Dear doctor

Is gluten the problem?

Q My daughter suffers from persistent anaemia, despite taking iron supplements and being on the sort of contraception that stops her periods. Someone has suggested that she cuts out wheat from her diet. Could this be a sensible thing for her to do?

A Your daughter could have coeliac disease which is caused by an inability to digest gluten, a protein in wheat, rye, barley and oats. It affects one in 1,000 of us and tends to run in families. Eating gluten inflames the gut which can cause dramatic weight loss, vomiting and diarrhoea. Her GP can do a blood test and should request antigliadin antibodies. With a positive result, your daughter would then be referred to a gastroenterologist for a biopsy (tissue sample) from the small intestine which is done as an outpatient. The treatment for Coeliac is to avoid gluten like the plague. Gluten-free products are much more varied and palatable than they used to be and can be bought in supermarkets as well as on prescription.

I always need a pee

Q I am a 60-year-old man in general good health. For about a year I have needed to urinate every 30 minutes or so. Long journeys and social occasions present real problems. Sleep is also disturbed as I have to get up to use the loo. My GP has physically examined me for prostate trouble and says nothing is wrong. He says my problem is a male "design fault" and prescribed oxybutynin hydrochloride which at first helped a little but now is having less and less effect. Is it just the ageing process, or is there anything else going on?

A Your GP has obviously put a finger in your back passage and deemed your prostate gland normal. But the urethra runs through the middle of your prostate and even minimal enlargement of the prostate can obstruct the urine outflow. So you need a blood test to check PSA (a chemical which rises if the prostate is enlarged or diseased) and an ultrasound scan to measure your prostate accurately. Your urine should be checked for infection and blood and urine or blood tested for diabetes. Next step might be referral to a urologist to look inside your bladder (cystoscopy) to check there are no growths causing the bladder irritation.

Gallbladder blues

Q My wife, aged 60, had her gallbladder removed over two years ago because of a perceived problem with gallstones. Since the operation, she has suffered from continuous bowel trouble inducing violent sickness, with either total constipation or diarrhoea. The specialist says it is "nothing to do with the gallbladder removal". Understandably she no longer trusts their judgment.

A It's probably not the gallbladder operation that is causing her so much grief, but the fact that her problems never really were due to gallstones. Gallbladder pain happens when it's inflamed (cholecystitis) because of stones blocking the outlet. If your gall bladder is inflamed, fat in the diet can cause pain in the upper right-hand side of your abdomen, sometimes lasting several hours, as well as vomiting, shortness of breath and even jaundice. Your wife was well advised to have her gallbladder removed. But the fact that she still has digestive problems warrants investigation to look for other causes.

· These answers should never be used as a substitute for seeking medical help. If you have a question for Dr Robinson, email or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.

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