Diagnosing ankylosing spondylitis Ankylosing spondylitis can be difficult to diagnose. This is because it develops slowly. This can lead to a delay in diagnosis as back pain is fairly common in the community. There can be a delay in presentation and subsequent referral to specialist (Rheumatologist). You should speak to your GP if you have symptoms of ankylosing spondylitis. They will usually ask: what symptoms you’re experiencing when the symptoms started how long you’ve had symptoms for Your GP may also arrange blood tests to check for signs of inflammation and x-rays of your lower back and pelvis. A Rheumatologist is a specialist in conditions that affect the muscles and


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check for signs of inflammation and x-rays of your lower back and pelvis. A Rheumatologist is a specialist in conditions that affect the muscles and joints. The Rheumatologist may carry out other tests which can include: an x-ray a MRI scan an ultrasound scan genetic testing Treatment for ankylosing spondylitis There is no cure for ankylosing spondylitis. But, treatment is available to help relieve the symptoms. Treatment can also help delay or prevent the spine from fusing (joining up) and stiffening. In most cases, treatment will involve a mix of: exercise physiotherapy medication Most people with ankylosing spondylitis will not need surgery. But, if the joint becomes very damaged, joint replacement surgery may be recommended. This can help to improve pain and movement in the joint. Excercise Keeping active can improve your posture and range of spinal movement. It can also prevent your spine from becoming stiff and painful. Further information on exercise for ankylosing spondylitis


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range of spinal movement. It can also prevent your spine from becoming stiff and painful. Further information on exercise for ankylosing spondylitis Physiotherapy Physiotherapy is a key part of treating ankylosing spondylitis. A Physiotherapist can explain the best exercises for you. They can also draw up an exercise programme that suits you. Types of physiotherapy for ankylosing spondylitis include: a group exercise programme an individual exercise programme massage hydrotherapy (exercise in warm swimming pool) With hydrotherapy the buoyancy of the water helps make movement easier by supporting you. The warmth can also help relax your muscles. Some people prefer to swim or play sport to keep flexible. This is usually fine, although some daily stretching and exercise is also important. Speak to your Physiotherapist or Rheumatologist if you’re worried about taking up a new type of sport or exercise. The National Ankylosing Spondylitis Society (NASS) has information about different


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if you’re worried about taking up a new type of sport or exercise. The National Ankylosing Spondylitis Society (NASS) has information about different types of exercise to help you manage your condition. Medication You may need painkillers to manage ankylosing spondylitis. But, not everyone needs them all the time. Types of painkillers you may be prescribed include: non-steroidal anti-inflammatory drug (NSAID) paracetamol Some people may be given a type of medication called Biologics. These are used if painkillers and exercise don’t help. Examples of Biologics used are: Anti TNF medication (Adalimumab, Etanercept, Golimumab) Monoclonal Antibody Treatment (Secukinumab, Ixekizumab) JAK Inhibitors (Baricitinib, Updacitinib) All these medications work by reducing inflammation. Corticosteroids Corticosteroids have a powerful anti-inflammatory effect. They can be taken as tablets or injections. If a particular joint is inflamed, corticosteroids can be injected directly into the joint. After


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effect. They can be taken as tablets or injections. If a particular joint is inflamed, corticosteroids can be injected directly into the joint. After the injection, you will need to rest the joint for up to 48 hours. Disease-modifying anti-rheumatic drugs (DMARDs) DMARDs may be prescribed in ankylosing spondyliits if there is pain and inflammation in peripheral joints such as the hands, knees, feet. They don’t work on the spine. Living with ankylosing spondylitis While there is no cure for ankylosing spondylitis, most people are able to live a relatively normal life with minimal changes to their daily activities. Work Over time, ankylosing spondylitis can affect your ability to work. Most people can remain at work with some changes. These will help with posture when you are standing or sitting for long periods. They’ll also help with fatigue. This could mean adjusting your work station or ensuring you take regular breaks. You should discuss this with your employer. Complications of


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This could mean adjusting your work station or ensuring you take regular breaks. You should discuss this with your employer. Complications of ankylosing spondylitis Ankylosing spondylitis can affect many parts of the body. It can cause complications in your day-to-day life and may lead to other health conditions. Some complications associated with ankylosing spondylitis include: less flexibility in the spine joint damage – leading to pain and stiffness osteoporosis spinal fractures iritis – painful eyes, swelling, sensitivity to light blurry or cloudy vision, redness in part of the eye cauda equina syndrome If you have ankylosing spondylitis, you may also have a higher risk of developing cardiovascular disease (CVD). Source: Scottish Society for Rheumatology - Opens in new browser window Last updated: 06 February 2025 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal


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page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Other health sites Pain Concern Versus Arthritis: AS National Ankylosing Spondylitis Society NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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https://www.nhsinform.scot/illnesses-and-conditions/mental-health/eating-disorders/anorexia-nervosa/


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Anxiety disorders in children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Mental health Anxiety disorders in children Anxiety disorders in children It’s normal for children to feel worried or anxious from time to time, like when they’re starting school or nursery, or moving to a new area. Anxiety is a feeling of unease, like worry or fear. It’s an understandable reaction in children to change or a stressful event. But for some children, anxiety affects their behaviour and thoughts on a daily basis. This can interfere with their school, home and social life. If your child is anxious for a period of time and it’s impacting on day to day life you may need to speak to a healthcare professional to help support your child. For example, if they feel they cannot go to school or see their friends anymore. So how do you know when your child’s anxiety has


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support your child. For example, if they feel they cannot go to school or see their friends anymore. So how do you know when your child’s anxiety has reached this stage? What are the signs of anxiety in children? Anxiety can make a child feel scared, panicky, embarrassed or ashamed. Some of the signs to look out for in your child are: finding it hard to concentrate not sleeping, or waking in the night not eating properly quickly getting angry or irritable, and being out of control during outbursts constantly worrying or having negative thoughts feeling tense and fidgety, or using the toilet often always crying being clingy all the time (when other children are ok) complaining of tummy aches and feeling unwell being withdrawn and not wanting to do things they used to enjoy Your child may not be old enough to recognise why they’re feeling this way. The reason for the anxiety (if there is one) will differ depending on the age of the child. Separation anxiety is common in younger


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feeling this way. The reason for the anxiety (if there is one) will differ depending on the age of the child. Separation anxiety is common in younger children. Older children and teenagers tend to worry more about school performance, relationships or health. What types of anxiety do children and teenagers experience? The common types of anxiety in children and teenagers are : A fear or phobia about something specific Young children are commonly afraid of things like the dark or imaginary things like monsters. This is a normal part of growing up, but has the potential to become a phobia (a type of anxiety disorder) when the fear becomes overwhelming and affects your child’s day-to-day life. Read about phobias Feeling anxious for most of the time for no apparent reason It’s normal for children to frequently have fears and worries. Some anxious children may develop a condition called generalised anxiety disorder when they get older. Generalised anxiety disorder causes you to feel anxious


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children may develop a condition called generalised anxiety disorder when they get older. Generalised anxiety disorder causes you to feel anxious about a wide range of situations and issues, rather than one specific event. It’s a feeling of constant fear or dread all the time that makes doing daily tasks hard because of feelings of anxiety. People affected by it feel anxious most days and often struggle to remember the last time they felt relaxed. Separation anxiety Separation anxiety means a child worrying about not being with their parent or regular carer. It’s common in young children, and normally develops at about 6 months of age. It can make settling into nursery or school or with a child minder very difficult. Separation anxiety in older children may be a sign that they’re feeling insecure about something. They could be reacting to changes at home or at school, for example. Social anxiety Social anxiety is not wanting to go out in public, see friends or take part in activities.


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changes at home or at school, for example. Social anxiety Social anxiety is not wanting to go out in public, see friends or take part in activities. Social ‘shyness’ is perfectly normal for some children and teenagers. However it becomes a problem – ‘social anxiety disorder’ – when everyday activities like shopping or speaking on the phone cause intense, overwhelming fear. Children affected by it tend to fear doing or saying something they think will be humiliating. Social anxiety disorder tends to affect older children who’ve gone through puberty. School-based anxiety Some children become anxious about going to school. This could also be about schoolwork, friendships or bullying, especially if they’re changing school or moving up a level. They may not always share these worries with you, and instead they may say they have a tummy ache or are feeling sick. One of the signs is crying or seeming tired in the morning. This may be a problem that needs tackling if it is significantly


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or are feeling sick. One of the signs is crying or seeming tired in the morning. This may be a problem that needs tackling if it is significantly affecting their daily life. Less common anxiety disorders Post-traumatic stress disorder and obsessive compulsive disorder are other anxiety disorders that can occasionally affect children, but are usually seen in adults. When is anxiety a disorder that needs treating? You should seek help for your child’s anxiety if: you feel it’s not getting better or is getting worse, and efforts to tackle it yourself have not worked you think it’s slowing down their development or having a significant effect on their schooling or relationships it happens very frequently or they feel anxious all the time it’s making them feel physically unwell a lot of the time like feeling sick or having constant headaches your child becomes very withdrawn and is anxious about doing things they used to enjoy How serious can it be? Long-term anxiety can severely interfere


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child becomes very withdrawn and is anxious about doing things they used to enjoy How serious can it be? Long-term anxiety can severely interfere with a child’s personal development, family life and schooling. Anxiety disorders that start in childhood often persist into the teenage years and early adulthood. Teenagers with an anxiety disorder can also: experience clinical depression feel hopeless misuse drugs What can I do to help my child? If a child is experiencing anxiety, there’s plenty parents and carers can do to help. First, it’s important to listen to your child about their anxiety or worries. YoungMinds has advice and resources for parents. YoungScot has advice and support for young people. Where should I go for help? You can talk to your GP or someone at your child’s school like the school nurse. You might want to do this on your own or with your child, or your child might be able to have an appointment without you. The healthcare professional should listen to your concerns


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own or with your child, or your child might be able to have an appointment without you. The healthcare professional should listen to your concerns and offer some advice about what to do next. Your child may be referred to the local child and adolescent mental health service (CAMHS). CAMHS staff are trained to help young people with a wide range of problems. Professionals who work in CAMHS services include: psychologists psychiatrists nurses occupational therapists physiotherapists and other specially trained professionals They should offer help and support to parents and carers as well as the child. More about CAMHS Youth counselling services If your child doesn’t want to see a doctor, they may be able to get help from a local youth counselling service. Youth counselling services are specially set up for young people to talk about what’s worrying them, and get advice. For more information, search Scotland’s Service Directory for mental health and wellbeing services in your area.


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worrying them, and get advice. For more information, search Scotland’s Service Directory for mental health and wellbeing services in your area. Counselling may also be available in your local school. Telephone or online help Telephone helplines or online services can be helpful for children and young people. They might feel it’s easier to talk to someone who doesn’t know them. YoungScot has information about support organisations. YoungMinds has information about where to get support. How do you treat anxiety disorders? The type of treatment offered will depend on what is causing your child’s anxiety. It can be helpful for your child to talk in confidence about what’s worrying them to a trained person, especially as it’s someone they don’t know. If your child is being seen at CAMHS, they might see a child and adolescent psychotherapist or a clinical psychologist. If they’re at a youth counselling service, it might be a trained youth counsellor or psychotherapist. These sessions can


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or a clinical psychologist. If they’re at a youth counselling service, it might be a trained youth counsellor or psychotherapist. These sessions can help them work out what is making them anxious and how they can work through the situation. Psychological therapies Psychological therapies can really help with anxiety. They’re evidence based talking treatments, like cognitive behavioural therapy, that are proven to help. Cognitive behavioural therapy (CBT) is a talking therapy that can help your child manage their problems by changing the way they think and behave. It’s been proven to help with anxiety and is commonly offered to young people who are anxious. Your child will work with the psychological therapist to find ways to change the way they think. They’ll help your child to find strategies for coping in situations that make them anxious. The psychological therapies matrix describes the most helpful talking therapies for anxiety. What is psychological therapy? Medication If your


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The psychological therapies matrix describes the most helpful talking therapies for anxiety. What is psychological therapy? Medication If your child’s anxiety problem has not got better, your doctor may talk to you about trying medication. A type of antidepressant, called a selective serotonin reuptake inhibitor (SSRI), may help your child feel calmer and differently about things. Antidepressants usually take around 2 to 4 weeks to work properly, so you or your child may not notice the difference immediately. It’s natural to be concerned about side effects. Your child should be aware of any possible adverse effects and should tell you or their doctor if they happen. Why are some children affected and others not? Some children are simply born more nervous and anxious and less able to cope with stress than other children. Sometimes traumatic life events like an illness, or an accident, can cause anxiety. This can happen even if your child was previously confident by nature before. A


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life events like an illness, or an accident, can cause anxiety. This can happen even if your child was previously confident by nature before. A child’s anxious personality may be partly determined by the genes they’ve inherited from their parents. Parents of anxious children may recognise the signs and remember feeling and behaving the same when they were younger. Life events Some children can also develop anxiety after a series of difficult life events. They may be able to cope with one of these events, but several difficult events together, or a traumatic single event, may be too much for them to cope with. Examples are: frequently moving house and school – it can be hard to settle when you’re always expecting change divorce or separation of parents death of a close relative or friend becoming seriously ill or injured in an accident having someone in the family who is ill or disabled school-related issues like homework or exams, or bullying or friendship problems becoming involved


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someone in the family who is ill or disabled school-related issues like homework or exams, or bullying or friendship problems becoming involved in crime being abused or neglected Medical conditions Children with certain conditions such as attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorders may experience anxiety as part of the symptoms of their condition. This is because of differences in the way their brain functions. Source: NHS 24 - Opens in new browser window Last updated: 02 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Other health sites YoungMinds YoungScot NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and


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sites YoungMinds YoungScot NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/appendicitis/


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Appendicitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Appendicitis Appendicitis About appendicitis Symptoms of appendicitis Diagnosing appendicitis Treating appendicitis Complications of appendicitis About appendicitis Appendicitis is a painful swelling of the appendix. The appendix is a small, thin pouch about 5 to 10cm (2 to 4 inches) long. It’s connected to the large intestine, where stools (faeces) are formed. Nobody knows exactly why we have an appendix, but removing it isn’t harmful. Appendicitis typically starts with a pain in the middle of your tummy (abdomen) that may come and go. Within hours, the pain travels to the lower right-hand side, where the appendix usually lies, and becomes constant and severe. Pressing on this area, coughing, or walking may all make the pain worse. You may lose


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the appendix usually lies, and becomes constant and severe. Pressing on this area, coughing, or walking may all make the pain worse. You may lose your appetite, feel sick, and occasionally experience diarrhoea. Read more about the symptoms of appendicitis. When to get medical help If you’re experiencing abdominal pain that’s gradually getting worse, contact your GP or local out-of-hours service immediately. If these options aren’t available, phone NHS 24’s 111 service for advice. You should phone 999 for an ambulance if you have sudden pain that continues to get worse and spreads across your abdomen. These are signs your appendix may have burst, which can lead to potentially life-threatening complications. Read more about: diagnosing appendicitis complications of appendicitis How appendicitis is treated In most cases of appendicitis, the appendix needs to be surgically removed as soon as possible. Removal of the appendix, known as an appendectomy or appendicectomy, is one of the most


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appendix needs to be surgically removed as soon as possible. Removal of the appendix, known as an appendectomy or appendicectomy, is one of the most common operations in the UK and its success rate is excellent. The operation is most commonly performed as keyhole surgery (laparoscopy), which involves making several small cuts in your abdomen, through which special surgical instruments are inserted. Open surgery, where a larger, single cut is made in the abdomen, is usually carried out if the appendix has burst or access is more difficult. Most people make a full recovery from an appendectomy in a couple of weeks, although strenuous activities may need to be avoided for up to 6 weeks after open surgery. Read more about treating appendicitis. What causes appendicitis? It’s not exactly clear what the causes of appendicitis are. Most cases are thought to occur when something blocks the entrance of the appendix. For example, a blockage may be formed by a small piece of faeces or an upper


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are thought to occur when something blocks the entrance of the appendix. For example, a blockage may be formed by a small piece of faeces or an upper respiratory tract infection could lead to a swollen lymph node within the wall of the bowel. This obstruction leads to the development of inflammation and swelling. The pressure caused by the swelling can then lead to the appendix bursting. As the causes aren’t fully understood, there’s no guaranteed way of preventing appendicitis. Who’s affected? Appendicitis is a common condition. It’s estimated around 1 in every 13 people develop it at some point in their life. Appendicitis can develop at any age, but it’s most common in young people aged from 10 to 20 years old. Symptoms of appendicitis Appendicitis typically starts with a pain in the middle of your tummy (abdomen) that may come and go. Within hours, the pain travels to your lower right-hand side, where the appendix is usually located, and becomes constant and severe. Pressing on


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go. Within hours, the pain travels to your lower right-hand side, where the appendix is usually located, and becomes constant and severe. Pressing on this area, coughing, or walking may all make the pain worse. If you have appendicitis, you may also have other symptoms, including: feeling sick (nausea) being sick loss of appetite diarrhoea a high temperature (fever) and a flushed face When to get medical help If you’re experiencing abdominal pain that’s gradually getting worse, contact your GP or local out-of-hours service immediately. If these options aren’t available, phone NHS 24 111 Service for advice. Appendicitis can easily be confused with something else, such as: gastroenteritis severe irritable bowel syndrome (IBS) constipation bladder or urine infections Crohn’s disease pelvic infection In young women, these symptoms can sometimes have a gynaecological cause, such as an ectopic pregnancy or menstrual pain. However, any condition that causes constant stomach pain requires


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have a gynaecological cause, such as an ectopic pregnancy or menstrual pain. However, any condition that causes constant stomach pain requires urgent medical attention. You should phone 999 for an ambulance if you get a pain that suddenly becomes worse and spreads across your abdomen. These are signs your appendix may have burst. If the appendix bursts, it can cause peritonitis, a potentially serious infection of the inner lining of the abdomen. Read more about the complications of appendicitis. Diagnosing appendicitis Appendicitis can be tricky to diagnose unless you have the typical symptoms, which are only present in about half of all cases. Also, some people’s appendixes may be located in a slightly different part of their body, such as: the pelvis behind the large intestine around the small bowel near the right lower part of the liver Some people develop pain similar to appendicitis, but it’s caused by something else, such as: gastroenteritis severe irritable bowel syndrome (IBS)


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Some people develop pain similar to appendicitis, but it’s caused by something else, such as: gastroenteritis severe irritable bowel syndrome (IBS) constipation a bladder or urine infection Your GP will ask about your symptoms, examine your abdomen, and see if the pain gets worse when pressure is applied to the appendix area (your lower right-hand side). If your symptoms are typical of appendicitis, this is normally enough for your GP to make a confident diagnosis. In this case, you’ll immediately be referred to hospital for treatment. Further tests If your symptoms aren’t typical, further tests may be required in hospital to confirm the diagnosis and rule out other conditions. Further tests may involve: a blood test to look for signs of infection a pregnancy test for women a urine test to rule out other conditions, such as a bladder infection an ultrasound scan to see if the appendix is swollen a computerised tomography (CT) scan It can sometimes take time to get test results. Your


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an ultrasound scan to see if the appendix is swollen a computerised tomography (CT) scan It can sometimes take time to get test results. Your surgeon may recommend a laparoscopy to inspect your appendix and pelvic organs if the diagnosis is still uncertain. You’ll usually be advised to have your appendix removed if appendicitis is suspected, rather than run the risk of it bursting. This means some people will have their appendix removed even though it’s eventually found to be normal. In some cases where a diagnosis is not certain, a doctor may recommend waiting up to 24 hours to see if your symptoms improve, stay the same, or get worse. If your doctor suspects your appendix has burst, you’ll be sent to hospital immediately for treatment. Read more about treating appendicitis. Treating appendicitis If you have appendicitis, your appendix usually needs to be removed as soon as possible. This operation is known as an appendectomy or appendicectomy. Surgery is usually also recommended if


