Hepatitis C: managing symptoms
This section provides some suggestions for relieving some of the more common symptoms experienced by people with hepatitis C. People with hepatitis C can experience a range of symptoms. Some people will experience isolated symptoms while others will experience a number of symptoms at the same time.
You should discuss the full range of your symptoms with your doctor to identify what the causes may be and explore treatment and management options.
Some people find complementary and alternative therapies help to manage some symptoms.
Flu-like symptoms
People with hepatitis C can, periodically, experience flu-like symptoms. These usually last a few days to a week, however, they can last longer. The most common symptoms are fever, chills, headaches, fatigue, and muscle aches.
Fevers may be treated with medications designed to reduce fever (such as paracetamol). Muscle or joint aches may be treated with anti-inflammatory medication. It is important to follow the manufacturer’s directions and never exceed the recommended dosage when using any medication. Because some medications can impact the liver it is important to discuss their use with your doctor first.
Some herbal products such as herbal teas may help relieve flu-like symptoms for some people.
Fatigue and sleep disturbances
Fatigue can be described as a sense of excessive tiredness and lack of energy. Many people with hepatitis C will experience fatigue at some stage. Fatigue can impact on work, family relations and other activities. It can cause you to be withdrawn, moody, cranky and irritable, have outbursts of anger and a lack of energy or feelings of physical weakness. A good night’s rest will not always help you overcome fatigue. Fatigue may also be linked to other factors, such as depression.
Problems with sleeping vary widely for people who have hepatitis C and can include difficulty falling asleep, waking up a lot or sleeping excessive amounts. Sleep disturbances are common among the general population and it is often difficult to work out what impact hepatitis C is having on a person’s sleeping patterns. Sleep problems have an impact on a person’s quality of life and can exacerbate other symptoms of hepatitis C, especially fatigue.
General lifestyle practices can impact on fatigue and sleeping patterns:
- eat a well-balanced diet.
- drink alcohol in moderation or not at all and stop or reduce smoking.
- do regular moderate exercise.
Making adjustments to your day-to-day life may support you to manage fatigue. Have realistic expectations of yourself and what you are able to do. Don’t beat yourself up over feeling tired and lethargic:
- plan the day’s activities around times that tiredness and fatigue normally appear. When energy is higher complete extra tasks (e.g. cook food in batches and freeze to eat later);
- sit down to iron clothes or shower, so you don’t have to support yourself;
- use equipment that helps you conserve energy. For example, use a washing trolley instead of carrying the washing to the line;
- pace yourself during the day and allow yourself regular breaks; and
- take short naps during the day. However, be aware that excessive sleep can cause people to feel more tired and may cause sleep difficulties at night.
Practices that may help manage sleeping difficulties include:
- set specific sleep times to try to regulate your body clock;
- allow enough time for eight hours sleep each day. Eight hours sleep is generally enough for an adult, although individual needs will vary;
- establish a bedtime routine that you do most nights before bed. This may involve washing your face, having a warm drink and reading a book or magazine;
- avoid exercising just before sleeping;
- minimise caffeine intake (such as in coffee and cola drinks) in the afternoon, particularly if sleep is difficult;
- jasmine tea, camomile tea, lavender scent and warm milk may help to relax people and assist with sleep; and
- occasional use of sleeping sedatives may provide some relief. Consult your doctor before using sleeping sedatives.
Dry mouth and mouth ulcers
Hepatitis C infection can cause a dry mouth. This can occur when the amount or quality of saliva decreases. Symptoms of a dry mouth can include: bad breath; cracked lips; sore mouth and throat; difficulty eating and swallowing; mouth ulcers; tooth decay; and tooth sensitivity.
Some hints to relieve dry mouth and manage mouth ulcers to consider include:
- maintain good oral hygiene with regular brushing and flossing particularly after meals and before bed;
- visit a dentist regularly;
- keep the mouth moist by sipping water regularly;
- chewing sugar-free gum can stimulate saliva;
- use lip balm;
- avoid hot or spicy foods, which can irritate a dry mouth;
- if eating is painful choose soft, mashed or minced foods;
- try pharmacy oral health products that are designed to ease the discomfort of a dry mouth, such as mouthwash and moisturiser gel;
- consider rinsing the mouth with salty water and gargling with mild mouthwash;
- gels and creams available from your pharmacy may reduce discomfort and aid healing of ulcers; and
- speak with a doctor about these symptoms—there may be a prescription medication that could help.
Dry eyes
Hepatitis C infection can potentially cause dry eyes. This may be due to inflammation of the glands that produce tears.
To help manage dry eyes:
- avoid smoke, direct wind, and air conditioning;
- consider using a humidifier, particularly in winter;
- deliberately blink more often to moisten the eyes; and
- consider eye ointments or eye drops. Discuss the use of ointments with your doctor or pharmacist.
Mood swings, anxiety and depression
Symptoms can include feelings of hopelessness, irritability, lack of interest in your usual activities and extended periods of sadness and/or despair. These feelings may also be caused by issues unrelated to hepatitis C.
Depression and anxiety are nothing to be ashamed of, and can be treated.
Talk with
a health professional such as a counsellor or doctor. There are possible treatments
for anxiety and depression such as counselling, medication, relaxation activities,
support groups, and self-help books.
Sharing your feelings and concerns with people you trust can help. Gentle physical activities can help to lift a person’s mood. Consider gentle exercise such as a daily walk, yoga, massage or scheduling regular relaxation times.
