Why are my muscles so sore? And do I have piles?

TRAINING PAIN

TRAINING PAIN

Q. I often get muscle pain after I exercise. If the exercise is strenuous, or if I change my gym routine, the pain can be intense for up to two days. Sometimes it takes nearly a week to go. The trainers at the gym say that this is called "delayed onset muscle soreness", caused by damage and inflammation. Can I do anything to prevent this from occurring? I am in my early thirties, very fit, and a gym fanatic.

A. Delayed onset muscle soreness (DOMS) affects some people after they do exercises that they are not used to doing. The soreness reaches a peak within 48 hours after the exercise, and then gradually resolves over a few days. Studies show that it is probably due to damage to the muscle fibres. After the damage occurs, the body overreacts by sending white blood cells in to remove the damaged muscle cells. Unfortunately, this leads to further damage to muscle tissue. It doesn't cause lasting damage, but it's painful. Sports experts recommend stretching before and after exercise, together with mild painkillers or anti-inflammatory drugs such as ibuprofen. There is scientific evidence that massaging the muscles after exercise reduces soreness, but it doesn't seem to affect the amount of muscle damage or inflammation. Perhaps the best advice is to be careful with new exercises. Start slowly, and let your muscles get used to new exercises before you start to punish them.

DODGY DIAGNOSIS?

Q. I have had a health problem for a number of years. It flares up from time to time, and the pain is severe and sleep difficult. Pain develops around the anus and on the anal walls. Once in a while, there is blood. Only liberal use of analgesics makes it tolerable. The pain diminishes after a week or so to manageable levels, but I still have to use suppositories. A consultant diagnosed that I have an allergy to my own excreta (a subject upon which he wrote a scientific paper, he said). My GP disagrees with this diagnosis. After a cursory examination she said that I had infected haemorrhoids, but she wasn't confident so has tried to get a specialist's opinion, for which I have been waiting ages. I eat a very low-fat/low-sugar/wholegrain diet. Exercise can make things worse, and prolonged sitting doesn't help. I have never had a proper internal examination (not even by the first consultant), so you will understand that I have serious doubts as to the usefulness of the medical profession, a sentiment that I hope will not offend you.

A. I am not offended by your doubts about the usefulness of the medical profession. But I am worried that it seems to have failed you so miserably. Even junior medical students know that the best way to make a diagnosis is to start by listening to the patient's story. Usually, the diagnosis is clear just from the history. The next step is to examine the patient. If the diagnosis is still not clear, it may be necessary to do tests, scans, X-rays or other investigations. From your story, it sounds as though you have either haemorrhoids (piles) or an anal fissure. Haemorrhoids are blood vessels that swell up and get sore and inflamed. An anal fissure is a small crack in the skin of the anus that can be intensely painful. Both conditions can cause bleeding and come and go over months and years. An internal examination should be able to distinguish between these conditions (or discover another cause for your problems). Both are curable, but the treatment for each is different. Insist on seeing a rectal specialist, who can do what is necessary to solve your problem. It shouldn't be difficult.

IDEAL PRESSURE

Q. I am 65 and recently had a coronary angioplasty. What blood pressure should I be aiming for?

A. Blood pressure is always expressed as two numbers. The first number is the systolic pressure, the second the diastolic pressure. For many years it was said that "normal" systolic blood pressure was "100 plus your age". So, in the 1950s and 1960s, the answer to your question would have been to aim for a blood pressure of 165. But it is now clear that, although blood pressure tends to rise with age, "100 plus your age" isn't good enough. Aim for a systolic blood pressure of 120. You may not be able to achieve it, but it can still be your target.

Have your say: Readers write

LH from Stockport has discovered an unexpected solution to the problem of a persistently runny nose:

As someone who has spent most of her adult life saying, 'No, I don't have a cold', I have discovered a rather radical cure - get pregnant! I have realised that I have changed from a blocked-up nose person to a breathe-easy one. Bliss. I'll have to wait to see if it continues after the birth. But I do wonder why.

And AS resorted to a more mainstream cure:

I suffered with severe allergic rhinitis and nasal polyps for over 10 years, and it completely ruled and ruined my life. But, as you suggested in your article, I was prescribed Flixonase Nasule Drops (containing steroids) and now I am completely cured. The drops were fantastic and I wish I had been prescribed them earlier. No other over-the-counter sprays or antihistamines help severe rhinitis or nasal polyps, but these drops have shrunken my polyps and I now have a full and happy life again.

Send your questions and suggestions to: A Question of Health, The Independent, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182; or e-mail health@independent.co.uk

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