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usually needs to be removed as soon as possible. This operation is known as an appendectomy or appendicectomy. Surgery is usually also recommended if there’s a chance you have appendicitis but it’s not been possible to make a clear diagnosis. This is because it’s considered safer to remove the appendix than run the risk of the appendix bursting. In humans, the appendix doesn’t perform any important function and having it removed doesn’t cause any long-term problems. The procedure Appendectomies are carried out under general anaesthetic using either a keyhole or open technique. Keyhole surgery Keyhole surgery (laparoscopy) is usually the preferred method of removing the appendix because the recovery tends to be quicker than with open surgery. This operation involves making 3 or 4 small cuts (incisions) in your tummy (abdomen). Special instruments are then inserted, including: a tube that gas is pumped through to inflate your abdomen – this allows the surgeon to see your appendix more


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are then inserted, including: a tube that gas is pumped through to inflate your abdomen – this allows the surgeon to see your appendix more clearly and gives them more room to work a laparoscope – a small tube containing a light source and a camera, which relays images of the inside of the abdomen to a television monitor small surgical tools used to remove the appendix Once the appendix has been removed, the incisions will usually be closed with dissolvable stitches. Regular stitches may also be used, which need to be removed at your GP surgery 7 to 10 days later. Open surgery In some circumstances, keyhole surgery isn’t recommended and open surgery is performed instead. These include: when the appendix has already burst and formed a lump called an appendix mass when the surgeon isn’t very experienced in laparoscopic removal people who have previously had open abdominal surgery In these cases, the operation involves making a single larger cut in the lower right-hand side of your


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who have previously had open abdominal surgery In these cases, the operation involves making a single larger cut in the lower right-hand side of your abdomen to remove the appendix. When there’s widespread peritonitis – infection of the inner lining of the abdomen – it’s sometimes necessary to operate through a long cut along the middle of the abdomen in a procedure called a laparotomy. As with keyhole surgery, the incision is closed using either dissolvable stitches or regular stitches that need to be removed at a later date. After both types of surgery, the removed appendix is routinely sent to a laboratory to check there are no signs of cancer. This is a precautionary measure, although it’s rare for a serious problem to be found. Recovery One of the main advantages of keyhole surgery is the recovery time tends to be short and most people can leave hospital a few days after the operation. If the appendix is operated upon promptly, most patients can go home within 24 hours. With open


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can leave hospital a few days after the operation. If the appendix is operated upon promptly, most patients can go home within 24 hours. With open or complicated surgery – for example, if you have peritonitis – it may take up to a week before you’re well enough to go home. For the first few days after the operation you’re likely to experience some pain and bruising. This improves over time, but you can take painkillers if necessary. If you had keyhole surgery, you may experience pain in the tip of your shoulder for about a week. This is caused by the gas that was pumped into the abdomen during the operation. You may also experience some short-term constipation. You can help reduce this by not taking codeine painkillers, eating plenty of fibre, and staying well hydrated. Your GP can prescribe medication if the problem is particularly troublesome. Before leaving hospital, you’ll be advised about caring for your wound and what activities you should avoid. In most cases, you can return to


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Before leaving hospital, you’ll be advised about caring for your wound and what activities you should avoid. In most cases, you can return to normal activities in a couple of weeks, although more strenuous activities may need to be avoided for 4 to 6 weeks after open surgery. When to seek medical advice While you recover, it’s important to keep an eye out for signs of any problems. Contact the hospital unit where the appendectomy was performed or your GP for advice if you notice: increasing pain and swelling you start vomiting repeatedly a high temperature (fever) any discharge coming from the wound the wound is hot to touch These symptoms could be a sign of infection. Risks Appendectomies are one of the most commonly performed operations in the UK, and serious or long-term complications are rare. However, like all types of surgery, there are some risks. These include: antibiotics may be given before, during, or after the operation to minimise the risk of serious infections bleeding


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are some risks. These include: antibiotics may be given before, during, or after the operation to minimise the risk of serious infections bleeding under the skin that causes a firm swelling (haematoma) – this usually gets better on its own, but you should see your GP if you’re concerned scarring – both surgical techniques will leave some scarring where the incisions were made a collection of pus (abscess) – in rare cases, an infection caused by the appendix bursting can lead to an abscess after surgery hernia – at the site of the open incision or any of the incisions used in the laparoscopic approach The use of general anaesthetic also carries some risks, such as the risk of an allergic reaction or inhaling stomach contents, leading to pneumonia. However, serious complications like this are very rare. Alternatives to emergency surgery In some cases, appendicitis can lead to the development of a lump on the appendix called an appendix mass. This lump, consisting of appendix and fatty


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some cases, appendicitis can lead to the development of a lump on the appendix called an appendix mass. This lump, consisting of appendix and fatty tissue, is an attempt by the body to deal with the problem and heal itself. If an appendix mass is found during an examination, your doctors may decide it’s not necessary to operate immediately. Instead, you’ll be given a course of antibiotics and an appointment will be made for an appendectomy a few weeks later, when the mass has settled. Another possible alternative to immediate surgery is the use of antibiotics to treat appendicitis. However, studies have looked into whether antibiotics could be an alternative to surgery and as yet there isn’t enough clear evidence to suggest this is the case. Complications of appendicitis If appendicitis isn’t treated, the appendix can burst and cause potentially life-threatening infections. Phone 999 for an ambulance if you have abdominal (tummy) pain that suddenly gets much worse and spreads across


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life-threatening infections. Phone 999 for an ambulance if you have abdominal (tummy) pain that suddenly gets much worse and spreads across your abdomen. These are signs your appendix may have burst. Peritonitis If your appendix bursts, it releases bacteria into other parts of the body. This can cause a condition called peritonitis if the infection spreads to the peritoneum, the thin layer of tissue that lines the inside of the abdomen. Symptoms of peritonitis can include: severe continuous abdominal pain feeling sick or being sick a high temperature (fever) a rapid heartbeat shortness of breath with rapid breathing swelling of the abdomen If peritonitis isn’t treated immediately, it can cause long-term problems and may even be fatal. Treatment for peritonitis usually involves antibiotics and the surgical removal of the appendix (appendectomy). Abscesses Sometimes an abscess forms around a burst appendix. This is a painful collection of pus that occurs as a result of the body’s


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Abscesses Sometimes an abscess forms around a burst appendix. This is a painful collection of pus that occurs as a result of the body’s attempt to fight the infection. It can also occur as a complication of surgery to remove the appendix in about 1 in 500 cases. Abscesses can sometimes be treated using antibiotics, but in the vast majority of cases the pus needs to be drained from the abscess. This can be carried out under ultrasound or computerised tomography (CT) guidance using local anaesthetic and a needle inserted through the skin, followed by the placement of a drain. If an abscess is found during surgery, the area is carefully washed out and a course of antibiotics is given. Source: NHS 24 - Opens in new browser window Last updated: 04 July 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message


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been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Also on NHS inform Self-help guide: Abdominal pain NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions-that-can-affect-multiple-parts-of-the-body/arthritis/


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Arthritis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions that can affect multiple parts of the body Arthritis Arthritis Arthritis is a common condition that causes pain and inflammation in a joint. It affects people of all ages, including children. Types of arthritis The 2 most common types of arthritis are: osteoarthritis rheumatoid arthritis Other types of arthritis include: ankylosing spondylitis gout psoriatic arthritis enteropathic arthritis reactive arthritis secondary arthritis Other conditions related to arthritis include: cervical spondylosis fibromyalgia lupus polymyalgia rheumatica Arthritis in children Arthritis is often associated with older people, but it can also affect children. Most types of childhood arthritis are known as juvenile idiopathic arthritis (JIA). JIA causes pain and inflammation in


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it can also affect children. Most types of childhood arthritis are known as juvenile idiopathic arthritis (JIA). JIA causes pain and inflammation in one or more joints for at least 6 weeks. Although the exact cause of JIA is unknown, the symptoms often improve as a child gets older. This means they can lead a normal life. Further information on arthritis in children from Versus Arthritis Symptoms of arthritis Your symptoms will vary depending on the type of arthritis you have. Speak to your GP practice if you have: joint pain tenderness in the joints stiffness in the joints inflammation in and around the joints restricted movement in the joints warm, red skin on your joints weakness and muscle wasting Treatment for arthritis There’s no cure for arthritis, but there are many treatments that can help manage the condition. The best treatment for you will depend on what type of arthritis you have. Often, you will need a combination of treatments to help manage arthritis. Some common


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for you will depend on what type of arthritis you have. Often, you will need a combination of treatments to help manage arthritis. Some common treatments for arthritis include: painkillers non-steroidal anti-inflammatory drugs (NSAIDs) corticosteroids disease modifying anti-rheumatic drugs (DMARDs) physiotherapy regular exercise In severe cases, surgery may be recommended. This includes: joint replacement joint fusion osteotomy (where a bone is cut and re-aligned) Further information on treatments for arthritis from Versus Arthritis Occupational therapy An Occupational Therapist can help if you have severe arthritis that affects your: ability to move around your home carry out everyday tasks, like cooking and cleaning They can tell you about equipment you may need to help you live independently. Depending on the type of arthritis, your GP may be able to refer you to an NHS Occupational Therapist. Further information on Occupational Therapy How to protect your joints If you have


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your GP may be able to refer you to an NHS Occupational Therapist. Further information on Occupational Therapy How to protect your joints If you have arthritis, it’s important to look after your joints to prevent more damage. Do use larger, stronger joints as levers – for example, take the pressure of opening a heavy door on your shoulder rather than on your hand use several joints to spread the weight of an object – for example, use both hands to carry your shopping try to avoid gripping too tightly – grip as loosely as possible or use a padded handle to widen your grip try to avoid sitting in the same position for long periods of time – take regular breaks so you can move around How to do tasks at home If you have arthritis, carrying out tasks around the home can be a challenge. But, making some practical changes to your home and changing the way you work should make things easier. Do keep things in easy reach use a hand rail to help you get up and down the stairs use long-handled


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the way you work should make things easier. Do keep things in easy reach use a hand rail to help you get up and down the stairs use long-handled tools to pick things up or to clean fit levers to taps to make them easier to turn use electric kitchen equipment, like tin openers, when preparing food Living with arthritis Living with arthritis isn’t easy. Carrying out simple, everyday tasks can often be painful and difficult. But, there are many things you can do to make sure you live a healthy lifestyle. Work Many people with arthritis want to continue to work for many reasons. For example, for better financial security and higher self-esteem. You may find work challenging, but your employer should help you get the training and support you need. Speak to your line manager or HR department about your condition to get the right support. Treatment can also help you return to work after being diagnosed with arthritis. If your arthritis is so severe that you’re unable to work, help is


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Treatment can also help you return to work after being diagnosed with arthritis. If your arthritis is so severe that you’re unable to work, help is available. For example, the Personal Independence Payment. Further information on work and arthritis from Versus Arthritis Diet It’s very important to eat a healthy, balanced diet if you have arthritis. Eating healthily will give you all the nutrients you need and help you maintain a healthy weight. Your diet should include a variety of foods from all 5 food groups. These are: fruit and vegetables starchy foods – like bread, rice, potatoes and pasta meat, fish, eggs and beans milk and dairy foods foods containing fat and sugar Further information on a healthy, balanced diet Managing your weight If you’re overweight, losing weight can help you cope with arthritis. Too much weight places excess pressure on the joints in your hips, knees, ankles and feet. This can lead to more pain and mobility problems. Further information on managing your


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pressure on the joints in your hips, knees, ankles and feet. This can lead to more pain and mobility problems. Further information on managing your weight Exercise If your arthritis is painful, you may not feel like exercising. But, being active can help reduce and prevent pain. Alongside a healthy diet, regular exercise can help you lose weight which will place less strain on your joints. Regular exercise can also: improve the range of movement in your joints improve joint mobility increase muscle strength reduce stiffness boost your energy As long as you do the right type and level of exercise for your condition, your arthritis won’t get any worse. Speak to your GP for advice about the type and level of exercise that’s right for you. Further information on exercising with arthritis from Versus Arthritis Telecare Self-Check online tool The Telecare Self-Check online tool can help you find the right support for you in your area. Source: Scottish Society for Rheumatology - Opens in new


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Telecare Self-Check online tool can help you find the right support for you in your area. Source: Scottish Society for Rheumatology - Opens in new browser window Last updated: 07 February 2025 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Also on NHS inform Support for people waiting on hip or knee replacement surgery Other health sites National Rheumatoid Arthritis Society The Pain Toolkit Versus Arthritis NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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Asthma | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Lungs and airways Asthma Asthma Asthma is a long-term condition caused by inflammation of the airways in the lungs. You can develop asthma at any age. Symptoms of asthma Symptoms include: coughing wheezing chest tightness breathlessness Symptoms can vary from person to person. They’re often worse at night and early in the morning, or with certain triggers. Asthma is well controlled in most people most of the time. It shouldn’t restrict your daily life (including your sleep) in any way. You should work with your healthcare professionals to help control your asthma. When to get medical advice Phone 999 or go to A&E if: You have asthma and: you have severe difficulty breathing – for example, you struggle to speak without pausing, gasping or choking you have severe chest pain in the middle of your


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severe difficulty breathing – for example, you struggle to speak without pausing, gasping or choking you have severe chest pain in the middle of your chest that isn’t going away – it may feel like pressure, tightness or squeezing you have pain that spreads to your arms, back, neck and jaw you feel more drowsy than usual or find it more difficult to wake up your lips or skin are turning pale, blue or grey – on brown or black skin this is easier to see on the palms of your hands Your child has asthma and: their lips or skin are turning pale, blue or grey – on brown or black skin this is easier to see on the palms of their hands is breathing fast or stops or pauses has severe difficulty breathing – they may make grunting noises or suck their stomach in under their ribcage is pulling in at their throat area (tracheal tug) or their windpipe is more prominent is limp, floppy or not responding like they normally do – they may find it difficult to focus on you or are more difficult to wake up


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more prominent is limp, floppy or not responding like they normally do – they may find it difficult to focus on you or are more difficult to wake up than usual Contact your GP practice urgently if you or your child: are more short of breath than usual, whilst using your inhalers as prescribed have pain when breathing in or coughing are feeling confused, dizzy, or lightheaded have a tight chest that is tighter than usual feel sick or are being sick – for example, you can’t keep food or fluids down are coughing up blood (haemoptysis) have pain or swelling in 1 of your legs have heart palpitations – this may feel like your heart is racing, going too slowly or skipping a beat or like a fluttering feeling in your chest If your GP practice is closed, phone 111. Speak to your GP practice if you or your child: have symptoms that are not improving have asthma and your symptoms are affecting your daily life have had a cough for more than 3 weeks What to do if you’re having an asthma attack Take


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have asthma and your symptoms are affecting your daily life have had a cough for more than 3 weeks What to do if you’re having an asthma attack Take 1 to 2 puffs of your reliever inhaler (usually blue) immediately. Use a spacer if you have one. If it is 2 puffs, these should be 1 at a time. Sit down and try to take slow, steady breaths. If you do not start to feel better, take 1 puff of your reliever inhaler every 1 minute. You can take up to 10 puffs. This is easier using a spacer if you have one. If you do not feel better after taking your inhaler or if you’re worried, phone 999. If an ambulance does not arrive within 10 minutes and you’re still feeling unwell, repeat step 3. Your inhaler could be empty. Change to another inhaler if you can to check if it helps. If your symptoms improve and you do not need to phone 999, you still need to see a doctor or asthma nurse within 24 hours. Diagnosing asthma If you have symptoms of asthma, your GP may ask you: when your symptoms happen how


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to see a doctor or asthma nurse within 24 hours. Diagnosing asthma If you have symptoms of asthma, your GP may ask you: when your symptoms happen how often you get symptoms if you have noticed any triggers if you have eczema or hay fever Tests Tests you may be offered include: spirometry – where you breathe into a machine to check how well your lungs work peak expiratory flow test – uses a small hand-held device to measure how fast you can blow air out of your lungs in one breath airways responsiveness – measures how your airways react when they come into contact with a trigger testing airway inflammation – either with a mucus sample or measuring your nitric oxide concentration (a high level can be a sign of airway inflammation) allergy tests – to check if your asthma is linked to allergies like dust mites, pollen, or food Treatment for asthma There is no cure for asthma but there are treatments that can help: prevent future symptoms and attacks relieve your symptoms Most people will


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asthma There is no cure for asthma but there are treatments that can help: prevent future symptoms and attacks relieve your symptoms Most people will take medications once or twice daily, usually using an inhaler. Your nurse, doctor or pharmacist will teach you how to properly use your inhaler. Watch Asthma + Lung UK’s videos on how to use your inhaler Finding and avoiding your possible triggers is also important. Some treatments may have side effects. Personal asthma action plan If you’re diagnosed with asthma, your healthcare professional will agree a personal asthma action plan with you. This could include information like: the medicines you need to take how to recognise when your symptoms are getting worse what to do if your symptoms get worse Your personal asthma action plan should be reviewed with your nurse, doctor or pharmacist at least once a year. If your symptoms are severe, it can be reviewed more regularly. Reliever inhalers Reliever inhalers – may be a blue inhaler or a


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least once a year. If your symptoms are severe, it can be reviewed more regularly. Reliever inhalers Reliever inhalers – may be a blue inhaler or a combination inhaler – help asthma symptoms quickly, usually within 3 to 5 minutes. They widen your airways, making it easier to breathe again. It’s a short-lived medication and will last for around 4 hours. Everyone with asthma should be given a reliever inhaler which may be blue or may be a combination inhaler that you usually use for maintenance treatment. If your asthma is well controlled, you should rarely need to use an extra reliever. Preventer inhalers Preventer inhalers work over time to reduce the inflammation and sensitivity of your airways. They reduce the chances of asthma attacks. They must be used regularly (usually twice a day) to keep asthma under control. It can take a while for your preventer inhaler to work fully. You may still occasionally need to use reliever doses of your blue inhaler or the combination


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take a while for your preventer inhaler to work fully. You may still occasionally need to use reliever doses of your blue inhaler or the combination preventer-reliever inhaler. If you smoke, preventer inhalers may not work as well for you. Combination inhalers If using reliever and preventer inhalers does not control your asthma, you may need an inhaler that combines both. Combination inhalers are used every day to help stop symptoms occurring and provide long-lasting relief if they do occur. Some combination inhalers can also be used as relievers as well as being your usual preventer treatment. This is referred to as MART (Maintenance and reliver Treatment) or AIR (Anti-inflammatory reliever) treatment. It’s important to use it regularly, even if you do not have symptoms. Used inhalers There is no recycling scheme available for used inhalers. You should return all your used or expired inhalers to your community pharmacy for safe disposal. Spacers should be replaced each year if used


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You should return all your used or expired inhalers to your community pharmacy for safe disposal. Spacers should be replaced each year if used regularly. Old spacers go into the household bin. Inhalers and the environment Using your preventer inhaler correctly and keeping your symptoms under control is good for your health and the environment. Some inhalers have a lower carbon footprint and are better for the environment than others. The best inhaler is one that works well for you. Speak to your healthcare professional about whether lower global warming potential inhalers would be right for you. Other preventer medicines If your asthma isn’t controlled by using inhalers alone, you may be prescribed: Montelukast – tablets that block part of the chemical reaction involved in the swelling (inflammation) of the airways theophyllines – tablets that help widen the airways by relaxing the muscles around them, and are also relatively weak anti-inflammatory agents biological treatments Oral


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that help widen the airways by relaxing the muscles around them, and are also relatively weak anti-inflammatory agents biological treatments Oral steroids If your asthma is still not under control, you may be prescribed a short course of oral steroid tablets or, more rarely, regular steroid tablets. This treatment should be monitored by a hospital asthma specialist. Long-term use of oral steroids has serious possible side effects, so they’re only used once other treatments have been tried. Your healthcare professional should talk about the risks and benefits with you. You should be given a steroid treatment card by your healthcare professional. Complementary therapies Breathing exercises can improve symptoms and reduce the need for reliever medicines in some people. These include breathing exercises taught by a physiotherapist and yoga. Breathing and relaxation exercises What causes asthma? It’s not clear exactly what causes asthma. It’s likely to be a combination of factors. You’ve a


