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What is the cause and treatment of chronic pain in the buttocks?

Q: I am suffering from severe pain in my buttocks. It started all of sudden 4 years back and I was not able to move. There was no history of sudden fall or accident. The first time there was severe pain in my right buttock. I was advised to take complete bed rest, a pain killer and exercise for a week's time. The condition improved. After two months again there was a severe pain in my left buttock. I was advised bed rest, pain killer and exercises again. After twenty days it improved and the pain came down. I took an MRI of the spine, but there was no complaint. After 2 years I conceived and gave birth to a son. It was a caesarean. Seven months after my delivery, I got chronic pain in my left buttock. I took a pain killer, rest, hot water massages and exercises and it got better. But after seven months I had the pain again. This time I was not able to move. Hot water massage and exercises improved the condition. But I am having continuous pain in my buttocks, though tolerable. Another doctor asked me to take an MRI of the sacro-iliac joint. The report says that there was inflammation in my left sacro-iliac joint. He gave me an antioxidant for twenty days and asked me not to do any exercises. But I felt no improvement. I consulted another orthopaedician who said that I have an inflammation or arthritis. He advised not to take any tablets or exercise. I am confused as what to do? What is my problem? Is it arthritis, disc bulge or something else? Should I take medicines? Should I exercise because it helps me a lot? Is this problem life threatening? Which doctor should I consult?

A:From your symptoms you could be having referred pain from a disc prolapse or pain of sacroilitis or both of these together. The distinction can be made only on careful clinical examination. Some times even this may be difficult. Possibly that is why you are getting conflicting advice from your doctors. You may see inflammation in the sacroiliac joint on MRI especially after delivery. Though usually it settles by the time your MRI was done, it could just be an incidental finding. On the other hand you had pain before your delivery. So it is unlikely to be sacroiliac pain related to pregnancy or child birth. This goes more in favour of a referred pain from disc prolapse. The periods of remission also go in favour of a disc symptom. An MRI may show a disc bulge or prolapse but all disc bulges on MRI need not necessarily be the cause of pain. So you have to be careful in making a diagnosis. Subtle clinical signs will have to be elicited by your physician / surgeon to differentiate a true disc prolapse and an asymptomatic disc bulge seen on MRI. You might think that you have been able to make no decision. I cannot be certain but I can only give my biases based on the limited information that I have. 1. Your symptom is more like to be a referred pain from disc. 2. If there is a sacroiliitis it could possibly be an association. 3. You should improve with continued extension exercises for your back. 4. There is no need of strict bed rest. You could do whatever activities you wish to do within limits of pain tolerance. 5. Medicines only help to tide over pain. You had the symptom for 4 years now. Obviously it is not life threatening. 6. I would suggest a clinical re-evaluation by a competent orthopaedic surgeon.

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