Introduction
Depression is more than simply feeling unhappy or fed up for a few days.
We all go through spells of feeling down, but when you're depressed you feel persistently sad for weeks or months, rather than just a few days.
Some people still think that depression is trivial and not a genuine health condition. They're wrong. Depression is a real illness with real symptoms, and it's not a sign of weakness or something you can "snap out of" by "pulling yourself together".
The good news is that with the right treatment and support, most people can make a full recovery.
How to tell if you have depression
Depression affects people in different ways and can cause a wide variety of symptoms.
They range from lasting feelings of sadness and hopelessness, to losing interest in the things you used to enjoy and feeling very tearful. Many people with depression also have symptoms of anxiety.
There can be physical symptoms too, such as feeling constantly tired, sleeping badly, having no appetite or sex drive, and complaining of various aches and pains.
The severity of the symptoms can vary. At its mildest, you may simply feel persistently low in spirit, while at its most severe depression can make you feel suicidal and that life is no longer worth living.
Most people experience feelings of stress, sadness or anxiety during difficult times. A low mood may improve after a short time, rather than being a sign of depression.
When to see Dr. B C Shah
It's important to seek help from Dr. B C Shah if you think you may be depressed.
Many people wait a long time before seeking help for depression, but it's best not to delay. The sooner you see a doctor, the sooner you can be on the way to recovery.
Sometimes there is a trigger for depression. Life-changing events, such as bereavement, losing your job or even having a baby, can bring it on.
People with a family history of depression are also more likely to experience it themselves.
But you can also become depressed for no obvious reason.
Depression is quite common and affects about one in 10 of us at some point. It affects men and women, young and old.
Depression can also strike children.
Treatment
Treatment for depression involves either medication or talking treatments, or usually a combination of the two. The kind of treatment that Dr. B C Shah recommends will be based on the type of depression you have.
Living with depression
Many people with depression benefit by making lifestyle changes such as getting more exercise, cutting down on alcohol and eating more healthily.
Self-help measures such as reading a self-help book or joining a support group are also worthwhile.
Symptoms of clinical depression
The symptoms of depression can be complex and vary widely between people. But as a general rule, if you are depressed, you feel sad, hopeless and lose interest in things you used to enjoy.
The symptoms persist for weeks or months and are bad enough to interfere with your work, social life and family life.
There are many other symptoms of depression and you're unlikely to have every one listed below.
If you experience some of these symptoms for most of the day, every day for more than two weeks, you should seek help from Dr. B C Shah.
Psychological symptoms include:
Continuous low mood or sadness
Feeling hopeless and helpless
Having low self-esteem
Feeling tearful
Feeling guilt-ridden
Feeling irritable and intolerant of others
Having no motivation or interest in things
Finding it difficult to make decisions
Not getting any enjoyment out of life
Feeling anxious or worried
Having suicidal thoughts or thoughts of harming yourself
Physical symptoms include:
Moving or speaking more slowly than usual
Change in appetite or weight (usually decreased, but sometimes increased)
Constipation
Unexplained aches and pains
Lack of energy or lack of interest in sex (loss of libido)
Changes to your menstrual cycle
Disturbed sleep (for example, finding it hard to fall asleep at night or waking up very early in the morning)
Social symptoms include:
Not doing well at work
Taking part in fewer social activities and avoiding contact with friends
Neglecting your hobbies and interests
Having difficulties in your home and family life
Depression can come on gradually, so it can be difficult to notice something is wrong. Many people continue to try to cope with their symptoms without realising they are ill. It can take a friend or family member to suggest something is wrong.
Doctors describe depression by how serious it is:
Mild depression has some impact on your daily life
Moderate depression has a significant impact on your daily life
Severe depression makes it almost impossible to get through daily life – a few people with severe depression may have psychotic symptoms
Grief and depression
It can be hard to distinguish between grief and depression. They share many of the same characteristics, but there are important differences between them.
Grief is an entirely natural response to a loss, while depression is an illness.
People who are grieving find their feelings of loss and sadness come and go, but they're still able to enjoy things and look forward to the future.
In contrast, people who are depressed have a constant feeling of sadness. They don't enjoy anything and find it hard to be positive about the future.
Other types of depression
There are different types of depression, and some conditions where depression may be one of the symptoms. These include:
Postnatal depression. Some women develop depression after having a baby. Postnatal depression is treated in similar ways to other forms of depression, with talking therapies and antidepressant medicines.
Bipolar disorder is also known as "manic depression". It's where there are spells of depression and excessively high mood (mania). The depression symptoms are similar to clinical depression, but the bouts of mania can include harmful behaviour such as gambling, going on spending sprees and having unsafe sex.
Seasonal affective disorder (SAD). Also known as "winter depression", SAD is a type of depression that has a seasonal pattern usually related to winter.