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and relaxation exercises What causes asthma? It’s not clear exactly what causes asthma. It’s likely to be a combination of factors. You’ve a higher chance of having asthma if you have: an allergy such as eczema, allergic rhinitis, food allergy or hay fever a family history of asthma or other similar conditions bronchiolitis (a common childhood lung infection) as a child childhood exposure to tobacco smoke, particularly if your mother also smoked during pregnancy been born prematurely, especially if you needed a ventilator to support your breathing after birth a low birth weight as a result of restricted growth within the womb Some people may also be at risk of developing asthma through their job. Triggers An asthma trigger is something that irritates your lungs. When you come into contact with a trigger your airways narrow, the muscles around them tighten, and you make more sticky mucus (phlegm). Common asthma triggers include: infections in the upper airways like colds and the flu


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around them tighten, and you make more sticky mucus (phlegm). Common asthma triggers include: infections in the upper airways like colds and the flu dust mites animal fur feathers pollen cigarette smoke chemical fumes pollution exercise mould or damp emotions – including stress or laughing food allergies certain weather non-steroidal anti-inflammatory drugs (NSAIDs), like aspirin and ibuprofen beta-blockers sometimes given for high blood pressure or some types of heart disease foods containing sulphites – such as concentrated fruit juice, jam, prawns and many processed or pre-cooked meals Asthma may also be triggered by allergens or chemicals breathed in at work. Speak to your GP if you think your symptoms are worse at work and get better on holiday. You may be able to help your symptoms by avoiding your asthma triggers. Living with asthma Exercising with asthma Speak to your nurse, doctor or pharmacist if you have asthma symptoms during or after exercise. They may review your asthma


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Exercising with asthma Speak to your nurse, doctor or pharmacist if you have asthma symptoms during or after exercise. They may review your asthma plan to make sure your symptoms are under control. They may also advise that you: make sure the people you’re exercising with know you have asthma increase your fitness levels slowly always have your reliever inhaler (usually blue) with you when you exercise always warm up and cool down If you have symptoms while you’re exercising, stop, take your reliever inhaler, and wait until you feel better before starting again. Read further information about keeping active Pregnancy, periods, menopause and asthma Hormones can change asthma symptoms. For example, around the time of your period, during menopause, and during pregnancy. You should continue to manage your asthma in the same way. Make sure your asthma is well controlled during pregnancy. Most medicines used for asthma are safe to take during pregnancy and when breastfeeding. You should not


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asthma is well controlled during pregnancy. Most medicines used for asthma are safe to take during pregnancy and when breastfeeding. You should not take leukotriene receptor antagonists if you’re pregnant, unless advised to by a healthcare professional. Source: Scottish Government - Opens in new browser window Last updated: 18 February 2025 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Also on NHS inform Allergies Breathing and relaxation exercises Keeping active Quit Your Way Scotland Other health sites Asthma + Lung UK: Asthma Asthma + Lung UK: Asthma treatments Asthma + Lung UK: Inhaler choices Asthma + Lung UK: How inhalers affect the environment Allergy UK: Asthma SIGN: Asthma NHS inform About NHS inform Editorial policy Contact


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choices Asthma + Lung UK: How inhalers affect the environment Allergy UK: Asthma SIGN: Asthma NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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Atopic eczema | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Skin, hair and nails Atopic eczema Atopic eczema About atopic eczema Symptoms of atopic eczema Causes of atopic eczema Diagnosing atopic eczema Treating atopic eczema Complications of atopic eczema About atopic eczema Atopic eczema, also known as atopic dermatitis, is the most common form of eczema. It mainly affects children, but can also affect adults. Eczema is a condition that causes the skin to become itchy, red, dry and cracked. It is a long-term (chronic) condition in most people, although it can improve over time, especially in children. Atopic eczema can affect any part of the body, but the most common areas to be affected are: backs or fronts of the knees outside or inside of the elbows around the neck hands cheeks scalp People with atopic eczema usually have periods when


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backs or fronts of the knees outside or inside of the elbows around the neck hands cheeks scalp People with atopic eczema usually have periods when symptoms are less noticeable, as well as periods when symptoms become more severe (flare-ups). Read more about the symptoms of atopic eczema and diagnosing atopic eczema. Atopic eczema causes itchy, red, dry and cracked skin.Source: https://dermnetnz.org/ What causes atopic eczema? The exact cause of atopic eczema is unknown, but it’s clear it’s not down to one single thing. It often occurs in people who get allergies – “atopic” means sensitivity to allergens. It can run in families, and often develops alongside other conditions, such as asthma and hay fever. The symptoms of atopic eczema often have certain triggers, such as soaps, detergents, stress and the weather. Sometimes food allergies can play a part, especially in young children with severe eczema. Read more about the causes of atopic eczema. Treating atopic eczema There is


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can play a part, especially in young children with severe eczema. Read more about the causes of atopic eczema. Treating atopic eczema There is currently no cure for atopic eczema, but treatment can help relieve the symptoms and many cases improve over time. However, severe eczema often has a significant impact on daily life and may be difficult to cope with physically and mentally. There is also an increased risk of skin infections. Many different treatments can be used to control symptoms and manage eczema, including: self care techniques, such as reducing scratching and avoiding triggers emollients (moisturising treatments) – used on a daily basis for dry skin topical corticosteroids– used to reduce swelling, redness and itching during flare-ups When to get professional advice Pharmacy First Scotland: Atopic eczema treatment from your pharmacyIf you have atopic eczema or symptoms of atopic eczema you can get advice and treatment directly from a pharmacy. Find your local pharmacy on


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pharmacyIf you have atopic eczema or symptoms of atopic eczema you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotland’s Service Directory.Search for a pharmacy near you Atopic eczema isn’t usually serious and can be treated by a pharmacist. Your pharmacist may recommend that you contact your GP practice if required. Read more about treating atopic eczema and the complications of atopic eczema. Who is affected? About 1 in 5 children in the UK has atopic eczema. In 8 out of 10 cases, the condition develops before a child reaches the age of 5. Many children develop it before their first birthday. Atopic eczema can improve significantly, or even clear completely, in some children as they get older. About half of all cases improve a lot by the time a child reaches 11 years, and around two-thirds improve by the age of 16. However, the condition can continue into adulthood and can sometimes develop for the first time in adults. Symptoms of atopic


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by the age of 16. However, the condition can continue into adulthood and can sometimes develop for the first time in adults. Symptoms of atopic eczema Atopic eczema causes areas of skin to become itchy, dry, cracked, sore and red. There will usually be periods where the symptoms improve, followed by periods where they get worse (flare-ups). Flare-ups may occur as often as 2 or 3 times a month. Atopic eczema can occur all over the body, but is most common on the hands (especially fingers), the insides of the elbows or backs of the knees, and the face and scalp in children. The face is more commonly involved in adults. The severity of atopic eczema can vary a lot from person to person. People with mild eczema may only have small areas of dry skin that are occasionally itchy. In more severe cases, atopic eczema can cause widespread red, inflamed skin all over the body and constant itching. Scratching can disrupt your sleep, make your skin bleed, and cause secondary infections. It can


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inflamed skin all over the body and constant itching. Scratching can disrupt your sleep, make your skin bleed, and cause secondary infections. It can also make itching worse, and a cycle of itching and regular scratching may develop. This can lead to sleepless nights and difficulty concentrating at school or work. Areas of skin affected by eczema may also turn temporarily darker or lighter after the condition has improved. This is more noticeable in people with darker skin. It’s not a result of scarring or a side effect of steroid creams, but more of a “footprint” of old inflammation and will eventually return to its normal colour. Atopic eczema often occurs on the insides of the elbows.Source: https://dermnetnz.org/ Atopic eczema can occur on the face.Source: https://dermnetnz.org/ Signs of an infection Occasionally, areas of skin affected by atopic eczema can become infected. Signs of an infection can include: your eczema getting a lot worse fluid oozing from the skin a yellow crust


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by atopic eczema can become infected. Signs of an infection can include: your eczema getting a lot worse fluid oozing from the skin a yellow crust on the skin surface or small yellowish-white spots appearing in the eczema the skin becoming swollen and sore a high temperature (fever) and generally feeling unwell See your doctor as soon as possible if you think your or your child’s skin may have become infected. Read more about infections and other complications of atopic eczema. Causes of atopic eczema Atopic eczema is likely to be caused by a combination of things. People with atopic eczema often have very dry skin because their skin is unable to retain much moisture. This dryness may make the skin more likely to react to certain triggers, causing it to become red and itchy. You may be born with an increased likelihood of developing atopic eczema because of the genes you inherit from your parents. Research has shown children who have 1 or both parents with atopic eczema, or who have


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eczema because of the genes you inherit from your parents. Research has shown children who have 1 or both parents with atopic eczema, or who have other siblings with eczema, are more likely to develop it themselves. Atopic eczema is not infectious, so it cannot be passed on through close contact. Eczema triggers There are a number of things that may trigger your eczema symptoms. These can vary from person to person. Common triggers include: irritants – such as soaps and detergents, including shampoo, washing up liquid and bubble bath environmental factors or allergens– such as cold and dry weather, dampness, and more specific things such as house dust mites, pet fur, pollen and moulds food allergies– such as allergies to cows’ milk, eggs, peanuts, soya or wheat certain materials worn next to the skin – such as wool and synthetic fabrics hormonal changes – women may find their symptoms get worse in the days before their period or during pregnancy skin infections Some people also report


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changes – women may find their symptoms get worse in the days before their period or during pregnancy skin infections Some people also report their symptoms get worse when the air is dry or dusty, or when they are stressed, sweaty, or too hot or too cold. If you are diagnosed with atopic eczema, your pharmacist or GP will work with you to try to identify any triggers for your symptoms. Read more about diagnosing atopic eczema. Diagnosing atopic eczema Your GP will usually be able to diagnose atopic eczema by looking at your skin and asking questions about your symptoms. These questions may include asking: whether the rash is itchy and where it appears when the symptoms first began whether it comes and goes over time whether there is a history of atopic eczema in your family whether you have any other conditions, such as allergies or asthma You should tell your pharmacist or GP if your condition is affecting your quality of life – for example, if you have difficulty sleeping because of


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You should tell your pharmacist or GP if your condition is affecting your quality of life – for example, if you have difficulty sleeping because of itching, or your eczema limits your everyday activities. Checklist for diagnosing atopic eczema Typically, to be diagnosed with atopic eczema you should have had an itchy skin condition in the last 12 months and 3 or more of the following: visibly irritated red skin in the creases of your skin, such as the insides of your elbows or behind your knees (or on the cheeks, outsides of elbows, or fronts of the knees in children aged 18 months or under) at the time of examination by a health professional a history of skin irritation occurring in the same areas mentioned above generally dry skin in the last 12 months a history of asthma or hay fever– children under 4 must have an immediate relative, such as a parent, brother or sister, who has one of these conditions the condition started before the age of 2 (this does not apply to children under


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such as a parent, brother or sister, who has one of these conditions the condition started before the age of 2 (this does not apply to children under the age of 4) Establishing triggers Your pharmacist should work with you to establish if any triggers make your eczema worse. You may be asked about your diet and lifestyle to see if something obvious may be contributing to your symptoms. For example, you may have noticed some soaps or shampoos make the eczema worse. You may also be asked to keep a food diary to try to determine whether a specific food makes your symptoms worse. A food diary involves writing down everything you eat and making a record of any eczema flare-ups you have. Your pharmacist can then use the diary to see if there is a pattern between your symptoms and what you eat. Allergy tests are not usually needed to identify triggers, although they are sometimes helpful in identifying food allergies that may be triggering symptoms in young children or in those where a food


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although they are sometimes helpful in identifying food allergies that may be triggering symptoms in young children or in those where a food allergy is suspected. Read more about triggers and causes of atopic eczema. Treating atopic eczema There is no cure for atopic eczema, but treatments can ease the symptoms. Many children find their symptoms naturally improve as they get older. The main treatments for atopic eczema are: emollients (moisturisers) – used every day to stop the skin becoming dry topical corticosteroids– creams and ointments used to reduce swelling and redness during flare-ups Other treatments include topical pimecrolimus or tacrolimus for eczema in sensitive sites not responding to simpler treatment, antihistamines for severe itching, bandages or special body suits to allow the body to heal underneath, or more powerful treatments offered by a dermatologist (skin specialist). The various treatments for atopic eczema are outlined below. Self care As well as the


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treatments offered by a dermatologist (skin specialist). The various treatments for atopic eczema are outlined below. Self care As well as the treatments mentioned above, there are things you can do yourself to help ease your symptoms and prevent further problems. Try to reduce the damage from scratching Eczema is often itchy and it can be very tempting to scratch the affected areas of skin. But scratching usually damages the skin, which can itself cause more eczema to occur. The skin eventually thickens into leathery areas as a result of chronic scratching. Deep scratching also causes bleeding and increases the risk of your skin becoming infected or scarred. Try to reduce scratching whenever possible. You could try gently rubbing your skin with your fingers instead. If your baby has atopic eczema, anti-scratch mittens may stop them scratching their skin. Keep your nails short and clean to minimise damage to the skin from unintentional scratching. Keep your skin covered with light


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their skin. Keep your nails short and clean to minimise damage to the skin from unintentional scratching. Keep your skin covered with light clothing to reduce damage from habitual scratching. Avoid triggers Your pharmacist will work with you to establish what might trigger the eczema flare-ups, although it may get better or worse for no obvious reason. Once you know your triggers, you can try to avoid them. For example: if certain fabrics irritate your skin, avoid wearing these and stick to soft, fine-weave clothing or natural materials such as cotton if heat aggravates your eczema, keep the rooms in your home cool, especially the bedroom avoid using soaps or detergents that may affect your skin – use soap substitutes instead Although some people with eczema are allergic to house dust mites, trying to rid your home of them isn’t recommended as it can be difficult and there is no clear evidence that it helps. Read more about preventing allergies. Dietary changes Some foods, such as


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as it can be difficult and there is no clear evidence that it helps. Read more about preventing allergies. Dietary changes Some foods, such as eggs and cows’ milk, can trigger eczema symptoms. However, you should not make significant changes to your diet without first speaking to your pharmacist or GP. It may not be healthy to cut these foods from your diet, especially in young children who need the calcium, calories and protein from these foods. If your GP suspects you have a food allergy, you may be referred to a dietitian (a specialist in diet and nutrition), who can help work out a way to avoid the food you’re allergic to while ensuring you still get all the nutrition you need. Alternatively, you may be referred to a hospital specialist such as an immunologist, dermatologist or paediatrician. If you are breastfeeding a baby with atopic eczema, get medical advice before making any changes to your regular diet. Emollients Emollients are moisturising treatments applied directly to


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eczema, get medical advice before making any changes to your regular diet. Emollients Emollients are moisturising treatments applied directly to the skin to reduce water loss and cover it with a protective film. They are often used to help manage dry or scaly skin conditions such as atopic eczema. In addition to making the skin feel less dry, they may also have a mild anti-inflammatory role, and can help reduce the number of flare-ups you have. Choosing an emollient Several different emollients are available. You may need to try a few to find one that works for you. You may also be advised to use a mix of emollients, such as: an ointment for very dry skin a cream or lotion for less dry skin an emollient to use instead of soap an emollient to add to bath water or use in the shower one emollient to use on your face and hands, and a different one to use on your body The difference between lotions, creams and ointments is the amount of oil they contain. Ointments contain the most oil so


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one to use on your body The difference between lotions, creams and ointments is the amount of oil they contain. Ointments contain the most oil so they can be quite greasy, but are the most effective at keeping moisture in the skin. Lotions contain the least amount of oil so are not greasy, but can be less effective. Creams are somewhere in between. If you have been using a particular emollient for some time, it may eventually become less effective or may start to irritate your skin. If this is the case, your pharmacist will be able to recommend another product that suits you better. The best emollient is the one you feel happy using every day. How to use emollients Use your emollient all the time, even if you are not experiencing symptoms. Many people find it helpful to keep separate supplies of emollients at work or school, or a tub in the bathroom and one in a living area. To apply the emollient: use a large amount don’t rub it in – smooth it into the skin in the same direction the


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the bathroom and one in a living area. To apply the emollient: use a large amount don’t rub it in – smooth it into the skin in the same direction the hair grows instead after a bath or shower, gently pat the skin dry and apply the emollient while the skin is still moist to keep the moisture in You should use an emollient at least twice a day if you can, or more often if you have very dry skin. During a flare-up, apply generous amounts of emollient more frequently, but remember to treat inflamed skin with a topical corticosteroid as emollients used on their own are not enough to control it. Don’t put your fingers into an emollient pot – use a spoon or pump dispenser instead, as this reduces the risk of infection. And never share your emollient with other people. Topical corticosteroids If your skin is sore and inflamed, your pharmacist may recommend a topical corticosteroid (applied directly to your skin), which can reduce the inflammation within a few days. Topical corticosteroids can


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recommend a topical corticosteroid (applied directly to your skin), which can reduce the inflammation within a few days. Topical corticosteroids can be prescribed in different strengths, depending on the severity of your atopic eczema and the areas of skin affected. They can be very mild (such as hydrocortisone), moderate (such as clobetasone butyrate), or even stronger (such as mometasone). If you need to use corticosteroids frequently, see your GP regularly so they can check the treatment is working effectively and you are using the right amount. How to use topical corticosteroids Don’t be afraid to apply the treatment to affected areas to control your eczema. Unless instructed otherwise by your doctor, follow the directions on the patient information leaflet that comes with your medication. This will give details of how much to apply. Most people will only have to apply it once a day as there is no evidence there is any benefit to applying it more often. When using a topical


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apply. Most people will only have to apply it once a day as there is no evidence there is any benefit to applying it more often. When using a topical corticosteroid: apply your emollient first and ideally wait around 30 minutes until the emollient has soaked into your skin, or apply the corticosteroid at a different time of day (such as at night) apply the recommended amount of the topical corticosteroid to the affected area continue to use it until 48 hours after the flare-up has cleared so the inflammation under the skin surface is treated Occasionally, your doctor may suggest using a topical corticosteroid less frequently, but over a longer period of time. This is designed to help prevent flare-ups. This is sometimes called “weekend treatment”, where a person who has already gained control of their eczema uses the topical corticosteroid every weekend on the trouble sites to prevent them becoming active again. Side effects Topical corticosteroids may cause a mild stinging sensation


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every weekend on the trouble sites to prevent them becoming active again. Side effects Topical corticosteroids may cause a mild stinging sensation for less than a minute as you apply them. In rare cases, they may also cause: thinning of the skin – especially if the strong steroids are used in the wrong places, such as the face, for too long (for example, several weeks) changes in skin colour – usually, skin lightening after many months of using very strong steroids, but most lightening after eczema is a “footprint” of old inflammation and nothing to do with treatments acne(spots) – especially when used on the face in teenagers increased hair growth Most of these side effects will improve once treatment stops. Generally, using a strong topical corticosteroid for many months, using them in sensitive areas such as the face, armpits or groin, or using a large amount will increase your risk of side effects. For this reason, you should be prescribed the weakest effective treatment to


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groin, or using a large amount will increase your risk of side effects. For this reason, you should be prescribed the weakest effective treatment to control your symptoms. Antihistamines Antihistamines are a type of medicine that blocks the effects of a substance in the blood called histamine. They can help relieve the itching associated with atopic eczema. They can either be sedating, which cause drowsiness, or non-sedating. If you have severe itching, your pharmacist may suggest trying a non-sedating antihistamine. If itching during a flare-up affects your sleep, your pharmacist may suggest taking a sedating antihistamine. Sedating antihistamines can cause drowsiness into the following day, so it may be helpful to let your child’s school know they may not be as alert as normal. Bandages and wet wraps In some cases, your GP may prescribe special medicated bandages, clothing or wet wraps to wear over areas of skin affected by eczema. These can either be used over emollients or with


