DR. ELLIE CANNON: Why can’t high-tech scans find the cause of my son’s urinary tract pain?

My 35 year old son was diagnosed with a water infection which later turned out to be a prostate problem. Since then he has been suffering from pain in his lower abdomen. He had MRI and CT scans but nothing was found. Do you have any idea what could be the cause? He is getting desperate.

Urinary tract infections (UTIs) and prostate problems are more common in middle age, but also occur in younger men. In these cases, we recommend a comprehensive sexual examination and, if necessary, an examination by a urologist.

Sexually transmitted infections can cause urinary tract infection-like symptoms and persistent pelvic or abdominal pain. A GP can arrange a test or have it carried out at a sexual health clinic. Such problems usually do not show up during a CT or MRI scan.

If all the proper tests have been done, we may simply not be able to explain the cause of his pain. It happens. This is sometimes called chronic pelvic pain syndrome.

A sexual health specialist or urologist may recommend a referral to a pelvic physiotherapist, who may be able to offer exercises to relax muscles and relieve discomfort.

Broadly, pain management is a specialty in healthcare and treatment can include medication, psychotherapy and lifestyle interventions. GPs and pharmacists specialize in this and may be able to provide referrals to local pain groups and advice on safe regular pain medication.

In some areas, it may be possible to provide cognitive behavioral therapy (CBT) for the pain, which helps people live with it. There are apps that can do this too.

Exercise is also therapeutic for many types of pain and worth trying. Some forms, such as swimming or Pilates, may be better than others.

Six years ago I had neck surgery but got an infection and was given strong antibiotics for three months. Then I got C. diff and was given more antibiotics for it. Things improved, but I suffered from severe food intolerances – mainly gluten and lactose. I deal with the extreme symptoms by following the FODMAP diet, which means I avoid many foods. But is there anything that can be done to give me some semblance of a normal life again?

The medical community is not particularly good at treating food intolerances because they are difficult to diagnose and can cause an incredibly wide range of symptoms.

True intolerances can lead to headaches, skin problems, stomachaches, stools and brain fog, among other things. To add to the confusion, people are often convinced they have intolerances after taking tests purchased online.

We often encourage patients to keep a diary to see if they can control what they do and eat when symptoms occur. To determine if they are really causing problems, it makes sense to eliminate the suspect foods one at a time for at least two weeks.

For some people with lactose intolerance, there may be a small amount they can tolerate without symptoms, and this is learned through trial and error.

We see that patients who receive repeated antibiotics develop irritable bowel syndrome (IBS). Antibiotics target bacteria, but they can inadvertently kill “friendly” microbes in the gut.

FODMAPs are foods that cause gas formation during digestion and are known triggers for many people. A low-FODMAP diet may be helpful for people with irritable bowel syndrome, along with peppermint oil capsules and certain bowel medications.

Probiotic supplements can also help. These replace depleted gut bacteria and should be tried over a four-week period, using the same dose and brand consistently, to see if they help.

Six months ago I had a breast removed and a seroma developed. I was told it would go away on its own, but it’s still there. It’s a hard knot and doesn’t hurt, but it hurts a little where the stitches were. Should I just forget about it and hope it goes away with time?

A seroma can sometimes develop after surgery, where fluid accumulates in the area where the tissue was removed. It is usually best to leave it alone as the fluid can naturally be absorbed back into the body.

However, sometimes this is not the case and in these cases we can empty it with a needle, a process that may need to be repeated. The decision to do this depends on how bad the discomfort is – for example, whether the scar is tight or causes tension and extends around the scar.

Concerns also arise if the wound grows larger, is red, painful, hot, or the wound does not heal properly. In the event of an infection, you must see a doctor urgently.

Surgeons can see their patients for about six weeks after the operation, but not again after that. This means that it is often the primary care physician who deals with postoperative complications such as seromas.

First, a GP can help determine the need for further treatment and also address other issues such as pain relief or wound care. Referral back to the surgeon may be warranted.

Sometimes this can be done more easily by a cancer nurse if the patient is still under the care of a nurse.

RSV is a nasty virus, so let’s introduce the vaccine to children

Have you heard of RSV? It stands for Respiratory Syncytial Virus and my practice is currently full of it – as it is every winter – even though no one seems to have heard of the disease at the time of diagnosis.

Anyone can become infected with RSV, which usually causes mild cold symptoms. But the biggest concern is that it can cause bronchiolitis – a type of respiratory infection that can require hospitalization for oxygen – in young children and the elderly.

Have you heard of RSV? It stands for Respiratory Syncytial Virus and my practice is currently full of it – as it is every winter – even though no one seems to have heard of the disease at the time of diagnosis

A vaccine called Nirsevimab was developed and approved by Britain’s medicine regulators more than a year ago, but has yet to be rolled out.

RSV is a disease that scares parents and worries children, and reducing infection levels could also ease the burden on the NHS over the winter. It’s not too late to get the vaccination program up and running – as we saw during the pandemic, it can happen quickly if the will is there.

Strong arms can save your life

When young people fall, they usually just brush it off – but as they get older, this is no longer the case, as falls can lead to broken bones and serious infections.

And it is not uncommon to hear of a disease that leads to a series of problems that can even lead to death. The risk of this increases with age and more than half of people over 80 fall at least once a year.

Scientists now believe this is due to the decline in older people’s arm dexterity, which means they are slower to react and regain their balance when they slip. Findings from a team at the University of Arizona suggest that older people should do arm exercises to combat this.

I know exercise can be intimidating because age often comes with joint pain, but Versus Arthritis is a great resource for exercises that are good even when you’re sore and stiff (versusarthritis.org).