DEAR DR. GOTT: I am a 76-year-old female with RLS for many years. The symptoms have increased in the past 10 years. It begins about two hours after supper and I must walk for some relief. Then it continues (many times with jerking) when I go to bed so I have to get up and walk. I average about four to five hours of sleep every night and don’t nap during the day. I have been on the low-dose generic drug for Mirapex for several years. It worked very well for about seven to eight months, then started lessening.
I now suspect that my ongoing constipation problem, which has increased with aging, is the cause of my RLS. My primary care doctor disagrees but the RLS symptoms seem related to my difficulty with having bowel movements, especially since they occur mostly after supper. Have any studies been done on that possibility?
I have varicose veins and I should mention that before reluctantly agreeing to go on Mirapex, I consulted a vascular surgeon who diagnosed that a valve was not closing properly in my left groin and I was getting overflow. But he concluded that RLS was my primary problem. I had phlebitis after childbirth 40 years ago and have worn 20-30 compression stockings every day since 1970. I also take calcium for osteopenia as well as a daily multi-vitamin, along with fish oil and vitamins C and D.
I hope I have given you enough information and would welcome your comments and advice. Thank you.
DEAR READER: RLS (restless legs syndrome) is a neurological disorder and life-long condition that is believed to affect as much as 10% of the US population. It occurs more frequently in women than in men and can affect people of all ages. Symptoms occur primarily in the evening when a person attempts to relax. Sensations range in severity from person to person. An interesting and unusual aspect of this movement disorder is that rest of the lower extremities exacerbates the symptoms rather than providing relief which is only achieved by movements such as walking, through massage and perhaps warm baths for stress reduction.
Symptoms are generally restricted to the lower extremities between the knees and ankles but there can be an extension into the arms, feet and thighs with an irresistible and uncontrollable urge to move the legs. Aching, tingling, pulling, crawling sensations that can last for an hour or throughout the night are common.
Medications, to include pramipexole (Mirapex) and ropinirole (Requip) have been approved for relief of symptoms. Sleep can be interrupted, which may be a rather bizarre thing for me to say because many individuals spend the entire night walking for relief. Tranquilizers and medications for Parkinson’s may be prescribed by a physician. On the downside, those same tranquilizers and some drugs provided for Parkinson’s can cause daytime drowsiness that continues the cycle of napping during the day and being awake most of the night.
On the home front, my old trick of placing a small bar of soap under your bottom bed sheet where your legs rest has brought relief from leg cramps to thousands of my readers. Or, you might consider drinking pickle juice or eating a pickle before retiring for the evening. Another helpful trick is to stretch the posterior leg muscles. Simply plant your feet on the floor about two feet from a wall and, keeping the body straight, lean forward onto the wall.
Now on to your constipation, a known side effect of Mirapex. Other known issues from this drug include dry mouth, headache, fatigue and stomach upset. Calcium carbonate which you are on for your osteopenia can also cause constipation, so you might consider speaking with your physician regarding the matter. Perhaps you can consider drinking warm prune juice every other day for symptom relief.
I have read “headlines” associating constipation with RLS but cannot find valid, scientific studies that would allow me to tell you there is a direct correlation. A number of large centers have had legitimate recorded trials in the past regarding RLS but none specifically linking the two. Institutions include the Cleveland Clinic, Charlottesville Medical Research, Georgia Health Sciences University and others. In fact, one is ongoing right now at the Sleep Health Center in Brighton, MA for a new investigatory medication for RLS. I don’t know where you reside or what your local resources are so I recommend you contact your nearest major facility for assistance. If that doesn’t prove fruitful, contact the RLS Foundation at www.RLS.org to determine what studies might be available in the near future.
Readers who would like other home remedies for leg cramps and information on other topics can order my Health Report “More Compelling Home Remedies” by sending a self-addressed, stamped, number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