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special medicated bandages, clothing or wet wraps to wear over areas of skin affected by eczema. These can either be used over emollients or with topical corticosteroids to prevent scratching, allow the skin underneath to heal, and stop the skin drying out. Corticosteroid tablets Corticosteroid tablets are rarely used to treat atopic eczema nowadays, but may occasionally be prescribed for short periods of 5 to 7 days to help bring particularly severe flare-ups under control. Longer courses of treatment are generally avoided because of the risk of potentially serious side effects. If your GP thinks your condition may be severe enough to benefit from repeated or prolonged treatment with corticosteroid tablets, they will probably refer you to a specialist. Seeing a specialist In some cases, your GP may refer you to a specialist in treating skin conditions (dermatologist). You may be referred if your GP is not sure what type of eczema you have, normal treatment is not your eczema, your


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skin conditions (dermatologist). You may be referred if your GP is not sure what type of eczema you have, normal treatment is not your eczema, your eczema is affecting your daily life, or it’s not clear what is causing it. A dermatologist may be able to offer the following: a thorough review of your existing treatment – to make sure you are using enough of the right things at the right times topical calcineurin inhibitors – creams and ointments that suppress your immune system, such as pimecrolimus and tacrolimus very strong topical corticosteroids bandages or wet wraps phototherapy – ultraviolet (UV) light that reduces inflammation immunosuppressant tablets – to suppress your immune system, such as azathioprine, ciclosporin and methotrexate alitretinoin – medicine to treat severe eczema affecting the hands in adults A dermatologist may also offer additional support to help you use your treatments correctly, such as demonstrations from nurse specialists, and they may be able to refer


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also offer additional support to help you use your treatments correctly, such as demonstrations from nurse specialists, and they may be able to refer you for psychological support if you feel you need it. Complications of atopic eczema People with atopic eczema can sometimes develop further physical and psychological problems. Bacterial skin infections As atopic eczema can cause your skin to become cracked and broken, there is a risk of the skin becoming infected with bacteria. The risk is higher if you scratch your eczema or do not use your treatments correctly. Signs of a bacterial infection can include: fluid oozing from the skin a yellow crust on the skin surface small yellowish-white spots appearing in the eczema the skin becoming swollen and sore a high temperature (fever) and generally feeling unwell Your normal symptoms may also get rapidly worse and your eczema may not respond to your regular treatments. You should see your doctor as soon as possible if you think your or your


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rapidly worse and your eczema may not respond to your regular treatments. You should see your doctor as soon as possible if you think your or your child’s skin may have become infected. They will usually prescribe antibiotic tablets, capsules or cream to treat the infection, as well as making sure the skin inflammation that led to the infection is well controlled. Speak to your pharmacist or GP if these don’t help or your symptoms get worse. Once your infection has cleared, your GP should prescribe new supplies of any creams and ointments you’re using to avoid contamination. Old treatments should be disposed of. Viral skin infections It’s also possible for eczema to become infected with the herpes simplex virus, which normally causes cold sores. This can develop into a serious condition called eczema herpeticum. Symptoms of eczema herpeticum include: areas of painful eczema that quickly get worse groups of fluid-filled blisters that break open and leave small, shallow open sores on


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include: areas of painful eczema that quickly get worse groups of fluid-filled blisters that break open and leave small, shallow open sores on the skin a high temperature and generally feeling unwell, in some cases Contact your doctor immediately if you think you or your child may have eczema herpeticum. If you cannot contact your GP, call NHS 111 or go to your nearest hospital. If you are diagnosed with eczema herpeticum, you will be given an antiviral medication called aciclovir. Psychological effects As well as affecting you physically, atopic eczema may also affect you psychologically. Preschool children with atopic eczema may be more likely to have behavioural problems such as hyperactivity than children who do not have the condition. They are also more likely to be more dependent on their parents. Bullying Schoolchildren may experience teasing or bullying if they have atopic eczema. Any kind of bullying can be traumatic and difficult for a child to deal with. Your child may


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teasing or bullying if they have atopic eczema. Any kind of bullying can be traumatic and difficult for a child to deal with. Your child may become quiet and withdrawn. Explain the situation to your child’s teacher and encourage your child to tell you how they are feeling. The National Eczema Society provides information about regional support groups, where you may be able to meet other people living with atopic eczema. Problems sleeping Sleep-related problems are common among people with eczema. A lack of sleep may affect mood and behaviour. It may also make it more difficult to concentrate at school or work. If your child has problems sleeping because of their eczema, they may fall behind with their schoolwork. It might help to let their teacher know about their condition so it can be taken into consideration. During a severe eczema flare-up, your child may need time off from school. This may also affect their ability to keep up with their studies. Self-confidence Atopic eczema can


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your child may need time off from school. This may also affect their ability to keep up with their studies. Self-confidence Atopic eczema can affect the self-confidence of both adults and children. Children may find it particularly difficult to deal with their condition, which may lead to them having a poor self-image. If your child is severely lacking in confidence, it may affect their ability to develop social skills. Support and encouragement will help boost your child’s self-confidence and give them a more positive attitude about their appearance. Speak to your GP if you are concerned your child’s eczema is severely affecting their confidence. They may benefit from specialist psychological support. Source: NHS 24 - Opens in new browser window Last updated: 13 January 2025 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g.


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You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Also on NHS inform Discoid eczema Varicose eczema Other health sites National Eczema Society: Discoid eczema National Eczema Society British Association of Dermatologists: Atopic eczema Search for a pharmacy near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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https://www.nhsinform.scot/illnesses-and-conditions/cardiovascular-disease/heart-disease/atrial-fibrillation/


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https://www.nhsinform.scot/illnesses-and-conditions/mental-health/attention-deficit-hyperactivity-disorder-adhd/


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Attention deficit hyperactivity disorder (ADHD) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Mental health Attention deficit hyperactivity disorder (ADHD) Attention deficit hyperactivity disorder (ADHD) Attention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms that include: difficulty concentrating and paying attention hyperactivity impulsiveness Symptoms of ADHD in children and teenagers Symptoms of ADHD tend to be noticed at an early age. They may become more noticeable when a child’s circumstances change, like when they start school. The main symptoms of ADHD in children and teenagers are: Inattentiveness The main signs of inattentiveness are: having a short attention span being easily distracted making careless mistakes appearing forgetful losing things being unable to stick at tedious or time-consuming tasks


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span being easily distracted making careless mistakes appearing forgetful losing things being unable to stick at tedious or time-consuming tasks appearing to be unable to listen to or carry out instructions constantly changing activity or task having difficulty organising tasks Hyperactivity and impulsiveness The main signs of hyperactivity and impulsiveness are: being unable to sit still, especially in quiet surroundings constantly fidgeting being unable to concentrate on tasks excessive physical movement excessive talking being unable to wait their turn acting without thinking interrupting conversations little or no sense of danger Symptoms of ADHD in adults If you’re an adult with ADHD, you may find that: you get easily distracted and find it hard to notice details, particularly with things you find boring it’s hard to listen to other people – you may find yourself finishing their sentences for them or interrupting them it’s hard to follow instructions you find it hard to organise


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people – you may find yourself finishing their sentences for them or interrupting them it’s hard to follow instructions you find it hard to organise yourself – you start a lot of things without ever finishing them you find it hard to wait you fidget and can’t sit still when there’s nothing much going on you’re forgetful and tend to lose or misplace things you easily get irritable, impatient or frustrated and lose your temper quickly you feel restless or edgy, have difficulty turning your thoughts off you find stress hard to handle you tend to do things on the spur of the moment, without thinking, which gets you into trouble Some people with ADHD have problems with inattentiveness, but not with hyperactivity or impulsiveness. Related conditions Some people might have other conditions alongside ADHD. Related conditions in children and teenagers with ADHD Some children may also have signs of other problems or conditions alongside ADHD, like: anxiety disorder oppositional defiant disorder


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with ADHD Some children may also have signs of other problems or conditions alongside ADHD, like: anxiety disorder oppositional defiant disorder (ODD) – this involves negative and disruptive behaviour, particularly towards figures of authority conduct disorder – this often involves antisocial behaviour, like stealing and harming people or animals depression sleep problems autistic spectrum disorder (ASD) epilepsy Tourette’s syndrome learning difficulties, like dyslexia The symptoms of ADHD can improve with age. Although many adults diagnosed with the condition at a young age continue to experience problems. Related conditions in adults with ADHD ADHD in adults can occur alongside several related problems or conditions. One of the most common conditions is depression. Other conditions that adults may have alongside ADHD include: personality disorders bipolar disorder obsessive-compulsive disorder (OCD) ADHD can also cause problems like difficulties with relationships and social


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disorders bipolar disorder obsessive-compulsive disorder (OCD) ADHD can also cause problems like difficulties with relationships and social interaction. Causes of ADHD The exact cause of ADHD isn’t fully understood. A combination of the following factors might be responsible: Genetics ADHD tends to run in families. The genes you you inherit from your parents are a factor in developing the condition. The way ADHD is inherited is complex and isn’t thought to be related to a single gene. Brain function and structure Research has identified some possible differences in the brains of people with ADHD. Some studies involving brain scans have suggested that certain areas of the brain may be a different size in people with ADHD. Other studies have suggested that people with ADHD may have a chemical imbalance in the brain. Or that some chemicals may not work properly. Groups at risk Certain people are also believed to be more at risk of ADHD, including people: who were born prematurely (before


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not work properly. Groups at risk Certain people are also believed to be more at risk of ADHD, including people: who were born prematurely (before the 37th week of pregnancy) or with a low birthweight with epilepsy with brain damage – which happened either in the womb or after a severe head injury later in life Diagnosing ADHD Speak to your GP if you think that you or your child may have ADHD. If you’re worried about your child, it may help to speak to their teachers before seeing your GP. This means you can find out if they have any concerns about your child’s behaviour. Your GP can’t formally diagnose ADHD. They can discuss your concerns with you and refer you for a specialist assessment, if necessary. Treating ADHD Treatment for ADHD can help relieve the symptoms. ADHD can be treated using medication or therapy. A combination of both is often best. Treatment is usually arranged by a specialist, like a paediatrician or psychiatrist. Treatment of ADHD might include: Medication


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both is often best. Treatment is usually arranged by a specialist, like a paediatrician or psychiatrist. Treatment of ADHD might include: Medication Medication might help you or your child concentrate better, be less impulsive and feel calmer. Therapy You might be offered therapy. This might be: psychoeducation behaviour therapy parent training education programmes cognitive behavioural therapy social skills training Further support The Scottish ADHD Coalition have information about local support groups in Scotland. Procrastintion Station are a Community Interest Company giving advice and support to adults with ADHD in Scotland. Last updated: 06 September 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Also on NHS inform Anxiety


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Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Also on NHS inform Anxiety Depression Autism spectrum disorder (ASD) Epilepsy Tourette's syndrome Bipolar disorder Obsessive compulsive disorder (OCD) Other health sites Mental Health Foundation: ADHD ADHD UK Scottish ADHD Coalition NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/neck-and-back-problems-and-conditions/back-problems/


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Bacterial vaginosis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Sexual and reproductive Bacterial vaginosis Bacterial vaginosis Bacterial vaginosis is not a sexually transmitted infection. It’s an imbalance of the usual bacteria found in the vagina. Symptoms of bacterial vaginosis Often there are no symptoms of bacterial vaginosis. Some women may notice a change in the normal discharge from the vagina. This discharge will usually be white or grey, thin or watery and have a strong, unpleasant fishy smell. This can be more noticeable during and after sex, and during periods. Bacterial vaginosis does not usually cause itching or irritation. What to do if you think you may have bacterial vaginosis Check if you could be triggering it with toiletries. Consider over the counter treatments from your pharmacy. Contact your GP practice for an appointment


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if you could be triggering it with toiletries. Consider over the counter treatments from your pharmacy. Contact your GP practice for an appointment or book an appointment at your local sexual health service. What does a bacterial vaginosis test involve? Sometimes treatment is given based on symptoms without the need for an examination or test. Sometimes a diagnosis can be made straightaway because of how the discharge looks. Sometimes the sample will be sent to a lab for testing. You are more likely to need a test if you have frequent episodes of discharge. Your nurse or doctor may perform an internal examination to check your vagina for signs of bacterial vaginosis. They may use a swab to collect a sample of the discharge from your vagina. A swab looks a bit like a cotton bud and collecting a sample only takes a few minutes. It’s not painful, but it may be a little uncomfortable for a moment. If your nurse or doctor suspects you are at risk of an STI they may do more tests. Treatment


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but it may be a little uncomfortable for a moment. If your nurse or doctor suspects you are at risk of an STI they may do more tests. Treatment for bacterial vaginosis Bacterial vaginosis is treated with antibiotics. Antibiotics must be prescribed by a doctor or nurse. You may be given an antibiotic cream or gel to use in your vagina, instead of antibiotic tablets by mouth. While you’re there, make sure you tell the doctor or nurse if you: are pregnant think you might be pregnant are breastfeeding These may affect the type of treatment you’re given. You can still have sex while being treated for bacterial vaginosis as it’s not sexually transmitted. However antibiotics and creams can affect condoms and other forms of contraception. Speak to your doctor or pharmacist who can give you further information. Partners do not usually need treatment. Non-antibiotic treatment is also available to buy in pharmacies. What causes bacterial vaginosis? Bacteria called lactobacilli naturally live in


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Non-antibiotic treatment is also available to buy in pharmacies. What causes bacterial vaginosis? Bacteria called lactobacilli naturally live in your vagina and stop other bacteria from growing there. Sometimes the balance of these bacteria changes. If this happens you can develop bacterial vaginosis. Bacterial vaginosis can’t be passed on. But it’s more common in sexually active people. Other things that may increase the risk of getting it include: having a new sexual partner having multiple sexual partners smoking using scented soaps or perfumed bubble bath putting antiseptic liquids in the bath douching (washing or cleaning out the vagina with water or other fluids) using vaginal washes or deodorant using strong detergents to wash your underwear receiving oral sex How to prevent bacterial vaginosis The causes of bacterial vaginosis are not fully understood, so it may not be possible to completely prevent it. However, you may be able to lower your risk of developing it by following


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not fully understood, so it may not be possible to completely prevent it. However, you may be able to lower your risk of developing it by following our genital washing advice. Source: Scottish Government - Opens in new browser window Last updated: 02 December 2022 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/muscular-dystrophy/becker-muscular-dystrophy/


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https://www.nhsinform.scot/illnesses-and-conditions/kidneys-bladder-and-prostate/benign-prostate-enlargement/


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Benign prostate enlargement | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Kidneys, bladder and prostate Benign prostate enlargement Benign prostate enlargement About benign prostate enlargement Symptoms of benign prostate enlargement Causes of benign prostate enlargement Diagnosing benign prostate enlargement Treating benign prostate enlargement Complications of benign prostate enlargement About benign prostate enlargement Benign prostate enlargement (BPE), also known as benign prostatic hyperplasia (BPH), is a condition that affects older men and anyone with a prostate. It’s particularly common in men and anyone with a prostate over 50 years of age and isn’t usually a serious threat to health. Prostate gland The prostate is a small gland, located in the pelvis, between the penis and bladder. It’s involved in the production of semen. The prostate


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gland The prostate is a small gland, located in the pelvis, between the penis and bladder. It’s involved in the production of semen. The prostate produces a thick, white fluid that’s made into a thinner liquid by a protein called prostate-specific antigen (PSA). The liquid is then mixed with sperm, produced by the testicles, to create semen. If the prostate becomes enlarged, it can place pressure on the bladder and urethra (the tube through which urine passes). This can affect how you pass urine and may cause: difficulty starting urination a frequent need to urinate difficulty fully emptying the bladder In some men and anyone with a prostate, the symptoms are mild and don’t require treatment. In others, the symptoms can be very troublesome and have a major impact on a person’s quality of life. Read more about the symptoms of benign prostate enlargement Many people worry that having an enlarged prostate means they have an increased risk of developing prostate cancer. This isn’t the


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enlargement Many people worry that having an enlarged prostate means they have an increased risk of developing prostate cancer. This isn’t the case. The risk of prostate cancer is no greater for people with an enlarged prostate than it is for those without an enlarged prostate. What causes benign prostate enlargement? The cause of prostate enlargement is unknown, but most experts agree that it’s linked to hormonal changes that occur as a man gets older. Read more about the causes of benign prostate enlargement How is benign prostate enlargement diagnosed? If your GP suspects that you have an enlarged prostate, you’ll be asked to complete a questionnaire to assess your symptoms. Each question has 5 possible answers that carry a score, and your overall score indicates the severity of your symptoms. Your GP will also want to rule out other conditions that cause similar symptoms to prostate enlargement. You may have a number of standard tests, such as urine tests, plus some more specific


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conditions that cause similar symptoms to prostate enlargement. You may have a number of standard tests, such as urine tests, plus some more specific tests, such as a blood test that measures PSA. Read more about diagnosing benign prostate enlargement Treating benign prostate enlargement Treatment for an enlarged prostate is determined by the severity of your symptoms. If you have mild to moderate symptoms, you won’t receive any immediate medical treatment, but you’ll have regular check-ups to carefully monitor your prostate. You’ll probably also be advised to make lifestyle changes, such as limiting your caffeine and alcohol intake, and exercising regularly, to see if they improve your symptoms. As well as lifestyle changes, medication is usually recommended to treat moderate to severe symptoms of benign prostate enlargement. Finasteride and dutasteride are medications that are commonly used. They block the effects of a hormone called dihydrotestosterone (DHT) on the prostate gland,


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and dutasteride are medications that are commonly used. They block the effects of a hormone called dihydrotestosterone (DHT) on the prostate gland, which can reduce the size of the prostate and improve associated symptoms. Alpha blockers may also be prescribed. They help to relax your bladder muscles, making it easier to pass urine. Tamsulosin and alfuzosin are two alpha blockers commonly used to treat benign prostate enlargement. Surgery is usually only recommended for moderate to severe symptoms of benign prostate enlargement that have failed to respond to medication. Read more about treating benign prostate enlargement Complications of benign prostate enlargement Benign prostate enlargement can sometimes lead to complications such as a urinary tract infection (UTI) or acute urinary retention. Serious complications are rare. Read more about the complications of benign prostate enlargement How common is benign prostate enlargement? Benign prostate enlargement is a condition


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more about the complications of benign prostate enlargement How common is benign prostate enlargement? Benign prostate enlargement is a condition associated with ageing and is common in men and anyone with a prostate over 50 years of age. Symptoms of benign prostate enlargement The symptoms of benign prostate enlargement are caused by the enlarged prostate placing pressure on the bladder and urethra (which carries urine from the bladder to the penis). This can affect urination in a number of ways. For example, it can: make it difficult for you to start urinating weaken the flow of urine or cause ‘stopping and starting’ cause you to strain to pass urine cause you to need to urinate frequently cause you to wake up frequently during the night to urinate cause a sudden urge to urinate, which can result in urinary incontinence if you can’t find a toilet quickly enough cause you to not be able to empty your bladder fully cause blood in the urine (haematuria) In the later stages, benign


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find a toilet quickly enough cause you to not be able to empty your bladder fully cause blood in the urine (haematuria) In the later stages, benign prostate enlargement can cause urine retention and other complications such as bladder stones, bladder infections and kidney damage. When to seek medical advice See your GP if you notice any problems with, or changes to, your usual pattern of urination. Even if the symptoms are mild, they could be caused by a condition that needs to be investigated. Any blood in the urine must be investigated by your GP to rule out other more serious conditions. Causes of benign prostate enlargement The exact cause of benign prostate enlargement is unknown, but research suggests that hormones probably play an important role in the condition’s development. Hormones are powerful chemicals that can have a wide range of effects on the cells of the body. One theory is that as some men and anyone with a prostate gets older, the levels of a type of hormone called


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of effects on the cells of the body. One theory is that as some men and anyone with a prostate gets older, the levels of a type of hormone called dihydrotestosterone (DHT) increases, which may stimulate the growth of the prostate. Another theory suggests that two hormones, testosterone and oestrogen, play a role. Younger men and anyone with a prostate produce high levels of testosterone and much smaller levels of oestrogen. But as they get older, levels of testosterone decrease, which means they then have a higher proportion of oestrogen in their body. It’s been suggested that the relative increase in oestrogen may stimulate prostate growth. Risk factors Research has shown that rates of benign prostate enlargement are higher among men and anyone with a prostate with high blood pressure and diabetes. However, both diabetes and high blood pressure are associated with the natural ageing process, so there may not be a direct connection between the three conditions. Diagnosing benign


