THIS week I am very grateful to two readers who wrote in with questions on urology (waterworks). I am always delighted to hear from any reader in my capacity as an NHS GP, however my advice can only be used as a guide and for information, not a substitute for consulting with your own regular doctor.

Question: I’m in my early forties and I requested a general check-up from my GP. Why isn’t testing for prostate cancer part of this? Suresh, 43.

Answer: A general check-up usually involves recording measurements of height and weight to calculate your BMI as well as a blood pressure reading. Routine blood tests check your full blood count, kidney and liver function tests, as well as sugars to screen for pre or actual diabetes. These tests identify conditions that may improve with lifestyle modification.

The issue of screening for prostate cancer is contentious. Some advocate the use of the Prostate Specific Antigen (PSA) blood test, irrespective of whether a man has symptoms, whereas others advise it should be used if the individual complains of Lower Urinary Tract Symptoms (LUTS), these being trouble starting to urinate (hesitancy), a reduced flow, and dribbling after finishing urination (terminal dribbling). Needing to get up during sleep to pass water is also a sign of prostate issues.

Although a raised PSA may indicate prostate cancer, it can also be raised for up to 48 hours after sexual intercourse, after vigorous exercise, and for up to 6 weeks after a urinary tract infection.

A PSA blood test is of less use without a rectal examination, which some men are reluctant to undergo. However, you can have a normal PSA and an abnormal feeling prostate.

Hence, a normal PSA doesn’t automatically rule out prostate cancer, and a raised PSA doesn’t definitely mean you have the disease.

In the UK, current advice is not to ignore any alteration in your urinary habits and seek prompt medical advice. A specialist (urologist) may advocate regular PSA checks for those with a strong family history of prostate cancer, but in those without this, who don’t have any symptoms, the argument for routine blood tests is weaker.

A PSA blood test is of less use without a rectal examination.

Question: I had my son three months ago, which was a very scary experience. It was a very long labour and, in the end, I needed to be cut and he was delivered with forceps. I’m ashamed to say that I now leak at points. Will it always be like this? Nuala, 31.

Answer: I am sorry to hear that you had a difficult time and I hope your son is well and that you are recovering both physically and mentally. Sadly, urinary incontinence, to varying degrees, is a complication of childbirth, particularly if your labour was prolonged and you needed assistance, referred to as instrumentation. The pelvic floor is often weakened by the process, and if an episiotomy was performed, or worse a tear occurred, this can compound the situation.

Urinary problems can occur after Caesarean section, but are less common than in mothers who have given birth vaginally.

Your first port of call would be a routine consultation with your GP who may wish to examine you to check the healing of your episiotomy wound as well as for signs of prolapse. He/she would likely refer you on to a gynaecologist for further examination and tests.

First line treatment would be intensive pelvic physiotherapy. There is strong evidence that if this is delivered by trained professionals, results are better than if you attempt this on your own. However, this should not stop you researching the topic for greater understanding. Many private providers exist. A Google search using “Mummy Physiotherapy” or “Mummy MOT” will yield several results. Please make sure providers are fully accredited.

A subspecialty of gynaecology, urogynaecology deals specifically with female urinary tract conditions. However, a urogynecologist may be reluctant to offer you an operation for several months after the birth, as the condition has the potential to improve with pelvic physiotherapy as well as the passage of time. However, they and their team are likely to keep you under regular follow-up to assess for improvement as well as provide support during this difficult time.

Perhaps the most important advice I can give is to never feel ashamed or embarrassed, but to be proactive in coming forward for help.