It sounds like your mother’s symptoms could be related to a few potential causes. Considering the location and type of pain, one possibility is coccydynia, which is pain in the tailbone area following a trauma such as a fall. The pain exacerbation with sitting and bending forward aligns with this diagnosis. Inflammation or bruising around the coccyx can cause intense pain, especially when pressure is applied, like during sitting. Another consideration could be a sacrococcygeal or pilonidal cyst, particularly given the swelling and inflammation she’s experiencing. This condition entails a fluid-filled cavity or abscess formation near the tailbone, often exacerbated by infection.
The sharp, stabbing nature of the pain and occasional discharge can also be indicative of a more precisely defined sacral nerve irritation or related soft tissue injury, possibly involving the gluteal muscles or ligaments around the area. Considering the symptoms of inflammation and discharge, it’s crucial to rule out any skin or soft tissue infection in the area, as well. Given the complexity and severity of her symptoms, I suggest that she follow up with her physician, possibly considering an orthopedic or pain specialist referral, particularly if these symptoms persist or intensify.
Diagnostic imaging, such as an X-ray or MRI, may be advised to provide further insight, especially to assess any structural damage or soft tissue concerns. Meanwhile, managing pain through prescribed medications like non-steroidal anti-inflamatory drugs (NSAIDs) for pain relief and reducing inflammation might be beneficial. Avoidments of prolonged sitting and using special cushions that distribute weight evenly can alleviate the pressure on the coccyx during recovery. If she’s on prednisone, following the doctor’s advice on tapering is important to avoid withdrawal effects. If infections like abscess are a concern, early intervention is advised to prevent complications. Further, warm baths or application of heat can help alleviate pain, but it’s vital to ensure open wounds or infections are not present that might worsen with moisture.
Lastly, since you’re considering the possibility of nerve involvement, some physical therapy or exercises, as advised by a healthcare professional, focusing on strengthening the core and relaxing the pelvic area, could support recovery and help reduce strain in the area. Her symptoms require careful assessment, so monitoring for any fever, increased discharge, or other new symptoms that could warrant more immediate medical evaluation is wise.
severe pain in the cleft between the buttocks, swelling, worsening with sitting/straining, and occasional mucus-like discharge—suggest that this is more likely a local soft tissue or skin-related condition rather than just a nerve issue from the fall. One important possibility is Pilonidal Sinus, which commonly occurs in that exact location and can become very painful, especially when sitting or bending. Another possibility is a Perianal Abscess, which can also cause intense pain and sometimes discharge, even if initially not obvious externally. While a fall may have triggered inflammation or irritation in the area, the persistent severe pain (up to 10/10), swelling, and discharge strongly suggest that there could now be an underlying infection or cyst formation rather than just a simple injury or nerve inflammation.
The medications she was given (like prednisone and amitriptyline) can help with inflammation and nerve-related pain, but they do not treat infections or abscesses, and steroids like prednisone can sometimes mask or worsen infections. Because her pain is severe and ongoing for more than 2 months, she should be re-evaluated urgently by a general surgeon. A proper physical examination—and if needed, ultrasound or MRI—can confirm whether there is a sinus, abscess, or other structural issue. If an abscess or pilonidal disease is present, treatment may require antibiotics or a minor surgical procedure (drainage) for relief.
Hello dear See i think it is trauma induced injury. It seems very minor but could be detrimental in future. I suggest you to please get following tests done and share result with orthopedician for better clarity For safety and improvement please donot take any medication without consulting the concerned physician Hopefully you recover soon CBC Esr CRP X ray pelvis Pelvic USG Ct scan Mri if recommended by orthopedician Merely medication will not provide permanent relief Regards Regards
Hello Thank you for describing her symptoms and the sequence of events so clearly. Based on what you’ve shared—pain and swelling in a specific area after a fall, increased inflammation when bending forward, and occasional mucus-like discharge during bowel movements—it’s reasonable to consider a few possibilities:
### Most Likely Causes
1. Soft Tissue Injury or Hematoma:
After a fall, bruising or swelling of the muscles, fat, or connective tissue near the rectal or perineal area is common. This can cause pain, swelling, and sometimes a feeling of fullness or inflammation, especially when moving or pressing on the area.
2. Nerve Irritation or Inflammation:
If the fall caused a stretch or compression of nerves in the lower back, buttock, or pelvic region, it can lead to persistent pain, sometimes radiating or worsening with movement. Amitriptyline is often prescribed for nerve-related pain.
3. Minor Anal or Perianal Injury:
Even if the doctor didn’t find a direct rectal problem, a small tear, fissure, or irritation near the anus can cause pain and sometimes mucus discharge, especially during bowel movements.
4. Less Likely but Possible:
- Localized infection or abscess (would usually cause redness, warmth, fever)
- Exacerbation of a pre-existing condition (like hemorrhoids or a cyst)
### Why Rest Helps Resting reduces pressure and movement in the injured area, which can temporarily decrease pain and swelling.
### What to Watch For - Increasing redness, warmth, or fever (could mean infection) - Worsening pain or swelling - Difficulty passing stool or urine - Persistent or increasing mucus or blood in stool
### Next Steps - Continue prescribed treatment and rest as advised. - Apply cold packs (if swelling is recent) or warm compresses (if swelling is older than 48 hours) for comfort. - If symptoms worsen or new symptoms develop, a follow-up with the doctor is important—sometimes imaging (like an ultrasound or MRI) is needed to rule out deeper injuries.
This type of pain after a fall is most often due to soft tissue or nerve irritation, but monitoring for any changes is important.
Thank you
Based on your description, the most likely causes include Coccydynia (tailbone injury/pain) or possibly a Pilonidal Abscess, especially since there is localized swelling, severe pain on sitting, and occasional discharge.
Pain after a fall that worsens with sitting and improves on lying down strongly suggests tailbone or soft tissue injury, but the presence of swelling and mucus-like discharge raises concern for an underlying infection or abscess that may need drainage.
I strongly recommend evaluation by a General Surgeon or orthopedician for physical examination and possibly imaging, as untreated infection or chronic inflammation can worsen and require targeted treatment.
Hello, thank you for sharing your concern. Based on your explanation, issues might be due to Coccyx injury or fracture, Soft tissue injury or ligament strain in that region or Local inflammation or swelling after trauma.
Pain that worsens on sitting, bending forward, walking, and straining, and improves with lying down, is very typical of tailbone (coccyx) injury.
However, the presence of swelling and mucus-like discharge suggests that there could also be a local infection, abscess, or pilonidal sinus, especially since the pain is severe and persistent. Here is my advise-
1. Avoid prolonged sitting (use a soft cushion or donut pillow). Give adequate rest and avoid strain. Use warm sitz baths (10–15 minutes, 2–3 times daily). You may use Tab. Paracetamol 650mg for pain relief.
2. Please get her examined again (preferably by a surgeon): She may need: Physical examination of the area. Possibly an X-ray of coccyx. If swelling persists, then Ultrasound/MRI.
3. Seek urgent care if: Fever develops. Swelling increases or becomes very tender. Pus discharge appears. Pain becomes unbearable.
4. The medications given earlier may help in some types of pain, but given the severity, swelling, and duration, a local structural or infective cause must be ruled out properly.
Overall, this condition is treatable, but she needs a proper re-evaluation and possibly imaging to identify the exact cause.
Feel free to reach out again.
Regards, Dr. Nirav Jain MBBS, D.Fam.Medicine