Causes
There is no single cause of depression. You can develop it for different reasons and it has many different triggers.
For some, an upsetting or stressful life event – such as bereavement, divorce, illness, redundancy and job or money worries – can be the cause.
Often, different causes combine to trigger depression. For example, you may feel low after an illness and then experience a traumatic event, such as bereavement, which brings on depression.
People often talk about a "downward spiral" of events that leads to depression. For example, if your relationship with your partner breaks down, you're likely to feel low, so you stop seeing friends and family and you may start drinking more. All of this can make you feel even worse and trigger depression.
Some studies have also suggested you're more likely to get depression as you get older, and that it's more common if you live in difficult social and economic circumstances.
Stressful events
Most people take time to come to terms with stressful events, such as bereavement or a relationship breakdown. When these stressful events happen, you have a higher risk of becoming depressed if you stop seeing your friends and family and you try to deal with your problems on your own.
Illness
You may have a higher risk of depression if you have a longstanding or life-threatening illness, such as coronary heart disease or cancer.
Head injuries are also an often under-recognised cause of depression. A severe head injury can trigger mood swings and emotional problems.
Some people may have an (underactive thyroid (hypothyroidism) due to problems with their immune system. In rarer cases a minor head injury can damage the pituitary gland, a pea-sized gland at the base of your brain that produces thyroid-stimulating hormones.
This can cause a number of symptoms, such as extreme tiredness and a loss of interest in sex (loss of libido), which can in turn lead to depression.
Personality
You may be more vulnerable to depression if you have certain personality traits, such as low self-esteem or being overly self-critical. This may be due to the genes you've inherited from your parents, or because of your personality or early life experiences.
Family history
If someone else in your family has suffered from depression in the past, such as a parent or sister or brother, then it's more likely you will too.
Giving birth
Some women are particularly vulnerable to depression after pregnancy. The hormonal and physical changes, as well as added responsibility of a new life, can lead to postnatal depression.
Loneliness
Becoming cut off from your family and friends can increase your risk of depression.
Alcohol and drugs
Some people try to cope when life is getting them down by drinking too much alcohol or taking drugs. This can result in a spiral of depression.
Cannabis helps you relax, but there is evidence that it can bring on depression, especially in teenagers.
And don't be tempted to drown your sorrows with a drink. Alcohol is categorised as a "strong depressant" and actually makes depression worse.
Diagnosing clinical depression
If you experience symptoms of depression for most of the day, every day for more than two weeks, you should seek help from Dr. B C Shah.
It is especially important to speak to Dr. B C Shah if you experience:
symptoms of depression that are not improving
your mood affects your work, other interests, and relationships with your family and friends
thoughts of suicide or self-harm
Sometimes, when people are depressed they find it hard to imagine that treatment can actually help. But the sooner you seek treatment, the sooner your depression will lift.
There are no physical tests for depression, though Dr. B C Shah may examine you and do some urine or blood tests to rule out other conditions that have similar symptoms, such as an underactive thyroid.
The main way in which Dr. B C Shah will tell if you have depression is by asking you lots of questions about your general health and how the way you are feeling is affecting you mentally and physically.
Try to be as open as you can be with the doctor. Describing your symptoms and how they are affecting you will really help Dr. B C Shah understand if you have depression and how severe it is.
Any discussion you have with Dr. B C Shah will be confidential. He will only ever break this rule if there's a significant risk of harm to either yourself or others, and if informing a family member or carer would reduce that risk.
Treating clinical depression
Treatment for depression usually involves a combination of medicines, talking therapies and self help.
Treatment options
The kind of treatment that your doctor recommends will be based on the type of depression you have. Below is a short description of the types of treatment your doctor may recommend.
Mild depression
Wait and see - If you're diagnosed with mild depression, your depression may improve by itself. In this case, you'll simply be seen again by Dr. B C Shah after two weeks to monitor your progress. This is known as watchful waiting.
Exercise - Exercise has been proven to help depression, and is one of the main treatments if you have mild depression. Dr. B C Shah may refer you to a qualified fitness trainer for an exercise scheme or you can find out more about starting exercisehere.
Self help groups - Talking through your feelings can be helpful. It can be either to a friend or relative, or you can ask Dr. B C Shah to suggest a local self-help group. He may also recommend self-help books and online cognitive behavioural therapy (CBT).
Mild to moderate depression
Talking therapy - If you have mild depression that isn't improving, or you have moderate depression, Dr. B C Shah may recommend a talking treatment (a type of psychotherapy). There are different types of talking therapy for depression including cognitive behavioural therapy (CBT) and counselling. Dr. B C Shah can refer you for talking treatment or, in some parts of the country, you might be able to refer yourself.
Moderate to severe depression
Antidepressants - Antidepressants are tablets that treat the symptoms of depression. There are almost 30 different kinds of antidepressant. They have to be prescribed by a doctor, usually for depression that is moderate or severe.
