Dear Dr. Roach: I am a 65-year-old woman and have had pain in my right hip for more than a year. I have a normal body mass index. My general practitioner diagnosed trochanteric bursitis and recommended stretches plus Voltaren cream to reduce the pain. The stretching helped, but Voltaren cream did nothing for me.
I asked my GP if a cortisone injection would reduce the pain, but she was not willing to try it, stating it would weaken the hip joint.
I bike 10 miles or walk five miles each day to get weight-bearing exercise. Do you have any suggestions?
N.H.
Greater trochanteric pain syndrome (the pain is near the bursa, but bursitis isn’t usually the primary problem) is a common condition — most common in women in their 60s — that is usually caused by stress to the tendon of the gluteus medius muscle. Pain and tenderness where the tendon inserts on the bone in the side of the hip is the key finding to make the diagnosis.
Before discussing treatment, it’s important to consider why people get it. It is often from abnormal movement of the hip, which in turn can be caused by many problems, including issues with the foot or knee. Bone issues, like scoliosis or a leg-length discrepancy, predispose to this condition. Treating the lateral hip pain without considering the underlying problem might help initially, only to lead to recurrences of the pain.
The gluteus muscles work with forceful extension of the hip, such as stair or hill climbing; or powerful cycling, such as sprinting or hill climbing. All of these can worsen your condition. Temporary reduction in activity until the pain gets under control is prudent.
My approach to this condition is a combination of injection of a cortisone-like drug and physical therapy. For those who don’t want the injection, oral anti-inflammatories can be substituted. Topical anti-inflammatories such as diclofenac (Voltaren) gel are most effective for people with a normal or below-normal BMI, but even then do not work on everybody. A single injection, or even if repeated once, is not likely to worsen osteoporosis or the hip joint.
Your symptoms have been going on too long, and I would refer a person like you to an expert in orthopedic surgery, who might obtain advanced imaging (such as MRI) to confirm the diagnosis. I have had an occasional patient with a tear of the gluteus medius tendon requiring repair.
Dear Dr. Roach: I am 76, and constipation has never been a concern, until now. I have benign prostatic hyperplasia, and multiple nightly urinations are the norm. I was recently prescribed tamsulosin. Could this be the cause?
M.R.
When a symptom begins after a new drug, it is wise to consider whether it’s a side-effect. It certainly could be for you, but constipation is not a common side-effect.
Constipation is more common as we age. Sixteen per cent of 65-year-old men have constipation, raising to 26% of men in their 80s (the rate for women is about 10% higher). I would also take a look at your diet for any changes, as well as making sure you drink enough water.
Finally, low thyroid levels are common in older folks, and it is worth a quick blood test if the problem persists.
