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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19441
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Hi I have pain in my perineum, sitting is painful. I have

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I have pain in my perineum, sitting is painful.
I have had anal investigations and MRI scans. no conclusion.
I have occasional massive pain in my coccyx (it happens about 4 hrs after I have sat badly and compressed it) This pain is relieved over about 20 mins if I use my finger to hook my coccyx backwards.
I am aware of a thickening over time (I am 67) of the inside of my coccyx.
I had a serious back injury (just above my pelvis) about 30 years ago - this required surgery.
My GP now thinks I need to see a neurologist as he feels the problem may be nerve related.
I fear the thickening of my sternum may be a tumour.
Do you have a suggestion for what could be causing my symptoms.
Thank you
It will help if you could provide some clarification and further information:
In one place you reference thickening of the coccyx and in another you reference thickening of the sternum.
Are there two places of thickening? Or was one of the statements an error?
Do you know whether the MRI was done of a level to assess the coccyx?

Customer: replied 4 years ago.

Sternum is an error - should have been sacrum.
I am unsure about how low the MRI scan went - lower body is all I recollect, and I never saw the scans.

So you are feeling thickening on the outer service of your sacrum, correct?
You mention that it has been getting worse over time, but do you recall the severity of the symptom when the last MRI was done?

Customer: replied 4 years ago.

Thickening appears to be between rectum and sacrum. My "bum hole" seems to be slightly more forward nowadays
Symptoms have existed for 10 yrs, but increase in severity 3-4 times per annum - as now.

I am asking all these questions because the MRI would be the most sensitive test to detect a tumour of the sacrum, if the MRI was done at the level of the sacrum and coccyx and the thickening was present at the time that the MRI was done.

Thickening can happen from a variety of other causes, such as fibrotic changes or inflammatory changes. But if the question is whether there may be a tumour present, then the MRI would be the correct test. And if the previous MRI was done of the proper level, there would be no reason to be concerned about a tumour.

As for other causes of perineal pain, there can be a variety of other conditions, but most of these conditions would have been detected by the evaluation that has been done by your GP. But your GP is also correct that it is possible to have a neurologic cause of the pain. A similar possibility would be spasm of the muscles of the perineum, which can occur with a neurologic condition or as a primary problem.

Therefore, you can confirm that the MRI included the level of the sacrum and coccyx, and if it did, it would be appropriate to next be seen by the Neurologist, as your GP suggested.

If you have any further questions, please let me know.

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