Combination therapy - Dr. B C Shah may recommend that you take a course of antidepressants plus talking therapy, particularly if your depression is quite severe. A combination of an antidepressant and CBT usually works better than having just one of these treatments.
Mental health teams - If you have severe depression, you may be referred to a mental health team made up of psychologists, psychiatrists, specialist nurses and occupational therapists. These teams often provide intensive specialist talking treatments as well as prescribed medication.
Living with clinical depression
There are some key steps you can take to lift your mood and help your recovery from depression.
Take your medication
It is important to take your medication as prescribed, even if you start to feel better.
If you stop your medication too soon, you could have a relapse of your depression. If you have any questions or concerns about the medication you're taking, talk to your doctor or pharmacist.
It may help to read the information leaflet that comes with your medication to find out about possible interactions with other drugs or supplements. Check with your doctor first if you plan to take any over-the-counter remedies such as painkillers, or any nutritional supplements. These can sometimes interfere with antidepressants.
Exercise and diet
Exercise and a healthy diet can make a tremendous difference to how quickly you recover from depression. And they will both improve your general health, too.
Research suggests that exercise can be as effective as antidepressants at reducing depression symptoms.
Being physically active lifts your mood, reduces stress and anxiety, boosts the release of endorphins (your body's feel-good chemicals) and improves your self-esteem.
It also helps your mood to have a healthy diet. In fact, eating healthily seems to be just as important for maintaining your mental health as it is for preventing physical health problems.

Introduction
Constipation is a common condition that affects people of all ages. It can mean that you are not passing stools (poo) regularly, or you are unable to completely empty your bowels.
Constipation can also cause your stools to be hard, lumpy, large or small.
The severity of constipation varies from person to person. Many people only experience constipation for a short time, but for others, constipation can be a chronic (long-term) condition that causes significant pain and discomfort and affects quality of life.
Read more information about the symptoms of constipation.
What causes constipation?
It's often difficult to identify the cause. However, there are a number of things that increase the risk of constipation, including:
Not eating enough fibre, such as fruit, vegetables and cereals
A change in your routine or lifestyle, such as a change in your eating habits
Ignoring the urge to pass stools
Side effects of certain medication
Not drinking enough fluids
Anxiety or Depression
In children, poor diet, fear about using the toilet and poor toilet training can all be responsible.
Should I see Dr. B C Shah?
You may be able to help treat constipation yourself by making simple changes to your diet and lifestyle. If these changes do not help, see Dr. B C Shah.
You should also speak to Dr. B C Shah is you suspect your child might be constipated.
Treating constipation
An oral laxative (medication to help you empty your bowels) is usually prescribed to treat constipation.
Treatment for constipation is effective, although in some cases it can take several months before a regular bowel pattern is re-established.
Preventing constipation
Making diet and lifestyle changes, such as eating high-fibre foods, drinking plenty of fluids and regularly exercising will help to prevent or ease your constipation.
It may also help to give yourself enough time and privacy to pass stools comfortably and never ignore the urge to go to the toilet.
Complications
For most people constipation rarely causes any complications, but people with long-term constipation can develop:
Haemorrhoids (piles)
Faecal impaction (where dry, hard stools collect in the rectum)
Faecal incontinence (the leakage of liquid stools)
Who is affected?
Constipation can occur in babies, children and adults, and affects twice as many women as men.
Older people are five times more likely than younger adults to have constipation, usually because of diet, lack of exercise, use of medication and poor bowel habits.
Approximately 40% of pregnant women experience constipation during their pregnancy.
Symptoms of constipation
When you are constipated, passing stools becomes more difficult than it used to be.
Normal bowel habits vary from person to person. For example, some adults normally go to the toilet more than once a day, whereas it's normal for others to go only every three or four days. Some infants pass stools several times a day, while others pass stools only a few times a week.
Difficulty passing stools
Passing stools may feel more difficult for several reasons. For example, you may be going significantly less frequently or much less effectively (you feel you are unable to completely empty your bowel).
Passing stools may also seem more difficult because your stools are:
Dry, hard and lumpy
Abnormally large
Abnormally small
As well as causing a change in your normal bowel habits, constipation can also cause the following symptoms:
Stomach ache and cramps
Feeling bloated
Feeling nauseous
Loss of appetite
Constipation in children
As well as infrequent or irregular bowel movements, a child with constipation may also have the following signs and symptoms:
Loss of appetite
Lack of energy
Being irritable, angry or unhappy
Foul-smelling wind and stools
Abdominal pain and discomfort
Soiling their clothes
Generally feeling unwell
If your child has these symptoms or has spoken to you about having difficulty passing stools, speak to Dr. B C Shah.
Causes of constipation
Most cases of constipation are not caused by a specific condition and it may be difficult to identify the exact cause.
