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home - Colon - Anal Diseases - Anal Pain 2 Coccygodynia Written by Dr Sebastian Zeki
Knowledge

Understands the clinical anatomy of the rectum and anus
Knows the causes of rectal bleeding and the methods of investigation
to determine the cause

Has awareness of the range of perianal conditions (which includes
abscesses and fistula), their clinical presentation and their
complications

Knows the techniques of investigation and the possible medical and
surgical treatments

Is aware of the treatment options for radiation proctitis
Skills
Take a history and appropriately examines the anus and rectum
Refers the patient for the appropriate endoscopic and radiological
investigations

Behaviours
Manages patients with anorectal disease in a sympathetic manner,
recognising and addressing the concerns caused by such conditions

Anal Pain 2 Coccygodynia

Anal Pain 2- CoccygodyniaPain in coccyx on manipulating coccyx ManagementThis is usually conservative.There is a better prognosis if it is caused by trauma. Acute coccydyniaManagement is with protection, analgesics, and heat or ice (whichever suits).Lean forward when sitting helps to relieve symptoms."Donut" cushions or "wedge" cushions can be useful Diagnostic radiographs are not useful in acute coccy-dynia unless other pathology suspected.Symptoms resolve over weeks or even months. Chronic coccydynia This occurs in a minority.MRI may show spinal tumours, degenerative joint disease, fractures.Local anesthetic can be injected under fluoroscopy or local anesthetic plus corticosteroids injections.Local anaesthetic injections may be directed at the sacrococcygeal junction, the caudal epidural space, or the ganglion impar, a midline sympathetic ganglion located just anterior to the sacro-coccygeal junction.Manipulate coccyx via the rectum to massage coccyx muscles and to mobilize fascia and the coccyx.-Coccygyectomy — Coccyx surgical excision- last resort. Diagnosis Pain and tenderness are well localized to the coccyx and can radiate to pelvic floor.Pain is often worse on sitting, leaning back, rising and with prolonged standing.Defaecation and sexual intercourse can be painful.Mobilization of teh coccyx can cause pain.Pain may be referred to the coccyx from diseases of the spine and pelvic organs.Spinal pathology, such as lumbar disk disease, may coexist with coccydynia, and may mimic its pain.Spinal disease alone does not cause coccygeal tenderness. Risk Factors: Being a middle aged fat female.One traumatic episode (falling backwards).Repetitive minor trauma —prolonged sitting with poor posture.Injury in childbirth — Posterior pressure exerted from the birth canal.Degenerative joint changes.Somatization.Uncommon causes- include metastatic cancers, chordomas, posterior spicules, benign notochordal cell tumors, avascular necrosis, arachnoidi-tis of the sacral nerves, and glomus tumours. Written by Dr Sebastian Zeki

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