I’m sure you know some of the simple things that can cause constipation—not eating enough (especially not enough fibre), not drinking enough fluids, and lack of exercise. Certain drugs can make the bowel work sluggishly, including most painkillers, the chemotherapy drugs vinblastine and vincristine and some antacids. The barium that is given by mouth for X-rays of the stomach and intestines or in enema form for X-rays of the lower bowel is also very constipating. Constipation is one of the symptoms caused by excessive calcium in the blood.

Another possible cause for constipation is damage to the nerves which supply the muscle in the wall of the bowel. This can happen if you have a cancer growth pressing on the spinal cord or on the nerves as they pass through the pelvis. With constipation due to nerve damage, you may not be able to tell when you need to open your bowels. This is because the nerves which carry this message are often damaged along with the ones which supply the bowel muscle.

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It can sometimes be quite difficult to work out which factors are playing a part in producing a certain symptom. Often it is more than one. It is not unusual for symptoms that begin for a physical reason to be aggravated by nervous tension. For instance, anxiety about nausea with chemotherapy can aggravate it and even result in it starting before you have your injection or tablets.

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True breast abscesses are painful and can grow up to between 5 and 10 cm (2 and 4 inches) or more across. They contain pus, which is made up of bacteria and secretions from within the breast, and are distinct from the inflammation due to duct ectasia and plasma cell mastitis. Abscesses can occur anywhere in the breast, the most common cause being blockage and infection of a milk duct during lactation.

Non-lactational abscesses may be associated with plasma cell mastitis and usually occur near the nipple. They are known as subareolar abscesses and are most common in pre-menopausal women. Many are associated with a nipple abnormality such as inversion or retraction.

If treatment begins at an early stage of abscess development, needle aspiration and antibiotics may be sufficient. Otherwise, surgery will be required to remove the abscess and drain away the pus. Expert medical advice should be taken to avoid the risk of mammillary fistulae which can follow simple excision.

Peripheral breast abscesses can also occur, but these are rare in non-lactating breasts. Early treatment with antibiotics may prevent an abscess from actually forming, but those that do not respond to antibiotics will need to be surgically incised and drained under a general anesthetic.

Nipple inversion

If an inverted nipple is stimulated, for example by stroking, it may become everted. When the stimulus is removed, the nipple will once again shrink and turn in on itself. Permanent inversion can cause difficulties with breast-feeding but can be corrected by a simple cosmetic operation.

Some women’s breasts develop with inverted nipples, but if nipple inversion occurs during maturity, its cause should be investigated. Although it is likely to be a normal variant, in some cases it may be a sign of an underlying cancer.

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