Perineal Pain (Perineum Pain): Causes, Symptoms, and How to Treat and Diagnose It

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Perineal PainWe’re going to talk about something that can be hard to talk about and yet, slightly amusing. Have you ever had a pain in your butt? Well, not your butt exactly—the space between your anus and your front-facing private parts. You may be suffering from something called perineal pain (also referred to as perineum pain), and it could either be nothing or the sign of something rather serious. In this article, we will discuss perineal pain causes, perineum pain treatment, diagnosis, risk factors, and everything in between. By the end of this piece, you will know all you need to know about perineal pain.

What Is Perineal Pain?

What is the perineum, and what is perineal pain? And, is it serious? Those are the questions that have likely been swirling in your head since you first started reading this article. The “what” is pretty simple: The perineum is the small patch of skin between the anus and genitals (vulva for women, scrotum for men). Perineal pain is pain concentrated in that area. The pain can occur in varying degrees. Unfortunately, perineal pain also has a number of different causes.

What Are the Causes of Perineal Pain?

The causes of perineal pain are pretty varied, but they fall into a few different categories. General causes, gynecologic causes, and abdominal causes.

1. General causes

Duct obstruction, entrapment of pudendal nerve, abscess, prostatitis, perineural cyst, ischiorectal abscess, benign prostatic hypertrophy, and prostatitis

2. Gynecologic causes

Ovarian cysts, pelvic inflammatory disease, dysmenorrhea, endometriosis, ovarian torsion, and ectopic pregnancy

3. Abdominal causes

Colitis, appendicitis, and proctitis

As you can see, each category has many different causes. Some of these causes aren’t incredibly serious, and others need immediate attention. With all of these different causes of perineal pain, there also comes a large variety of symptoms.

What Are the Symptoms of Perineal Pain?

The symptoms of perineal pain are almost as varied as a number of causes of perineal pain, but there are a few common symptoms that show up more than others. Those particular symptoms can include:

  • Genital pain
  • Urinary frequency/urgency
  • Pain with sitting
  • Rectal/perineum pain
  • Lower abdominal pain
  • Tailbone/low back pain
  • Pain during or after sex
  • Pain or relief after bowel movement.

You may find that these symptoms give rise to others. For instance, pain after sex or the frequent and urgent urination, may lead to symptoms of depression or anxiety for the sufferer. You may also find that a lot of these symptoms are persistent. Medications and common lower back pain or pain with sitting treatments do not work. Despite all of these symptoms and causes of perineum pain, there are ways to treat it.

Perineum Pain Treatment

So, you are in pain in one of the more awkward spots possible. If you think about it, that area of your body is connected to so many others. When you’re walking, it hurts; when you’re sitting, it hurts. It’s hard to get comfortable or do much of anything without causing yourself pain. However, there are some treatment options that might help.

1. Bed Rest

Three or four days of bed rest will help relax the perineal area. As we mentioned above, the perineum is involved in a lot of your everyday activities. If it’s simply stretched or bruised, or a perineum tear, all you may need is bed rest to allow the area to repair itself. If you try this method, it’s important to treat it as an actual bed rest: Lie in bed or on the couch in a position that doesn’t irritate the injury and stick with it.

2. Massage the Area

This can work for everyone, but seems to be decently effective on women experiencing pain due to pregnancy. There are a few different techniques, but the basic idea is to massage the area that hurts. This may also be done with a tennis ball. It is best to discuss the massage treatment route with your doctor beforehand, just to make sure you won’t make things worse.

3. Antibiotic Treatments

If this is your first experience with perineal pain, a doctor may prescribe antibiotics to heal the injury before it becomes more chronic in nature.

Perineal Irrigation

This is specifically for women who are experiencing perineal pain due to childbirth or pregnancy. A doctor may recommend the use of an irrigation bottle after urination. The bottle is filled with warm water, which helps rinse, relax, and clean the perineal area.

There are additional treatments focused on certain underlying causes. For example, if the root cause is duct obstruction or appendicitis, you will find that the perineum pain disappears following treatment for these issues.

Perineum Pain Risk Factors

Unfortunately, there are a lot of risk factors to consider with perineum pain. Misdiagnosis, for example, is quite common as there are plenty of issues that can cause this type of pain and also present similar symptoms. Internal hernias, for example, may be hidden due to the manner in which checks for perineum pain are performed. Your doctor may also wrongly identify the cause behind the pain, completely missing the actual source.

Diagnosing Perineum Pain

As you can probably tell by the long lists of symptoms and causes, diagnosing what is causing your pain can be a bit of a handful. You’ll be asked about your recent medical history and about the pain itself. When did it start? What were you doing when the pain started? How painful is it on a scale of 1 to 10? This is done, in part, to rule causes in or out. The discussion is usually followed by a physical exam, which will determine the amount of pain you are in and if there is anything in the area directly causing the pain.

Urinalysis is also a key test due to the area that is involved and how the perineum pain may cause issues with your urination. Ultrasounds may also be used to see if anything is blocked, and if all your internal bits and pieces are where they should be. Blood work may also be done to rule out infections or diseases.

Perineum Pain Can Be a Pain in the Butt, Literally

As may be obvious by now, perineum or perineal pain can really hurt. You may not have realized it, but this area of your body is well-connected to parts used for everyday actions. It can also be a figurative pain trying to figure out what’s causing the pain in the first place. Regardless, if you are suffering from this, your best move is to see a doctor. The sooner you see a medical professional, the sooner you can start treatment and put an end to the pain for good.



Sources:
“Treatment of Perineal Pain in NYC: Specialized Urological Care,” New York Urology Specialists, http://www.newyorkurologyspecialists.com/pain/perineal-pain/perineal-pain-causes-treatment/, last accessed April 28, 2017.
“Perineal Pain or Perineum Pain: Causes, Symptoms, Treatment, Recovery, Diagnosis, Pathophysiology,” ePain Assist, https://www.epainassist.com/pelvic-pain/perineal-pain-or-perineum-pain, last accessed April 28, 2017.
“Perineum Pain (Perineal Pain),” My Pelvic Health, http://www.mypelvichealth.ca/causes-pelvic-floor-pain/perineum-pain-perineal-pain/, last accessed April 28, 2017.
“Perineum Pain,” Pelvic Pain Help, https://www.pelvicpainhelp.com/perineum-pain/, last accessed April 28, 2017.
Pietrangelo, A., “How To Treat Perineal Pain And Swelling During And After Pregnancy,” Healthline, March 23, 2016, http://www.healthline.com/health/pregnancy/swollen-perineum#overview1, last accessed April 28, 2017.




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Up until the end of 2016, Brent Chittenden had been a freelance researcher and writer, writing about everything from entertainment—including pro wrestling and stand-up comedy—to health and nutrition, to culture and lifestyle. In 2017, he joined the Doctors Health Press full time and couldn’t be happier about it. With a graduate certificate in Radio and Broadcasting, Brent brings extensive experience as a communicator and researcher, adding to the many talented health authorities and professionals on whose expertise Doctors Health Press... Read Full Bio »