I love running but it’s become a pain in the backside
QAAI’ve taken up running and love it but I seem to have developed a pain deep in my buttock. My doctor thinks it’s something called piriformis syndrome, which I’ve never heard of. What is it and, more importantly, how is it treated? I was advised to do exercises, but is there anything else?
The piriformis is a muscle located deep inside the buttock and connects the sacrum – the triangular bone at the base of the spine – to the bump of bone at the top of the thigh, near the hip. It’s one of the muscles that helps to rotate the leg outwards at the hip joint.
Piriformis syndrome occurs when the muscle goes into spasm, which may come from overuse. This may have occurred if you have a slightly odd gait when you are running. It can also occur if the sacroiliac joint or the hip are slightly inflamed.
Treatment is usually with exercises that gently stretch the piriformis muscle, which are best done under the guidance of a physiotherapist, along with a deep massage.
Anti-inflammatory medicines, such as ibuprofen, can be helpful too. If the problem persists then a steroid injection into the piriformis muscle may bring relief.
Q
My elderly mother used to have problems with constipation, but now her bowels have gone the other way, as she often passes rather liquid stools, sometimes with very little control. Her doctor has given her stool bulking agents, which I think are a laxative. That seems wrong to me. Should I buy something to stop the diarrhoea from the chemist instead? I suspect that your mother may have what is known as “overflow diarrhoea”. It’s a condition that can occur in someone who has severe constipation, especially the elderly.
Hard stools accumulate in the lower bowel and eventually become impossible to pass, so they form a semi-blockage. Liquid stool from above then seeps out around the hard mass, which is then mistaken for diarrhoea. The condition can be diagnosed by doing a rectal examination.
Treatment involves clearing away the hard stools, which can usually be done with a combination of stool bulking agents such as fybogel or lactulose to soften them, together with a stimulant laxative such as senna or bisacodyl and sometimes with stool softening suppositories as well. However, in some cases an enema is required.
Once the blockage has been cleared, the most important thing is to avoid constipation in order to prevent the same thing happening again. This can usually be achieved by eating a diet that is high in fibre, together with drinking plenty of liquids.
However, in older people who often have smaller appetites, it can be difficult to eat enough fibre and so stool softening agents are often required. These need to be taken regularly, every day. The dose should be adjusted so that a motion is passed daily with no difficulty.
Q
I have irregular periods and a scan has shown that I have polycystic ovaries. I’m also overweight, and I’ve
read that taking metformin could help manage my condition. Could my GP prescribe this for me?
A
In Polycystic Ovarian Syndrome, or PCOS, more than 12 tiny cysts or follicles develop in the ovaries and the balance of hormones made by the ovaries is altered, with an increase in the male hormone testosterone. Often there is also an excess of luteinizing hormone (LH) compared to follicle stimulating hormone (FSH). Ovulation is also usually disrupted and this in turn can lead to very erratic periods.
However, the condition cannot be diagnosed on an ultrasound scan alone, as around 20 per cent of women have ovaries that contain many follicles, but in around 50 per cent of these cases their hormone levels and ovulation are normal.
Therefore diagnosis also requires a blood test. This is best done during a period, but clearly this can be a bit tricky if you never know when your next period is going to be. If it’s done midway between periods, it may need to be repeated.
The excess testosterone can lead to many women with PCOS having greasy skin and acne, and many put on weight, which is difficult to shift.
Women with PCOS have resistance to the action of insulin, which controls blood sugar levels. More insulin has to be produced by the pancreas to keep the blood sugar level in the normal range and this can contribute to weight gain.
Unfortunately, excess fat can make insulin resistance worse, so a vicious cycle of weight gain leading to more weight gain can occur.
The need to produce large amounts of insulin to control blood sugar levels can also mean women with PCOS, especially those who are overweight, are more at risk of developing diabetes.
Metformin is a medicine that makes the body’s cells more sensitive to insulin and it is often used to treat type 2 diabetes. In theory this should mean that it could help some women with PCOS, but unfortunately this has not proved to be the case in practice, though it does seem to help some women with PCOS who are trying to conceive.
It’s only usually prescribed by specialists, so if you want to consider it you will need a referral to a gynaecological endocrinologist, which your GP can arrange.
As I’m sure you know, at the moment waiting times for clinic appointments are very long, so in the meantime the best way of managing your condition is to try and lose weight by eating a healthy diet and doing lots of exercise.
If you have a health question for Dr Leonard, email her in confidence at yourhealth@express. co.uk. Dr Leonard regrets she cannot enter into personal correspondence or reply to everyone.