My daughter keeps pulling her hair out

Every week Cork GP Dr Pixie McKenna answers your questions

MY 15-YEAR-OLD recently finished her junior cert. She’s always worried about school. Leading up to the exams she even started pulling her hair out. As the exams went on she started to pull her eyebrows and eyelashes out as well. She seems fine now, should I just ignore this? Sarah, Mayo

THIS sounds like a condition known as trichotillomania, where there is a compulsion to pull the hair out. So, effectively, your daughter can’t stop herself.

It is not uncommon in teenage girls and may reflect an underlying psychological problem. It is often linked to stress and anxiety and now the exams have passed the hair pulling should pass, too.

Trichotillomania is a form of obsessive compulsive disorder (OCD), so in this context it is worth considering other behaviours that she may have.

Patterns include fixations with cleanliness, health issues and the repeated checking of locks. There may well be a family history of OCD or trichotillomania.

Don’t ignore it — this pattern is likely to be repeated if she experiences further stresses. Chat to her about her mood and any concerns or anxieties she may have.

If the behaviour has indeed stopped, then there may be no psychological need to engage in formal therapy. However, she will obviously have physical consequences from this activity and you should address these together.

Experienced beauticians and hairdressers are very sensitive to this problem and will have seen it before — check before you book. Your daughter is likely to feel some shame, embarrassment and isolation as a result of her hair pulling, so make sure she knows she has your support. I’M 39 AND worried about my bowels. I’ve been having tummy pain and constipation on and off for the past two months. I feel like I don’t empty properly, but also tend to feel better after I have opened my bowels. Apart from being a bit stressed I generally feel fine. Would the GP do anything or am I just best to wait and see?

Kenneth, Dublin ANY change in bowel habit that goes on for longer than six weeks warrants a review, even if you think you feel fine.

In patients under 50 the diagnosis is most likely to be an irritable bowel syndrome (IBS). Passing blood or weight loss would go against this diagnosis, but I assume, as you haven’t mentioned them, that they aren’t happening,

There is no diagnostic test for IBS — you have to fit a set of diagnostic criteria to be diagnosed. First, you must have suffered recurrent abdominal pain or discomfort at least three days per month in the past three months. You must also have two or more of the following: symptoms improve with defecation; the frequency of bowel motions has changed; the formation of stools has changed. Other symptoms that support IBS but are not diagnostic of it include straining, urgency, a feeling of incomplete emptying, passing mucous and bloating.

One in five of us are thought to have IBS, yet only 10-50% of those affected attend a doctor as a result. It makes no sense to sit at home worrying. This will only add to your stress and contribute to symptoms.

The first thing to do is get informed. Diet is key, so look at what might be triggering symptoms. Keep a food/symptom diary to find out what causes a flare-up.

You can describe your motions to the doctor by using The Bristol Stool Chart, a pictorial guide that shows seven different types of poo. This is a real ice-breaker when it comes to seeing the GP.

A GP normally does bloods to rule out coeliac disease, anaemia and inflammatory bowel disease. You would warrant referral to a gastroenterologist if you reported weight loss, passing blood, experienced symptoms at night, have a family history of colon cancer or your bloods showed abnormalities such as anaemia or evidence of inflammation.

DISCUSS other symptoms where relevant with your GP. At least a fifth patients with IBS have fibromyalgia. It also has an association with temporomandibular joint pain (jaw bone pain), pelvic pain and chronic fatigue.

There is also a link between this condition and anxiety and depression. There is a flipside to this in that the symptoms of severe IBS can also make you anxious and depressed. This makes it important to tease out which is a cause and which is an effect.

IBS runs in families. If you have a first-degree relative who is affected you are twice as likely to suffer. It can also come on after a bout of gastroenteritis, so mention any recent tummy upsets to your doctor.