Anokopchikovy pain syndrome (Koktsigodiniya)
The Anokopchikovy pain syndrome (koktsigodiniya) is the pathological state which is characterized by pristupoobrazny or constant pains in the field of a tailbone, back pass and a rectum in the absence of organic pathology. The pain syndrome is more expressed at rest and at night, not connected with the act of defecation. The disease has the exhausting character, causes sleeplessness, a depression, frustration of sex life, often leads to working capacity violation. The disease is diagnosed on the basis of complaints and data of survey after an exception of other diseases. Treatment - the physical therapy, psychotherapy, at inefficiency is shown operation.
Anokopchikovy pain syndrome (Koktsigodiniya)
Anokopchikovy pain syndrome – a disease which main symptom is persistent crotch pain, in an anus and a tailbone. Is is polietiologichesky pathology that speaks about variety of probable factors of its emergence. Unites in itself such clinical manifestations as an anizm, proktalgiya, anal neuralgia, anorektalny pains, a koktsigodiniya.
Diagnosing of a koktsigodiniya demands careful inspection for identification of the reason of development of a syndrome and the choice of tactics of treatment. As a separate disease the traumatic koktsigodiniya which results from injuries of a tailbone inclined to pathological mobility is considered. The Anokopchikovy pain syndrome is characterized persistent long (sometimes existing for several years) by pains which unexpectedly arise and also unexpectedly stop, can accrue and weaken depending on position of a body, amplify during the walking, a natuzhivaniye and pressing on a tailbone.
As a rule, pains at a koktsigodiniya are not connected with changes of weather, diseases of urinogenital system, osteochondrosis and spondilyozy. Due to certain difficulties on identification of the reason and the choice of measures of etiologichesky treatment, treatment of an anokopchikovy pain syndrome represents heavy, sometimes an unsoluble task.
Causes of a koktsigodiniya
Anokopchikovy pain can be a consequence of injuries: a bruise or a change of a tailbone (both fresh, and arisen in the past, sometimes for a long time), disorders of functioning of neuromuscular system of a pelvic bottom and retroanal zone, pathology of bones of a basin and the lower department of a backbone, a disease of a spine column with the expressed neurologic component, the diseases of direct intestines (hemorrhoids, an anal crack, proktit and paraproktit, sigmoidit, etc.) including treated, consequences of hard proceeding childbirth, omission of a crotch, tendency to long sitting in a toilet, the psychoemotional reasons (sometimes sick consultation of the psychotherapist or mental health services is required by a koktsigodiniya). Frustration of a chair (chronic locks or diarrheas) can also promote development of anorektalny pain.
The Anokopchikovy pain syndrome on primary localization of pain is subdivided into directly koktsigodiniya (pain in the field of a tailbone) and an anorektalny pain syndrome (pain mainly settles down in the field of back pass and a rectum).
The Anokopchikovy pain syndrome includes the following clinical symptoms: pain in the field of a tailbone (koktsigodiniya), in back pass (anorektalny pains), arising without the visible reasons at any time, can have various duration and also suddenly or to abate gradually. Pain can have various character: to be stupid or sharp, cutting, pricking, constant and skhvatkoobrazny, pulsing. Irradiation of pain to the buttock area, a sacrum, a hip can take place.
Pain which is localized in a rectum (proktalgiya), as a rule, develops unexpectedly, a bowl at night, 15-30 minutes then abates last. Intervals between attacks of a proktalgiya can be quite long. Pain sometimes is followed by an intestines spazmirovaniye. Crotch pains can promote development in men of a painful priapizm. Sometimes the attack of anorektalny pain can be provoked by sexual intercourse. Quite often anokopchikovy pain syndrome in the period of sharp clinic is followed by the general neurovegetative symptoms – pallor and perspiration of integuments.
Koktsigodiniya is localized mainly in the field of a tailbone, amplifies when pressing on it, can increase after walking. Sometimes pain hardly gives in to locating, patients state complaints to morbidity in a rectum, in a zone of a tailbone noting feeling of weight, burning, discomfort.
Anorektalny neuralgia represents diffusion morbidity in a zone of back pass, sometimes with irradiation in a sacrum and buttocks, a hip and a vagina. Anorektalny neuralgia most often arises at women of post-climacteric age and quite often accompanies various neurotic and neurologic diseases (to depressions, neurosises, morbid depression).
The Anokopchikovy pain syndrome often has neurogenetic character. At many patients long pain is associated with a dangerous fatal disease, the persistent kantserofobiya quite often develops, patients demand to make the attending physician the fullest inspection and to appoint surgical treatment.
