Doc, why do I suffer breathing difficulties at night?

Dr Flo, I constantly have breathing problems especially at night. I struggle to breathe for about 30 minutes in the middle of the night, while in the daytime I struggle to breathe for about four minutes. I have to use an inhaler every night. I had an asthma test done but it was negative. A doctor told me my breathing problems are caused by stress since I have been through a series of stressful events. Please help. Muchira

Dear Muchira,

Being short of breath can happen for various reasons. It can happen because the body needs more oxygen than it is receiving, for example, when you are doing something physically exerting, when there is emotional excitement, or when there is a fever, or low blood level, or an acid-base imbalance in the body.

It can also happen when there is a problem with the lungs due to illness or injury, and when there is a condition that causes narrowing of the airways like asthma or bronchitis. Accumulation of fluid in the lungs due to infection, or due to heart, kidney or liver failure can also cause breathing difficulties.

Because your breathing difficulties are worse at night and are relieved by an inhaler, you are likely to be suffering from asthma.

Asthma is an allergic airway condition, where there is inflammation, swelling and narrowing of the breathing tubes. They may also be clogged with mucus.

This may be triggered by cold, dust, pollen, fur, smoke, strong smells, exercise or chest infections.

When the blockage happens, you may cough, experience chest tightness and/or pain, difficulty breathing, and a whistling sound from the chest when breathing (wheezing).

Asthma symptoms tend to be worse at night due to the cold air, and the symptoms improve when an inhaler is used.

Stress or emotional excitement, both positive and negative, can lead to difficulty breathing, because some hormones are released into the blood stream that can cause the airways to narrow.

 When this happens, it may be accompanied by palpitations (noticeably rapid heartbeat). This usually goes away on its own after a few minutes, when you relax or breathe in and out slowly.

For proper diagnosis and treatment, see a chest specialist, and be followed up by one doctor. In the meantime, keep warm, especially at night, avoid the triggers, and use the inhaler as prescribed.

Dr Flo, I am 33 years old. I was recently diagnosed and treated for pelvic inflammatory disease. Is it true that it causes infertility and if it does, is infertility reversible? Does my partner need to be treated? Millicent

Dear Millicent,

Pelvic inflammatory disease (PID) is an infection of the upper female reproductive tract, that is, the uterus, the fallopian tubes and ovaries.

The infection can also spread to the pelvis (the section of the body cavity where these organs are found). It can cause lower abdominal pain, discomfort, pain or bleeding during intercourse, pain when passing urine, an abnormal vaginal discharge, heavy, painful periods, and bleeding between periods.

PID is caused by bacterial infection that moves up from the vagina and/or cervix, to infect the upper reproductive organs. These bacteria may be those that normally live in the vagina, or they may be due to a sexually transmitted infection.

Risk factors for developing PID include engaging in sexual intercourse from an early age, having multiple partners, not using condoms and having an abortion using invasive procedures. There’s a very small risk in the first few weeks of using an intrauterine device (coil).

Treatment involves several antibiotics, and an injection. It is important to complete the medication even if you feel better halfway through. Avoid sexual intercourse during treatment. Your partner should also be tested and treated, to avoid recurring or spread of the infection.

When diagnosed and treated early and properly, you are less likely to experience the complications of PID. If you have recurrent PID or if treatment is delayed, then the risk increases. The main complication of PID is formation of scar tissue in the fallopian tubes, causing narrowing.

This makes it difficult for eggs to pass from the ovaries to the uterus. It also increases the chances of having an ectopic pregnancy in the fallopian tubes, and can lead to infertility. Only about 10 per cent of those with PID suffer from infertility.

If the infertility is due to narrowing or blocking of the tubes by scar tissue, surgery can be done to “widen” the passage within the fallopian tubes. If infertility results because the fallopian tubes are both damaged as a result of ectopic pregnancies, then that cannot be corrected. You would need to have assisted reproduction i.e. in vitro fertilisation.

Dr Flo, I am 22 years old. During intercourse, I don’t get wet and nowadays I get very tight and dry. What do you think is the issue? The mention of menopause at my age freaks me out. Anna

Dear Anna,

In normal circumstances, the walls of the vagina have a constant thin layer of fluid that keeps them lubricated. The hormone oestrogen helps to maintain the lubrication. During sexual intercourse, increased lubrication is one of the physical signs of arousal and excitement.

Dryness can affect women of any age, though it is most common in menopausal women. Changes in hormone levels can affect vaginal lubrication. These hormonal changes can be due to pregnancy, breastfeeding, use of hormonal contraceptives, cancer treatment or anti-oestrogen medication for treating fibroids or endometriosis. Other causes of dryness include douching, vaginal infection, use of anti-histamines and some anti-depressants.

During sexual intercourse, lack of adequate foreplay, fatigue and relationship concerns can all lead to lack of lubrication. To manage it, there should be enough time for foreplay before sexual intercourse and you need to be relaxed. You can use a lubricant like K-Y Jelly to avoid friction and injury. Also avoid douching, bubble baths and perfumed soaps.

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