Coccygodynia – polietiologic disease that requires a comprehensive survey to identify the main possible causes of pain and persistent complex medical treatment, sometimes with the participation of a psychiatrist. This is a typical example of pain as a primary syndrome. Treatment in most cases should be in the “pain clinics”.
In the literature on chronic pain syndrome Ecopsychology region, uses a broad range of terms for definition of this disease, however, in the International classification of diseases mentioned only two — the “proctalgia” and “coccygodynia”. The definition is a broader concept that integrates a number of manifestations (aNISM, proctalgia, anal neuralgia, anorectal pain, coccygodynia), the main symptom of which is pain in the perineum, anus or tailbone. Separately it is necessary to consider only traumatic coccygodynia, where the immediate cause of the pain is injured pathologically movable coccyx.
Pain in the sacrum and coccyx are associated most often with injury (kicking, riding on bad roads), and the injury could take place long before the onset of pain, but there may be other causes of pain (eg, long sitting on a soft).
“Rectal pain” can be:
- subtle disorders of the neuromuscular apparatus positionering space and the entire pelvic floor;
- the omission of the perineum;
- operations on the anus, leading to cicatricial deformation of the anus;
- long sitting in the toilet;
Anakopiyskoy pain syndrome combines several very painful symptoms:
- pain directly to the coccyx (“coccygodynia”);
- pain in the anus and in the rectum, often without any reason (“anorectal pain”).
The pain can be ongoing or occur suddenly, without apparent cause, last for different times and as suddenly disappear. The character of pain is different – stabbing, stupid, radiating to the perineum, buttocks and thigh etc.
The main manifestation Ecopsychology pain syndrome pain is localized either in the rectum or in the anal canal or in the coccyx. Sometimes accurately localize the pain is impossible. For proctalgia is characterized by the sudden onset of pain in the rectum lasting from a few seconds to 15-30 minutes, which occur generally at night. The pain is difficult to predict, and the intervals between pain attacks can be quite long. The pain may be accompanied by stomach cramps, painful priapism, neurovegetative disorders (pallor, sweating). Sometimes these symptoms arise after sexual intercourse.
Coccygodynia is pain in the coccyx, aggravated by movements or pressure on the coccyx. Sometimes to precisely localize the painful spot fails and patients complain of pain in the rectum, heaviness or burning sensation in the area of the coccyx, and persistent discomfort in this area.
At anorectal neuralgia the pain is diffuse, it may radiate to the sacrum, buttocks, thighs or vagina. A similar clinical picture is usually observed in women older than 50 years and is often accompanied by other neurological and neurasthenic disorders — hypochondria, depression. Sometimes patients has led to a strong kantserofobiey, and they require a doctors immediate surgical treatment, because we believe in the organic nature of their illness.
Classification and types
“Coccygodynia” a pain directly to the coccyx.
“Perianal pain syndrome” or “anorectal pain” – pain in the anus and in the rectum, often for no reason.
Pain in the anus and the coccyx considered as a manifestation of Ecopsychology pain syndrome only after exclusion of organic nature of the disease. To establish this diagnosis it is necessary to exclude a number of orthopedic and neurological diseases with similar clinical signs (anal fissure, hemorrhoids, abscess, sciatica, sciatica, etc.). Only after the exclusion or cure these diseases and save pain in Ecopsychology region purposefully examine the patient to identify Ecopsychology pain syndrome.
Great importance for the diagnosis is the examination of the patient in the knee-elbow position, during which analyzes the changes and pain in the lumbar, sacrococcygeal areas and the perineum. Then the patient on the gynecological chair in position for campsite. When digital examination of the anal canal and rectum to pay attention to the presence of cicatricial and inflammatory changes in the anal canal and the crypts morganeve, the condition of the coccyx and sacrococcygeal joint, as well as the presence of muscle spasm and pain on palpation of the pelvic floor muscles. Women have resorted to the study of bimanual vaginal and rectal. Then do sigmoidoscopy to exclude proctitis and other diseases of the distal colon.
Other methods of examination should be performed x-rays of the sacrum and coccyx in order to exclude traumatic diseases of this area. Then hold electrophysiological study of the obturator apparatus of the rectum and pelvic floor muscles to confirm or exclude the presence of muscle spasm in this area, to clarify the nature of defecation the patient, determine the type of motility in the distal colon. Also needed scatological study and the sowing of a feces on a microflora. To exclude internal intrarectal intussusception barium enema is conducted with protodemocratic and ultrasonography with a rectal sensor. It is also important to exclude diseases of the pelvic organs in women and prostate in men. If necessary, connect to inspection urologist, gynecologist, traumatologist and neurologist.
Diagnosis anakopiyskoy pain syndrome may be supplied only in case of exclusion of all possible organic lesions!
In patients with anecortave pain treatment starts with the complex of therapeutic measures aimed at correcting all violations. As a rule, they are combined in nature and are often combined with banal proctologic diseases. The key to the effectiveness of conservative treatment are strictly individual approach in each case, the definition of the leading link in the pain syndrome and complex therapy. In the conservative Arsenal of means of influence include physical therapy (rectal darsonvalization, ultrasound procedures, diadynamic currents, UHF-therapy, mud tampons and applications). If there is a patient muscle spasm treatment complement massage spastic muscles with irrigation of the rectum microclimate with 0.5% solution of antipyrine and the subsequent oil microclimate. It is useful to Supplement the treatment with acupuncture or electroacupuncture, receive a sedative on the recommendation of a neurologist.
In the absence of proper treatment and the presence of pathologically rolling an injured coccyx attracted for consultations of traumatologist and raise the question about the necessity of coccygectomy (removal of coccyx).
Forecast. Anakopiyskoy pain syndrome is difficult to diagnose and extremely difficult to treat disease. Success in its treatment depends on correctly identify the causes of disease and the massive complex therapy with the use of a variety of treatment methods.