DR. ELLIE: I’m a man and I suffer from urinary tract infections all the time. Antibiotics don’t prevent them from coming back, do I just have to live with them?

For the past two years I have had constant urinary tract infections.

I have tried four different antibiotics, but as soon as I stop one course the problem comes back. Do I just have to live with it or are there other options? By the way, I’m a man.

Dr. Ellie Cannon replies: Urinary tract infections (UTIs) are a common problem in women, but are much less common in men. So if a man has recurring urinary tract infections, further investigation is warranted.

One cause may be a blockage that interrupts the flow of urine from the bladder. This can cause urine to build up and stagnate in the tubes, increasing the risk of infection. Constipation, which puts pressure on the bladder, may be the cause, or an enlarged prostate that prevents proper flow from the bladder.

Interruption of urine flow can also be caused by stones in the bladder or by narrowing in the urethra itself, which is known as a urethral stricture. UTIs are also more common in men who have diabetes or have a suppressed immune system, for example as a result of medication.

A GP must investigate this before seeking specialist help by means of blood tests and an ultrasound of the kidneys and bladder.

Treatment for recurring urinary tract infections in a man may include a regular nightly low dose of an antibiotic.

Specialists may prescribe a treatment called hippurate, an antiseptic that prevents infections by keeping the urine acidic.

I have recently developed swollen, stiff knees – and I find it difficult to walk. Although I have had breast cancer and have osteoporosis, I am otherwise fit and not overweight. What could be the cause?

Dr. Ellie answers: Swollen and stiff knees and pain when walking sounds

such as osteoarthritis. Although unfitness and obesity increase the risk, it is related to age more than anything else.

Depending on how the arthritis has affected the joint, discomfort may also occur when climbing stairs or sitting for too long. Osteoarthritis can also cause weakness: legs that give way, knees lock, and difficulty bending and straightening joints. In addition, the joints may also feel warm and sensitive.

Too much rest can actually increase stiffness and walking problems. That is why we advise patients to keep moving. To make this easier, doctors recommend taking a painkiller such as paracetamol before exercising.

For knee pain, pain-relieving creams or gels such as ibuprofen or diclofenac can also work very well – you can buy them without a prescription in pharmacies. For stronger pain relief, a prescription from your GP is required.

If it gets really bad, they may also consider a referral for a steroid pain injection.

I have suffered from chronic back pain for years. I was recently prescribed a medication called nortriptyline. It seems to be working – my pain is about 50 percent less bad. However, I have a terrible itch all over my body. There is no rash or spots visible anywhere. Could the pills be the cause?

Dr. Ellie answers: The spinal cord, located in the spine, is a column of nerves that run from the brain to the lower back and connect to the rest of the nerves in the body.

When there are problems with the spine – such as herniated discs or crumbling bones – this puts pressure on these nerves.

And that can lead to severe, long-term back pain.

Patients with back pain often try many different types of painkillers, sometimes without success. Finding a drug that reduces pain by half is extremely positive.

Nortriptyline is a medication used specifically to treat nerve pain and is usually taken at night because it can make people feel sleepy. Other side effects include digestive problems such as constipation, dizziness and headaches.

It is also possible that you may have a very serious allergic reaction to the drug. This would cause swelling of the throat and mouth, hives and breathing difficulties.

Usually a low dose is started and it is only increased very slowly to reduce possible side effects.

Itching is a common side effect of many medications and can certainly be a result of nortriptyline use.

It’s disappointing to have to deal with an unpleasant side effect from a drug that works very well. Under the supervision of a doctor, it may be worthwhile to reduce the dose. This can stop the itching without decreasing the positive effect of the medicine.

Another option would be to continue with the same dose, but take even more tablets, such as an antihistamine, to control the itching.

Itching can rarely be the result of liver problems. Since this can be caused by nortriptyline, it should be checked with a blood test.

Don’t underestimate how bad the flu can feel

Quite a few people have asked me if the flu is particularly serious this year. Someone in his early fifties told me, “I’ve never been so sick in my life.” He even suggested that there might be “something different” going on this year.

But I don’t think so. People just don’t realize how bad – and dangerous – flu can be.

Although some people can get the flu quite mildly, it is not just a bad cold. Symptoms include very severe muscle pain that prevents you from getting out of bed, as well as high fever, breathing difficulties and headaches. These can last a week or more.

It all depends on your health, how much of the virus you have been exposed to, and other factors.

The reason we offer flu vaccines is because this is a virus that can be fatal. Don’t underestimate it.

Do you have a question for Dr. Ellie Cannon? Email DrEllie@mailonsunday.co.uk. Dr. Cannon cannot enter into personal correspondence and her responses must be placed in a general context.