What makes me so gassy and constipated? DR. MARTIN SCURR on the symptoms that many find difficult to discuss

Question: I suffer from flatulence and sometimes mucus. I also get constipation, for which I take a laxative. But even after going to the toilet, I still feel like I need to go again. Are these problems linked – and is there a cure?

Name and address provided.

Dr. Martin Scurr: Many people find these types of symptoms difficult to discuss, so I commend you for bringing up this important topic.

The feeling of not being able to empty the rectum completely is called tenesmus. It’s a constant feeling, the feeling that you haven’t managed to get it all out and have to try again. Sometimes it also causes stomach pain.

You didn’t mention bleeding, which is reassuring, but the mucus is not normal.

Tenesmus is a symptom of an underlying condition. You should talk to your doctor about this and request a referral for further testing.

The most common possible cause is inflammation in the lower intestine, for example due to inflammatory bowel diseases such as Crohn’s disease.

The first examination, called sigmoidoscopy, involves passing a thin telescope into the rectum and colon. The specialist may also suggest a colonoscopy to examine the entire length of the colon.

The phlegm and tenesmus may, but not necessarily, be related to the flatulence. The main thing is to make an exact diagnosis.

Question: My 65-year-old brother developed a blood clot in his leg six months ago and has been taking anticoagulants daily since then. But during a recent hospital check-up, doctors said the clot is still there and will always be there. Is this correct?

Jo Whyley, by email.

Answer: I understand your confusion. Your brother was diagnosed with deep vein thrombosis (DVT), probably via a scan after he developed symptoms; the most common form of DVT is unexplained swelling in the leg. It can also cause pain and an unexplained increase in visible veins in the lower part of the affected leg.

The veins below the knee are more superficial, so if a deep vein is blocked by a clot, these superficial veins must carry most, if not all, of the blood flow, and become very prominent (the veins higher up are typically deeper and covered by fat ).

The danger of a DVT is that the clot, or part of it, can break off and travel back to the heart through the bloodstream.

Because clots are soft and gel-like, they are pumped through the chambers of the heart to the lungs, which can lead to a potentially fatal blockage of a blood vessel there, known as a pulmonary embolism.

In your longer letter, you mention that your brother has been prescribed rivaroxaban, a blood thinner designed to reduce the risk of pulmonary embolism.

But this drug does not completely dissolve the clot. Instead, it ‘stabilizes’ it; This means that within days, and over the next few weeks, the clot shrinks and essentially becomes scar material that refuses to break off. When your brother was reexamined months later, the doctor identified this remaining healed clot material.

It is no longer a blood clot, in the same sense, and it is no longer accurate to describe it as a DVT.

Although it may shrivel further, it will always be there.

An important question for anyone with a DVT is identifying the cause. If there is no obvious cause – such as the immobility caused by a long journey – the patient should be tested for thrombophilia, a condition that increases the risk of clots.

This can be caused by many factors, ranging from genetic diseases such as protein C deficiency to liver disease.

• Write to Dr. Scurr from Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email: drmartin@dailymail.co.uk.
• Dr. Scurr cannot enter into personal correspondence. Answers should be taken in a general context. If you have health problems, consult your own doctor.

In my opinion… Chemical link of weedkiller to male fertility

As chairman of the ethics committee of a fertility clinic, I am interested in male infertility – and have long been concerned about declining sperm counts. Between 1951 and the 1970s these fell by 50 percent, from an average of 107 million sperm cells per milliliter to 48 million.

Subsequently, a review of 185 studies from the period 1973 to 2011 revealed a further decline of 50 percent in 2017.

Possible causes of this worrying decline include pollutants called endocrine-disrupting chemicals – and in particular glyphosate, a herbicide.

A 2022 study published in the journal Environmental Science and Pollution Research suggested that more than 99 percent of people in France had residues of glyphosate in their urine — not surprising considering the chemical is sprayed on wheat fields before harvest .

Environmental pollution is more than just global warming – according to some estimates, the number of healthy sperm cells is dropping 1 to 2 percent per year, so we could lose the ability to reproduce within 20 years – which all other concerns about the environment will take away. in a tilted hat.