Pain in the sacrum is provoked by lesions of the sacrum itself, sacroiliac joints, surrounding soft tissues, nervous structures and pelvic organs. It can be sharp, dull, pressing, aching, pulling, constant, intermittent, weak or intense. Sometimes there is a connection with the level of physical activity, the menstrual cycle and other circumstances. To determine the cause of pain in the sacrum, a survey, an objective examination, radiography, CT and other studies are carried out. Until the diagnosis is established, rest is recommended, in some cases the use of painkillers is allowed.
Why does the sacrum hurt
Traumatic injuries
Pain in the sacrum after injury is more often caused by hematomas and soft tissue bruises. With a bruise, the pain syndrome is moderate, disappears within a few days. The edema is small, the movements are slightly limited, the condition is satisfactory. With a hematoma above the sacrum, a painful tumor-like formation is found, which either gradually resolves over 2-3 weeks, or turns into a cavity with liquid contents.
Fractures of the sacrum are extremely rare, as a rule, combined with multiple fractures of the pelvic bones. They arise after a high-energy injury: a road accident, a fall from a height, etc. The pain syndrome is very intense, movements are sharply limited, the condition is serious. In the region of the sacrum and pelvic bones, bruising may be detected, and pathological mobility is possible.
Diseases of the spine
The cause of pain in the area of the sacrum is often diseases of the lower parts of the spinal column. The pain can be local, spread to the lower back and buttocks. With degenerative-inflammatory processes, muscle strain, painful sensations are aching or pulling, aggravated after exercise, when the weather changes. When the nearby nerve structures are compressed, the pains become shooting, radiate to the legs, and significantly limit mobility.
Pain syndrome is observed in the following pathologies of the spine:
- Degenerative : intervertebral hernia, disc protrusion, osteochondrosis, spondylarthrosis.
- Anomalies of development : lumbarization, sacralization.
- Curvature of the spine : scoliosis, kyphoscoliosis, pathological kyphosis and lordosis, flat back.
- Inflammatory : spondylitis.
- Oncological : primary tumors and metastatic lesions of the lower spine and spinal cord.
- Polyetiological : spondylolisthesis.
In addition, pain syndrome is detected in all types of osteoporosis, including juvenile, senile, postmenopausal and idiopathic. Pain in osteoporosis, as a rule, is insignificant, aggravated after a load and a long stay in an uncomfortable position. An increase in the intensity and duration of pain with a decrease in the strength of bone tissue may indicate the presence of a pathological fracture.
Pain in the sacrum
Neurological pathologies
Burning, shooting pains that radiate to the legs or buttocks, combined with disorders of sensitivity and movement, are characteristic of such neurological disorders as:
sacroiliitis
Inflammation of the sacroiliac joint is more often unilateral, but it can also be bilateral, observed in many diseases, manifested by pain on the side of the sacrum. The characteristics of the pain syndrome are determined by the type of pathology:
- Purulent . Rapidly increasing sharp pains, aggravated by extension of the limb. Combined with a forced position of the body, chills, hyperthermia, severe intoxication.
- With tuberculosis . The pain is vague, without a clear localization. Palpation of the joint is moderately painful. Stiffness, local hyperthermia are observed. Over time, streaks often form on the thigh.
- With brucellosis . The pain is short-term, slight or moderate, aggravated by movement. The persistent pain syndrome is less often noted.
- In rheumatic diseases . It is detected in Bechterew's disease, psoriatic arthritis. Painful sensations are not intense, increase at rest, weaken during exercise, and are supplemented by morning stiffness.
Women's diseases
Pain in the projection of the sacrum is observed in gynecological and obstetric pathologies. More often non-intense, dull, aching, accompanied by pain in the lower abdomen. In chronic processes, they persist for a long time, often combined with chronic pelvic pain syndrome in women. They are found in the following diseases and conditions:
- During pregnancy : spontaneous abortion, low placenta.
- In childbirth : pathological preliminary period of childbirth, discoordinated labor activity.
- Violations of the position of the uterus : hyperanteflexia, retroflexia.
- Congenital anomalies : doubling of the uterus, uterine aplasia, unicornuate and bicornuate uterus, "baby" uterus.
- Inflammatory : oophoritis, metritis, metroendometritis.
- Associated with menstruation : dysmenorrhea.
- Tumors and tumor-like formations : paraovarian cyst, uterine fibroma, cervical cancer, cancer of the uterine body.
- After gynecological operations : abortions, curettage, plastic surgery.
