Coccygodynia – TREATMENT
Diagnosis and treatment of pain anokopchikovogo
PROCTOLOGY – 2009
The term "coccygodynia" or anokopchikovy pain, indicated by a condition in which severe pain observed in the anus or tailbone.
The reasons for this syndrome are many. Often, in order to identify it, we have to work hard and bring different specialists, including psychiatrists. Thus, the main manifestation coccygodynia is a pain in the anus.
The most common cause of pain in the coccyx is the injuries. It may be falling on the tailbone, a kick or a solid object. Noteworthy is the fact that the injury itself could be long before the pain in the coccyx, and the patient may not associate with the resulting injury was once his condition. In addition to trauma may be other causes coccygodynia (for example, if you sit long on the "soft").
Among the reasons anokopchikovogo pain include:
- Pathology of the neuromuscular system pozadianalnogo space and pelvic floor.
- Omission of the perineum.
- Postponed surgery on the anal canal, which led to the cicatricial deformations anus.
- The habit of sitting on the toilet for a long time.
- Long-term constipation,
When anokopchikovom pain usually occurs two symptoms:
- pain directly to the coccyx (the very "coccygodynia")
- pain in the anal canal and rectum, often for no apparent reason (called "anorectal pain").
Pain when anokopchikovom pain may be constant, occur suddenly. The duration of such pain can be different, it can pass itself at any time. By its nature, the pain may be in the form of tingling, dull, give to the buttocks, perineum, etc. Pain – is the basic and main symptom in coccygodynia. In this very pain is usually localized in the rectum or anal canal, or in the coccyx. Sometimes the patient can not even pinpoint the location of pain.
Rectalgia usually manifested by the sudden appearance of pain in the rectum lasting from several seconds to half an hour. The pain is usually at night. When will the pain is impossible to predict. At the same time intervals without pain can be quite lengthy. Rectalgia can be combined with spastic pains, and priapism (painful erection), vegetative disorders (pale skin, sweating).
When coccygodynia main symptom – a coccygeal pain. It is usually stronger when the pressure on the coccyx, or the movements of the patient. The patient often can not determine the exact location of the pain. They may be concerned about a feeling of heaviness or burning in the area of the coccyx and the constant feeling of discomfort in the area.
Anorectal neuralgia more related to neurological problems. It shows diffuse pain that gives to the sacrum, coccyx, buttocks, thighs or vagina. Such symptoms are often seen in women older than 50 years and is usually combined with other neurological and neurasthenic disorders (hypochondriasis, depression). Often these patients suffer from "kantserofobiey" – the fear of cancer, and they are asking doctors to make sure their operation.
Classification anokopchikovogo syndrome
Kopchikoanalny syndrome can be divided into:
- "Coccygodynia" – pain in the coccyx.
- "Perianal pain" or "anorectal pain" – is characterized by pain in the anus and rectum, often for no apparent reason.
Diagnosis of the syndrome anokopchikovogo
In order for the doctor could put anokopchikovogo syndrome diagnosis should first delete all the diseases that manifest themselves as pain in the coccyx and the anus. Diagnosis anokopchikovogo pain involves the exclusion of other proctologic and neurological disorders, which appear mostly pain. This is such diseases as:
- anal fissure ,
- abscess ,
- sciatica (neuritis of the sciatic nerve).
Only after the doctor rule out these diseases can be directly examine the patient to identify anokopchikovogo pain.
In the diagnosis of the syndrome anokopchikovogo apply the whole arsenal of research that are used in proctology:
- external examination,
- digital rectal examination,
- Abdominal ultrasound,
Women have also made sure and gynecological examination.
Digital rectal examination the anal canal and rectum allows the doctor to identify changes in the intestinal wall that occurs with hemorrhoids, papillitis , chronic paraproctitis, as well as evaluate the state of the coccyx and the sacro-coccygeal joint. In addition, such a study to determine the presence of muscle spasm and pain on palpation of the pelvic floor muscles.
Anoscopy and sigmoidoscopy allows the doctor to see the status of the lumen of the colon and detect diseases such as internal hemorrhoids, anal papillae, polyps, tumors. Irrigografiya – it's method of X-ray studies of the rectum. It also allows you to identify tumors and other changes from the side wall of the colon. In order to eliminate the disease of the coccyx and sacrum applied X-rays. It allows you to identify the transferred fractures, subluxations coccyx.
It is equally important study in diagnosis anokopchikovogo syndrome – electrophysiological study sphincter apparatus of the rectum and pelvic floor muscles. It allows you to confirm or exclude the muscle spasm in that area, as well as to clarify the nature of the patient's bowel movements, abdominal ultrasound can also detect changes in the colon, as well as evaluate its motility.
Diagnosis anokopchikovogo syndrome also includes gynecological examination in women and men – a survey of the prostate. In case of need to consult professionals such as urology, gynecology, trauma and be sure to neurologist.
It was only after the exclusion of all other diseases that can manifest with pain in the anus and the coccyx, a doctor can diagnose anokopchikovogo pain.
Treatment anokopchikovogo syndrome
Treatment anokopchikovogo syndrome is an individual character in each case and depends on the major elements of the pain symptom. Therapy anokopchikovogo syndrome should be comprehensive. The complex of therapeutic measures that are used in anokopchikovom syndrome includes a physiotherapy: darsonvalization rectal, ultrasound therapy, diadynamic currents, UHF-therapy, mud baths and applications.
When bowel spasm appointed microclysters with 0.5% solution of antipyrine and the subsequent oil mikroklizm. Very effective in the treatment of acupuncture and electroacupuncture, or as well as sedatives (after consultation with the neurologist). If the pain is associated with abnormal mobility of the previously injured coccyx, after consultation, it may be deleted (the operation is performed traumatologist or orthopedist).
Anokopchikovy pain – the disease is quite difficult to detect, and even more difficult to treat. The effectiveness of the treatment depends on how correctly identified the cause of the pain and the treatment of properly selected.
CENTER PROCTOLOGY Professor PROMA – GERMANY
SURGICAL DIVISION CB 6 RZD – MOSCOW
Examination and treatment in GERMANY – Institute "DIAGNOSTIX"
AID IN THE TREATMENT –