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pressure are associated with the natural ageing process, so there may not be a direct connection between the three conditions. Diagnosing benign prostate enlargement To find out whether your prostate gland is enlarged, you’ll need to have a few tests. Some tests will be carried out by your GP and others will be carried out by a urologist (a doctor who specialises in urinary problems). First, your GP will ask about your symptoms. If it seems that you have symptoms of benign prostate enlargement, the next stage is to calculate your International Prostate Symptom Score (IPSS). International Prostate Symptom Score (IPSS) You’ll be asked to complete a questionnaire to assess your symptoms. Each question has 5 possible answers that carry a score, and your overall score is used to assess the severity of your symptoms. The checklist includes the following questions. Over the past month, how often: have you had the sensation of not completely emptying your bladder after urinating? have you had


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following questions. Over the past month, how often: have you had the sensation of not completely emptying your bladder after urinating? have you had to urinate again less than 2 hours after finishing urinating? have you found that you stopped and started again when urinating? have you found it difficult to postpone urination? have you had a weak stream of urine? have you had to push or strain to begin urinating during the course of one night? have you had to get up during the night to urinate? After your GP has assessed the severity your symptoms, they’ll aim to rule out other conditions with similar symptoms using certain tests. Ruling out other conditions The symptoms of benign prostate enlargement are similar to those of other conditions, including prostate cancer. Therefore, your GP will need to be completely sure that your symptoms aren’t caused by cancer. Urine tests A urine test can be used to check whether your symptoms are caused by an infection in your urinary system, such


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aren’t caused by cancer. Urine tests A urine test can be used to check whether your symptoms are caused by an infection in your urinary system, such as a kidney infection or bladder infection. Rectal examination You may need a rectal examination to check whether you might have prostate cancer. Prostate cancer can cause the prostate gland to become hard and bumpy. Your GP will put on a glove and lubricate one of their fingers, before gently pushing this finger into your bottom and up into your rectum. As the rectum is close to the prostate gland, they’ll be able to check whether the surface of the gland has changed. The procedure will feel a little uncomfortable, but it isn’t usually painful. Prostate cancer doesn’t always cause changes to the prostate gland, so you may need to have some more specialised tests to rule it out. You will probably be referred to a urologist for these tests. Prostate-specific antigen (PSA) test A blood test can be used to measure the amount of the PSA


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probably be referred to a urologist for these tests. Prostate-specific antigen (PSA) test A blood test can be used to measure the amount of the PSA protein that’s produced by the prostate. A raised PSA level indicates enlargement of the prostate, and a significantly raised level may indicate prostate cancer. However, as with a rectal examination, a PSA test can’t provide a definitive diagnosis of prostate cancer. Transrectal ultrasound (TRUS) A TRUS is a type of ultrasound scan specifically designed to study the prostate and the surrounding area. An ultrasound probe is placed into your rectum and uses soundwaves to build a detailed image of your prostate. This type of scan measures the size of your prostate and can be used to either confirm or rule out a diagnosis of prostate cancer. Computer tomographic (CT) urogram A CT urogram is used to study the urinary tract (the bladder and the tubes through which urine passes, also known as the ureter and urethra). A CT urogram can be used to


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to study the urinary tract (the bladder and the tubes through which urine passes, also known as the ureter and urethra). A CT urogram can be used to check for blockages in your urinary system that could be causing your symptoms, such as a kidney stone or bladder stone. It can also be used to detect any damage in the urinary tract. During a CT urogram, you’ll be injected with a harmless radioactive dye, which will be visible on X-rays. After 30-60 minutes, the dye should have passed into your urinary tract and a series of X-rays will be taken. In some cases, you may be asked to pass urine before the final X-ray is taken. Voiding charts A voiding chart is a urination diary, which you may be asked to keep for 24 hours. You’ll be asked to record how often you urinate, as well as details about how you urinate – for example, whether your urination is stopping and starting, or whether it’s difficult to start urinating. A voiding chart is a good way of finding out more information about your


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is stopping and starting, or whether it’s difficult to start urinating. A voiding chart is a good way of finding out more information about your symptoms and can be used to determine the type of treatment that would be most effective in controlling your symptoms. Uroflowmetry Uroflowmetry measures the pressure of your bladder and how well your bladder works when you urinate. You’ll be given a local anaesthetic and a small flexible tube (catheter) will be inserted into your urethra and moved up into your bladder. Water will then be injected through the catheter and into your bladder. A computer connected to the catheter measures the pressure inside your bladder and can assess how well your bladder is working. As with voiding charts, uroflowmetry is a good way of determining what type of treatment will help to control your symptoms. Treating benign prostate enlargement The treatment for an enlarged prostate gland will depend on how severe your symptoms are. The 3 main treatments are:


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benign prostate enlargement The treatment for an enlarged prostate gland will depend on how severe your symptoms are. The 3 main treatments are: lifestyle changes medication surgery If your symptoms are mild to moderate, you may not receive any immediate medical treatment, but you’ll have regular check-ups to carefully monitor your prostate gland. This is often referred to as ‘watchful waiting’. You may also be advised to make lifestyle changes to see whether they improve your symptoms. Lifestyle changes If your prostate gland is enlarged, you may be advised to: avoid drinking any liquids for 1 to 2 hours before going to bed – this will reduce your chances of waking up during the night to pass urine (nocturia) experiment with the time you take prescribed medication – for example, taking it at 7pm may help prevent nocturia stop drinking alcohol and caffeine, or limit your consumption of them – these drinks can irritate your bladder and make your symptoms worse exercise regularly –


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alcohol and caffeine, or limit your consumption of them – these drinks can irritate your bladder and make your symptoms worse exercise regularly – research shows moderate exercise, such as walking for 30 to 60 minutes a day, can improve symptoms, although it’s unclear exactly why this is the case join a patient support group – your doctor should be able to recommend one, which may help you manage mild symptoms without the need for medication Bladder training Bladder training is an exercise programme that aims to increase the time between urination and the amount of urine your bladder can hold. You’ll be given a target, such as waiting at least 2 hours between each time you urinate. It’s a good idea to use a bladder training chart, which allows you to record each time you pass urine and the volume of urine passed – you’ll need a plastic jug to measure this. Your doctor should give you a chart to take home. You’ll also be taught a number of exercises, such as breathing, relaxation and


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jug to measure this. Your doctor should give you a chart to take home. You’ll also be taught a number of exercises, such as breathing, relaxation and muscle exercises, to help take your mind off the need to urinate. Over time your target time will be increased, and at the end of the programme you should find that you’re able to go for longer without urinating. Bladder training should only be carried out under medical supervision. Medication Medication, in combination with the lifestyle changes above, is usually recommended to treat moderate to severe symptoms of benign prostate enlargement. Finasteride or dutasteride Finasteride and dutasteride are widely used to treat benign prostate enlargement. They block the effects of a hormone called dihydrotestosterone (DHT) on the prostate gland, which can reduce the size of the prostate and improve your associated symptoms. Find out about the causes of prostate enlargement If you’re prescribed one of these medications, you may experience an


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your associated symptoms. Find out about the causes of prostate enlargement If you’re prescribed one of these medications, you may experience an immediate improvement in symptoms. However, you’ll need to take it for at least six months to get the maximum benefit, and your doctor will need to monitor you every year. Use condoms if you’re sexually active – both finasteride and dutasteride can have an adverse effect on your sperm. If you get a woman pregnant, there’s a risk the baby could develop birth defects. Other possible side effects can also include impotence and little or no sperm when you ejaculate. In many cases, these side effects will improve as your body gets used to the medication. See your GP if the side effects are troubling you. Alpha blockers Alpha blockers help relax the muscles of your bladder, making it easier to pass urine. You may be prescribed alpha blockers as your primary treatment or in combination with finasteride. Tamsulosin and alfuzosin are 2 alpha blockers


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You may be prescribed alpha blockers as your primary treatment or in combination with finasteride. Tamsulosin and alfuzosin are 2 alpha blockers commonly used to treat benign prostate enlargement. Side effects of tamsulosin and alfuzosin are uncommon and usually mild. They include: dizziness headaches weakness little or no sperm when you ejaculate You should only begin taking alpha blockers over a restful weekend when you’re not planning to drive, as there’s a risk they could cause low blood pressure (hypotension) and fainting. Generally, if you experience dizziness while taking this medication, avoid driving or operating heavy machinery until it’s passed. Surgery Surgery is usually only recommended for moderate to severe symptoms of benign prostate enlargement that have failed to respond to medication. Various procedures can be used to reduce the pressure on your bladder. Transurethral resection of the prostate (TURP) Transurethral resection of the prostate (TURP) involves inserting


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reduce the pressure on your bladder. Transurethral resection of the prostate (TURP) Transurethral resection of the prostate (TURP) involves inserting a small instrument called a resectoscope into your urethra, the tube that carries urine from the bladder to the penis. A wire loop heated by an electric current is used to remove excess tissue from your prostate. TURP is carried out using either a general anaesthetic, where you’re asleep, or a spinal anaesthetic, where you’re awake, but the lower half of your body is numbed. The procedure can take up to an hour, depending on how much tissue needs to be removed. Most people are well enough to leave hospital 2 to 3 days after the operation. After surgery, you’ll be unable to urinate normally at first because of your swollen urethra. A thin tube called a catheter will be inserted into your urethra and up into your bladder to allow urine to drain away. This will usually be removed 24 to 48 hours after surgery. A common complication of TURP


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and up into your bladder to allow urine to drain away. This will usually be removed 24 to 48 hours after surgery. A common complication of TURP is you’ll no longer produce semen when you ejaculate. This is known as retrograde ejaculation. It causes sperm to go into your bladder rather than out of your penis during ejaculation. However, you’ll still experience the physical pleasure associated with ejaculation (the climax). Bladder neck incision (TUIP) Bladder neck incision involves widening the urethra so it is easier to pass urine. It is also known as transurethral incision of the prostate (TUIP). Like TURP, the surgeon will insert a resectoscope into your urethra. The resectoscope has a heated wire loop at the end and is used to make small cuts (incisions) in the muscle where the prostate meets the bladder. This type of surgery relaxes the opening to the bladder, helping urine flow out of it. As with TURP, TUIP is carried out under a spinal or general anaesthetic. After surgery, you


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the opening to the bladder, helping urine flow out of it. As with TURP, TUIP is carried out under a spinal or general anaesthetic. After surgery, you may not be able to urinate and a catheter may be needed to empty your bladder. Like TURP, you’ll only need to use a catheter for a short time until you’re able to urinate normally. There’s less of a risk of retrograde ejaculation with TUIP compared with TURP, although it can sometimes still occur. Holmium laser enucleation of the prostate (HoLEP) Holmium laser enucleation of the prostate (HoLEP) is similar to a TURP. Excess prostate tissue is removed using an instrument inserted through the urethra. However, it uses a laser, rather than a wire loop. There are some advantages to using this technique rather than a TURP, but also some disadvantages. If you have been offered a HoLEP, you may want to ask your surgeon to explain why this was chosen for you, and the risks and benefits compared with TURP. Insertion of prostatic urethral lift


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want to ask your surgeon to explain why this was chosen for you, and the risks and benefits compared with TURP. Insertion of prostatic urethral lift implants The insertion of prostatic urethral lift implants is a new surgical procedure that can help relieve urinary symptoms. The procedure can be carried out under local anaesthesia or general anaesthesia. It involves inserting tiny implants through the urethra. The implants are then positioned to hold the enlarged prostate away from the urethra so it isn’t blocked. One of the big advantages of prostatic urethral lift implants compared with TURP and TUIP is a reduced risk to your sexual function – there is less chance of erectile dysfunction and ejaculation problems. There’s also less tissue injury, which means your recovery will be quicker and you won’t need to stay in hospital as long. However, prostatic urethral lift implants are unlikely to provide permanent symptom relief in all cases. And as it’s a new procedure, the long-term


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However, prostatic urethral lift implants are unlikely to provide permanent symptom relief in all cases. And as it’s a new procedure, the long-term outcomes are unknown and availability may be limited. Read more about the use of prostatic urethral lift implants to relieve symptoms of prostate enlargement. Transurethral vaporisation of the prostate (TUVP) Transurethral vaporisation of the prostate (TUVP) is similar to a TURP, but parts of the prostate are destroyed (vaporised) rather than cut away. Studies have shown that TUVP is as effective as TURP at improving symptoms. But some men and anyone with a prostate may need more treatment in the future. Greenlight laser surgery (PVP) A laser can sometimes be used to destroy the prostate tissue. This particular form of TUVP is called photoselective vaporisation of the prostate (PVP), or Greenlight laser surgery. A thin, flexible instrument called a cytoscope is inserted into the urethra. A laser fibre is then passed through the cytoscope


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laser surgery. A thin, flexible instrument called a cytoscope is inserted into the urethra. A laser fibre is then passed through the cytoscope to destroy the excess prostate tissue that is blocking the urine flow. The procedure is recommended for those who don’t have a high risk of developing complications from treatment, such as men and anyone with a prostate who: doesn’t have urinary retention doesn’t have an increased risk of bleeding has a prostate smaller than 100ml In these ‘low-risk’ groups, Greenlight laser surgery is thought to be as effective as TURP, but also has several benefits. These include: a shorter hospital stay – the procedure is often carried out as a day case the catheter can be removed sooner recovery is quicker there’s a lower risk of complications The National Institute for Health and Care Excellence (NICE) website has more information about GreenLight XPS for treating benign prostatic hyperplasia. Open prostatectomy An open prostatectomy is a procedure that


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has more information about GreenLight XPS for treating benign prostatic hyperplasia. Open prostatectomy An open prostatectomy is a procedure that may be more effective than TURP if you have severe benign prostate enlargement. However, it’s now rarely used, even for larger prostates, because other techniques have been developed, such as HoLEP. During an open prostatectomy, an incision will be made in your tummy and the outer portion of your prostate will be removed. The procedure carries a higher risk of complications, such as erectile dysfunction and urinary incontinence. There’s also a greater chance that these complications will become permanent than if they occur after TURP. Complications of benign prostate enlargement Benign prostate enlargement can sometimes lead to complications, such as a urinary tract infection or acute urinary retention. Urinary tract infections If you’re unable to empty your bladder properly, there’s a risk that bacteria in your urinary system won’t get


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retention. Urinary tract infections If you’re unable to empty your bladder properly, there’s a risk that bacteria in your urinary system won’t get flushed out and will spread through the urine to cause a urinary tract infection (UTI). Symptoms of a UTI include: cloudy, bloody or bad–smelling urine pain in your lower abdomen (tummy) nausea vomiting shaking and chills a high temperature of 38C (100.4F) or above UTIs can be treated with antibiotics. A single UTI isn’t usually serious, but repeated UTIs can damage your kidneys and bladder. If you have a history of repeated UTIs, you may need to have surgery. Acute urinary retention Acute urinary retention (AUR) is the sudden inability to pass any urine. AUR should be treated as a medical emergency, because without prompt treatment urine may be passed back up into the kidneys, which can damage them. Symptoms of AUR include: the sudden inability to pass urine severe lower abdominal pain swelling of the bladder that you can feel with your


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them. Symptoms of AUR include: the sudden inability to pass urine severe lower abdominal pain swelling of the bladder that you can feel with your hands Phone 999 and ask for an ambulance if you or someone you know experiences the symptoms of AUR. AUR can be treated using a thin tube (catheter) to drain the urine out of your bladder. In very serious cases, surgery may be required to empty the bladder. Source: NHS 24 - Opens in new browser window Last updated: 26 March 2025 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Also on NHS inform Transurethral resection of the prostate (TURP) Other health sites Cancer Research UK: Prostate cancer Prostate Cancer UK: prostate information NHS inform About NHS inform Editorial policy Contact us


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health sites Cancer Research UK: Prostate cancer Prostate Cancer UK: prostate information NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-adults/bile-duct-cancer-cholangiocarcinoma/


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https://www.nhsinform.scot/illnesses-and-conditions/mental-health/eating-disorders/binge-eating-disorder-bed/


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Binge eating disorder | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Mental health Eating Disorders Binge eating disorder (BED) Binge eating disorder (BED) Binge eating disorder (BSL) | Binge eating disorder (audio) | Binge eating disorder (BED) is a serious eating disorder. Someone with BED will regularly eat very large quantities of food over a short period of time without feeling like they’re in control of what they’re eating. This eating behaviour causes feelings of distress and guilt and being overwhelmed. If you’re binge eating and then making yourself sick on a regular basis, this is more likely to be bulimia nervosa. BED can affect anyone of any age, gender, ethnicity or age. Binge eating disorder is more common than other eating disorders. In the UK around 1 in 25 people experience symptoms of binge eating disorder. There’s no one way for


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is more common than other eating disorders. In the UK around 1 in 25 people experience symptoms of binge eating disorder. There’s no one way for someone with binge eating disorder to look. What is bingeing? Signs that an episode of overeating is a binge, include: eating much faster than normal eating until you feel uncomfortably full regularly eating a large amount of food when you’re not hungry eating alone or secretly due to being embarrassed or ashamed about the amount of food you’re consuming having feelings of guilt, shame or disgust during or after a binge Symptoms of BED The main signs of BED are regularly: eating a large quantity of food over a short time (bingeing) feeling out of control of your eating and feeling distressed restricting your eating or putting strict rules around eating fasting for long periods of time before or after a binge hoarding food feeling ashamed and hiding evidence of eating from others – close family and friends may be unaware of the distress and


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after a binge hoarding food feeling ashamed and hiding evidence of eating from others – close family and friends may be unaware of the distress and binges planning the day around food by trying to restrict how much food you eat and then fasting which may lead to more binges having low self-esteem and feeling shame being preoccupied about weight and body shape Speak to your GP practice if you’re experiencing these symptoms and think you might have BED. If you feel like you have to purge what you’ve eaten after a binge to avoid gaining weight, you may have symptoms of bulimia nervosa. If binges don’t happen regularly, and your weight is very low, you may have symptoms of anorexia nervosa. Treatment for BED There are treatments available for BED. Treatment does not directly focus on weight loss. It focuses on addressing things like relationships, feelings and thoughts that result in a person having a difficult relationship with food. Guided self-help Guided self-help is where you work


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feelings and thoughts that result in a person having a difficult relationship with food. Guided self-help Guided self-help is where you work through information and activities on your own. You’ll also have regular support sessions with a professional. Cognitive behavioural therapy (CBT) Another treatment is cognitive behavioural therapy (CBT), either individually or as part of a group. CBT starts with the idea that thoughts, feelings, and behaviour are linked and affect one another. If problems in your life are causing you to binge eat, CBT helps you to reduce bingeing. It helps to identify the underlying issues so you’re less likely to binge in the future. It’ll focus on what’s keeping the eating disorder going rather than diet or weight loss. Learn more about talking therapies Interpersonal psychotherapy Interpersonal psychotherapy explores the link between relationships, feelings and eating behaviours. Family based treatment Children and young people might be offered Family Based


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the link between relationships, feelings and eating behaviours. Family based treatment Children and young people might be offered Family Based Treatment (FBT). This involves the whole family in solving their child or young person’s eating disorder. During FBT parents and carers are an essential part of the solution and members of the treatment team. Medication Medication is not recommended to treat BED but may be prescribed to treat other health conditions you might have alongside BED. The eating disorders SIGN guideline has more information about treatment for eating disorders. Long term physical effects of binge eating Binge eating often leads to weight gain. Being overweight or obese can put you at risk of a number of physical health problems, some of which can be life threatening. These include: high cholesterol high blood pressure diabetes osteoarthritis some types of cancer If you think you might have a binge eating problem, help is available. You can get support to tackle both