However, several factors can increase your chances of having constipation, including:
Not eating enough fibre, such as fruit, vegetables and cereals
A change in your routine or lifestyle, such as a change in your eating habits
Having limited privacy when using the toilet
Ignoring the urge to pass stools
Immobility or lack of exercise
Not drinking enough fluids
Being underweight or overweight
Anxiety or depression
Psychiatric problems, such as those brought on by sexual abuse, violence or trauma
Medication
Sometimes, constipation may be a side effect of a medicine that you are taking. Common types of medication that can cause constipation include:
Aluminium antacids (medicine to treat indigestion)
Antidepressants
Antiepileptics (medicine to treat epilepsy)
Antipsychotics (medicine to treat schizophrenia and other mental health conditions)
Calcium supplements
Codeine, found in some types of painkiller
Diuretics (water tablets)
Iron supplements
If your constipation is caused by medication, the condition usually eases once you stop taking the medicine. However, under no circumstances should you stop taking your medication unless Dr. B C Shah advises you to.
Speak to Dr. B C Shah if you experience constipation due to a medicine. He may be able to prescribe an alternative.
Pregnancy
About 40% of women experience some form of constipation during their pregnancy, mostly during the early stages of their pregnancy.
Constipation occurs during pregnancy because your body produces more of the female hormone progesterone which acts as a muscle relaxant.
Your bowel normally moves stools and waste products along to the anus by a process known as peristalsis. This is when the muscles that line the bowel contract and relax in a rippling, wave-like motion. An increase in progesterone makes it more difficult for the bowel muscles to contract, making it harder to move waste products along.
If you are pregnant, there are ways that you can safely treat constipation without harming you or your baby.
Other conditions
In rare cases, constipation can be a sign of an underlying condition, such as:
Colon or rectal cancer
Diabetes
Hypercalcaemia, when there is too much calcium in the bloodstream
Underactive thyroid
Muscular dystrophy, a genetic condition that causes muscle wasting
Multiple sclerosis, a condition that affects the nervous system
Parkinson's disease, a brain condition that affects the co-ordination of body movements
Spinal cord injury
Anal fissure, a small tear of the skin just inside the anus
Inflammatory bowel disease, a condition that causes the intestines to become inflamed (irritated and swollen)
Irritable bowel syndrome (IBS)
Babies and children
Constipation in babies and children is quite common. A Poor diet, fear about using the toilet and poor toilet training can all be responsible.
Poor diet
Children who are over-fed are more likely to have constipation, as are those who do not get enough fluids. Babies who have too much milk are also more likely to get constipation. As with adults, it is very important that your child has enough fibre in their diet.
Toilet training
Make sure that you do not make your child feel stressed or pressured about using the toilet. It is also important to let your children try things by themselves (when appropriate). Constantly intervening when they are using the toilet may make them feel anxious.
Toilet habits
Some children can feel stressed or anxious about using the toilet. They may have a phobia about using the toilet, or feel that they are unable to use the toilets at school.
This fear or phobia may be the result of your child experiencing pain when passing stools. This can lead to poor bowel habits, where children ignore the urge to pass stools and instead withhold them for fear of experiencing pain and discomfort. However, this will mean that their condition only worsens.
Other conditions
In rare cases, constipation in babies and children can be a sign of an underlying condition such as:
Hirschsprung's disease, which affects the bowel, making it difficult to pass stools
Anorectal malformation, where the baby's anus and rectum do not form properly
Spinal cord abnormalities, including rare conditions such as spina bifida and cerebral palsy
Cystic fibrosis, a genetic condition that causes the body to produce thick and sticky mucus, which can lead to constipation
Diagnosing constipation
Constipation is a very common condition. Dr. B C Shah will not usually need to carry out any tests or procedures, but will confirm a diagnosis of constipation based on your medical history and your symptoms.
Dr. B C Shah will ask you some questions about your bowel habits. Do not feel embarrassed about describing your bowel pattern and stools to him. It is important that Dr. B C Shah is aware of all of your symptoms so he can make the correct diagnosis.
Dr. B C Shah may also ask questions about your diet, level of exercise and whether there have been any recent changes in your routines.
Doctors define constipation in a number of ways:
Opening the bowels less than three times a week
Needing to strain to open your bowels on more than a quarter of occasions
Passing a hard or pellet-like stool on more than a quarter of occasions
Physical examination
If Dr. B C Shah suspects that you may have faecal impaction (when dry, hard stools collect in your rectum), he may carry out a physical examination.
A typical examination will begin with you lying on your back while Dr. B C Shah feels your abdomen. You will then lie on your side while Dr. B C Shah performs a rectal examination using a lubricated, gloved finger. He can feel for any stools that may have collected.
Dr. B C Shah will rarely have to conduct an internal physical examination on a child. Instead, the diagnosis can normally be made by feeling their abdomen (tummy).
