Pain in the sacrum( sakrodinia) - Causes, symptoms and treatment. MF.

  • Pain in the sacrum( sakrodinia) - Causes, symptoms and treatment. MF.

    Sacrum is a large triangular bone located at the base of the spine and forms the upper posterior part of the pelvic cavity, like a wedge located between two pelvic bones. The upper part of the sacrum connects to the last lumbar vertebra, the lower one - to the coccyx.

    Sacral vertebrae, vertebrae sacrales, number 5, grow together in an adult in a single bone - sacrum. After 15 years, the fusion of the three lower ones begins, and to 25 - the two upper sacral vertebrae begin. The sacrum, os sacrum, has the form of a wedge, is located under the last lumbar vertebra and participates in the formation of the posterior wall of the small pelvis. In the bone, the front and back surfaces are distinguished, the two lateral edges, the base( the wide part facing upwards) and the apex( the narrow part pointing downwards).From the base to the top of the sacrum, the bone is perforated by a curved shape of the sacral canal, Canalis sacralis. The anterior surface of the sacrum is smooth, concave, facing the pelvic cavity and therefore it is called the pelvic surface, facies pelvina;it preserves traces of fusion of the bodies of the five sacral vertebrae in the form of four parallel transverse lines, lineae transversae. To the outside of each of them there are four sacral sacrum apertures, foramina sacralis pelvina, which posteriorly and medially lead to the cavity of the sacral canal( through which the anterior branches of the sacral spinal nerves and the vessels accompanying them pass).

    Violation of the function of the right sacroiliac joint .Displacement impedes the circulation of blood in the right leg, which causes convulsions and pain in the muscles. This is the case of the displacement of the right pelvic bones. Not only that the wrong joint gives pain to the sacrum, so the person is losing weight and suffers from diarrhea and impaired functions of the liver, stomach and intestines. Women often have gynecological diseases.

    With the displacement of the pelvic bones on the left , the patients are obese, easily cold, often suffer from constipation and impairment of the functions of the heart and lungs.

    Sacrodonia ( sacrodynia: anat. [Os] sacrum sacrum + Greek odynē pain) - pain in the sacrum caused by various pathological processes in the pelvis and adjacent areas.

    Pain in the sacrum is not a disease, but a symptom complex, which only rarely needs to be explained by specific causes, such as prolapse of the adhesive disc, malignant tumors, visceral, neurological or vascular disorders. The term "pain in the sacrum" is, therefore, ascribed only to the localization in the region of the binder disk surrounding the longitudinal ligaments and intervertebral joints, from which, apparently, pain comes. The cause of pain, however, only in rare cases can be explained by morphological changes.

    When worried about the sacrum, the back pain is so strong that you can not think of anything else. Pain increases with sitting, fast rising, torso bending forward, lifting gravity. Pain can also be given in the lower back and in the sacrum at the same time. People often confuse the coccyx and the sacrum - pain in the coccyx is often mistaken for sacral problems. In general, the sacrum is located below the coccyx, however they distinguish where the coccyx and where the sacrum, as a rule, are the surgeon, manual therapist and people related to medicine.

    What diseases cause pain in the sacrum:

    The main causes of pain in the sacrum:

    Pain in the sacrum can occur with osteochondrosis of the lumbosacral spine, spondylolisthesis( spinal instability with displacement of the vertebral bodies), with abnormalities of the lumbosacral spine - sacralization, lumbarization, non-healing of the vertebral arches( Bifid's back, spina Bifida).

    Also, pain in the sacrum( sakrodinia) can lead to inflammation of the periarticular tissue( parametritis), compaction of the sacro-uterine ligaments and other pathological processes in the adjacent areas of the pelvic organs. There are frequent pains in the sacrum( sakrodinia) as well as after gynecological manipulations and surgeries.

    1. Pain in the sacrum is observed more often with gynecological diseases, for example, with external endometriosis, localized in the area of ​​sacro-uterine ligaments and / or behind the cervix. Pain in endometriosis is cyclical and increases during menstruation.

    2. Pain in the sacrum, intensifying with physical exertion, is noted in a chronic posterior parameter, leading to the contraction of the rectal-uterine ligaments.

    3. Pain in the sacrum can be associated, for example, with anomalies in the development of the spine, especially with a transitional lumbosacral vertebra. In such cases, pain in the sacrum usually appear suddenly after a load on the spine, the torso of the trunk to the sides, when it falls to the feet, and also with awkward movements.

    4. Aching pain in the sacrum is often a symptom of the displacement of the V lumbar vertebra in the anteroposterior direction - spondylolisthesis. C. may also occur in pathological processes in the muscles of the gluteal region, lesions of the sacroiliac ligament.

    5. With thrombophlebitis of the iliac and pelvic veins, pains can be given back and sacrum in the back.

    6. Pain in the sacrum can appear when the fetus is in the back position( or occipital), in which the nape of the child presses on the bone of the sacrum giving birth, this is the back of the pelvis. However, such pain can occur after another position of the fetus or when changing from the rear to the front. The cause may be the occurrence in this place of increased muscle tension.

    7. The pain that arises in the sacrum and lumbosacral joint causes a special and serious problem. Almost always, and especially in women, these pains are associated with existing inflammatory or dyshormonal processes of the pelvic organs. Despite the signs of a far from perfect spinal column in this area, pain is most often associated with other causes - the spine state only prepares a "minimum resistance point" for the formation of a pain syndrome. Yes, and men, especially the elderly, often demonstrate sacral pain, which is based on either the processes of the prostate, or - the rectum.

    8. Traumatic injury of the sacrum. Patients complaining of pain in the sacrum, often forced to take unusual postures of the body due to spasm of the sacrum-vertebral muscles. The pain is usually limited to the lower back and disappears for several days if the patient is at rest.

