For the past two years I have had constant urine infections.
I have tried four different antibiotics, but as soon as I stop a course the problem returns. Should I just learn to live with it or are there any other options? I’m male, by the way.
Dr Ellie Cannon replies: Urinary tract infections (UTIs) are a common problem in women but are far less common in men. So if a man is having recurrent UTIs, it warrants further investigation.
One cause may be a blockage that interrupts the flow of urine from the bladder. This allows urine to collect 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 stops good flow out of the bladder.
Treatment for recurrent UTIs in a man might be a regular nightly low dose of an antibiotic
Interruption to the flow of urine can also be caused by stones within the bladder or narrowing with the urethra itself, which is known as a urethral stricture. UTIs are also more common in men who have diabetes or are immune suppressed, for example as a result of medication.
A GP should look into this before any specialist input is sought using blood tests and an ultrasound scan of the kidneys and bladder.
Treatment for recurrent UTIs in a man might be a regular nightly low dose of an antibiotic.
Specialists can prescribe a treatment called hippurate, an antiseptic that prevents infection by keeping the urine acidic.
I have recently developed swollen, stiff knees – and I’m finding it difficult to walk. Although I’ve had breast cancer, and suffer from osteoporosis, I’m otherwise fit and not overweight. What could the cause be?
Dr Ellie replies: Swollen and stiff knees and pain on walking sounds
like osteoarthritis. Although being unfit and overweight increases the risk, it’s related to age more than anything.
Depending on how the arthritis has affected the joint, the discomfort can also occur when using stairs or sitting down for too long. Osteoarthritis can also cause weakness – legs that give way, locking of the knees and difficulty bending and extending the joints. Alongside this, the joints may also feel warm and tender to touch.
Too much rest can actually increase the stiffness and difficulties walking, which is why we advise patients to keep moving. In order to make this easier, doctors recommend taking a painkiller such as paracetamol before activity.
For knee pain, painkiller creams or gels like ibuprofen or diclofenac can also work very well – you can buy them over the counter in the pharmacy. For stronger pain relief, a prescription from the GP would be needed.
If things get really bad, they can also consider a referral for a steroid pain injection.
I’ve suffered with chronic back pain for years. Recently I was prescribed a drug called nortriptyline. It seems to work – my pain is about 50 per cent less bad. However, I’ve developed a horrible itch all over my body. There’s no rash or marks anywhere to be seen. Could the pills be to blame?
Dr Ellie replies: The spinal cord, which sits inside the spine, is a column of nerves that runs from the brain to the lower back and connects to the rest of the nerves in the body.
When there are problems with spine – such as slipped discs, or crumbling bones – it 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 to no effect. Finding a medicine that reduces pain by half is extremely positive.
Nortriptyline is a medication that is used specifically to treat nerve pain, and it’s usually taken at night as it can cause people to feel drowsy. Other side effects include digestive problems such as constipation, dizziness and headaches.
It’s also possible to have a very serious allergic reaction to the drug. This would cause swelling of the throat and mouth, hives and difficulty breathing.
Usually the medication is started at a low dose and is only increased very slowly in order to reduce potential side effects.
Itchiness is a common side effect of many medications and it certainly could be a result of taking nortriptyline.
It is disappointing to have to deal with a distressing side effect in a medication that is working very well. Under the supervision of a doctor, it may be worth reducing the dose. This may stop the itch without any reduction in the positive effect of the drug.
Another option would be to continue at the same dose but take further tablets such as an antihistamine to control the itch.
Itching can, on rare occasions, be a result of liver problems, and since this can be caused by nortriptyline it needs to be checked with a blood test.
Do you have a question for Dr Ellie Cannon? Email DrEllie@mailonsunday.co.uk. Dr Cannon cannot enter into personal correspondence and her replies should be taken in a general context.