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osteoarthritis some types of cancer If you think you might have a binge eating problem, help is available. You can get support to tackle both the physical and mental effects of binge eating. Getting help for binge eating disorder If you have eating problems or think you may have an eating disorder, it’s important to seek help as soon as possible. You could: talk to someone you trust, like a friend or member of your family see your GP – you may find it helpful to bring someone with you for support contact an anonymous helpline like Beat’s helpline Helping someone else If someone close to you is showing signs of an eating disorder, you can offer help and support. You could try talking to them about how they feel and listening to what they say without judgement. You can encourage them to think about getting help. Try not to put pressure on them or be critical of them, as this could make things worse. You could also offer to help by going with the person to see their GP. Your GP or a


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on them or be critical of them, as this could make things worse. You could also offer to help by going with the person to see their GP. Your GP or a healthcare professional can give you advice on how to help someone. This includes giving you information on: the treatments available how you can support them during their treatment helping you understand BED Read more about how you can support someone with an eating disorder Further support Find information and services that can offer advice and support about eating disorders Source: Scottish Government - Opens in new browser window Last updated: 29 April 2025 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats Binge eating disorder (BSL) | Binge eating disorder (audio) | Binge eating disorder


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of 500 characters Send feedback Other languages and formats Binge eating disorder (BSL) | Binge eating disorder (audio) | Binge eating disorder (BSL) | Binge eating disorder (audio) | Add this page to Info For Me Also on NHS inform Eating disorders Anorexia nervosa Avoidant restrictive food intake disorder (ARFID) Bulimia nervosa Eating disorder resources How to support someone with an eating disorder Self-esteem self-help guide Other health sites Beat Eating Disorders Cared Scotland FEAST Freed for all Peace pathway SupportED Scotland NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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Bladder cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Bladder cancer Bladder cancer About bladder cancer Symptoms of bladder cancer Causes of bladder cancer Diagnosing bladder cancer Treating bladder cancer Complications of bladder cancer Preventing bladder cancer About bladder cancer Bladder cancer is where a growth of abnormal tissue, known as a tumour, develops in the bladder lining. In some cases, the tumour spreads into the surrounding muscles. The most common symptom of bladder cancer is blood in your urine, which is usually painless. If you notice blood in your urine, even if it comes and goes, you should speak to your GP, so the cause can be investigated. Read about the symptoms of bladder cancer Types of bladder cancer Once diagnosed, bladder cancer can be classified by how far it has spread. If the


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Read about the symptoms of bladder cancer Types of bladder cancer Once diagnosed, bladder cancer can be classified by how far it has spread. If the cancerous cells are contained inside the lining of the bladder, doctors describe it as non-muscle-invasive bladder cancer. This is the most common type of bladder cancer, accounting for 7 out of 10 cases. Most people don’t die as a result of this type of bladder cancer. When the cancerous cells spread beyond the lining, into the surrounding muscles of the bladder, it’s referred to as muscle-invasive bladder cancer. This is less common, but has a higher chance of spreading to other parts of the body and can be fatal. If bladder cancer has spread to other parts of the body, it’s known as locally advanced or metastatic bladder cancer. Read more about diagnosing bladder cancer Why does bladder cancer happen? Most cases of bladder cancer appear to be caused by exposure to harmful substances, which lead to abnormal changes in the bladder’s cells


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happen? Most cases of bladder cancer appear to be caused by exposure to harmful substances, which lead to abnormal changes in the bladder’s cells over many years. Tobacco smoke is a common cause and it’s estimated that half of all cases of bladder cancer are caused by smoking. Contact with certain chemicals previously used in manufacturing is also known to cause bladder cancer. However, these substances have since been banned. Read more about the causes of bladder cancer and preventing bladder cancer Treating bladder cancer In cases of non-muscle-invasive bladder cancer, it’s usually possible to remove the cancerous cells while leaving the rest of the bladder intact. This is done using a surgical technique called transurethral resection of a bladder tumour (TURBT). This is followed by a dose of chemotherapy medication directly into the bladder, to reduce the risk of the cancer returning. In cases with a higher risk of recurrence, a medication known as Bacillus Calmette-Guérin (BCG)


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bladder, to reduce the risk of the cancer returning. In cases with a higher risk of recurrence, a medication known as Bacillus Calmette-Guérin (BCG) may be injected into the bladder to reduce the risk of the cancer returning. Treatment for high-risk non-muscle-invasive bladder cancer, or muscle-invasive bladder cancer may involve surgically removing the bladder in an operation known as a cystectomy. When the bladder is removed, you’ll need another way of collecting your urine. Possible options include making an opening in the abdomen so urine can be passed into an external bag, or constructing a new bladder out of a section of bowel. This will be done at the same time as a cystectomy. If it’s possible to avoid removing the bladder, or if surgery is not suitable, a course of radiotherapy and chemotherapy may be recommended. Chemotherapy may sometimes be used on its own before surgery or before being combined with radiotherapy. After treatment for all types of bladder cancer, you’ll


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may sometimes be used on its own before surgery or before being combined with radiotherapy. After treatment for all types of bladder cancer, you’ll have regular follow-up tests to check for signs of recurrence. Read more about treating bladder cancer Who is affected? Bladder cancer is more common in older adults, with more than half of all new cases diagnosed in people aged 75 and over. Bladder cancer is also more common in men than in women, possibly because in the past, men were more likely to smoke and work in the manufacturing industry. Symptoms of bladder cancer Blood in your urine is the most common symptom of bladder cancer. The medical name for this is haematuria and it’s usually painless. You may notice streaks of blood in your urine or the blood may turn your urine brown. The blood isn’t always noticeable and it may come and go. Less common symptoms of bladder cancer include: a need to urinate on a more frequent basis sudden urges to urinate a burning sensation when passing


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Less common symptoms of bladder cancer include: a need to urinate on a more frequent basis sudden urges to urinate a burning sensation when passing urine If bladder cancer reaches an advanced stage and begins to spread, symptoms can include: pelvic pain bone pain unintentional weight loss swelling of the legs When to seek medical advice If you ever have blood in your urine – even if it comes and goes – you should speak to your GP, so the cause can be investigated. Having blood in your urine doesn’t mean you definitely have bladder cancer. There are other, more common, causes including: a urinary tract infection, such as cystitis a kidney infection kidney stones urethritis an enlarged prostate gland, in men Causes of bladder cancer Bladder cancer is caused by changes to the cells of the bladder. It’s often linked with exposure to certain chemicals, but the cause isn’t always known. What is cancer? Cancer begins with a change (mutation) in the structure of the DNA in cells, which can


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chemicals, but the cause isn’t always known. What is cancer? Cancer begins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means that cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour. Increased risk Several factors have been identified that can significantly increase your risk of developing bladder cancer. Smoking Smoking is the single biggest risk factor for bladder cancer. This is because tobacco contains cancer-causing (carcinogenic) chemicals. If you smoke for many years, these chemicals pass into your bloodstream and are filtered by the kidneys into your urine. The bladder is repeatedly exposed to these harmful chemicals, as it acts as a store for urine. This can cause changes to the cells of the bladder lining, which may lead to bladder cancer. It’s estimated that just over a third of all cases of bladder cancer are caused by smoking. People who smoke may be up to four times more likely to


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It’s estimated that just over a third of all cases of bladder cancer are caused by smoking. People who smoke may be up to four times more likely to develop bladder cancer than non-smokers. Exposure to chemicals Exposure to certain industrial chemicals is the second biggest risk factor. Previous studies have estimated that this may account for around 25% of cases. Chemicals known to increase the risk of bladder cancer include: aniline dyes 2-Naphthylamine 4-Aminobiphenyl xenylamine benzidine o-toluidine Occupations linked to an increased risk of bladder cancer are manufacturing jobs involving: dyes textiles rubbers paints plastics leather tanning Some non-manufacturing jobs have also been linked to an increased risk of bladder cancer. These include taxi or bus drivers, as a result of their regular exposure to the chemicals present in diesel fumes. The link between bladder cancer and these types of occupations was discovered in the 1950s and 1960s. Since then, regulations relating to


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fumes. The link between bladder cancer and these types of occupations was discovered in the 1950s and 1960s. Since then, regulations relating to exposure to cancer-causing chemicals have been made much more rigorous and many of the chemicals listed above have been banned. However, these chemicals are still linked with cases of bladder cancer now, as it can take up to 30 years after initial exposure to the chemicals before the condition starts to develop. Other risk factors Other factors that can increase your risk of bladder cancer include: radiotherapy to treat previous cancers near the bladder, such as bowel cancer previous treatment with certain chemotherapy medications, such as cyclophosphamide and cisplatin previous surgery to remove part of the prostate gland, during treatment for benign prostate enlargement having diabetes – bladder cancer is thought to be linked to certain treatments for type 2 diabetes having a tube in your bladder (an indwelling catheter) for a long time,


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cancer is thought to be linked to certain treatments for type 2 diabetes having a tube in your bladder (an indwelling catheter) for a long time, because you have nerve damage that has resulted in paralysis long-term or repeated urinary tract infections (UTIs) long-term bladder stones having an early menopause (before the age of 42) an untreated infection called schistosomiasis, which is caused by a parasite that lives in fresh water – this is very rare in the UK How does bladder cancer spread? Bladder cancer usually begins in the cells of the bladder lining. In some cases, it may spread into surrounding bladder muscle. If the cancer penetrates this muscle, it can spread to other parts of the body, usually through the lymphatic system. If bladder cancer spreads to other parts of the body, such as other organs, it’s known as metastatic bladder cancer. Diagnosing bladder cancer If you have symptoms of bladder cancer, such as blood in your urine, you should speak to your GP. Your GP may


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cancer. Diagnosing bladder cancer If you have symptoms of bladder cancer, such as blood in your urine, you should speak to your GP. Your GP may ask about your symptoms, family history and whether you’ve been exposed to any possible causes of bladder cancer, such as smoking. In some cases, your GP may request a urine sample, so it can be tested in a laboratory for traces of blood, bacteria or abnormal cells. Your GP may also carry out a physical examination of your rectum and vagina, as bladder cancer sometimes causes a noticeable lump that presses against them. If your doctor suspects bladder cancer, you’ll be referred to a hospital for further tests. In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of bladder cancer and refer people for the right tests faster. Find out who should be referred for further tests for suspected bladder cancer. At the hospital Some hospitals have specialist clinics for


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faster. Find out who should be referred for further tests for suspected bladder cancer. At the hospital Some hospitals have specialist clinics for people with blood in their urine (haematuria), while others have specialist urology departments for people with urinary tract problems. Cystoscopy If you’re referred to a hospital specialist and they think you might have bladder cancer, you should first be offered a cystoscopy. This procedure allows the specialist to examine the inside of your bladder by passing a cystoscope through your urethra (the tube through which you urinate). A cystoscope is a thin tube with a camera and light at the end. Before having a cystoscopy, a local anaesthetic gel is applied to your urethra (the tube through which you urinate) so you don’t feel any pain. The gel also helps the cystoscope to pass into the urethra more easily. The procedure usually takes about 5 minutes. Imaging scans You may be offered a CT scan or an MRI scan if the specialist feels they


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more easily. The procedure usually takes about 5 minutes. Imaging scans You may be offered a CT scan or an MRI scan if the specialist feels they need a more detailed picture of your bladder. An intravenous (IV) urogram may also be used to look at your whole urinary system before or after treatment for bladder cancer. During this procedure, dye is injected into your bloodstream and X-rays are used to study it as it passes through your urinary system. Transurethral resection of a bladder tumour (TURBT) If abnormalities are found in your bladder during a cystoscopy, you should be offered an operation known as TURBT. This is so any abnormal areas of tissue can be removed and tested for cancer (a biopsy). TURBT is carried out under general anaesthetic. Sometimes, a sample of the muscle wall of your bladder is also taken to check whether the cancer has spread, but this may be a separate operation within 6 weeks of the first biopsy. You should also be offered a dose of chemotherapy after the


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has spread, but this may be a separate operation within 6 weeks of the first biopsy. You should also be offered a dose of chemotherapy after the operation. This may help to prevent the bladder cancer returning if the removed cells are found to be cancerous. See treating bladder cancer for more information about the TURBT procedure Staging and grading Once these tests have been completed, it should be possible to tell you the grade of the cancer and what stage it is. Staging is a measurement of how far the cancer has spread. Lower-stage cancers are smaller and have a better chance of successful treatment. Grading is a measurement of how likely a cancer is to spread. The grade of a cancer is usually described using a number system ranging from G1 to G3. High-grade cancers are more likely to spread than low-grade cancers. The most widely used staging system for bladder cancer is known as the TNM system, where: T stands for how far into the bladder the tumour has grown N stands for


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used staging system for bladder cancer is known as the TNM system, where: T stands for how far into the bladder the tumour has grown N stands for whether the cancer has spread into nearby lymph nodes M stands for whether the cancer has spread into another part of the body (metastasis), such as the lungs T stages The T staging system is as follows: TIS or CIS (carcinoma in situ) – a very early high-grade cancer confined to the innermost layer of the bladder lining Ta – the cancer is just in the innermost layer of the bladder lining T1 – the cancerous cells have started to grow into the connective tissue beyond the bladder lining Bladder cancer up to the T1 stage is usually called early bladder cancer or non-muscle-invasive bladder cancer. If the tumour grows larger than this, it’s usually called muscle-invasive bladder cancer and is categorised as: T2 – the cancer has grown through the connective tissue, into the bladder muscle T3 – the cancer has grown through the layer of muscles,


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as: T2 – the cancer has grown through the connective tissue, into the bladder muscle T3 – the cancer has grown through the layer of muscles, into the surrounding layer of fat If the tumour grows larger than the T3 stage, it’s considered to be advanced bladder cancer and is categorised as: T4 – the cancer has spread outside the bladder, into surrounding organs N stages The N staging system is as follows: N0 – there are no cancerous cells in any of your lymph nodes N1 – there are cancerous cells in just one of your lymph nodes in your pelvis N2 – there are cancerous cells in two or more lymph nodes in your pelvis N3 – there are cancerous cells in one or more of your lymph nodes (known as common iliac nodes) deep in your groin M stages There are only two options in the M system: M0 – where the cancer hasn’t spread to another part of the body M1 – where the cancer has spread to another part of the body, such as the bones, lungs or liver The TNM system can be difficult to understand, so


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M1 – where the cancer has spread to another part of the body, such as the bones, lungs or liver The TNM system can be difficult to understand, so don’t be afraid to ask your care team questions about your test results and what they mean for your treatment and outlook. Treating bladder cancer The treatment options for bladder cancer largely depend on how advanced the cancer is. Treatments usually differ between early stage, non-muscle-invasive bladder cancer and more advanced muscle-invasive bladder cancer. Multidisciplinary teams (MDTs) All hospitals use MDTs to treat bladder cancer. These are teams of specialists that work together to make decisions about the best way to proceed with your treatment. Members of your MDT may include: a urologist – a surgeon specialising in treating conditions affecting the urinary tract a clinical oncologist – a specialist in chemotherapy and radiotherapy a pathologist – a specialist in diseased tissue a radiologist – a specialist in detecting disease


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– a specialist in chemotherapy and radiotherapy a pathologist – a specialist in diseased tissue a radiologist – a specialist in detecting disease using imaging techniques You should be given the contact details for a clinical nurse specialist, who will be in contact with all members of your MDT. They’ll be able to answer questions and support you throughout your treatment. Deciding what treatment is best for you can be difficult. Your MDT will make recommendations, but remember that the final decision is yours. Before discussing your treatment options, you may find it useful to write a list of questions to ask your MDT. Non-muscle-invasive bladder cancer If you’ve been diagnosed with non-muscle-invasive bladder cancer (stages CIS, Ta and T1), your recommended treatment plan depends on the risk of the cancer returning or spreading beyond the lining of your bladder. This risk is calculated using a series of factors, including: the number of tumours present in your bladder whether the


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the lining of your bladder. This risk is calculated using a series of factors, including: the number of tumours present in your bladder whether the tumours are larger than 3cm (1 inch) in diameter whether you’ve had bladder cancer before the grade of the cancer cells These treatments are discussed in more detail below. Low-risk Low-risk non-muscle-invasive bladder cancer is treated with transurethral resection of a bladder tumour (TURBT). This procedure may be performed during your first cystoscopy when tissue samples are taken for testing (see diagnosing bladder cancer). TURBT is carried out under general anaesthetic. The surgeon uses an instrument called a cystoscope to locate the visible tumours and cut them away from the lining of the bladder. The wounds are sealed (cauterised) using a mild electric current, and you may be given a catheter to drain any blood or debris from your bladder over the next few days. After surgery, you may be given a single dose of chemotherapy, directly


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to drain any blood or debris from your bladder over the next few days. After surgery, you may be given a single dose of chemotherapy, directly into your bladder, using a catheter. The solution is kept in your bladder for around an hour before being drained away. Most people are able to leave hospital less than 48 hours after having TURBT and are able to resume normal physical activity within 2 weeks. You should be offered follow-up appointments at 3 months and nine months to check your bladder, using a cystoscopy. If your cancer returns after 6 months and is small, you may be offered a treatment called fulguration. This involves using an electric current to destroy the cancer cells. Intermediate-risk People with intermediate-risk non-muscle-invasive bladder cancer should be offered a course of at least 6 doses of chemotherapy. The liquid is placed directly into your bladder, using a catheter, and kept there for around an hour before being drained away. You should be offered follow-up


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is placed directly into your bladder, using a catheter, and kept there for around an hour before being drained away. You should be offered follow-up appointments at 3 months, 9 months, 18 months, then once every year. At these appointments, your bladder will be checked using a cystoscopy. If your cancer returns within 5 years, you’ll be referred back to a specialist urology team. Some residue of the chemotherapy medication may be left in your urine after treatment, which could severely irritate your skin. It helps if you urinate while sitting down and that you’re careful not to splash yourself or the toilet seat. After passing urine, wash the skin around your genitals with soap and water. If you’re sexually active, it’s important to use a barrier method of contraception, such as a condom. This is because the medication may be present in your semen or vaginal fluids, which can cause irritation. You also shouldn’t try to get pregnant or father a child while having chemotherapy for


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in your semen or vaginal fluids, which can cause irritation. You also shouldn’t try to get pregnant or father a child while having chemotherapy for bladder cancer, as the medication can increase the risk of having a child with birth defects. High-risk People with high-risk non-muscle-invasive bladder cancer should be offered a second TURBT operation, within 6 weeks of the initial investigation (see diagnosing bladder cancer). A CT scan or an MRI scan may also be required. Your urologist and clinical nurse specialist will discuss your treatment options with you, which will either be: a course of Bacillus Calmette-Guérin (BCG) treatment – using a variant of the BCG vaccine an operation to remove your bladder (cystectomy) The BCG vaccine is passed into your bladder through a catheter and left for 2 hours before being drained away. Most people require weekly treatments over a 6-week period. Common side effects of BCG include: a frequent need to urinate pain when urinating blood in your


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require weekly treatments over a 6-week period. Common side effects of BCG include: a frequent need to urinate pain when urinating blood in your urine (haematuria) flu-like symptoms, such as tiredness, fever and aching urinary tract infections If BCG treatment doesn’t work, or the side effects are too strong, you’ll be referred back to a specialist urology team. You should be offered follow-up appointments every 3 months for the first 2 years, then every 6 months for the next 2 years, then once a year. At these appointments, your bladder will be checked using a cystoscopy. If you decide to have a cystectomy, your surgeon will need to create an alternative way for urine to leave your body (urinary diversion). Your clinical nurse specialist can discuss your options for the procedure and how the urinary diversion will be created. Read about the complications of bladder cancer surgery for more information about urinary diversion and sexual problems after surgery. After having a


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Read about the complications of bladder cancer surgery for more information about urinary diversion and sexual problems after surgery. After having a cystectomy, you should be offered follow-up appointments including a CT scan at six and 12 months, and blood tests once a year. Men require an appointment to check their urethra once a year for 5 years. Muscle-invasive bladder cancer The recommended treatment plan for muscle-invasive bladder cancer depends on how far the cancer has spread. With T2 and T3 bladder cancer, treatment aims to cure the condition if possible, or at least control it for a long time. Your urologist, oncologist and clinical nurse specialist will discuss your treatment options with you, which will either be: an operation to remove your bladder (cystectomy) – see above radiotherapy with a radiosensitiser Your oncologist should also discuss the possibility of having chemotherapy before either of these treatments (neoadjuvant therapy), if it’s suitable for you.