Further tests
If you are experiencing severe symptoms, your doctor may request further tests, such as blood tests or thyroid tests, to diagnose or rule out other conditions.
As there is an increased risk of colorectal cancer in older adults, Dr. B C Shah may also request tests to rule out a diagnosis of cancer, including a barium enema or colonoscopy.
Treating constipation
Treatment for constipation depends on the cause, how long you have had the condition and how severe your symptoms are. In many cases it is possible to relieve symptoms through dietary and lifestyle changes.
This section covers the following:
Lifestyle advice
Laxatives
Treating faecal impaction
Pregnancy or breastfeeding
Babies who have not yet been weaned
Babies who are eating solids
Children
Lifestyle advice
Dr. B C Shah will first advise you about how you can change your diet and lifestyle, which may mean that your constipation passes without the use of medication.
Some ways you can help treat your constipation are listed below.
Increase your daily intake of fibre. You should eat at least 18-30g of fibre a day. High-fibre foods include fruit, vegetables and cereals.
Add some bulking agents, such as wheat bran, to your diet. These will help make your stools softer and easier to pass.
Avoid dehydration by drinking plenty of water.
Get more exercise by going for a daily walk or run.
If your constipation is causing pain or discomfort, you may want to take a painkiller such as paracetamol. Make sure you always follow the dosage instructions carefully. Children under 16 years of age should not take aspirin.
Identify a routine of a place and a time of day when you are comfortably able to spend time in the toilet. Respond to your bowel's natural pattern: when you feel the urge, do not delay.
If these diet and lifestyle changes do not help, Dr. B C Shah may prescribe an oral laxative.
Laxatives
Laxatives are a type of medicine that help you pass stools. There are several different types and each one has a different effect on your digestive system.
Bulk-forming laxatives
Dr. B C Shah will normally start you on a bulk-forming laxative. These laxatives work by helping your stools to retain fluid. This means they are less likely to dry out, which can lead to faecal impaction. Bulk-forming laxatives also make your stools denser and softer, which means they should be easier to pass.
Commonly prescribed bulk-forming laxatives include ispaghula husk, methylcellulose and sterculia. When taking this type of laxative, you must drink plenty of fluids. Also, do not take them before going to bed. It will usually be two to three days before you feel the effects of a bulk-forming laxative.
Osmotic laxatives
If your stools remain hard after you have taken a bulk-forming laxative, Dr. B C Shah may prescribe an osmotic laxative instead. Osmotic laxatives increase the amount of fluid in your bowels. This helps to stimulate your body to pass stools and also softens stools.
Commonly prescribed osmotic laxatives include lactulose and macrogols. As with bulk-forming laxatives, make sure you drink enough fluids. It will usually be two to three days before you feel the effect of the laxative.
Stimulant laxatives
If your stools are soft but you still have difficulty passing them,Dr. B C Shah may prescribe a stimulant laxative. This laxative stimulates the muscles that line your digestive tract, helping them to move stools and waste products along your large intestine to your anus.
The most commonly prescribed stimulant laxatives are senna, bisacodyl and sodium picosulphate. These laxatives are usually only used on a short-term basis, and they will usually start to work within 6 to 12 hours.
According to your individual preference and the speed with which you require relief, Dr. B C Shah may decide to combine different laxatives.
How long will I take laxatives for?
If you have only experienced constipation for a short time, Dr. B C Shah will normally advise you to stop taking the laxative once your stools are soft and easily passed.
However, if you have constipation due to a medicine or an underlying medical condition, you may have to take laxatives for much longer, possibly many months or even years.
If you have been taking laxatives for some time, you may have to gradually reduce your dose rather than coming off them straight away. If you have been prescribed a combination of laxatives, you will normally have to reduce the dosage of each laxative, one at a time, before you can stop taking them. This can take several months.
Dr. B C Shah will advise you when it is best to stop taking them.
Treating faecal impaction
Faecal impaction occurs when stools become hard and dry and collect in your rectum. This obstructs the rectum, making it more difficult for stools to pass along.
If you have faecal impaction, you will initially be treated with a high dose of the osmotic laxative macrogol. After a few days of using this laxative, you may also have to start taking a stimulant laxative.
If you do not respond to these laxatives, you may need one of the medications described below.
Suppository: this type of medicine is inserted into your anus. The suppository gradually dissolves at body temperature and is then absorbed into your bloodstream. Bisacodyl and glycerol are two medicines that can be given in suppository form.
Mini enema: this is when a medicine in fluid form is injected through your anus and into your large bowel. Docusate and sodium citrate can be given in this way.
Pregnancy or breastfeeding
If you are pregnant, there are ways for you to safely treat constipation without harming you or your baby. Dr. B C Shah will first advise you to change your diet by increasing fibre and fluid intake. You will also be advised to do gentle exercise.
