In the past few years I've develop urinary incontinence. It's got so bad that I worry about leaving the house. I'm a 73-year-old woman. What should I do?
Despite what some people might say, urinary incontinence is not a normal part of ageing - and there are steps patients can take to combat the distressing symptom.
The condition, where there is leakage of urine, is extremely common, with one in three people experiencing it at some point in their lives.
The main types of incontinence include stress incontinence, when leakage occurs on coughing, laughing, sneezing or running; urge incontinence where patients feel an intense urgency to urinate and may leak due to overactivity of the bladder muscle; and overflow incontinence, where the bladder doesn't fully empty and then leaks. Many patients experience a combination of these forms of incontinence.
The good news is that there are a lot of different treatment options for urinary incontinence. Research shows that losing weight, avoiding alcohol and cutting down on caffeine can reduce the symptoms.
There are also NHS-backed daily exercises that are proven to reduce incontinence. These are known as pelvic floor exercises - and they are designed to strengthen the muscles that help control the passage of urine and faeces.
These are the muscles patients can feel tense up when they try to stop themselves from peeing or farting.
One such exercise involves squeezing the pelvic floor muscles, holding the squeeze for two or three seconds initially, relaxing the muscles and then repeating the action ten times.
Patients who do this every day will almost certainly see improvements to their stress incontinence. A GP can also refer patients to a women's health physiotherapist, who can guide them through exercises and other techniques to avoid leaks.
Urinary incontinence is not a normal part of ageing - and there are steps patients can take to combat the distressing symptom
Interestingly, many female patients do not realise that incontinence can be triggered by the menopause - the midlife reduction in sex hormones that all women go through.
As these hormones fall, the lining of the urethra - the tube that carries urine from the bladder - can thin, making leaks more likely.
And, crucially, vaginal oestrogen, an artificial version of the sex hormone that is applied directly to the vagina, can help improve the symptoms by strengthening the urethral tissue. However, it is usually used in combination with other techniques like pelvic floor exercises.
Many patients also wear incontinence pads that absorb any excess urine and help avoid embarrassing wet patches. However, these products aren't long-term solutions, which is why it's important that patients don't suffer in silence and speak to their GP about treatment.
I've been told I have severe arthritis in my left hip and will need a replacement. What should I do in the lead-up to the surgery?
People often assume that an arthritis diagnosis automatically means they will need joint replacement surgery. However, many patients - even those scheduled for the op - can avoid the invasive procedure by making lifestyle changes.
The majority of people who require a joint replacement have osteoarthritis, or wear-and-tear arthritis, where the cartilage in the joint thins, resulting in the area becoming stiff, swollen and painful.
The first response that many patients have to a flare-up of osteoarthritis is to ease-up and avoid moving the painful joint too much. However, research now shows this is the wrong approach.
It's crucial that patients with osteoarthritis keep moving, taking part in regular exercise like swimming, running or even just regular brisk walks. Of course, this can be challenging when a joint is inflamed.
This is why osteoarthritis patients are advised to see a physiotherapist, who can provide exercises to strengthen the muscles around the inflamed area, improving mobility and reducing pain.
Moreover, studies show that patients who maintain a healthy weight are less likely to need joint replacement surgery. Many patients with obesity who also have osteoarthritis find that, when they lose weight, their pain levels go down, which in turn makes exercising easier.
There are also steps that patients should take to avoid aggravating the inflammation. This includes avoiding high heels and instead wearing comfortable shoes. Patients with hip osteoarthritis are advised to avoid low seats, as getting up off them can be challenging.
And, when pain flare-ups get particularly bad, patients can take over-the-counter pain relief like ibuprofen or paracetamol.
It's never too late to tackle osteoarthritis - even for patients who are told that joint replacement surgery may be needed.
I have had a hiatus hernia for nearly a year now. I was given heartburn tablets to manage the symptoms but it's only getting worse. However, I've been told I don't qualify for surgery. What should I do?
In most cases, the symptoms of a hiatus hernia can be managed with lifestyle changes.
A hiatus hernia is when part of the stomach moves upwards into the chest. This won't trigger symptoms for every sufferer, but many do. The worst of these is heartburn - uncomfortable burning in the chest - caused by acid being pushed up into the oesophagus. This is often accompanied with bloating, nausea, vomiting, difficulty swallowing and bad breath.
Surgery is sometimes offered to combat the problem; however, this is only when lifestyle changes and medications have been exhausted.
First, it's crucial for patients to work out what sets off these symptoms. Many people report that their heartburn symptoms get worse after a big meal. So, instead, they switch to eating smaller meals but more frequently.
Likewise, avoiding eating within four hours of bedtime can also stave off some of the symptoms. Many patients prop up their head in bed with pillows, as this stops acid from rising into the throat.
Certain foods can also trigger heartburn. The worse culprits tend to be fizzy drinks, alcohol, citrus, spicy, fatty or fried foods.
Losing weight is also one of the most effective ways of limiting heartburn symptoms if you have obesity or are overweight. Most heartburn patients will be offered a daily tablet called a proton pump inhibitor; the most popular of which is omeprazole. This reduces the amount of acid produced in the stomach. However, there are other medicines patients can be offered including alginates; antacids like Gaviscon; as well as H2 receptor blockers.
All of these can counter excess acid rising into the oesophagus. Some are available over-the-counter while others require a prescription from a GP.