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should also discuss the possibility of having chemotherapy before either of these treatments (neoadjuvant therapy), if it’s suitable for you. Radiotherapy with a radiosensitiser Radiotherapy is given by a machine that beams the radiation at the bladder (external radiotherapy). Sessions are usually given on a daily basis for 5 days a week over the course of 4 to 7 weeks. Each session lasts for about 10 to 15 minutes. A radiosensitiser should also be given alongside radiotherapy for muscle-invasive bladder cancer. This is a medicine which affects the cells of a tumour, to enhance the effect of radiotherapy. It has a much smaller effect on normal tissue. As well as destroying cancerous cells, radiotherapy can also damage healthy cells, which means it can cause a number of side effects. These include: diarrhoea inflammation of the bladder (cystitis) tightening of the vagina (in women), which can make having sex painful erectile dysfunction (in men) loss of pubic hair infertility tiredness


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tightening of the vagina (in women), which can make having sex painful erectile dysfunction (in men) loss of pubic hair infertility tiredness difficulty passing urine Most of these side effects should pass a few weeks after your treatment finishes, although there’s a chance they’ll be permanent. Having radiation directed at your pelvis usually means you’ll be infertile for the rest of your life. However, most people treated for bladder cancer are too old to have children, so this isn’t usually a problem. After having radiotherapy for bladder cancer, you should be offered follow-up appointments every 3 months for the first 2 years, then every 6 months for the next 2 years, and every year after that. At these appointments, your bladder will be checked using a cystoscopy. You may also be offered CT scans of your abdomen, pelvis and chest after 6 months, 1 year and 2 years. A CT scan of your urinary tract may be offered every year for 5 years. Surgery or radiotherapy? Your MDT may


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after 6 months, 1 year and 2 years. A CT scan of your urinary tract may be offered every year for 5 years. Surgery or radiotherapy? Your MDT may recommend a specific treatment because of your individual circumstances. For example, someone with a small bladder or many existing urinary symptoms is better suited to surgery. Someone who has a single bladder tumour with normal bladder function is better suited for treatments that preserve the bladder. However, your input is also important, so you should discuss which treatment is best for you with your MDT. There are pros and cons of both surgery and radiotherapy. The pros of having a radical cystectomy include: treatment is carried out in one go you won’t need regular cystoscopies after treatment, although other less invasive tests may be needed The cons of having a radical cystectomy include: it can take up to 3 months to fully recover a risk of general surgical complications, such as pain, infection and bleeding a risk of complications


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it can take up to 3 months to fully recover a risk of general surgical complications, such as pain, infection and bleeding a risk of complications from the use of general anaesthetic an alternative way of passing urine out of your body needs to be created, which may involve an external bag a high risk of erectile dysfunction in men (estimated at around 90%) as a result of nerve damage after surgery, some women may find sex uncomfortable, as their vagina may be smaller a small chance of a fatal complication, such as a heart attack, stroke or deep vein thrombosis (DVT) The pros of having radiotherapy include: there’s no need to have surgery, which is often an important consideration for people in poor health your bladder function may not be affected, as your bladder isn’t removed there’s less chance of causing erectile dysfunction (around 30%) The cons of having radiotherapy include: you’ll require regular sessions of radiotherapy for 4 to 7 weeks short-term side effects are common,


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30%) The cons of having radiotherapy include: you’ll require regular sessions of radiotherapy for 4 to 7 weeks short-term side effects are common, such as diarrhoea, tiredness and inflammation of the bladder (cystitis) a small chance of permanently damaging the bladder, which could lead to problems urinating women may experience a narrowed vagina, making sex difficult and uncomfortable Chemotherapy In some cases, chemotherapy may be used during treatment for muscle-invasive bladder cancer. Instead of medication being put directly into your bladder, it’s put into a vein in your arm. This is called intravenous chemotherapy and can be used: before radiotherapy and surgery to shrink the size of any tumours in combination with radiotherapy before surgery (chemoradiation) to slow the spread of incurable advanced bladder cancer (palliative chemotherapy) There isn’t enough evidence to say whether chemotherapy is an effective treatment when it’s given after surgery to prevent the cancer


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chemotherapy) There isn’t enough evidence to say whether chemotherapy is an effective treatment when it’s given after surgery to prevent the cancer returning. It’s usually only used this way as part of a clinical trial. See clinical trials for bladder cancer for more information. Chemotherapy is usually given over a few consecutive days at first. You’ll then have a few weeks off to allow your body to recover before the treatment begins again. This cycle will be repeated for a few months. As the chemotherapy medication is being injected into your blood, you’ll experience a wider range of side effects than if you were having chemotherapy directly into the bladder. These side effects should stop after the treatment has finished. Chemotherapy weakens your immune system, making you more vulnerable to infection. It’s important to report any symptoms of a potential infection, such as a high temperature, persistent cough or reddening of the skin, to your MDT. Avoid close contact with people


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of a potential infection, such as a high temperature, persistent cough or reddening of the skin, to your MDT. Avoid close contact with people who are known to have an infection. Other side effects of chemotherapy can include: nausea vomiting hair loss lack of appetite tiredness Locally advanced or metastatic bladder cancer The recommended treatment plan for locally advanced or metastatic bladder cancer depends on how far the cancer has spread. Your oncologist should discuss your treatment options with you, which may include: a course of chemotherapy treatments to relieve cancer symptoms Chemotherapy If you receive a course of chemotherapy, you’ll be given a combination of drugs to help relieve the side effects of treatment. Treatment may be stopped if chemotherapy isn’t helping, or a second course may be offered. Relieving cancer symptoms You may be offered treatment to relieve any cancer symptoms. This may include: radiotherapy to treat painful urination, blood in urine, frequently


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You may be offered treatment to relieve any cancer symptoms. This may include: radiotherapy to treat painful urination, blood in urine, frequently needing to urinate or pain in your pelvic area treatment to drain your kidneys, if they become blocked and cause lower back pain Palliative care If your cancer is at an advanced stage and can’t be cured, your MDT should discuss how the cancer will progress and which treatments are available to ease the symptoms. You can be referred to a palliative care team, who can provide support and practical help, including pain relief. Read more about end of life care Complications of bladder cancer A diagnosis of bladder cancer, and some treatments for the condition, can have a significant impact on your life. Emotional impact The emotional impact of living with bladder cancer can be huge. Many people report experiencing a kind of ‘rollercoaster’ effect. For example, you may feel down at receiving a diagnosis, up when the cancer is removed, and down


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experiencing a kind of ‘rollercoaster’ effect. For example, you may feel down at receiving a diagnosis, up when the cancer is removed, and down again as you try to come to terms with the after-effects of your treatment. This type of emotional disruption can sometimes trigger feelings of depression. Signs that you may be depressed include: having continuous feelings of sadness or hopelessness no longer taking pleasure in the things you enjoy Contact your GP for advice if you think you may be depressed. There’s a range of relatively successful treatments for depression, including antidepressant medication and therapies such as cognitive behavioural therapy (CBT). Read more about coping with cancer Urinary diversion If your bladder is removed, an alternative way of passing urine out of your body will be created during the operation. This is called urinary diversion. There are various types of urinary diversion, which are described below. In some cases, you may be able to make a choice


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is called urinary diversion. There are various types of urinary diversion, which are described below. In some cases, you may be able to make a choice based on your personal preferences. However, certain treatment options will not be suitable for everyone. Your multidisciplinary team (MDT) can provide information on the most suitable options for you. Urostomy A urostomy is carried out during a radical cystectomy. A small section of the small bowel is removed and connected to your ureters (the 2 tubes that normally carry urine out of the kidneys). The surgeon then creates a small hole in the surface of your abdomen and the open end of the removed bowel is placed in this hole, creating an opening known as a stoma. A special waterproof bag is placed over the stoma to collect urine. A stoma nurse will teach you how to care for your stoma, and how and when to change the bag. Continent urinary diversion Continent urinary diversion is similar to a urostomy, but without an external bag.


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and how and when to change the bag. Continent urinary diversion Continent urinary diversion is similar to a urostomy, but without an external bag. Instead, a section of your bowel is used to create a pouch inside your body that stores urine. The ureters are connected to the pouch and the pouch is connected to an opening in the abdominal wall. A valve in the opening (stoma) prevents urine leaking out. The pouch is emptied using a thin, flexible tube (catheter). Most people need to empty their pouch about 4 or 5 times a day. Bladder reconstruction In some cases it may be possible to create a new bladder, known as a neobladder. This involves removing a section of your bowel and reconstructing it into a balloon-like sac, before connecting it to your urethra (the tube that carries urine out of the body) at one end and your ureters at the other end. However, bladder reconstruction isn’t suitable for everyone. You’ll be taught how to empty your neobladder by relaxing the muscles in your


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other end. However, bladder reconstruction isn’t suitable for everyone. You’ll be taught how to empty your neobladder by relaxing the muscles in your pelvis, while tightening the muscles in your abdomen at the same time. Your neobladder won’t contain the same types of nerve endings as a real bladder, so you won’t get the distinctive sensation that tells you to pass urine. Some people experience a feeling of fullness inside their abdomen, while others have reported they feel like they need to pass wind. Because of the loss of normal nerve function, most people with a neobladder experience some episodes of urinary incontinence, which usually occurs during the night, while they’re asleep. You may find it useful to empty your neobladder at set times during the day, including before you go to bed, to help prevent incontinence. Sexual problems Erectile dysfunction Contact your MDT if you lose the ability to obtain or maintain an erection after a radical cystectomy. It may be possible for


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Erectile dysfunction Contact your MDT if you lose the ability to obtain or maintain an erection after a radical cystectomy. It may be possible for you to be treated with a type of medicine known as phosphodiesterase type 5 inhibitors (PDE5). PDE5s work by increasing the blood supply to your penis. PDE5s are sometimes combined with a device called a vacuum pump, which consists of a cylinder connected to a pump. The penis is placed inside the cylinder and the air is pumped out. This creates a vacuum that causes blood to flow into the penis. A rubber ring is then placed around the base of the penis, which allows an erection to be maintained for around 30 minutes. Read more about treating erectile dysfunction Narrowing of the vagina Both radiotherapy and cystectomy can cause a woman’s vagina to become shortened and narrowed, which can make penetrative sex painful or difficult. There are 2 main treatment options available if you have a narrowed vagina. The first is to apply hormonal cream


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sex painful or difficult. There are 2 main treatment options available if you have a narrowed vagina. The first is to apply hormonal cream to the area, which should help to increase moisture inside your vagina. The second is to use vaginal dilators. These are plastic cone-shaped devices of various sizes that are designed to gently stretch your vagina and make it more supple. It’s usually recommended that you use dilators for a 5 to 10-minute period every day, starting with the dilator that fits in easiest first and gradually increasing the size, as your vagina stretches over the following weeks. Many women find this an embarrassing issue to discuss, but the use of dilators is a well-recognised treatment for narrowing of the vagina. Your specialist cancer nurse should be able to provide more information and advice. You may find that the more often you have penetrative sex, the less painful it becomes. However, it may be several months before you feel emotionally ready to be intimate


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more often you have penetrative sex, the less painful it becomes. However, it may be several months before you feel emotionally ready to be intimate with a sexual partner. Macmillan Cancer Support has further information about sex and the side effects of cancer treatment. Preventing bladder cancer It’s not always possible to prevent bladder cancer, but some risk factors have been identified, which may increase your risk of developing the condition. Stopping smoking If you smoke, giving up is the best way to reduce your risk of developing bladder cancer and preventing it from recurring. If you decide to stop smoking, you could contact the Quit Your Way Scotland service on 0800 84 84 84 (8.00am to 10.00pm, every day). The specially trained helpline staff will offer you free expert advice and encouragement. If you’re committed to giving up smoking, but don’t want to be referred to a stop smoking service, your GP should be able to prescribe medical treatment to help with any withdrawal


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smoking, but don’t want to be referred to a stop smoking service, your GP should be able to prescribe medical treatment to help with any withdrawal symptoms you may experience after giving up. For more information and advice about giving up smoking, have a browse through stop smoking treatments and the stop smoking home page. Workplace safety Your risk of bladder cancer could be increased if your job involves exposure to certain chemicals. Occupations linked to an increased risk of bladder cancer are manufacturing jobs involving: rubber dyes textiles plastic leather tanning diesel fumes Nowadays, there are rigorous safety protocols in place designed to minimise your risk of exposure, and chemicals known to increase the risk of bladder cancer have been banned. If you’re uncertain about what these protocols involve, talk to your line manager or health and safety representative. If you’re concerned that your employer may be disregarding recommendations about workplace safety, you should


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or health and safety representative. If you’re concerned that your employer may be disregarding recommendations about workplace safety, you should contact the Health and Safety Executive for advice. Diet There’s some evidence to suggest that a diet high in fruit and vegetables and low in fat can help to prevent bladder cancer. Even though this evidence is limited, it’s a good idea to follow this type of healthy diet, as it can help to prevent other types of cancer, such as bowel cancer, as well as serious health conditions, including high blood pressure (hypertension), stroke and heart disease. A low-fat, high-fibre diet is recommended, including plenty of fresh fruit and vegetables (5 portions a day) and whole grains. Limit the amount of salt you eat to no more than 6g (0.2oz) a day (1 teaspoon) because too much can increase your blood pressure. You should try to avoid foods that contain saturated fat, as it can increase your cholesterol levels. Foods high in saturated fat include:


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pressure. You should try to avoid foods that contain saturated fat, as it can increase your cholesterol levels. Foods high in saturated fat include: meat pies sausages and fatty cuts of meat butter ghee (a type of butter often used in Indian cooking) lard cream hard cheese cakes and biscuits foods that contain coconut or palm oil However, a balanced diet should include a small amount of unsaturated fat, because this will actually help to control your cholesterol levels. Foods high in unsaturated fat include: oily fish avocados nuts and seeds sunflower, rapeseed, olive and vegetable oils Read more about healthy eating Source: NHS 24 - Opens in new browser window Last updated: 14 October 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For


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or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Also on NHS inform Radiotherapy Chemotherapy Other health sites Cancer Research UK: Bladder cancer Fight Bladder Cancer: What is bladder cancer? Macmillan Cancer Support: Bladder cancer Penny Brohn UK Scottish Cancer Network: Patient information Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-teenagers-and-young-adults/bone-cancer-teenagers-and-young-adults/


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Bone cancer: Teenagers and young adults | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Cancer Cancer types in teenagers and young adults Bone cancer: Teenagers and young adults Bone cancer: Teenagers and young adults Introduction The bones Tests for bone cancer Treating bone cancer Life after treatment for bone cancer Introduction This section about bone cancer is for teenagers and young adults. There are different types of bone cancer, and most of this information applies to all types. If you have a rare type of bone cancer and want to know more, you could talk to the Macmillan Support Line. If you’re looking for information about bone cancer in people of all ages, read our general bone cancer section. Types of bone cancer There are different types of bone cancer. The 2 most common bone cancers to affect teenagers are osteosarcoma and Ewing


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section. Types of bone cancer There are different types of bone cancer. The 2 most common bone cancers to affect teenagers are osteosarcoma and Ewing sarcoma. Osteosarcoma Osteosarcomas are most likely to affect bones in the leg, especially around the knee joint, but they can affect any bone. Ewing sarcoma Ewing sarcoma can affect any bone, but it’s most common in the pelvis (which is made up of the tail bone and the 2 hip bones), or in leg bones. Ewing sarcoma can sometimes start outside the bone in the soft tissue. This is called soft tissue Ewing sarcoma, and is treated in the same way. Sarcoma is the name for a cancer that starts in any connective tissue, such as muscle, fat or cartilage. In this information we sometimes use the term ‘bone tumour’. This means the same as bone cancer. Causes The cause of bone cancer is unknown. Because it’s more common in young people, doctors think that it may be linked to the changes that happen when bones are growing. There is lots of ongoing


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it’s more common in young people, doctors think that it may be linked to the changes that happen when bones are growing. There is lots of ongoing research into the possible causes. People often think a knock or injury might have caused bone cancer, but there’s no evidence for this. Remember that nothing you’ve done has caused the cancer. Signs and symptoms of bone cancer Bone cancer symptoms vary, and not everyone will feel the same. Many symptoms are similar to everyday aches and pains, so they can be mistaken for other things, like strains, sports injuries or growing pains. The main symptoms are: pain or tenderness – this may start as an ache that doesn’t go away and may be made worse by exercise or feel worse at night swelling around the affected area of bone – swelling may not show up until the tumour is quite large and it isn’t always possible to see or feel a lump if the affected bone is deep inside the body reduced movement – if the bone tumour is near a joint (like an elbow or


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possible to see or feel a lump if the affected bone is deep inside the body reduced movement – if the bone tumour is near a joint (like an elbow or knee), it can make it harder to move the joint; if it’s in a leg bone, it may cause a limp; if it’s in the backbone (spine), it may press on nerves and cause tingling and numbness in the legs or arms a broken bone – a bone may break suddenly, or after only a minor fall or accident if the bone has been weakened by cancer. There might also be other symptoms including: tiredness a high temperature loss of appetite weight loss If you have any of these symptoms, or you are worried that you may have a bone tumour, you should get it checked by your GP. They can talk to you about your symptoms, and arrange tests if they feel they’re needed. Remember – most people with these symptoms won’t have bone cancer. The bones Knowing what your bones do might help you understand what bone cancer is. Bones are like human scaffolding. They help keep you


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bone cancer. The bones Knowing what your bones do might help you understand what bone cancer is. Bones are like human scaffolding. They help keep you upright. The human skeleton is made up of more than 200 bones of different shapes and sizes. Bones do lots of important things: they work with joints and connective tissue so that you can move around they protect parts of the body from injury – for example, the ribs protect the heart and lungs they store calcium some bones contain bone marrow, which make blood cells Joints Joints help bones fit together so that we can move freely. There are different types of joint. Some work as levers, like the finger joint. Others are ball-and-socket joints, such as the hip joint. There are different types of connective tissue that help bones move: ligaments are tough cords of tissue that attach bones to each other cartilage is a slippery material that covers the ends of bones to stop them rubbing together muscles are made of tough, stretchy tissue and


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other cartilage is a slippery material that covers the ends of bones to stop them rubbing together muscles are made of tough, stretchy tissue and give strength tendons are strong cords of tissue that attach muscles to bones We also have more information about: symptoms of bone cancer having tests for bone cancer treatment for bone cancer life after bone cancer If you’re looking for information about bone cancer in people of all ages, read our general bone cancer section. Tests for bone cancer There are some tests you might have when you visit your GP or at the hospital. The tests will help the doctors see whether you have bone cancer. Visiting your GP If you think you might have some of the symptoms of bone cancer, you should speak to your GP. Your GP will talk to you about your symptoms, examine you and usually arrange some tests, such as X-rays and blood tests. There may be a number of reasons why you’re feeling unwell, so it can be difficult to diagnose the problem straight away.


