The wedge-shaped bone at the base of the spine is called the sacrum. Pain in the sacrum is considered one of the most severe among those occurring in the spine. It becomes more intense when sitting, standing up suddenly, bending forward and lifting heavy objects.
Pain in the sacrum in men is much less common than in representatives of the fair half of humanity. This is explained by the fact that women's vertebrae are not as strong as men's, and therefore it is much harder for them to bear loads. We should not forget about the additional loads on the female sacrum during pregnancy and menstruation. All these factors determine the more frequent occurrence of pain in the sacrum in women.
The term “sacrodynia” is used to refer to pain in the sacral area that occurs as a result of pathologies in the pelvis and adjacent areas.
At CELT you can get advice from a specialist algologist.
Make an appointment
Why does the sacrum hurt?
Traumatic injuries
Pain in the sacrum after injury is often caused by hematomas and soft tissue bruises.
When a bruise occurs, the pain is moderate and disappears within a few days. The swelling is small, movements are slightly limited, the condition is satisfactory. With a hematoma over the sacrum, a painful tumor-like formation is detected, 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, they are combined with multiple fractures of the pelvic bones. They occur after a high-energy injury: a car accident, a fall from a height, etc. The pain syndrome is very intense, movements are severely limited, and the condition is serious. Bruises may be detected in the area of the sacrum and pelvic bones, and pathological mobility is possible.
Spinal diseases
The cause of pain in the sacral area is often diseases of the lower parts of the spinal column. The pain can be local and spread to the lower back and buttocks. With degenerative-inflammatory processes, muscle overstrain, painful sensations are aching or pulling, intensifying after exercise, when the weather changes. When nearby nerve structures are compressed, the pain becomes shooting, radiates to the legs, and significantly limits mobility.
Pain syndrome is observed in the following pathologies of the spine:
- Degenerative
: intervertebral hernia, disc protrusion, osteochondrosis, spondyloarthrosis. - Developmental anomalies
: lumbarization, sacralization. - Spinal curvatures
: 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 is usually minor, intensifying after exercise and prolonged exposure to an uncomfortable position. An increase in the intensity and duration of pain with a decrease in bone tissue strength may indicate the presence of a pathological fracture.
Sacral pain
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:
- lumbosacral plexitis;
- cauda equina syndrome;
- radicular syndrome.
Sacroiliitis
Inflammation of the sacroiliac joint is most often unilateral, but 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 growing sharp pain, aggravated by straightening the limb. Combined with forced body position, chills, hyperthermia, severe intoxication. - For tuberculosis
. The pain is vague, without clear localization. Palpation of the joint is moderately painful. Stiffness and local hyperthermia are observed. Over time, swelling often forms on the thigh. - For brucellosis
. The pain is short-term, minor or moderate, intensifies with movement. Persistent pain syndrome is less common. - For rheumatic diseases
. Identified in ankylosing spondylitis and psoriatic arthritis. The painful sensations are not intense, intensify at rest, weaken with exercise, and are supplemented by morning stiffness.
Women's diseases
Pain in the projection of the sacrum is observed in gynecological and obstetric pathologies. Most often mild, dull, aching, accompanied by pain in the lower abdomen. In chronic processes, they persist for a long time and are often combined with chronic pelvic pain syndrome in women. Found in the following diseases and conditions:
- During pregnancy
: spontaneous abortion, low location of the placenta. - During childbirth
: pathological preliminary period of labor, discoordinated labor. - Violations of the position of the uterus
: hyperanteflexia, retroflexion. - Congenital anomalies
: duplication of the uterus, uterine aplasia, one-horned and two-horned uterus, “baby” uterus. - Inflammatory
: oophoritis, metritis, metroendometritis. - Associated with menstruation
: dysmenorrhea. - Tumors and tumor-like formations
: paraovarian cyst, uterine fibroid, cervical cancer, uterine body cancer. - After gynecological operations
: abortion, curettage, plastic surgery.
Other pelvic diseases
Regular or radiating pain in the sacrum is also detected in diseases of other pelvic organs:
- Urological
: interstitial cystitis, bladder cancer. - Andrological
: prostatitis, prostate cancer. - Proctological
: rectal cancer. - Others
: adhesive disease, pelvic varicose veins.
Along 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 cause pain in the sacrum:
- Myalgia and myositis
. Pain occurs against the background of overload, acute infectious diseases. - Coxarthrosis.
Painful sensations can be provoked by non-physiological load on the spine. - Mental disorders
. Psychosomatic pain is observed in hysteria, neurasthenia, and depression. They do not fit into the picture of a specific disease and are often unusual in nature.
What is contraindicated for lumbosacral pain?
The painful area should not be heated; the inflammatory process will worsen due to increased blood flow. There is no need to eliminate pain if the cause is unclear. Otherwise, bone destruction will be provoked, muscle tissue will become irritated when moving during absent symptoms. You cannot realign the vertebrae without diagnosing and finding out the causes of the spinal blockage.
