DR ELLIE CANNON: Why can’t high-tech scans spot the cause of my son’s UTI pain?

My son, who is 35, was diagnosed with a water infection, which later turned out to be prostate problems. Since then he has suffered 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 becomes desperate.

Urinary tract infections (UTIs) and prostate problems are more common in middle age, but are also seen in younger men. In these cases we recommend a complete sexual health screening and possibly a check-up with a urologist.

Sexually transmitted infections can cause UTI-like symptoms, as well as persistent pain in the pelvis or abdomen. A GP can arrange testing or this can be done at a sexual health clinic. Such problems do not normally show up on 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 the muscles and help reduce discomfort.

More broadly, managing pain is a healthcare specialty, and treatment can include medication, psychotherapy, and lifestyle measures. 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 undertake cognitive behavioral therapy (CBT) for the pain, which helps people learn to live with it. There are apps available that can do this too.

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

Six years ago I had surgery on my neck, but developed an infection and was put on strong antibiotics for three months. I then developed C. diff and was given more antibiotics for it. It cleared up, but I was left with severe food intolerances – mainly gluten and lactose. I manage the extreme symptoms by following the FODMAP diet, which means cutting out many foods. But can anything be done to give me back some semblance of a normal life?

The medical profession is not very 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, stomach aches, bowel movements and brain fog, among other things. To add to the confusion, people are regularly 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 are doing and eating when symptoms strike. Eliminating suspected trigger foods one at a time, each for at least two weeks, is a good way to see if they are really causing problems.

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

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

FODMAPs are foods that cause gas formation when digested and are known triggers for many people. A low-FODMAP diet may be helpful for people with IBS, along with peppermint oil capsules and certain intestinal medications.

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

Six months ago I had a breast removed and developed a seroma. I was told it would go away on its own but it is still there. It is a hard lump and not painful, but it is a little painful where the stitches were. Should I just forget about it and hope it goes away with time?

After surgery, a seroma can sometimes develop, where fluid builds up in the area where the tissue was removed. Usually the advice is to leave it alone, because the fluid can be reabsorbed into the body naturally.

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

There would also be concern if the wound became larger, was red, painful or warm, or prevented the wound from healing properly. A doctor must then see it urgently if it is infected.

Surgeons may see their patients for about six weeks after surgery, but not after that. This means that it is often the GP who deals with postoperative complications such as seromas.

Initially, a GP can help assess the need for further treatment and also look at other issues such as pain relief or wound care. A referral back to the surgeon may be warranted.

Sometimes this can be done more easily through a cancer nurse, if the patient is still seen by one 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 – although no one seems to have heard of the condition when we diagnose it.

Anyone can get RSV, which usually causes mild cold symptoms, but the biggest concern is that in young children and the elderly it can lead to bronchiolitis – a type of respiratory infection that may require hospitalization for oxygen.

A jab called nirsevimab was developed and approved by British drug regulators more than a year ago but has yet to be rolled out.

RSV is a disease that terrifies parents and worries children, and reducing the number of infections could also ease the winter burden on the NHS. It is not too late to get the vaccination program underway – as we have seen during the pandemic, things can happen quickly if there is the will to do so.

Strong arms can save your life

When young people fall over, they usually just shrug it off – but this is not the case as we get older, as tumbling can cause fractures and serious infections.

And it's not uncommon to hear of one leading to a series of problems that can even result in death. The risk of this increases with age, and more than half of people over 80 will fall at least once a year.

Scientists now believe this is due to the deterioration of arm dexterity in the elderly, meaning they are slower to react and regain their balance if they slip. Findings from a team at the University of Arizona suggest that older people should do arm exercises to counteract this.

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