Saturday 27 May 2017

Ask the GP: HELP - I've been having dizzy spells since I gave birth

NINA BYRNE

Q: I had my daughter two years ago and ever since she was born I have had a dizzy feeling when I lay down. It feels like the room is spinning - the same feeling you get when you lie down after a few drinks.

I really believe it is related to pregnancy and childbirth, as I had a late miscarriage recently and the symptoms were much worse after both birth experiences. Do you have any idea what this might be?

Is it something I need to worry about?

A: Vertigo causes a feeling of dizziness or spinning even when one is not moving. A person may also experience vomiting or nausea. The inner ear contains a maze of loops and pouches called the semi-circular canals and otolithic organs. These make up what is called the vestibular system. The semi-circular canals contain fluid and are located at right angles to each other. When we change position the movement of the fluid in these canals sends messages to the brain which, combined with messages sent from the eyes, gives us our sense of position and balance.

Even though your symptoms occurred post pregnancy it is most likely that your vertigo is due to one of the more common causes. One of the most common causes is dehydration - drinking at least 1.5 litres per day helps

Benign positional vertigo (BPV) causes sudden brief episodes of dizziness that usually occur when we changes the position of the head. There are small crystals that normally lie in the otolithic organs. In BPV some of these may be dislodged moving into the semi-circular canals. This alters the message to the brain leading to the symptom of dizziness. Most cases of BPV settle themselves over time but other treatment may involve a series of head movements performed by a specialist (Epley Manoeuvre).

More persistent dizziness or vertigo may be due to vestibular neuritis. This causes the sudden onset of severe vertigo that can persist for days or weeks. It is thought to be due to a viral infection which affects the inner ear. Symptoms of a cold or flu may occur in the days or weeks prior to this. Hearing may also be affected in some people. Thankfully this condition also settles itself spontaneously in most cases.

Meniere's disease tends to carry on for longer causing vertigo that is associated with ringing in the ears (Tinnitus), hearing loss and a feeling of fullness in the ear. It is thought to be caused by changes in the composition and amount of fluid in the vestibular system. Vertigo comes on suddenly and lasts up to 24 hours. Attacks often occur in clusters with long periods of feeling well in-between. Hearing loss is initially intermittent but over time may become permanent.

Treatments vary and include fluid tablets (to adjust the fluid and mineral balance in the inner ear), hearing aids, steroids or other local treatments.

An acoustic neuroma is a benign tumour that can grow on a nerve near the inner ear. This leads to tinnitus, hearing loss and vertigo. An MRI scan is often arranged in those with vertigo in order to rule this out.

Post natal vertigo is rarely due to damage that occurs to the balance cells in the ear due to pressure changes in labour. If this is suspected a CT scan can confirm. This can be repaired with specialised surgery so is worth exploring.

Other causes of dizziness that may be confused with vertigo include: changes in blood pressure or heart rate, nerve problems, Stroke or transient ischaemic attacks, medications and anxiety. Medication can be prescribed to reduce the symptoms of vertigo. The symptoms can be very distressing but there are virtually no known long term complications.

drnina@independent.ie

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