Night leg pain is especially common in elderly persons. While the pain can sound similar at first, there are actually very different causes for this pain. Some causes are urgent. Others are a nuisance, but can wait. So, telling the difference between potential causes is important.
Urgent Night Leg Pain in Elderly
Blood Clots
A blood clot in the leg is called a deep vein thrombosis, or DVT. We should never miss a DVT, because it can move to the lungs and cause a pulmonary embolism (PE). Many elderly people with DVT will not experience any symptoms. But, most older people who develop a blood clot in the leg will experience swelling and pain. The swelling can be in the ankle, calf, thigh or all of these places. Pain will usually be in the same area where the swelling is present.
The diagnosis of a DVT is usually simple and done with an ultrasound. Ultrasound utilizes sound waves. There are no needles, and no dye involved. Once the DVT is diagnosed, treatment is started quickly with blood thinners. The quicker the diagnosis is made, and the quicker treatment is started, the better the chances of good outcomes.
Poor Artery Blood Flow
Another important and urgent cause of night leg pain in elderly people is lack of blood flow. Some people suffer from narrowed arteries and even artery blockages. The most common cause is atherosclerosis. This means that over the years damage from factors such as cholesterol, elevated blood pressure and smoking accumulates to block the arteries. If the blockages are severe, then they may cause complete lack of blood flow. People who suffer from complete lack of blood flow will have pain in the toes and feet when they raise their legs in bed. This pain is called rest pain. Rest pain is a sign of very poor artery blood flow.
Ignoring rest pain will have several negative results. First, the pain itself. But, without treatment the pain will progress and people will develop open sores and even gangrene.
The diagnosis of poor artery blood flow is usually simple. One way is to measure the blood pressure over the legs. Low blood pressure in the legs means there is not enough blood there. Another way to make the diagnosis is with an ultrasound. But sometimes people will need a more sophisticated test like a CAT scan or MRI.
It is important to treat rest pain quickly, to avoid the negative consequences. Treatment will start with medication, but unfortunately, usually people will need to have a procedure. The procedure will either be with a catheter or open surgery.
Infection
Infections can be dangerous, especially in elderly people. An infection of the skin over the leg is called cellulitis. Without treatment the skin infection can progress to the deep tissues and even into the blood stream. So it is important to recognize a skin infection over the leg quickly.
Cellulitis usually cause leg pain, swelling and redness. If you touch the leg it will be hot. The patient might also have fever and they may feel sick. If the infection got into the blood stream, there may be chills and rigors.
The treatment of cellulitis is with antibiotics. Some people will need to receive the antibiotics through the vein. In other instances, you taking pills might be enough. You can improve the leg pain with elevation and with cold compresses on the affected area.
Joint Inflammation
An inflamed joint will be swollen, warm, red and tender. The professional term for an inflamed joint is arthritis. In fact, there is more than one reason for arthritis. For instance, infection, an auto-immune condition or crystals that build up inside the joint.
Some forms of arthritis tend to be more painful at night. The most famous of these is gout. Gout is considered so painful, that people used to believe it was caused by daemons.
The treatment of joint inflammation depends on the cause. For instance, if the cause is infection, the treatment is with antibiotics. But, if the cause is gout, the treatment is with medications such as colchicine and steroids. Some people will require a procedure to drain the joint. This is done with a needle and a syringe.
Other Causes of Leg Pain in Elderly
Night Cramps
Night cramps are painful, spontaneous, leg cramps that happen during sleep. There are many reasons for night cramps. Some of these reasons are more typical in elderly persons. For instance, dehydration is common in elderly people, especially at night. This is because many elderly people suffer from problems with urinary control. Basically, they don’t want to have to get up at night to pee, so they refrain from drinking. Elderly people might also have electrolyte imbalances because of water pills that they take. Other medications, also more common in the elderly, might be a risk for night cramps altogether. For all these reasons, night cramps are a common cause for night leg pain in elderly people.
Night Leg Pain in Seniors after Activity
The cause for leg pain after activity is the buildup of toxic materials in and around the muscle as well as possible injury to the muscle. People who are fit are able to withstand more activity than people who are not. Basically, their muscles and metabolism are used to it. On the other hand, people who over-extend, will often suffer the consequences. For this reason, new exercises should be introduced gradually, especially in elderly people.
Pain can start several hours after the activity. Often, the pain is worse the day and night after the activity. Sore muscles will usually resolve over time. By the way, stretching, which has many benefits, probably does not do much to relieve sore muscles after exercise.
Tight Muscles
As we age, our muscles becomes tighter. We lose our flexibility. Also, no one really stretches. So the problem just gets worse. Tight muscles have a tendency to also be tender. But, tight muscles can develop into night cramps very rapidly. This is because it takes very little to trigger a severe contraction in muscles that are already quite tight.
Pulled Muscle
A pulled muscle is another term for a muscle strain. It is different than tight muscles. A pulled muscle is a type of injury. Older people are at risk for pulled muscles because we lose balance as we age. A pulled muscle can cause pain that can linger.
Muscle and Tendon Injuries
Some muscle and tendon injuries are more common in older people. For instance, an Achilles tendon rupture or a Baker’s cyst can cause leg pain. A bleed into a muscle will cause a painful bruise. Usually, a person will know about the injury that caused the problem. Often, it will be a fall. But sometimes the injury will happen during an activity.
The diagnosis of a muscle or tendon injury is not always simple. True, sometimes a bruise will be easy to see. But other times, you might need to have imaging such as a special ultrasound, a CAT scan or an MRI.
Treatment of muscle and tendon injuries starts with rest, icing, compression and elevation (the famous R.I.C.E treatment). But sometimes this will not be enough. For some injuries, you will need a special brace, boot or cast. In other instances, you might need surgery to help you get back on your feet. Literally.
Leaky Vein Valves
Leg veins have valves that make sure blood is pumping in the right direction. If these valves are not working properly, there could be backflow of blood and pressure will build up in the legs. The professional term for this is venous insufficiency. This pressure will be worse toward the end of the day, after building up all throughout the day. People describe heavy legs more than actual pain. Raising the legs in bed can help with this discomfort, but this may take time. As venous insufficiency is very common, it is also a common cause of night leg pain in elderly.
Other causes of leg swelling are also common in older people and can also cause leg discomfort. For instance, dependent edema and lymphedema can cause leg heaviness that will often be worse toward the end of the day.
Night Leg Pain in Elderly from Nerve Damage
Nerve damage is called neuropathy. The symptoms of neuropathy leg pain are worse at night. The most common cause of peripheral neuropathy is diabetes. Obviously, diabetes is very common, and it is more common with age. If you suspect neuropathy, your doctor should identify the cause. Some causes will be reversible. If not, they should discuss whether to offer you medical treatment for the symptoms.
About Author