Other pelvic diseases
Ordinary or radiating pain in the sacrum are also detected in diseases of other pelvic organs:
- Urological : interstitial cystitis, bladder cancer.
- Andrological : prostatitis, prostate cancer.
- Proctological : cancer of the rectum.
- Others : adhesive disease, varicose veins of the pelvic veins.
Simultaneously with pain in the sacral region in chronic andrological pathologies, chronic pelvic pain syndrome in men is often diagnosed.
Other diseases
Sometimes the following diseases become the cause of pain in the sacrum:
- Myalgia and myositis . Pain occurs against the background of overload, acute infectious diseases.
- Coxarthrosis. Pain can be provoked by a non-physiological load on the spine.
- Mental disorders . Psychosomatic pains are observed in hysteria, neurasthenia, depression. They do not fit into the picture of a certain disease, they often differ in an unusual character.
Diagnostics
Patients with pain in the sacrum often turn to a neurologist or orthopedic traumatologist. In case of diseases of the internal organs, patients are examined by doctors of the appropriate profile. As part of the examination, the following procedures may be prescribed:
- Neurological examination. It is required for diseases of the spinal column, damage to the nervous structures. It is carried out to study reflexes, sensitivity, coordination of movements and muscle strength.
- Gynecological examination. Indicated for diseases of the female reproductive system. It is performed to detect developmental anomalies, inflammatory and tumor processes.
- Digital rectal examination. Depending on the symptoms, it provides for the study of the prostate or rectum to assess the state of the organ, to detect volumetric formations.
- ultrasound. Necessary for diseases of the pelvic organs. Ultrasound of the female genital organs, ultrasound of the prostate and bladder, or ultrasound of the rectum with a rectal probe may be performed.
- Radiography. X-rays of the sacrum, lumbar and pelvis show fractures, degenerative and inflammatory changes, and volumetric formations.
- Other visualization methods . To detail the information obtained in the course of radiography, if necessary, tomographic studies are performed. CT allows you to assess the state of solid structures, MRI is used to study soft tissues.
- Functional research. Patients with neurological pathology are prescribed electroneurography and the study of evoked potentials.
- Laboratory tests. Studies of blood, urine and feces, microbiological and histological analyzes are performed for gynecological, andrological, proctological and rheumatic pathologies, inflammatory processes.
Manual techniques for pain in the sacrum
Treatment
Help at the prehospital stage
With bruises and hematomas, rest should be ensured. Suspicion of a sacral fracture is an indication for immediate hospitalization. The patient must be laid on a shield, given an anesthetic drug. In case of non-traumatic pathologies of the spine and neurological disorders, local warming, anti-inflammatory and analgesic agents are effective.
With dysmenorrhea, analgesics are allowed. If other gynecological pathologies are suspected, especially those that suddenly arise and are accompanied by increasing pain, self-treatment can be dangerous. An urgent examination by a gynecologist is required.
Conservative therapy
The plan of conservative measures is determined by the nature of the pathology. The list of used treatment methods includes:
- Protective mode . Recommended for injuries, diseases of the spine and nervous tissue. May include bed rest, load limitation, the use of orthopedic devices.
- NSAIDs . Indicated for rheumatic pathology, chronic pain caused by damage to the musculoskeletal system. They are prescribed in the form of tablets, injections and topical medications.
- Chondroprotectors . They are used in degenerative diseases to restore cartilage tissue.
- Physiotherapy . Physiotherapeutic measures are carried out for pain in the sacrum, not associated with volumetric processes. Electrophoresis, thermotherapy, magnetotherapy, laser therapy are used. For many pathologies, the treatment regimen includes massage, exercise therapy, acupuncture.
- Chemotherapy, radiation therapy. Necessary for oncological lesions. They can be carried out as an independent treatment or as an addition to the operation.
Surgery
The tactics of surgical treatment depends on the localization of the pathological process:
- Diseases of the spine : nucleoplasty, microdiscectomy, discectomy, facetectomy, laminectomy, sequestrectomy, removal of tumors.
- Women's diseases : removal of a paraovarian cyst, hysterectomy, panhysterectomy, supravaginal amputation of the uterus, amputation of the cervix, instrumental removal of the fetal egg, etc.
- Urological and andrological pathologies : tumor removal, bladder resection, cystectomy, prostatectomy, cryoablation and FUS-ablation of the prostate.
In the postoperative period, recovery measures are carried out. In some pathologies, reconstructive interventions are subsequently carried out.