MEN’S HEALTH BY AARON SMITH
Leg cramps at night are a very common problem for both men and women. An estimated 50 per cent of people over 50 may experience leg cramps at night, and that percentage increases further at older ages. They seem to affect equal numbers of men and women. Most people describe either a tightening or an ache in the calf or thigh muscles which may or may not be associated with increased muscle tension in the area affected. The cramps usually last only seconds to minutes but may persist for much longer.
Some medical conditions may predispose people to leg cramps. New leg cramps should prompt a discussion with your health care provider about the possibility of electrolyte imbalances (such as sodium, potassium, and magnesium), diabetes, thyroid issues, and low vitamin B12 levels. In most cases some simple blood work can screen for these issues. Other more severe neurologic conditions may rarely be implicated, and your health care provider should be able to assess your risk and appropriate investigations.
Many medications can potentially cause leg cramps. Two of the most common culprits are diuretics and statins. Diuretics (sometimes referred to as “fluid pills”) are commonly used to treat issues such as high blood pressure, leg swelling, and congestive heart failure. Statin medications are commonly used to treat high cholesterol levels. Other medications that have been associated with leg cramps are beta-blockers (used to treat high blood pressure and fast heart rates), angiotension receptor antagonists (used to treat high blood pressure and some kidney issues), long acting bronchodilator type puffers (used in asthma and COPD), and benziodiazepines (used to treat anxiety and sleep disturbance; a common example would be ‘Ativan’). If you are experiencing leg cramps and you are prescribed any of these medications, it may be possible to change to a similar medication that would not cause cramps. Do not stop any prescription before you are assessed by your health care provider.
If medical causes and medication side effects have been ruled out, you probably have what health care professionals call “idiopathic” cramps (which is doctor slang for “we don’t know why”). This is by far the most common category of leg cramps that I see in my office. Even though the cause of your leg cramps may not be possible to figure out, there are things that you can do to reduce the pain and the frequency.
When a leg cramp hits, stretch the affected muscle forcefully and hold it in the stretched position for about 20 seconds. Some patients report relief if they get out of bed and stand on a hard floor, concentrating on pressing the foot downward. Other measures that seem to alleviate cramps are hot water and/or cold compresses as well as ice massage.
To prevent night time leg cramps, first try a stretching routine for your calf muscles. Supporting your weight on a wall or doorframe, lean forward and keep your legs straight with your feet flat on the floor until you feel a good stretch in your calf area. Hold yourself in this position for 20 seconds then release. Repeat this stretch five times. Go through this routine a couple of times a day and again just before bed. Another effective approach is to gently ride a stationary bicycle for a few minutes just prior to bed.
Should the above measures not provide relief, certain over-the-counter treatments have may be worth a try. Vitamin B complex supplements seem to help some people alleviate their cramps. Optimally they should be taken three times daily. Also, Vitamin E supplements have been shown to provide relief in some studies, although there is not as much evidence for this as there is for Vit B. Finally, lots of my patients have reported relief with magnesium supplements, but there has been no great medical evidence showing this works. If the vitamins fail, another home treatment with good evidence is a small dose of Benadryl (12.5-25mg) taken just before bedtime. There are a multitude of other “home” treatments that patients have reported success with, including among others a bar of soap or a penny in the bed and a drink of tonic water prior to bedtime. Again, there is no real medical evidence that these work.
If nighttime leg cramps continue to be an issue after medical causes are ruled out and the simple measures above have failed, your health care provider may want to try prescription medications. Treatments with good evidence include a class of medications called calcium channel blockers (which are also used commonly for blood pressure control) and a medication called Gabapentin (used commonly for other neurologic conditions such as neuralgias). Should these classes of medications fail, there are other prescription options such as quinine but these should be used with caution secondary to potential heart rhythym and blood-related side effects.
Finally, there is evidence that people with a relatively sedentary lifestyle who don’t get regular daytime exercise seem to be more affected by nighttime leg cramps than those who get regular physical activity. If you have a desk job or are not getting your 30 to 40 minutes of exercise per day, consider making a lifestyle change to include regular exercise. Not only could this help your leg cramps, but you’ll sleep better, be happier, and feel better.
Aaron Smith is a Family Physician practising in Westville. This column is intended to provide general information only. Always consult your primary healthcare provider for specific information on personal health matters. For previous articles and other Men’s Health information, be sure to check the facebook blog at www.facebook.com/themenshealthtoolbox or the website www.themenshealthtoolbox.com