If dietary and lifestyle changes do not work, you may be prescribed a laxative to help you pass stools more regularly.
Lots of laxatives are safe for pregnant women to use because most are not absorbed by the digestive system. This means that your baby will not feel the effects of the laxative.
Laxatives that are safe to use during pregnancy include the osmotic laxatives lactulose and macrogols. If these do not work, Dr. B C Shah may advise a small dose of bisacodyl or senna (stimulant laxatives).
However, senna may not be suitable if you are in your third trimester of pregnancy (27 weeks to birth) because this medicine is partially absorbed by your digestive system.
Babies who have not yet been weaned
If your baby is constipated but has not yet started to eat solid foods, the first way to treat them is to give them extra water between their normal feeds. If you are using formula milk, make the formula as directed by the manufacturer and do not dilute the mixture.
You may want to try gently moving your baby's legs in a bicycling motion or carefully massaging their abdomen (tummy) to help stimulate their bowels.
Babies who are eating solids
If your baby is eating solid foods, give them plenty of water or diluted fruit juice. Try to encourage them to eat fruit, which can be pureed or chopped, depending on their ability to chew. The best fruits for babies to eat to treat constipation are:
Apples
Apricots
Grapes
Peaches
Pears
Plums
Prunes
Raspberries
Strawberries
Never force your baby to eat food if they do not want to. If you do, it can turn mealtimes into a battle and your child may start to think of eating as a negative and stressful experience.
If your baby is still constipated after a change in diet, they may have to be prescribed a laxative. Bulk-forming laxatives are not suitable for babies, so they will usually be given an osmotic laxative. However, if this does not work, they can be prescribed a stimulant laxative.
Children
As with babies and adults, children with constipation will first be advised to change their diet. If this does not work, laxatives can be prescribed, usually an osmotic laxative followed, if necessary, by a stimulant laxative.
As well as eating fruit, older children should have a well-balanced diet, which also contains vegetables and wholegrain foods such as wholemeal bread and pasta.
Try to minimise stress or conflict associated with using the toilet or meal times. It is important to be positive and encouraging when it comes to establishing a toilet routine. Your child should be allowed at least 10 minutes on the toilet to make sure they have passed as many stools as possible.
To encourage a positive toilet routine, try making a diary of your child's bowel movements linked to a reward system. This can help them focus on using the toilet successfully.
Top tips for parents



A diet rich in fibre and with plenty of fluids will help, even if your child is being treated with laxatives.
Children with chronic (long-term) constipation do not normally have anything physically wrong with them. However, it can take time to correct the problem, so be patient.
Encourage your child to have a regular toilet habit and allow them plenty of time.
A reward chart for passing a stool can be useful if your child tends to ‘hold on’.
Complications with constipation
Constipation rarely causes any complications or long-term health problems. Treatment is usually effective, particularly if it is started promptly.
However, if you have chronic (long-term) constipation, you may be more at risk of experiencing complications.
Haemorrhoids
If you continually strain to pass stools, it can cause pain, discomfort and bleeding. Excessive straining can also lead to haemorrhoids (piles). Haemorrhoids are swollen blood vessels that form in the lower rectum and anus.
Haemorrhoids can cause:
itching around the anus
swelling of the anus
pain
bleeding from the anus
Faecal impaction
Chronic constipation can increase the risk of faecal impaction (where dried, hard stools collect in your rectum and anus). Once you have faecal impaction, it is very unlikely that you will be able to get rid of the stools naturally.
Faecal impaction worsens constipation because it makes it harder for stools and waste products to pass out of your anus as the path is obstructed.
If you experience faecal impaction, it can lead to a number of other complications. These include:
Swelling of the rectum
Losing sensation in and around your anus
Faecal incontinence, when you uncontrollably leak soft or liquid stools
Bleeding from your anus
Rectal prolapse, when part of your lower intestine falls out of place and protrudes from your anus
Psychological effects
If your child experiences faecal incontinence, it may affect them psychologically.
Faecal incontinence can be very upsetting and embarrassing for children. If they are at school, they may find themselves teased or socially excluded. This can make a child feel withdrawn, alone and unable to talk about what they are experiencing.
If you notice a change in your child's behaviour, talk openly and honestly with them and encourage them to tell you how they are feeling.
Also try to speak to your child's teacher to make sure they understand the situation. The teacher can help ensure your child is not upset or left feeling excluded by other children.
Preventing constipation
Although constipation is common, you can take several steps to prevent it, including making diet and lifestyle changes.
Fibre
Make sure you have enough fibre in your diet. Most adults do not eat enough fibre. You should have approximately 18g of fibre a day. You can increase your fibre intake by eating more:
Fruit
Vegetables
Wholegrain rice
Wholewheat pasta
Wholemeal bread
Seeds
Nuts
Oats
Eating more fibre will keep your bowel movements regular because it helps food pass through your digestive system more easily. Foods high in fibre also make you feel fuller for longer.
