I suffer from spinal stenosis and even a half-hour walk makes the pain much worse. Should I persevere?
Denis O’Brien, Durham.
Spinal stenosis, a condition in which the space around the spinal cord narrows, affects around one in ten people. It is often caused by wear and tear of the spine.
As a result the nerve tissue becomes compressed, causing pain, numbness and weakness in the lower back and in one or both legs.
For exercise to be causing further pain sounds challenging, but with the right advice the pain can be relieved and exercise resumed.
The spinal cord is contained within the spinal canal. It ends near the bottom of the ribcage, where it divides into nerves, the cauda equina (which form the main nerve connections to the lower body and legs).
Spinal stenosis, a condition in which the space around the spinal cord narrows, affects around one in ten people. It is often caused by wear and tear of the spine
The lower part of the spine carries the greatest weight and, as we age, it wears out. This can cause tissue in the region to thicken, and bony projections known as osteophytes may grow to ‘protect’ the areas of damage.
But this causes narrowing within the spinal column which is often referred to as spinal stenosis. It means certain activities, and even being upright, can cause pinched nerves and therefore trigger pain.
Your daily exercise regimen — a 30-minute walk — is triggering irritation in the nerve roots in the lower part of the spine, leaving you with pain. I suggest you find ways to exercise that minimise the need to have an upright, load-bearing posture, such as weightlifting in a reclining position or swimming.
Your GP can refer you to a physiotherapist who will develop an exercise plan to help you.
I have chronic constipation even though I eat a healthy diet. Medications aren’t helping. My last PSA reading was 60, which I am told was due to my constipation. I am 82 and have benign prostatic hyperplasia.
Martyn Hyde, Witham on the Hill, Lincs.
‘Chronic’ constipation is where two or more of the following symptoms last three months or longer: a need to strain; a sensation of incomplete emptying; or fewer than three bowel movements in a week.
It’s usually due to a malfunction in the colon or rectum but can also be triggered by medication, such as opiates; a metabolic disease, such as an underactive thyroid; or colorectal and, more rarely, prostate cancer.
A PSA test checks levels of prostate-specific antigen, a protein produced by the prostate gland — raised levels are linked to prostate problems including benign prostatic hyperplasia (an enlarged prostate), infection and cancer.
At 60, your PSA is high even for someone with an enlarged prostate. This can be as a result of pressure on the prostate due to a loaded rectum.
The treatment depends on the cause. Laxatives add fibre and increase stool bulk. But you say Fybogel and the stool softener Dulcoease haven’t helped.
I recommend you try others, such as psyllium husk, a foodstuff also sold as a fibre supplement; lactulose, a sweet liquid formed from an indigestible carbohydrate; or polyethylene glycol. Patients have also spoken to me of the magic of eating two kiwi fruit twice daily for added fibre.
If these don’t help then prucalopride, which increases the movement of the bowels, may be effective. Discuss all of the above with your doctor.
Write to Dr Scurr
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Replies should be taken in a general context. Consult your own GP with any health worries.
In my view… Yes, questions remain but I’m having the jab
The race between the infectious nature of the SARS-CoV-2 virus and the vaccine that protects us from it is now on.
Despite the optimism the jab brings, we are still in want of many facts, given the rapid development of the vaccines.
The most common questions I am asked include, ‘What are the long-term risks of the vaccine?’ ‘What will happen to those whose second dose is delayed?’ and ‘Does it prevent transmission by the very large number of asymptomatic carriers?’
Others are gripped by conspiracy theories about the vaccine. Suspicion is intrinsic to human nature; it is not new. In 1885, a Leicester rally against the smallpox vaccine drew more than 80,000 people.
The only defence against suspicion is education. Therefore, I hope that the Government and vaccine makers will be able to provide information to address these concerns, to help all of us understand the risks — if any.
And, despite any uncertainties, I eagerly await the call to get my own vaccination.
The race between the infectious nature of the SARS-CoV-2 virus and the vaccine that protects us from it is now on