‘Brain fog’ and cognitive changes
Cognitive ability refers to a person’s ability to think clearly and to concentrate. Some people with hepatitis C notice a change in their cognitive ability. A person may find they cannot concentrate for long periods of time or that their thought processes seem slower than usual. Some people may have difficulty coming up with words they want to say, or just feel mentally tired. These cognitive changes are sometimes called ‘brain fog’. Like other symptoms of hepatitis C, cognitive changes can come and go. These symptoms can be caused by other things unrelated to hepatitis C, including depression and anxiety.
It is a good idea to discuss these symptoms and how to manage them with a health professional such as a counsellor or doctor. There are things you can do to lessen the impact of ‘brain fog’ on your life:
- make lists and work through them;
- give yourself more time to complete tasks; and
- discuss important decisions with someone you trust.
Nausea and poor appetite
Hepatitis C may cause episodes of nausea which can affect appetite. Although it is usually not accompanied by vomiting, it can be a very uncomfortable and debilitating symptom.
To manage nausea and indigestion consider the following hints:
- avoid having an empty stomach. Eat smaller meals more frequently;
- avoid eating large meals;
- Many people find they do not feel well after having fatty foods or alcohol. Limit your intake of fatty foods and alcohol;
- do not lie down immediately or within 30 minutes of eating;
- avoid cooking odours where possible. Try seeking assistance with meal preparation or using pre-prepared foods. It can be a good idea to prepare and freeze meals when you are feeling well for use when you are experiencing nausea;
- ginger, peppermint, spearmint, fennel seed and aniseed teas can reduce nausea, bloating and abdominal cramps. Fresh ginger, ginger tablets or ginger beer may also help; and
- try eating bitter foods before main meals to improve digestion (e.g. olives or rocket lettuce). If nausea persists consult your doctor who may be able to assist with other measures.
If nausea persists consult your doctor who may be able to assist with other measures.
It is important to maintain a good nutrient intake even when feeling nauseous or experiencing a loss of appetite. To maintain nutrient intake at these times, consider:
- eating small amounts often;
- eat when you feel most hungry. For many people this may be at breakfast time;
- try different foods to stimulate appetite, such as salty, sweet or sour foods;
- choose foods that contain lots of vitamins and minerals. For example milkshakes,yoghurt, dried fruits or nuts; and
- rinse your mouth with cold water before eating. This can help food taste more appealing.
Pain or discomfort of the liver
People with hepatitis C may experience episodes of abdominal pain. Pain or soreness on the right side just below the ribs could be from the liver.
Before attempting to treat pain or discomfort of the liver it is important to discuss symptoms and pain management with your doctor. For some people reducing alcohol consumption to below levels recommended for the general community or abstaining from alcohol altogether, may bring relief. Using a heat pack over the liver, particularly at night, may also relieve liver pain or discomfort.
Pain relief medication, both over-the-counter and on prescription, is generally considered acceptable for temporarily treating liver pain—but there are exceptions. The use of pain medication in people with chronic hepatitis should first be discussed with your doctor.
Muscle and joint pain
People with hepatitis C may experience muscle and joint pain. Common sites of joint pain are the hips, knees, fingers, and spine, although any joint can be a source of pain. Pain associated with hepatitis C can move around and come and go. Aches and pains in the muscles are usually experienced as a generalised feeling. However, some people report having pain in only one area of the body.
It is generally considered acceptable to take anti-inflammatory medication for muscle and joint pain (following the instructions on the packet). However, you should first consult your doctor about the use of anti-inflammatory drugs.
Some people find mild physical activity can help manage muscle and joint pain. Mild physical activity increases blood flow to joints and muscles and can reduce stiffness. Heat packs on the sore area, warm baths and massage may also provide temporary relief.
Some people find benefit in complementary and alternative therapies, such as herbal products or massage. You may like to consider the use of glucosamine sulphate to help reduce joint pain and improve mobility. If you pursue complementary and alternative therapies it is important that you tell your liver specialist and GP of any therapies that you have recently used, are using, or plan to use.
Fevers and night sweats
People with hepatitis C may experience fevers which may occur while sleeping. The fevers are usually low, typically less than 38.3 degrees. As the fever reduces people may experience chills and sweating.
Fevers may be treated by the use of anti-pyretic medication (such as paracetamol) before bed. Always follow the manufacturer’s directions when using medication and never exceed the recommended dosage. Medications can impact on the liver and the use of medication in people with hepatitis C should first be discussed with your doctor.
Change nightclothes if they get damp from sweat. Keep extra nightclothes by the bedside to enable quick changes in the night without having to wake fully to look for dry clothes. Try wearing pure cotton nightwear.
Some people have found relief from night sweats using herbal preparations. Consult with a complementary therapist or doctor to determine if complementary therapy may be suitable for you.
Skin conditions
People with hepatitis C may experience skin dryness, skin itching or skin rashes. Skin itching, rashes and other skin complaints may come or go.
Some skin problems may be given the clinical terms porphyria cutanea tarda (or ‘PCT’) or lichen planus (‘LP’). PCT may include skin rashes, blisters, scarring, pigmentation, milk white spots, and skin tightening. Lichen planus causes superficial inflammation that leads to itchy flat white and purplish patches on the skin and white patches in the mouth.
To help manage skin rashes and itches you can consider:
- avoiding perfumed soaps and shampoos to minimize skin irritation. Sorbolene cream can be used as a substitute for soap when bathing and an unperfumed skin moisturiser can be used to reduce skin dryness;
- keep the skin cool and avoid hot showers and baths;
- try to reduce sweating and limit exposure of the skin to the sun;
- talk to a pharmacist or doctor about managing the itching. They may be able to recommend suitable creams, lotions or oils to relieve dry skin and itchiness;
- avoid scratching the skin. Scratching can increase the itchiness; and
- try using a wrapped cold pack to relieve itchiness.