Dear doctor. Dr Ann Robinson answers your health questions.

Dr Ann Robinson on a skier's bruising experience, a very embarrassing problem, and one woman's experience with the 'mask of pregnancy'

Painful pull

Q: I've pulled a muscle in my right thigh (while skiing). It runs from behind my knee to about threequarters the way up the inside of my thigh. A week after pulling it, I have black and yellow bruising all along the line of the muscle and it still hurts, especially when I sit. What's the best thing to do to make it better? And could the bruising mean it's more serious than I think?

A: You can get a tremendous amount of bruising after tearing some fibres of a large muscle like the one that runs up the back of your thigh (which makes up part of your hamstrings). It is highly unlikely to signify any more serious underlying problem. Arnica tablets and cream are great favourites for "bringing out the bruise" but probably make not the slightest difference. When it aches, elevate your leg and put a cold compress (eg a bag of frozen peas wrapped in a pillowcase) under the bruised area.

As the muscle fibres heal, they will shorten so it's all too easy to sustain a similar injury again. The trick is to gradually stretch up the damaged fibres. This means gentle hamstring stretches (ie bending down to touch your toes), starting at a few a day (stop if it hurts) and building up until you have full stretch back. If you belong to a gym, you can use the hamstring- stretching machine with a light weight to further build up the strength.

Troublesome tear

Q: I have an excruciatingly painful and embarrassing problem. A tear in my anus means that passing a motion is almost unbearably painful and that I pass blood with my stool sometimes. I have been told I have an anal fissure and am on a waiting list to have my anus stretched - a prospect that fills me with consternation. Are there any other treatments I could try?

A: Anal fissures are horrible, extremely common and potentially treatable without recourse to surgery. The fissure is a small tear in the lining of the anal canal which sometimes develops after passing particularly hard stools. The sphincter that keeps us faecally continent goes into spasm and this can result in a long-term fissure, a skin tag that hangs down outside your anus and an abnormally tight anal opening. Most fissures heal on their own. It makes sense to avoid constipation by eating a high- fibre diet with plenty of fluids and soften the stool using laxatives or suppositories.

If you are still suffering after six weeks, you may need further treatment. Traditionally, the surgical options have been an anal stretch to loosen the tightened anus, or cutting part of the sphincter for a more long- lasting effect. The problem with the latter is that it can make you faceally incontinent.

Effective treatment is available now in the form of GTN ointment (0.2%) rubbed on to the anus. The active ingredient is the same drug that is used to treat angina. Happily, it relaxes the anal sphincter in the same way as it eases pressure on the heart and allows the fissure to heal. It needs to be specially made up by a pharmacist as it is not yet licenced for use in anal fissures. GTN can give you a whopping headache and you can't take Viagra with it as it is dangerous for the heart. You should see a specialist if bleeding continues to rule out bowel cancer.

Nail nightmare

Q: I've had a recurrent problem with an ingrowing toenail. It flares up occasionally, oozing pus from the corner and becoming very red and painful. I usually get away with an antiseptic cream and cotton wool but attacks are becoming more frequent and lasting longer. Can you help?

A: Ingrown nails may be caused by improper trimming, inherited nail deformities, injuries, fungal infections, or pressure. The big toe is the commonest victim.If the toe is infected, you might see pus or redness.You need to see a podiatrist (previously known as a chiropodist). If the nail is not infected, you may get away with having the corner of the nail trimmed to relieve the pain. For a partially ingrown nail, your podiatrist may need to remove one side of your nail back to the cuticle and treat the base. Severe infections or totally ingrown nails may require antibiotics and temporary or permanent removal of the entire nail. Before you faint at the thought of this medieval-style torture, rest assured that heavy duty volumes of local anaesthetic are used to numb the pain.

Perturbed by a patch

Q: I've a brownish patch that has appeared on my cheek since I've been pregnant. My baby is due in a few weeks time and I am getting a little concerned about the patch though my GP assured me it's not skin cancer. Will it go on its own or do I need to do something?

A: You've probably got chloasma, also known as melasma or "mask of pregnancy". In fact, you don't need to be a pregnant woman to get one, though it helps. It appears on the forehead, cheeks or lips. It is thought to be a reaction to hormones, hence its appearance while pregnant, on the pill or while using depot provera contraceptive injections. The patch of pigment tends to get darker in the sun. It usually fades a few months after delivery but can recur, and be darker, in future pregnancies. Men who use aftershave and then go out in the sun may also develop a similar patch of mottled pigmentation. This is called a phototoxic reaction and is due to ultraviolet radiation being absorbed by the chemical substance (perfume, cologne and other types of fragrance) on the skin.

Best advice for chloasma is to consider coming off the pill, use sunblock, avoid strong soaps, facial cleansers or aftershave and discuss with a dermatologist using bleaching creams that contain hydroquinone or other creams to decrease skin pigmentation. Camouflage creams are also available if you feel very self-conscious.

Cancer choices

Q: I have breast cancer, recently diagnosed. I am trying to find out as much as possible so I can make informed choices about my treatment. I am finding that I am overwhelmed by the information available on the internet and can't see the wood for the trees. Can you recommend any reliable source of information?

A: You are so right to inform yourself as fully as possible. Of all the sites I've checked out, I think the one run by CancerBACUP is the best - A full discussion with a member of your breast care team, followed by a second opinion if you feel you need it, should also help to clarify your thoughts. Good luck!

The GuardianTramp

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