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Pain in the sacral bone, the main causes

The sacrum is a triangular bone located in the lower part of the spine ,  between the fifth lumbar vertebra (L5) and the coccyx . 
The sacrum is the posterior wall of the pelvis. 
It is attached to the pelvis through the sacroiliac joints . 
On the sides of the sacrum there are four openings through which they pass:

  1. Nervos sacrais,
  2. Blood vessels

The main causes of pain in the sacral bone

When a person sits for many hours, the muscles and ligaments in the lower spine and hip flexors become shorter or have a retraction. 
Pain in the sacrum may be due to excessive stiffness or flexibility of the ligaments. 
This can be caused by :

  • A fall,
  • An accident at work
  • A traffic accident
  • Pregnancy,
  • Surgery in the hip or spine (for example, a vertebral fusion).

Several diseases can cause pain in this region. 
In the following list, there are the main causes:


Causes of Pain in the Sacrum During Pregnancy

The most frequent changes that may favor the appearance of back pain during pregnancy are:

  1. Relaxation of ligaments
    During the last trimester of pregnancy, relaxation of the pelvic ligamentsoccurs to allow the pelvis to dilate during labor. 
    This is caused by the presence of certain hormones in the blood (relaxin). 
    This causes the stretching of some muscles and therefore the discomfort.
  2. Weight gain
    Pregnancy can cause weight gain of up to 25%. 
    The pain is of the muscular type: the muscles get very tired until the end of the pregnancy.
  3. Displacement of the center of gravity
    Generally, women move the weight forward or backward. 
    The child’s weight and change in gait cause contractures in the pelvic and hip muscles.
  4. Sedentary lifestyle
    Because of fatigue , many women reduce physical activity in the third trimester. 
    This is probably the most important risk factor for low back pain in pregnancy.

During childbirth , muscles and ligaments can stretch, resulting in pain in the sacrum and coccyx that can last for months.


Pain in the sacrum caused by musculoskeletal disorders

Pain in the sacrum can be caused by diseases of the spine. 
The pain in the sacrum is severe and sudden when we move the weights incorrectly and the muscles of the spine get tired.

The sacrum can hurt even when exercises are done to strengthen the abdominalson the floor without the tapetino.

Musculoskeletal pain differs from other types because it feels:

  • When the patient sits down
  • When you get up from the chair
  • On bike, when you pedal on a climb with Mountain bike or race bike
  • After a while the patient is seated.

Symptoms usually go away when we walk or lie in bed . 
Sacral bone pain is very rare in children.

Among the natural remedies are:

  • Postural gymnastics
  • Arnica ointment
  • A cold compress can be applied during the first two days after the trauma, from the third day heat is better to promote healing
  • The heels can be useful if they are low, the sneakers are the most suitable
  • A lumbar and buttock massage


MRI of a Sacral Fracture

Sacral fracture

What are the Causes of a Sacral Bone Fracture?

The fracture of the sacrum is caused by:

  • A blow (trauma) on the spine
  • Intense physical activity like running with a backpack causes many microtraumas (stress fracture)
  • Traffic-accidents
  • A fall from a height (Denis et al., 1988).

What are the Signs and Symptoms of a Sacral Bone Fracture ?

Bone metabolic diseases ( osteoporosis or osteomalacia) can occur due to a loss of bone mineralization without symptoms. 
Contrary to what many people think, bone with osteoporosis does not cause spinal pain if a fracture does not occur

Treatment for fracture of the sacrum consists of resting and  magnetic therapy . 
The doctor may recommend a pain medication if the patient has a lot of pain, for example analgesics such as acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs such as diclofenac (Voltaren).

Heavy activity
Pain in the sacral bone may worsen during and after an exertion, for example, some exercises in the gym (especially squats and Leg-press). 
This is because functional overload causes the uterosacral ligament to stretch.

Pain in the upper part of the sacrum is a symptom of  spondylolisthesis of the fifth lumbar vertebra. 
This pathology consists of anterior displacement of L5 in relation to the sacrum.


Ligaments and nerves

The pain can be caused by the compression of the ligaments in the sciatic nerve , in this case it radiates to:

  • The thigh,
  • The leg,
  • The feet.

The ligament that connects the sacrum to the ischial spine (sacro-spinal ligament) and that which connects it to the large ischial (sacrotuberous) tuberosity is the main culprit. 
The sacro-vesical-uterine ligament can cause chronic pain.


Diseases that cause pain in the sacrum

Gynecological diseases
Pain in the sacral bone is frequent in gynecological diseases. In endometriosis the pain is at the level of the sacro-uterine ligament or behind the cervix (in the groin). 
The pain caused by endometriosis is cyclic and increases at the onset of the menstrual cycle ( menstruation stage).

Pain in the sacrum due to urologic or gynecological diseases
In the pelvic region, there are diseases that cause discomfort in the sacral bone. 
Possible causes include the following:

Circulation problems
Pain can be caused by thrombophlebitis of the iliac veins (Kogias et al., 2011).

Bone metastases are the most frequent malignant tumors in the sacrum. 
Cancer cells come from the primary tumor. 
Metastases in the sacrum usually originate from cancer in:

Clinical examination is not always effective: the tumors of the sacrum are asymptomatic for a long time. The most common initial symptom is local pain. 
At night the pain can aggravate.

Sacral tumor
A mass of cells that grows uncontrollably. 
Sacral bone cancer is rare (Quraishi et al. – 2012). 
Primary tumors of the sacrum (benign and malignant) may originate from the bone marrow.

cyst The pilonidal cyst is a small sac containing hair (Khanna et al., 2011) in the coccygeal sacral area. 
An infected cyst becomes a pilonidal abscess . 
The pilonidal cyst may occur due to ingrown hairs and infection of the hair follicle. 
The evolution of the abscess is the formation of a fistula.

Chronic prostatitis
It is the inflammation of the prostate gland . 
The main symptoms of rostatite chronic  are:

prostate cancer
If the mass size is large, some symptoms occur. 
The patient has an increased frequency of urination or a burning sensation when urinating.

Misconceived Beliefs
Many people think that pain in the coccyx and sacrum is caused by hemorrhoids or anal fissures because it often occurs during or after defecation, but there is no connection between them.

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