Diagnostics of a koktsigodiniya
The diagnosis "an anokopchikovy syndrome" is established only after careful inspection and an exception of the organic nature of morbidity. For this purpose it is necessary to make diagnostic actions for an exception of pathologies of a rectum (hemorrhoids, an anal crack, paraproktit, etc.), genitals (adneksit, an endometritis, prostatitis), neurologic and rheumatologic diseases (radiculitis, spondilit, a sciatica). The exception (or identification and treatment) these pathologies with the subsequent preservation of painful manifestations allows to diagnose the anokopchikovy pain syndrome taking place.
For the analysis of pain the patient in a knee and elbow position, and then on a gynecologic chair is examined. The proctologist makes a manual research of back pass, defining existence or lack of cicatricial changes, signs of an inflammation, injuries of a tailbone and sacral connections, a spazmirovaniye of muscles of the anal channel or a pelvic bottom. Consultation of the gynecologist is recommended to women, the bimanualny research of a vagina and rectum is made.
For the purpose of an exception of diseases of final departments of a large intestine make a rektoromanoskopiya. Anoskopiya (a research of the anal channel) and a rektoromanoskopiya give an idea of a condition of a mucous membrane of a rectum, allow to reveal internal gemorroidalny knots, polyps of a rectum and the inflamed anal nipples (papillit).
The radiological research of a rectum (irrigoskopiya) allows to find tumors, narrowing of a gleam of a large intestine. The X-ray analysis is also applied to visualization of a condition of a tailbone and a sacrum, bones of a basin, coxofemoral joints. On the roentgenogram it is possible to find signs of a fracture a tailbone, dislocations (incomplete dislocations), sites of osteoporosis and other pathologies of a bone tissue.
For the purpose of identification of a muscular spasm make an electrophysiological research of the locking device of a rectum and a muscular diaphragm of a pelvic bottom. Besides, such research allows to create idea of type of motility of intestines and features of work of its terminal departments. Laboratory researches the calla, a research a calla on the hidden blood, the general analysis of urine include a koprogramma, bacteriological crops, if necessary take for the analysis dabs from a vagina from women and a prostate secret at men. The intrarektalny invagination taking place come to light at an irrigoskopiya.
Besides, make visualization of bodies of a small pelvis by means of ultrasonography. For diagnostics of an anokopchikovy pain syndrome quite often attract to consultations of the urologist, gynecologist and andrologist, traumatologist and, in surely order, neurologic examination is conducted. For identification of the psycho-emotional causes of pain consultation of the psychotherapist is appointed.
Treatment of a koktsigodiniya
Carefully made inspection and identification of the reason of a pain syndrome is one of major factors of success of treatment. Therapeutic measures include etiologichesky treatment (elimination of a cause of illness), pathogenetic therapy (blocking of mechanisms of development of pathology) and the symptomatic means (directed to disposal of the patient of pain).
Application of physiotherapeutic techniques is quite widespread in complex treatment of a koktsigodiniya: laser radiation of low intensity, ultrasound, UVCh, influence by dynamic current, mud cure, X-ray therapy. Locally apply neuroblockade, candles and microenemas with anesthetizing and resolvents. Make their massage for removal of a spasm from muscles of a crotch and a pelvic bottom. If necessary treatment is appointed with the assistance of the psychiatrist.
Now the medicine pays special attention to treatment actually pains. In the developed countries (as well in Russia) the system of medical institutions which are directed first of all to treatment of pain any including the unknown, etiologies will be organized. It is preferable to perform treatment of pain without use of narcotic analgetics: to apply blockade of nervous fibers novocaine, local anesthetics, mud hot applications (peloidoterapiya). Today application of kortizonovy blockade is limited as they have lower efficiency and are badly transferred by patients.
Sometimes (in case of the psychogenic nature of pain) the good effect is reached, applying placebo. In cases of the increased uneasiness, depressions, other neurotic states appoint treatment by means of psychotherapeutic impacts and medicines of the central action (sedatives, tranquilizers, neuroleptics, etc.).
The traumatic koktsigodiniya can become the indication to expeditious treatment (a tailbone extirpation). The resection of a top of a tailbone or its fixation to a sacral bone are made in case of its full or partial separation. If that is not observed, surgery is inexpedient and can lead to deterioration in a state. It is possible to plan surgical actions only at exact definition of a traumatic origin of a koktsigodiniya and an exception of other possible reasons of pains.
The forecast at a koktsigodiniya
The Anokopchikovy pain syndrome quite hard gives in to therapeutic measures and has very expressed psycho-emotional component. However, at an integrated approach and careful inspection correctly chosen tactics of treatment promotes disposal of patients of pain and restoration of quality of life.
Koktsigodiniya and the anorektalny morbidity which is not connected with serious pathologies of bones of a backbone, bodies of a small pelvis and crotch does not lead to development of complications of somatic character and does not cause a lethal outcome.