If you are increasing your fibre intake, it is important to increase it gradually. A sudden increase may make you feel bloated. You may also produce more flatulence (wind) and have stomach cramps.
Fluids
Make sure that you drink plenty of fluids to avoid dehydration and steadily increase your intake when you are exercising or when it is hot. Try to cut back on the amount of caffeine, alcohol and fizzy drinks that you consume.
Toilet habits
Never ignore the urge to go to the toilet. Ignoring the urge can significantly increase your chances of having constipation. The best time for you to pass stools is first thing in the morning, or about 30 minutes after a meal.
When you use the toilet, make sure you have enough time and privacy to pass stools comfortably.
Exercise
Keeping mobile and active will greatly reduce your risk of getting constipation. Ideally, do at least 150 minutes of physical activity every week.
Not only will regular exercise reduce your risk of becoming constipated, but it will also leave you feeling healthier and improve your mood, energy levels and general fitness.

Introduction
A cystoscopy is a medical procedure used to examine the inside of the bladder.
It's carried out using a cystoscope, a thin, fibreoptic tube that has a light and a camera at one end.
The cystoscope is inserted into the urethra and is moved up into the bladder (the urethra is the tube that carries urine from the bladder, out of the body). The camera relays images to a screen where they can be seen by the urologist (specialist in treating bladder conditions).
There are two types of cystoscope:
Flexible cystoscope – a thin, flexible tube used when the only purpose of a cystoscopy is to look inside your bladder
Rigid cystoscope – a thin, straight metal tube that's used for passing small surgical instruments down through the cystoscope to remove a tissue sample or to carry out treatment
Most cystoscopies are performed as outpatient procedures, so you'll be able to go home on the same day.
What is a cystoscopy used for?
A cystoscopy can be used to investigate and treat symptoms and conditions that affect the bladder and urinary system. For example, it can be used to:
Check for abnormalities in the bladder
Remove a sample of bladder tissue for further testing (a biopsy) in cases of suspected cancer
Treat certain bladder conditions, such as removing small bladder stones
The results of a cystoscopy are usually available to discuss within a few days. However, if a biopsy is necessary it may take several weeks for the results to become available.
Is a cystoscopy painful?
You shouldn't feel any serious pain as a flexible cystoscopy is usually carried out using a local anaesthetic gel or spray to numb the urethra. A rigid cystoscopy is usually done under general anaesthetic (where you are asleep), or a spinal anaesthetic (epidural) that numbs all feeling below your spine.
However, for some people the procedure may feel uncomfortable and you may have mild side effects afterwards, such as muscle pain, nausea and blood in your urine.
You may also feel a burning sensation when passing urine for a few days after the procedure.
Complications of a cystoscopy
It's rare to experience serious complications after a cystoscopy, but you should contact Dr. B C Shah if you're having difficulty passing urine for more than eight hours after the procedure. You may have a swollen urethra.
There's also a small risk of developing a urinary tract infection (UTI) that affects your urethra, bladder or kidneys. You should see Dr. B C Shah if you experience symptoms of infection such as a high temperature (fever) of 38ºC (100.4ºF) or above.
Why a cystoscopy is needed
A cystoscopy can be used to investigate problems with your bladder or urinary system, or it may be used as part of a medical procedure.
Investigating symptoms
You may need to have a cystoscopy if you experience symptoms that suggest there's something wrong with your bladder. For example:
Urinary incontinence – the involuntary passing of urine
Blood in your urine (haematuria)
Persistent pelvic pain
Pain or a burning sensation when you pass urine (dysuria)
Frequently needing to urinate
Having a sudden urge to urinate
Not being able to pass urine or only being able to pass urine intermittently (‘stop-start’)
Having a feeling that your bladder isn't completely empty after passing urine
Investigating conditions
A cystoscopy may also be needed if you have a condition that affects your urinary system, such as a bladder tumour or a blocked urethra (the tube that carries urine from the bladder out of the body).
Other conditions that a cystoscopy may be used to detect or monitor include:
Serious or repeated infections
Polyps (non-cancerous growths)
Enlarged prostate – where the prostate becomes enlarged
Bladder stones
A narrowed or blocked urethra (urethral stricture)
Problems with the ureters (the tubes that connect the kidneys to the bladder)
Carrying out procedures
Dr. B C Shah can carry out a number of medical procedures using surgical instruments that are passed down the side channels of the cystoscope. These include:
Removal of a stone from the bladder or ureter
Obtaining a urine sample from each of the ureters to check for an infection or tumour
Removing a sample of tissue for testing in cases of suspected bladder cancer (biopsy)
Inserting a stent (a small tube) into a narrowed ureter to help the flow of urine
Injecting dye into the ureters up towards the kidneys which will be highlighted on an X-ray and will help identify problems, such as a blockage or a kidney stone
How a cystoscopy is performed
Before your appointment to have a cystoscopy, you will be sent information and instructions to follow.
