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Rectal Pain or Itching

You are having uncomfortable pain in the crease between your buttocks.

One of the conditions that may be the cause of your pain is an infected pilonidal cyst. An infected pilonidal cyst needs to be drained by a doctor. Schedule an urgent evaluation with your doctor to make sure that an infected cyst is not the source of your pain.

The two structures that commonly cause pain in the buttock crease are your tailbone (coccyx) and skin. There are five common problems that can result in pain in the buttock crease:

Bedsore (Decubitus Ulcer)

People who are bed-bound or obligated to remain in a wheelchair can remain in one position for long stretches of time. The skin over the tailbone receives poor circulation when it is compressed by sitting or lying. It is common for the skin overlying the tailbone to thin and disintegrate if a person's weight is not regularly shifted. The first signs of an ulcer are reddening of an area of skin and pain. When the skin breaks down, an open sore (ulcer) forms. Pressure ulcers on the buttock are called "decubitus ulcers." Relief of pressure and meticulous wound care is needed in order for a decubitus ulcer to heal.

Yeast infection (candidiasis)

Yeast infections can cause an itchy or painful red rash on the skin. It is most common for a yeast infection to affect the skin in the folds of the groin (at the top of the thigh) and the skin around the genitals, but it may also occur in the anus area or the buttock crease.

Infected pilonidal cyst

Where your skin and tissue fold inward at the top of your buttock crease, a hair can easily become ingrown so that its tip re-enters the skin and creates irritation. Doctors think that is a likely reason that the buttock crease can develop a pilonidal cyst, which is an irritated pocket of fluid and hairs under the skin surface. Pilonidal cysts are most common in men under age 40, and they are more likely to occur in people with abundant body hair. Pilonidal cysts that become infected can cause pain and may create an area on the overlying skin surface that is red, tender, and swollen. A pilonidal cyst can develop one or more draining holes to the skin surface, creating a constant discharge of blood, pus, or clear fluid. A cyst with a draining hole is known as a pilonidal sinus.

Hidradenitis suppurativa

Blockage of a hair follicle can allow sweat glands just beneath the hair root to become congested and inflamed. When this occurs, the sweat glands can deteriorate and combine into pockets of fluid under the skin. This can make the skin look as if it has acne, it can cause scarring, and it can cause you to form repeated "boils" (pockets of pus underneath the skin). Boils can be painful. If you have a lot of problems from congestion and inflammation of your sweat glands, your condition is called "hidradenitis suppurativa" (also known as "acne inversus"). Antibiotics may be helpful; large boils may require drainage by your doctor.

Pain from the tailbone (coccyx)

The coccyx (tailbone) is a pointed bone at the bottom of your sacrum. It is possible for the coccyx to crack or fracture with trauma. More commonly, pain in the tailbone arises due to the pull of strong pelvic muscles that attach to this bone. Coccyx pain can occur if a pelvic muscle is in spasm, a common problem after childbirth, pelvic surgery, or trauma.

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Harvard Health Publications Source: from the Harvard Health Publications Family Health Guide, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved.

Used with permission of StayWell.

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