    9. Tumor, infectious and metabolic diseases. Metastatic cancer of the breast, lung, prostate, thyroid, kidney, gastrointestinal tract, multiple myeloma and lymphoma( not Hodgkin and Hodgkin) are malignant tumors that most often attack the sacrum. Since their primary localization may escape attention or be asymptomatic, such patients may complain of pain in the sacrum when they see a doctor. Pain usually has a constant and aching nature, it is often not eliminated by rest. At night, pain can be worse.

    10. Infection damage to the sacrum is usually the result of infection with pyogenic microorganisms( staphylococcus or coliform bacteria) or a causative agent of tuberculosis, which is often difficult to recognize on the basis of clinical data. Patients complain of subacute or chronic pain in the sacrum, which increases with movement, but does not disappear at rest.

    11. In so-called metabolic bone diseases( osteoporosis or osteomalacia), a significant loss of bone substance can occur without any symptoms. Many patients with such conditions, however, complain of prolonged, dull, but not intense pain in the sacrum.

    12. Pain in the sacrum with urologic or gynecological diseases. In the pelvic region, there are rare diseases that cause vague pain in the sacrum, although gynecological disorders can manifest themselves in this way. Less than 1/3 of the cases of pathological changes in the pelvic region, accompanied by pain, are caused by the inflammatory process. Other possible causes, such as relaxation of the structures supporting the uterus, retroversion of the uterus, varicose veins of the pelvis and swelling of the ovaries, require further study. It is necessary to emphasize the significance of mental illness in most unrecognized cases.

    13. Pain during menstruation as such can be felt in the sacral region. It is rather poorly localized, tends to spread to the lower extremities and has the character of colic. The most important source of chronic pain in the sacrum radiating from the pelvic organs, however, is the uterosacral ligaments.

    14. Endometriosis or uterine cancer( of the body or neck) can affect these structures, and an incorrect position of the uterus can lead to their tension. The pain is felt in the center of the sacrum, below the lumbosacral articulation, but can be more pronounced on one side of the sacrum. In endometriosis, pain occurs before menstruation, lasts for a while and passes into pain during menstruation. Some researchers believe that the wrong position of the uterus( deviation to the posterior, omission and loss) leads to pain in the sacrum, especially after a prolonged stay on the legs. The influence of the position of the body in this case is similar to that observed when the uterosacral ligaments of fibroids of the uterus are stretched.

    15. Chronic prostatitis, confirmed by a violation of the function of the prostate gland, burning with urination, increased frequency of urination and a slight decrease in sexual potency, may be accompanied by aching pain in the sacrum;it can predominate on one side and irradiate into one leg if a seminal vesicle is involved in the painful process on the same side.

    16. Prostate cancer with metastases to the lower part of the spine is another common cause of pain in the sacrum or in the lower back. In this case, the pain may not be accompanied by an increase in the frequency of urination or burning. Tumor cells can infiltrate the spinal nerves, compression of the spinal cord is possible with the defeat of the epidural space. The diagnosis is established on the basis of research of the rectum, data of radiographic methods and radioisotope scanning of the spine and determination of the activity of acid phosphatase( especially the fraction of prostate phosphatase).

    17. Pain in the lumbosacral spine may increase, for example, with the expansion of the sigmoid colon due to congestion or exacerbation of colitis.

    Diagnosis of pain in the sacrum

    The diagnosis of sakrodinia is based on the exclusion or confirmation of sources of pain in the sacrum - the pathology of the lumbosacral spine and pelvic organs. Sacrodonia in the patient should be distinguished from traumatic injuries of the sacrum, sacroiliitis( inflammation of the sacroiliac joint), osteomyelitis and tumors of this localization.

    Computed tomography( CT) scan of the lumbosacral spine and pelvic bones helps to exclude sacroiliitis or arthrosis of the sacroiliac joint( articulation).Similarly, computed tomography( CT) scan of pelvic bones and the lumbosacral spine allows to exclude from the patient the oncological character of the defeat of the pelvic bones or vertebral bodies.

    MRI of the pelvic organs is prescribed to women for the exclusion of pain in the sacrum( sakrodinia) from inflammation of the periarticular tissue( parametritis), compaction of the sacro-uterine ligaments, etc.

    Treatment of sakrodynia

    Sacrodynia treatment is aimed at treating the underlying disease that causes pain in the armchair.

    For severe pain, analgesics, blockades( injections of drugs into the cavity of the sacroiliac joint( joint), the vertebral canal, into trigger points in the muscles) are prescribed. To facilitate the patient's condition helps physiotherapy( UHF, CMT accelerates the elimination of swelling, inflammation, soreness, recovery of the volume of movements in the muscles of the waist and buttocks), manual therapy and reflexotherapy( acupuncture), exercise therapy.

    There are several types of lumbosacral semi-rigid corsets. All of them are selected in size and can be repeatedly used in case of repeated occurrence of pain in the sacrum at sacroding. Wearing a semi-rigid lumbosacral corset helps limit the amount of movement in the lumbar spine. This helps to reduce pain in the area of ​​inflammation of the sacrum when sacroding and removing excessive protective tension and spasm of the muscles of the back and buttocks. In such a corset, the patient can move independently at home and on the street, sit in the car and at the workplace. The need to wear a corset disappears as soon as pain passes in the sacrum.

    To which doctors to contact if there is pain in the sacrum:

    Pain in the sacrum requires gynecological, urological and neurological examinations, as well as examination of the orthopedist. The nature of the lesion of the spine is established by means of radiography. Treatment is aimed at the underlying disease.

    Doctors who treat pain in the sacrum: