Piles are wrecking my life but my doctor refuses to help me. I hear this all the time, says DR ELLIE… there ARE answers, you just need to know what to ask for

My piles are so bad that they’re bleeding constantly, but my GP says it’s not serious enough for NHS treatment. What can I do?

Dr Ellie Cannon replies: Anyone suffering from long-lasting haemorrhoids (also called piles) should be referred to a specialist for further investigation and treatment.

Haemorrhoids are swollen and inflamed veins in the lower part of the rectum or anus.

They can cause itching, pain and bleeding, especially during bowel movements. The problem can often be brought on by constipation and straining on the toilet. Chronic coughing and heavy manual labour can also lead to haemorrhoids.

Any that regularly bleed must be investigated by a doctor. This is because bleeding from the back passage can also be a sign of rectal or anal cancer.

The priority when treating someone with haemorrhoids is to ensure they are not constipated or straining, otherwise the blood vessels will remain inflamed.

This means ensuring bowel movements are soft and easy to pass. This can be achieved by eating the NHS-recommended 30g of fibre a day. High-fibre foods include pulses, legumes, vegetables and wholegrain bread.

Most pharmacies also sell daily fibre supplements. Increasing water intake is crucial for healthy bowel movements, too.

GPs can prescribe painkillers and haemorrhoid treatments that contain local anaesthetic and steroids that can ease pain.

If these, with dietary changes, fail to make a difference then a patient can ask to be referred on to a haemorrhoid specialist, who may be able to provide more treatments, including chemicals that are injected into the blood vessels to make them shrink.

Another treatment involves tying bands around the veins to cut off their blood supply, which should help them shrink.

If all other options have been exhausted, surgery to remove the veins may be offered, but most people won’t require this.

My husband has started taking creatine gummies because he thinks they will help protect him from dementia. He has a very healthy diet, so will he actually benefit from them?

Dr Ellie Cannon replies: There is some evidence that creatine can help boost muscle growth and brain function, but the benefits are limited.

Creatine is found in protein-rich foods, such as meat, fish and dairy products. The body also produces its own – it is used by muscles in physical activity to boost energy levels. For this reason, creatine supplements are often taken by bodybuilders and high-intensity athletes who believe that it gives them extra energy, allowing them to work out for longer and build more muscle.

There are some scientific studies backing this up, though there is little evidence that people over 65 who take creatine will see their muscles grow more as a result.

In recent years there have also been some interesting studies that suggest creatine could boost brain function – improving short-term memory loss, for example – in people over the age of 60. It also appear to lower the risk of mental illnesses such as depression. However, there is no evidence this improved brain function can stave off dementia.

There are also some people for whom creatine may be unsafe, including those with diabetes, kidney and liver disease.

But the good news is that, for most people, there are few downsides to taking creatine, so there’s no harm in trying out the supplement.

My wife had an operation to remove cancer in her bladder, but unfortunately some remains – it had grown into the muscle. She’s been through chemo and hated the side effects so much she’s decided not to have any more. Would radiotherapy alone work as a cure?

Dr Ellie Cannon replies: Radiotherapy is often offered to muscle-invasive bladder cancer patients, but usually it is used in combination with other treatments.

Radiotherapy uses high-energy radiation to kill cancer cells. Chemotherapy uses potent medicines to do the job. Both can trigger debilitating side effects.

Radiotherapy can lead to nausea, fatigue and skin problems. Chemotherapy has similar effects, as well as weakening the immune system.

When cancer has grown into the bladder muscles, the two treatments are often used in combination to destroy the cancer. Radiotherapy alone may not give as good results.

However, there are other drugs, including immunotherapy, which helps the immune system recognise and destroy tumours.

Regardless of what medical studies show, it is always a patient’s choice as to what treatment they undergo. Some even forgo potentially curative intensive treatment, and focus on enjoying their final years free of side effects instead.

However, each patient’s cancer treatment is individualised to their illness, so the best person to speak to is the oncologist.

There are also charities that provide support and guidance for patients and families, such as fightbladdercancer.co.uk.

Migraines need not be such a headache

Many of my migraine patients are experiencing more of the debilitating headaches than usual.

This might be partly due to the changing seasons, which studies show can make them more likely. The good news is that there are now drugs available on the NHS that GPs can prescribe to combat worsening migraines.

However, many patients do not realise there are lifestyle changes they can make to lower their risk. I have first-hand experience of this, as I used to get them fairly regularly.

But when I cut back on coffee, fizzy drinks and onions – which all are shown to increase the chances of a migraine – I found that I had fewer attacks. I used to get them every six weeks or so. I’ve now gone six months without one.

Have you found a solution to your migraines? Please let me know using the email address below.

Fobbed off by your physio? 

I fear NHS physiotherapy is in a bad way, and set to get worse. For several years, patients who’ve been referred for physio have complained that they are not given any hands-on treatment and are simply ‘fobbed off’ with a sheet of exercises to follow.

The argument is that there is limited medical benefits to hands-on physiotherapy, while daily exercises lead to the best results. However, I’ve now heard from physios who say they are also sick of the exercise sheets – so much so that they are quitting the NHS.

Physios do their best work when they can build relationships with patients over repeated face-to-face sessions. But NHS resources are so stretched this has become impossible.

It means many physios now choose to only do private work, as handing out worksheets is not what they spent years training to do.

Do you have a question for Dr Ellie Cannon? Email DrEllie@mailonsunday.co.uk. Dr Cannon cannot enter into personal correspondence and her replies should be taken in a general context