What’s causing my recurrent throat irritation?

Hi Dr Flo,
For the past two years, I have been having recurrent throat irritation. I have taken medication many times, with no improvement. What can I do? I am getting concerned.

Dear reader,
Having a sore throat for two years can be caused by several issues. It is highly unlikely that you have an infection that has lasted that long. 
However, it can happen due to post-nasal drip, where mucus flows out and backwards, down your throat, causing irritation at the throat. This may be due to an allergy affecting the nose or sinuses. 
The sore throat may also be due to laryngopharyngeal reflux where stomach content comes back up the oesophagus and causes irritation at the throat, and sometimes some of it “spills over” into the airway, irritating the vocal cords. 
Asthma, chronic bronchitis and other chronic lung disorders can lead to persistent throat irritation due to recurrent cough and use of inhalers. There are also some medications, such as for hypertension, that can cause throat irritation, a feeling of something stuck in the throat or even cough. Other causes of throat irritation include anxiety, dehydration and voice strain.
When you are anxious about this particular problem, or about any other issues in general, then the throat muscles tense up, leading to a feeling of fullness in the throat. That is why many people clear their throats or try to loosen clothing around the neck when they are in a tense situation.
Also, the more you clear your throat or cough, the more you irritate it, which makes you feel like clearing your throat or coughing again, becoming a vicious cycle. It behaves like an itch – the more you itch, the more you feel like itching. The original cause of the sore throat or cough,  for example an infection, or allergy may have been managed already, but the throat irritation continues. 
Every one produces some mucus at the back of the throat every day, and swallows it at some point, most of the time without noticing. For those who clear the throat a lot, they are just more aware of this mucus.
It is advisable for you to visit an ear, nose and throat specialist for thorough examination and diagnostic tests. Treatment will depend on the underlying cause. For example, allergies are treated with anti-histamines, antibiotics will be given for any infection, a nasal spray can help decongest the sinuses and medication to reduce acid levels in the stomach. 
Also, take six to eight glasses of water per day, avoid straining your voice and avoid clearing your throat constantly and instead take a sip of water.

Daktari,
In the past one week, I have been having some back pain, usually at the end of my day at the office. Could it be because of the chair I sit on at work? The chair is usually not comfortable and I sit for many hours every day. Please assist.
Ken

Dear Ken,
The back pain that you have been having is most likely due to sitting for very long every day, on an uncomfortable chair, and also it is likely that you might not have a good sitting posture. You are supposed to sit upright, with the back at ninety degrees to your thighs, which should also be at ninety degrees to your legs. Your elbows should lie comfortably on your desk at chest level, and if you are using a computer, it should be at eye level, about 30cm from you. 
Do not hunch over when typing or writing, do not sit or type or write at an angle, and do not slouch on your chair, both in the office and at home. You should sit up even when watching TV and also stand and walk upright. Don’t sit for longer than 45 minutes without standing and moving around a bit. Try working while standing for a few minutes. 
If the pain is persistent, there are pain medications and muscle relaxants that you can use, and also ointments for massaging the back. Physiotherapy would also help, and you would be taught exercises that you can do by yourself.

Hello doctor,
I have been having blood in my stool on and off for some time. Kindly advise.
KL

Dear KL,
Bleeding after passing stool could be due to a tear in the lining of the anus or rectum because of friction from passing large stool, hard stool, or from diarrhoea. It could also be due to an abnormal growth in the intestines or rectum.
The bleeding can also be due to piles, otherwise known as haemorrhoids, which are veins that bulge or prolapse in the lower part of the rectum and anus. The walls of the veins stretch and get irritated, and easily get a tear and bleed, especially when passing stool. The piles may be on the outside around the anal opening, or may “come out” when passing stool, and sometimes can be pushed back in. These are called external haemorrhoids. If they are far up inside that they cannot be seen or felt, they are called internal haemorrhoids. Symptoms include a painful or itchy swelling at the anal opening, and pain or bleeding when passing stool.
They can be caused by straining when passing stool or diarrhoea and any activity that causes repeated high pressure in the abdominal region , for example a persistent cough and lifting weights. They are also more common in people who stand or sit for long periods of time, and also during pregnancy. Most of the time, they resolve easily with diet and lifestyle changes, and with treatment, though they can recur.
To manage the problem, try and prevent constipation by taking a lot of fluid and high fibre diet every day, exercise, schedule time each day for a bowel movement and take your time; use baby wipes instead of toilet paper. You can also take a sitz bath – sit in warm water for about 20min twice a day to help soothe the injured tissue.
There are fibre supplements that you can take to help with passing soft stool. There are other laxatives and stool softeners that can be prescribed by the doctor. There are also creams and suppositories that can be used to help with the healing of the torn tissue, and oral tablets that are prescribed to heal the veins.
In case symptoms persist despite these measures, surgery may need to be done to correct the problem.