If you're having a local anaesthetic you can eat and drink normally on the day of the appointment.
If you're having a spinal anaesthetic (epidural) or general anaesthetic, you won't be able to eat or drink for several hours before the procedure. Details of the exact number of hours will be included in the information leaflet that's sent to you.
Most prescription medication can be taken as usual on the day of your appointment. However, you may not be able to take aspirin, warfarin or ibuprofen, because they could cause excessive bleeding during the procedure.
If you're taking one of these medications, contact Dr. B C Shah for advice before your appointment. You may have to temporarily stop taking the medication.
The cystoscopy procedure
In most cases, a cystoscopy can be performed on an outpatient basis, which means that you will be able to go home on the same day.
When it's time for you to have the procedure, you'll be asked to empty your bladder by going to the toilet, before changing into a surgery gown. You may also be given an injection of antibiotics to reduce your risk of developing a bladder infection.
If you are having a local anaesthetic, an anaesthetic gel or spray will be applied to your urethra to numb it. If you're having an epidural or general anaesthetic, you will be given an injection of anaesthetic.
The cystoscope is lubricated with a special gel before being gently inserted into your urethra and passed into your bladder. Sterile water will be pumped through the cystoscope to expand your bladder. This enables Dr. B C Shah to get clearer view inside your bladder.
The cystoscope is usually kept in your bladder for between two and 10 minutes.
What to expect during a cystoscopy
People are often concerned that having a tube inserted into their urethra and up into their bladder will be painful. A cystoscopy isn't usually painful but it may sometimes be uncomfortable.
If you're having a cystoscopy under a local anaesthetic, you may feel a burning sensation and an urge to urinate when the cystoscope is inserted into and then removed from your urethra.
You may also feel an uncomfortable sensation of fullness and a need to urinate when water is pumped into your bladder to expand it.
If you're having an epidural, you may feel a brief stinging sensation when the needle is inserted into your back, and you may experience some mild back pain after the procedure has been completed.
If you're having a general anaesthetic, you won't feel any pain during the procedure. However, you may experience mild symptoms of muscle pain and nausea after the cystoscopy.
Results
In some cases, the urologist will be able to discuss the results of your cystoscopy and any associated implications with you as soon as you recover from the anaesthetic. However, it can sometimes take a few days for the results to become available. If a biopsy (tissue sample) was taken, it may take several weeks for the results to come back.
Recovering from a cystoscopy
The type of anaesthetic that's used will affect how long it takes to recover from a cystoscopy. It is also normal to experience some side effects for a few days afterwards.
Anaesthetic
If you have a local anaesthetic before having a cystoscopy, you will be able to go home as soon as the procedure has finished.
If you have a spinal anaesthetic (epidural) or general anaesthetic, it usually takes one to four hours to recover from its effects, so you'll need to arrange for someone to accompany you home.
After having a spinal or general anaesthetic, you should rest for the 24 hours following the procedure. Avoid driving, operating complex or heavy machinery and drinking alcohol during this period of time.
Side effects
Most people will experience a burning pain when passing urine during the first few days after a cystoscopy. This is normal and should stop within a few days.
Having blood in your urine or bleeding from your urethra is also common in the first few days after a cystoscopy, particularly in cases where the procedure is used to carry out a biopsy. Drinking plenty of water to avoid dehydration can help to ease both of these symptoms.
You should only be concerned about bleeding if:
Your urine becomes so bloody that you can't see through it
You notice clots of tissue in your urine
It lasts for more than a few days
If any of these occur, you should contact Dr. B C Shah for advice .
Risks of a cystoscopy
A cystoscopy is usually a safe procedure and serious complications are rare. Occasionally, there may be problems passing urine or an infection may develop.
Swollen urethra
A swollen urethra can make it difficult to pass urine. The urethra is the tube through which urine is passed from the bladder, out of your body when you urinate. However, the swelling should pass within a few days.
If you're unable to pass urine for more than eight hours after having a cystoscopy, you should contact hospital staff.
Damage to the urethra is slightly more common after a procedure where a rigid cystoscope needed to be used instead of a flexible cystoscope. You may need to have a catheter (thin tube) inserted through your urethra for a few hours afterwards to drain your bladder.
Urinary tract infections
Urinary tract infections (UTIs) are an infection of your urethra, bladder or kidneys. Symptoms of a UTI can include:
A burning sensation when urinating that lasts longer than two days
a high temperature (fever) of 38ºC (100.4ºF) or above
Unpleasant smelling urine
Nausea
Vomiting
Pain in your lower back or side
Contact Dr. B C Shah as soon as possible if you have any of the above symptoms. Most UTIs can be successfully treated with antibiotics.