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as X-rays and blood tests. There may be a number of reasons why you’re feeling unwell, so it can be difficult to diagnose the problem straight away. If your GP can’t find the cause, you may be referred to a specialist at the hospital. At the hospital The hospital you’re referred to will depend on the results of the tests. You may go straight to a doctor specialising in bone cancer, or you might see doctors with more general experience first. The hospital doctor will examine you and arrange for some of the following tests: X-rays bone scans biopsies MRI and/or CT scans If you’re diagnosed with bone cancer and not already seeing a specialist bone doctor, you’ll be referred to one. Further tests If the tests show you have bone cancer, you might need a few more tests to check how your body is working in general: blood tests tests to check your heart is healthy chest X-rays to check your lungs are healthy tests to check your kidneys are healthy – you may need to give a sample of pee


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your heart is healthy chest X-rays to check your lungs are healthy tests to check your kidneys are healthy – you may need to give a sample of pee (urine) to be tested This may seem like a lot of tests, but they’ll help the doctors plan the best treatment for you. Having tests and waiting for the results can be an anxious time. Talking about how you feel and getting support from family, friends, your specialist nurse or your doctor can help. We have more information about: the bones symptoms of bone cancer treatment for bone cancer life after bone cancer If you’re looking for information about bone cancer in people of all ages, read our general bone cancer section. Treating bone cancer The information on this page is about Ewing sarcoma and osteosarcoma. The 3 main treatments for bone cancer are chemotherapy, surgery and radiotherapy. Most people have a combination of these. Your doctors will plan your treatment based on: the type of bone cancer you have where the cancer is the stage


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people have a combination of these. Your doctors will plan your treatment based on: the type of bone cancer you have where the cancer is the stage of the cancer (this means whether it has spread outside the bone) how fast-growing the cancer is If you have any questions about your treatment, ask your doctor or nurse. They’ll be happy to help you understand what’s involved. You may be offered the opportunity to take part in a clinical research trial. These trials help doctors find new and better treatments for people with bone cancer. If your doctor thinks you are suitable for a clinical trial, they’ll discuss this with you. In this information we sometimes use the term ‘bone tumour’. This means the same as bone cancer. Chemotherapy Chemotherapy is when you’re given anti-cancer drugs to destroy the cancer cells. It’s an important treatment for bone tumours. It helps shrink the tumour before surgery or radiotherapy, and it can kill cells that have spread outside the bone. After your


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for bone tumours. It helps shrink the tumour before surgery or radiotherapy, and it can kill cells that have spread outside the bone. After your surgery or radiotherapy, you’ll usually have more chemotherapy. Chemotherapy for bone cancer is given into a vein, usually through a central line, a port or a PICC line. You’ll have chemotherapy over a few days and then you’ll have some time off to give your body a chance to recover from any side effects. The days you have the chemotherapy and the rest period afterwards is called a cycle. Most people have several cycles of chemotherapy. You’ll probably need to stay in hospital for some of the time during chemotherapy. The type of chemotherapy you have depends on whether the tumour is an Ewing sarcoma or an osteosarcoma. Chemotherapy for Ewing sarcoma For Ewing sarcoma, the drugs most often used first are vincristine, ifosfamide, doxorubicin and etoposide. Giving these drugs together is called VIDE. You’ll usually have 6 cycles of VIDE. After


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first are vincristine, ifosfamide, doxorubicin and etoposide. Giving these drugs together is called VIDE. You’ll usually have 6 cycles of VIDE. After your chemotherapy you may have surgery, or, if the tumour can’t be removed with an operation, you’ll have radiotherapy. Some people have both surgery and radiotherapy. The team looking after you will decide on the best combination for you. If you have surgery, you’ll have more chemotherapy afterwards to help stop the tumour coming back or spreading to other parts of the body. At the moment, there is a clinical trial called Euro-Ewing 2012 that is comparing different combinations of chemotherapy treatments before and after surgery for people with Ewing sarcomas. You can talk to your specialist doctor about whether you could take part in this trial. Chemotherapy for osteosarcoma Osteosarcoma is usually treated with 3 chemotherapy drugs called methotrexate, doxorubicin (Adriamycin) and cisplatin. Giving these drugs together is called MAP.


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is usually treated with 3 chemotherapy drugs called methotrexate, doxorubicin (Adriamycin) and cisplatin. Giving these drugs together is called MAP. You will usually have 6 cycles of chemotherapy in total. Each cycle takes about 5 weeks. After the first 2 cycles, you’ll have surgery to remove the cancer. If the cancer has spread, you may also need to have surgery on another part of your body. For example, if osteosarcoma spreads outside of the main tumour, it usually spreads to the lungs. If the cancer has spread to your lungs, you may need a second operation to remove the cancer in your lungs. If you have bone cancer that’s spread, your doctors will talk to you about what will happen next. After surgery, you’ll have 4 more cycles of MAP chemotherapy. You may also be given a new treatment called mifamurtide (Mepact), which helps your body kill tumour cells. Your doctor will tell you if you can have this drug as well as your chemotherapy. Side effects Different chemotherapy drugs cause


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kill tumour cells. Your doctor will tell you if you can have this drug as well as your chemotherapy. Side effects Different chemotherapy drugs cause different side effects. Some people have just a few side effects and others have more. It’s hard to know how it’s going to be for you. Most side effects are temporary and gradually disappear once treatment stops. The most common are a sore mouth, hair loss, tiredness, sickness and being more at risk of getting an infection. The most common side effect of mifamurtide is having a high temperature or feeling cold and shivery for a few hours after it’s given. Surgery The surgery you have will depend on the type of bone cancer you have and where it is in the body. Your surgeon will aim to remove all of the cancer, while trying to keep as much function in the limb as possible. Limb-sparing surgery Most people with bone cancer have an operation called limb-sparing surgery. This means the surgeon removes the cancer without having to remove the


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Most people with bone cancer have an operation called limb-sparing surgery. This means the surgeon removes the cancer without having to remove the arm or leg it’s in. You’ll have all the tumour taken away from your limb, including any bone and muscle affected by the tumour. It’s usually possible to remove the affected part of the bone and replace it with a custom-made metal fitting (endoprosthesis) or with a bone from another part of the body (bone graft). If the cancer affects a bone in or near a joint, the whole joint can often be replaced with an artificial one. In some cases, the surgeon can remove the affected bone without replacing it with anything and without it affecting the way you move. Before the operation If you’ve had chemotherapy, you’ll need 2 or 3 weeks to recover before you can have your operation. Doctors will make sure that you’re well enough to have the operation. If you’ve lost weight or been off your food, you might need to build yourself up a bit before the


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sure that you’re well enough to have the operation. If you’ve lost weight or been off your food, you might need to build yourself up a bit before the operation. The hospital dietitian can help you do this. You’ll probably see a physiotherapist, who’ll give you exercises to strengthen your muscles. You may like to see the replacement part or endoprosthesis (often just called a prosthesis) that will be put in during your operation. If you would like to see it, your surgeon or key worker can usually arrange this. After the operation You’ll have a bandage or splint on your limb to keep it supported and let it heal. You’ll probably have a tube, called a drain, coming out of your wound. This stops fluid building up in your wound. A nurse will take it out after about 3 to 4 days. You won’t feel like eating or drinking much for a few hours after your operation, so you’ll be given fluids into a vein. This is called a drip. You’ll probably feel a bit sore to begin with, but you’ll be given


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your operation, so you’ll be given fluids into a vein. This is called a drip. You’ll probably feel a bit sore to begin with, but you’ll be given strong painkillers to help. It’s important to tell the nurses if you need extra pain relief. The pain usually starts to get better within 2 or 3 days. As time goes on, you’ll need fewer painkillers and will start to feel a lot more comfortable. Once you’re home, you should start to feel a bit better and stronger every day. But if you do have any problems, it’s important to tell your doctor or nurse right away, so they can deal with them quickly. After your operation, you will need to do lots of physiotherapy to help you make the best possible recovery. This can feel like hard work but is really important. Your physiotherapist will tell you what exercises to do, and help you to do them regularly. If you notice any new redness, pain or swelling in the limb that’s been operated on, it’s very important to get in touch with your doctor right away.


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If you notice any new redness, pain or swelling in the limb that’s been operated on, it’s very important to get in touch with your doctor right away. You might have an infection that needs treatment, so you’ll need to see the surgeon who did your operation without delay. There’s more information about the long-term effects of limb-sparing surgery in our section on living with and after bone cancer. Amputation Sometimes the only way to get rid of the bone cancer affecting an arm or a leg is to remove the limb. This is called an amputation. It’s only done if there is no alternative. This is usually needed if the cancer has spread from the bone and has grown around nearby blood vessels. These need to be removed along with the cancer. Some people choose to have an amputation rather than limb-sparing surgery. You should be given a chance to discuss the advantages and disadvantages of both types of surgery with your team. An amputation may also need to be done if there’s an infection in the


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the advantages and disadvantages of both types of surgery with your team. An amputation may also need to be done if there’s an infection in the bone that doesn’t go away with treatment, or if the cancer comes back in the bone. Every person and every tumour is different, so you might meet other people with the same type of tumour, who are having slightly different surgery. Your specialist will talk to you about your operation and make sure you understand what’s involved. Before the operation Your doctor will talk things through with you so that you fully understand what’s involved. Losing a limb can feel very scary and it might help to talk to your specialist nurse, key worker or a counsellor about your feelings. It might also help to talk to someone who’s had an amputation – your nurse or doctor can arrange this. It’s really important to get support at this tough time. After the operation You’ll have bandages or a plaster cast on the area that’s been operated on. There’ll be a tube,


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get support at this tough time. After the operation You’ll have bandages or a plaster cast on the area that’s been operated on. There’ll be a tube, called a drain, coming from the wound. This stops fluid building up. A nurse will usually take it out after 3 or 4 days. You’ll also have a drip to give you fluid into a vein in your arm until you feel like eating and drinking again. You’ll probably feel a bit sore after your op, especially for the first 2 or 4 days, but you’ll be given strong painkillers to help with this. It’s important to tell the nurses if you need extra pain relief. As time goes on, you’ll need fewer painkillers and will start to feel a lot more comfortable. You may have pain that feels like it’s coming from the part of the limb that’s been removed. This is known as ‘phantom pain’. Let your doctor or nurse know if you have this. There are medicines that can help ease it or take it away. It usually gets better and goes away in time. A physiotherapist will visit you a


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this. There are medicines that can help ease it or take it away. It usually gets better and goes away in time. A physiotherapist will visit you a day or so after your operation. They’ll show you exercises to keep your muscles strong and flexible. If you’ve had an arm removed, you’ll be able to get up and move around once you’ve recovered from the anaesthetic and don’t feel too sore. If you’ve had a leg removed, the physiotherapist will show you how to move around in bed and get from your bed to a chair. You’ll probably be moving around with crutches or in a wheelchair within a few days. Once you’re up and about, you’ll go to the hospital gym for physiotherapy. This is a big part of your recovery. Your physiotherapist will give you more exercises to do as your wound heals and you get stronger. It’ll take a few months for your limb to heal to its final shape after the operation, so you won’t be fitted with your permanent prosthesis until this happens. In the meantime, you’ll be given a


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to its final shape after the operation, so you won’t be fitted with your permanent prosthesis until this happens. In the meantime, you’ll be given a temporary prosthesis and learn how to use it in physiotherapy. You should be able to go home about 2 weeks after your operation. There’s more information about the long-term effects of amputation in our section on living with and after bone cancer. Radiotherapy Radiotherapy treats cancer by using high-energy X-rays to destroy cancer cells. Radiotherapy is mainly used to treat Ewing sarcoma. You may have radiotherapy after your chemotherapy, or before or after having surgery. If you have osteosarcoma, you’re less likely to have radiotherapy treatment. But you might have it if an operation to remove the cancer isn’t possible. Occasionally, people with osteosarcoma have radiotherapy after surgery to remove their cancer. Radiotherapy is generally given every weekday (Monday to Friday) for 5 weeks. Each treatment takes a few minutes. Side


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to remove their cancer. Radiotherapy is generally given every weekday (Monday to Friday) for 5 weeks. Each treatment takes a few minutes. Side effects Radiotherapy isn’t painful, but it can cause other side effects. After a few treatments you may begin to feel tired, and your skin may go red or get darker and feel sore or itchy around the area that’s being treated. This gets better once your radiotherapy treatment is over. Other side effects depend on which part of your body is being treated. Having radiotherapy around a joint can make it feel stiff, but physiotherapy can help. We also have more information about: symptoms of bone cancer having tests for bone cancer life after bone cancer the bones If you’re looking for information about bone cancer in people of all ages, read our general bone cancer section. Life after treatment for bone cancer This information is about life after having surgery for bone cancer. Life after limb-sparing surgery The long-term effects of limb-sparing


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cancer This information is about life after having surgery for bone cancer. Life after limb-sparing surgery The long-term effects of limb-sparing surgery depend on which part of your body is affected and what kind of operation you have. The best person to ask about this is your surgeon. After limb-sparing surgery, the limb might not work as well as it used to. Physiotherapy is an important part of your recovery. You’ll be given exercises to do to help you get your limb working as well as possible. These can be hard work, but it’s important to keep going with them. Knee joint replacement If you’ve had a knee joint replacement, you’ll be able to walk and swim, but your doctor might advise you not to play high-impact sports like hockey, football, tennis or rugby. These activities could damage or loosen the new joint. It’s usually OK to run a short distance, for example for a bus. But running or jogging regularly wears out the new joint, so it’s best to avoid this. If your knee joint


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run a short distance, for example for a bus. But running or jogging regularly wears out the new joint, so it’s best to avoid this. If your knee joint wears out or loosens, you might need to have it replaced after a few years. Hip joint replacements After a hip joint replacement, you should be able to do most of your usual activities, but you’ll probably be advised to avoid running and high-impact sports. Shoulder replacement If you’ve had a shoulder replacement, you’ll be able to move your arm below shoulder height the same as before, but you might not be able to lift your arm above your shoulder. Bone graft If you’ve had an implant put into your limb while you’re still growing, you’ll need to have it lengthened as your leg or arm grows. Some types of implant can be lengthened without an operation, but with others you’ll need surgery. Your specialist or key worker can tell you what kind of implant you have. Life after amputation After amputation, you usually have an artificial limb


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Your specialist or key worker can tell you what kind of implant you have. Life after amputation After amputation, you usually have an artificial limb fitted. This is called a prosthesis. There are artificial limbs designed to let you do all types of physical activities, including walking, swimming, running, cycling and playing sports. Different types of prosthesis let you do different things. Some people have one for wearing day-to-day, and an extra one specially designed for something like swimming or doing athletics. How will I feel? Things may be tough as you get used to living with the changes in your body, but help is available. You might have lots of different emotions. You might be tearful, angry, fed up or sad at times. You might feel like you’ve lost all your confidence and that you’ll never be able to live a normal life or be in a relationship. These feelings are normal, and it’s important to get support to help you cope with them. You could talk to: your specialist nurse or


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a relationship. These feelings are normal, and it’s important to get support to help you cope with them. You could talk to: your specialist nurse or key worker family or friends a counsellor, which can be arranged by your nurses other young people in a similar situation Other people’s reactions can be hard to cope with too. You might be worried about what your friends think or how they’re going to treat you. The thought of going back to school, college or work can be scary. Even people in your family who you are close to might not know what to say or do. Others might say things that sound stupid or seem hurtful. Try to choose a couple of really close relatives or friends who you can talk to if things get you down. You might find it useful to talk to someone outside your close circle, like your specialist nurse, key worker or counsellor. Most people find it helps to talk about how they’re feeling or what’s on their mind. Follow-up When you finish your treatment, your doctor will talk


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Most people find it helps to talk about how they’re feeling or what’s on their mind. Follow-up When you finish your treatment, your doctor will talk to you about what happens next. They will explain some of the long-term risks that bone cancer and its treatment could have for you. They will make arrangements to see you in a clinic to see how you are getting on. We have more info about: the bones symptoms of bone cancer having tests for bone cancer treatment for bone cancer If you’re looking for information about bone cancer in people of all ages, read our general bone cancer section. Source: Macmillan - Opens in new browser window Last updated: 09 October 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Don’t include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Other health sites Scottish


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Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to Info For Me Other health sites Scottish Cancer Network: Patient information Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats © 2025 NHS 24 – v1.1.1.17852


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https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/bowel-incontinence/


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Bowel incontinence | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotland’s Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Bowel incontinence Bowel incontinence About bowel incontinence Causes of bowel incontinence Diagnosing bowel incontinence Treating bowel incontinence About bowel incontinence Bowel incontinence is an inability to control bowel movements, resulting in involuntary soiling. It’s also sometimes known as faecal incontinence. The experience of bowel incontinence can vary from person to person. Some people feel a sudden need to go to the toilet but are unable to reach a toilet in time. This is known as urge bowel incontinence. Other people experience no sensation before soiling themselves, known as passive incontinence or passive soiling, or there might be slight soiling when passing wind. Some people experience incontinence on a daily basis,


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as passive incontinence or passive soiling, or there might be slight soiling when passing wind. Some people experience incontinence on a daily basis, whereas for others it only happens from time to time. It’s thought 1 in 10 people will be affected by it at some point in their life. It can affect people of any age, although it’s more common in elderly people. It’s also more common in women than men. Why bowel incontinence happens Bowel incontinence is a symptom of an underlying problem or medical condition. Many cases are caused by diarrhoea, constipation, or weakening of the muscle that controls the opening of the anus. It can also be caused by long-term conditions such as diabetes, multiple sclerosis and dementia. Read more about the causes of bowel incontinence. Seeking advice and treatment Bowel incontinence can be upsetting and hard to cope with, but treatment is effective and a cure is often possible, so make sure you see your GP. It’s important to remember that: bowel


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and hard to cope with, but treatment is effective and a cure is often possible, so make sure you see your GP. It’s important to remember that: bowel incontinence isn’t something to be ashamed of – it’s simply a medical problem that’s no different from diabetes or asthma it can be treated – there’s a wide range of successful treatments bowel incontinence isn’t a normal part of ageing it won’t usually go away on its own – most people need treatment for the condition If you don’t want to see your GP, you can usually make an appointment at your local NHS continence service without a referral. These clinics are staffed by specialist nurses who can offer useful advice about incontinence. Read more about diagnosing bowel incontinence. How bowel incontinence is treated In many cases, with the right treatment, a person can maintain normal bowel function throughout their life. Treatment will often depend on the cause and how severe it is, but possible options include: lifestyle and dietary


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function throughout their life. Treatment will often depend on the cause and how severe it is, but possible options include: lifestyle and dietary changes to relieve constipation or diarrhoea exercise programmes to strengthen the muscles that control the bowel medication to control diarrhoea and constipation surgery, of which there are a number of different options Incontinence products, such as anal plugs and disposable pads, can be used until your symptoms are better controlled. Even if it isn’t possible to cure your bowel incontinence, symptoms should improve significantly. Read more about treating bowel incontinence. Causes of bowel incontinence Bowel incontinence is usually caused by a physical problem with the parts of the body that control the bowel. The most common problems are: problems with the rectum – the rectum is unable to retain poo properly until it’s time to go to the toilet problems with the sphincter muscles – the muscles at the bottom of the rectum don’t work


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to retain poo properly until it’s time to go to the toilet problems with the sphincter muscles – the muscles at the bottom of the rectum don’t work properly nerve damage – the nerve signals sent from the rectum don’t reach the brain These problems are explained in more detail below. It’s important to discuss any bowel problems with your GP as there’s a small chance they could be a sign of a more serious condition, such as bowel cancer. Problems with the rectum Constipation Constipation is a leading cause of bowel incontinence. In cases of severe constipation, a large, solid stool can become stuck in the rectum. This is known as faecal impaction. The stool then begins to stretch the muscles of the rectum, weakening them. Watery stools can leak around the stool and out of the bottom, causing bowel incontinence. This is called overflow incontinence and happens most commonly in elderly people. Repeated straining caused by constipation or faecal impaction can also lead to rectal prolapse,


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and happens most commonly in elderly people. Repeated straining caused by constipation or faecal impaction can also lead to rectal prolapse, when part of your lower intestine falls out of place and protrudes from your bottom. Rectal prolapse may also lead to bowel incontinence. Diarrhoea It’s difficult for the rectum to hold liquid stools (diarrhoea), so people with diarrhoea (particularly recurring diarrhoea) can develop bowel incontinence. Conditions that can cause recurring diarrhoea include: Crohn’s disease – inflammation of the digestive system irritable bowel syndrome – a condition that causes a range of digestive problems, such as diarrhoea and bloating ulcerative colitis – inflammation of the large bowel These conditions can also cause scarring of the rectum, which can lead to bowel incontinence. Haemorrhoids Haemorrhoids (piles) are enlarged blood vessels inside or around the bottom (the rectum and anus). Symptoms include discomfort, itching, bleeding or a lump hanging down


