Can Flexible Joints Cause You to Accidentally Leak? DR. MARTIN SCURR has the answer

Q: My granddaughter, who is three, was diagnosed with hypermobility from birth. It affected her progress in walking, but she caught up.

The problem now is that she soils herself a little several times a day. We wonder if hypermobility is to blame.

Name and address provided

A: I am grateful for your writing – hypermobility is a common problem, but understanding of it in the medical community is minimal. As a result, many people are left in some distress due to their symptoms, which include excessively stretchy skin, dislocated joints, pain and intestinal problems.

Essentially, hypermobility is a problem that affects the connective tissues – including cartilage and collagen – that act as the glue to bind the body together. In some people, the proteins in these connective tissues are defective.

The most common form is Ehlers-Danlos syndrome – which has 13 different subtypes and affects the connective tissue that supports the skin, tendons, ligaments, blood vessels and bones.

Most children are hypermobile to some degree, thanks to the flexible nature of their tissues, but some have symptoms of the condition, such as joint and muscle pain, low muscle tone, and weakness that affects their motor skills (for example, sitting, crawling, and walking). In these children, walking can take up to 20 months). Flat feet can also be a sign.

In recent years it has become clear that bladder and bowel problems are also not uncommon. This may be the result of a weakened anal sphincter, which controls the egress of stool, as part of a general weakness in the pelvic floor muscles.

Muscles and other tissues in the intestines can be affected, possibly helping to explain the abdominal pain, bloating, constipation, and even heartburn and vomiting that hypermobile people experience.

Many children improve as they get older. However, given your granddaughter’s early diagnosis and her current bowel problems, it is essential that she is regularly monitored by a pediatrician familiar with the condition.

Q: I’m 79 and three years ago I had a bout of shingles. It cleared up, but the skin around the infected area became tender and seems to be getting worse.

Brian Walker, Stockport

A: You have postherpetic neuralgia, a complication of shingles (also known as herpes zoster) – the pain is due to nerve damage.

Although the viral infection with shingles clears up (usually within six weeks, but more quickly if you are prescribed an antiviral drug such as aciclovir), residual pain is a common complication in older patients, affecting one in five over 70.

This is because the inflammation caused by shingles can lead to fibrosis (scar-like damage) in the nerves affected by the virus, even after the inflammation from the infection has cleared.

Pain that lasts for three months or more is defined as postherpetic neuralgia. In addition to pain, it can also cause a burning, itching and stinging sensation, which may be intermittent or constant. Many patients complain of burning pain at the slightest touch.

The most effective medications are gabapentin, pregabalin and tricyclic antidepressants, which work against nerve pain.

The key to success is to start with a low dose and gradually work your way up to higher doses.

I prescribe gabapentin or pregabalin and see patients weekly, increasing their dose from 75 mg per day to 150 mg and then to 300 mg.

If there is no change after a month or six weeks, I will switch to amitriptyline – an antidepressant. I prescribe 10 mg and increase the dose monthly.

The drug is almost always effective at about 70 mg per day, although dry mouth and drowsiness are common side effects.

If your GP is unwilling to supervise such a regimen, ask for a referral to a pain clinic.

IN MY OPINION… Good news for older women

While I sometimes lament how patient care is changing, sometimes it works to the benefit of everyone.

Take the way patients can buy previously prescription-only medications without a prescription. This now includes Ovesse cream, an effective treatment for vaginal dryness caused by tissue thinning during menopause.

There are many other invaluable treatments that pharmacies can supply without a prescription, such as eye drops for conjunctivitis (chloramphenicol) and fluconazole capsules for thrush, increasing customer convenience and reducing the workload for GPs.

But I’m concerned about recent changes that are making antibiotics available in this way.

Although the medicines that pharmacists can dispense are strictly limited (including the number of days of treatment), they cannot do a blood test to check whether infected tonsils are an early sign of, for example, glandular fever.

Instead, it’s guesswork, which can only lead to the pills being overprescribed, fueling the rise of antibiotic resistance. This policy may not be extended further.

• Write to Dr. Scurr from Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@ dailymail.co.uk – include your contact details. Dr. Scurr cannot enter into personal correspondence. Always consult your own doctor if you have health problems