If the vertebrae are displaced, this is not always a consequence of injury; the cause is often the processes of dystrophy and degeneration.
If you regularly adjust the vertebrae, destruction of the vertebral processes will occur and spinal instability will occur.
In order for the spinal column and the muscles around the vertebrae to relax properly, you need to sleep on an orthopedic mattress, with a bolster placed under the knee joints. You should not be on bed rest for a long period, as the muscles will become weakened and the problem will worsen. Even with severe pain, some physical activity is advisable.
You should not endure pain or self-medicate, as this will only worsen your health problems. It is necessary to urgently contact a specialist, then pathological changes in the body can be stopped and eliminated, the person will not lose his ability to work.
Diagnostics
Patients with pain in the sacrum more often turn to a neurologist or orthopedic traumatologist. In case of diseases of internal organs, patients are examined by doctors of the appropriate profile. The following procedures may be prescribed as part of the examination:
- Neurological examination.
Required for diseases of the spinal column and damage to nerve 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. Performed to identify developmental abnormalities, inflammatory and tumor processes. - Digital rectal examination.
Depending on the symptoms, it involves examining the prostate or rectum to assess the condition of the organ and detect space-occupying formations. - Ultrasound.
Necessary for diseases of the pelvic organs. An ultrasound of the female genital organs, an ultrasound of the prostate and bladder, or an ultrasound of the rectum with a rectal probe can be performed. - Radiography.
X-rays of the sacrum, lumbar region and pelvis show fractures, degenerative and inflammatory changes, and space-occupying formations. - Other imaging techniques
. To detail the information obtained during radiography, tomographic studies are performed, if necessary. allows you to assess the condition of hard structures, MRI is used to study soft tissues. - Functional studies.
Patients with neurological pathology are prescribed electroneurography and evoked potential studies. - Lab tests.
Blood, urine and feces studies, microbiological and histological analyzes are performed for gynecological, andrological, proctological and rheumatic pathologies, and inflammatory processes.
Manual techniques for pain in the sacrum
Possible complications and consequences
Since sarcodynia is not a disease, it is not capable of causing any complications, unlike the pathologies that caused it. If you ignore pain in the sacrum and do not seek medical help, inflammatory and degenerative processes rapidly progress. Therefore, sarcodynia is the first signal of a pathology developing in the body. The sooner its cause is discovered, the sooner treatment will begin. And this will avoid the development of serious complications.
Treatment
Pre-hospital assistance
For bruises and hematomas, rest should be ensured. Suspicion of a sacral fracture is an indication for immediate hospitalization. The patient must be placed on a backboard and given an anesthetic. For non-traumatic pathologies of the spine and neurological disorders, warming, anti-inflammatory and local anesthetics are effective.
For dysmenorrhea, analgesics are allowed. If you suspect other gynecological pathologies, especially those that suddenly arise and are accompanied by increasing pain, self-medication 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 treatment methods used includes:
- Protective mode
. Recommended for injuries, diseases of the spine and nervous tissue. May include bed rest, load limitation, and the use of orthopedic devices. - NSAIDs
. Indicated for rheumatic pathology, chronic pain caused by damage to the musculoskeletal system. Prescribed in the form of tablets, injections and topical medications. - Chondroprotectors
. Used for degenerative diseases to restore cartilage tissue. - Physiotherapy
. Physiotherapeutic measures are carried out for pain in the sacrum that is not associated with volumetric processes. Electrophoresis, heat therapy, magnetotherapy, and laser therapy are used. For many pathologies, the treatment regimen includes massage, exercise therapy, and acupuncture. - Chemotherapy, radiation therapy.
Necessary for oncological lesions. They can be carried out as an independent treatment or as an addition to surgery.
Surgery
The tactics of surgical treatment depend on the localization of the pathological process:
- Spinal diseases
: nucleoplasty, microdiscectomy, discectomy, facetectomy, laminectomy, sequestrectomy, tumor removal. - Women's diseases
: removal of paraovarian cyst, hysterectomy, panhysterectomy, supravaginal amputation of the uterus, amputation of the cervix, instrumental removal of the ovum, etc. - Urological and andrological pathologies
: tumor removal, bladder resection, cystectomy, prostatectomy, cryoablation and FUS ablation of the prostate gland.
In the postoperative period, restoration measures are carried out. For some pathologies, reconstructive interventions are subsequently performed.
How to treat back pain that radiates to your legs
During the period of acute pain, it is recommended to rest, take painkillers, as well as drugs that eliminate spasms of the back muscles. After the acute pain subsides, physiotherapy, massage, and therapeutic exercises are prescribed, which are included in the rehabilitation program for all patients with diseases and injuries of the spine.
Shpidonov Gennady Stanislavovich
Neurologist
Rostov State Medical University (neurology)
10 years of experience