7 July 1997
Dear Readers: Sincerely,
Dr. Warren hopes to help all who ask his advice and to enlighten all who read Ask Dr. Warren. For your own well being please keep in mind that
advice you read here may not apply exactly to your own situation, and that if you are sick, no information on the web can take the place of a hands on examination by your physician who knows you and cares about you.
Dr. Warren
I am a 26 year old male who can't recall any fall or specific trauma. I do however sit 10 hours daily at my job.
Any ideas of what is going on here?
-Sincerely,
CR
Dear CR: The main causes of coccygodynia are trauma/injury, arthritis, bone infection, and tumor. Common coccygodynia is associated in 48.4% of patients with a luxation (abnormal position) or hypermobility of the coccyx. Your evaluation sounds sufficient to have ruled out those causes. Unfortunately, that leaves as a possible diagnosis, idiopathic coccygodynia, which means cause unknown. I did, on one occasion, see a 16 year old boy who had coccygodynia of psychological origin based on conflicted homosexual feelings. The diagnosis of psychogenic pain should only be considered if a psychological basis can be found.
I did read once about injection of the coccygeal disc space with steroids under x-ray guidance as a possible treatment. Coccygectomy (surgical removal of the coccyx) has also had some success. If you sit a lot, the cushion you are using should be a donut just like patients who have rectal surgery use so that there is no pressure at all on your coccyx.
Sincerely,
Dr. Warren
-Thank you,
Anonymous
Dear Sir: Since you say that your swelling can be pushed up into your anus, it is most likely a hemorrhoid. Hemorrhoids are swollen veins in the anus and rectum. They can become inflamed and bleed. They are most common in constipated people but can occur in anyone. After pushing to have a bowel movement the hemorrhoid may protrude. When you wipe yourself it should be gently pushed back up into the anus because it may become more swollen and tender if left sticking out. Inflamed hemorrhoids can be treated with over-the-counter hemorrhoid preparations but if you have a great deal of discomfort there are prescription medications your doctor can offer.
An abscess in the area would most likely be firm and tender, and would not push up into the rectum. A fissure (tear in the skin) would also not push up into the rectum. If there is pus drainage you should see a physician. In fact, unless you feel certain that you know what you have, you should consider seeing a physician. You don't have anything serious, so don't be frightened, but only an examination can tell for sure what you have.
Sincerely,
Dr. Warren
-L
Dear L: Many babies spit up when they are burped. Sometimes the spitting may be forceful and be confused with vomiting, however, if the baby is gaining weight well and has a good appetite you don't have to worry. Of course if the baby eats too much he is likely to spit up even more, but the best way to determine if the baby is being fed the right amount is to see how the baby is growing and review the baby's feeding schedule with his pediatrician.
Sincerely,
Dr. Warren
-NN
Dear NN: Penicillin can clear up infections caused by bacteria, but it is not effective for treating virus infections. Even though the antibiotic may successfully treat an infection, that treatment cannot prevent your daughter from getting sick at a future date. Penicillins rarely cause any problems with anemia or other blood diseases, but they do have side effects, therefore, they should only be used when necessary to treat bacterial infections. The most common infections that children get are intestinal viruses and upper respiratory viruses. Virus infections don't respond to antibiotics, so they shouldn't be treated with antibiotics.
I have written several articles you might like to read for more information about antibiotics, intestinal viruses (gastroenteritis), and upper respiratory infections (URIs). They can be found on the web at the following URLs.
| Antibiotics: | http://www.mindspring.com/~drwarren/antibiot.htm |
| Gastroenteritis: | http://www.mindspring.com/~drwarren/gastro.htm |
| URIs: | http://www.mindspring.com/~drwarren/uri.htm |
Sincerely,
Dr. Warren
-NN
Dear NN: An eye that has been watery since birth and has intermittent discharge usually has a blocked or narrow tear duct. Massaging along the nose by the corner of the eye may help to push secretions through the duct and open it. The condition often improves as infants get older. Since your daughter has had this condition for eight months you should consult an ophthalmologist to see if her tear duct need s to be probed. This condition will not harm your daughter's sight.
Sincerely,
Dr. Warren
-BA
Dear BA: Your son has a hydrocoele which is a sac of fluid surrounding his testicle. The testicles are in the abdomen while the baby is developing in the womb. Before birth the testicles descend from the abdomen into the scrotum (the sac). As they descend they become surrounded by membranes inside the abdomen. These membranes fuse around the testicles and the connective tissue in the groin closes so that the testicles are sealed into the scrotum. If the membrane seals with fluid in it, then it's a hydrocoele. If the connective tissue in the groin doesn't close, that's a hernia. When a hernia bulges, intestines are poking through the opening into the scrotum. In most cases a hydrocoele feels different from a hernia, but if it is difficult to tell, the doctor can shine a light through it. The light doesn't shine through the intestine but it shines very well through a hydrocoele.
Hydrocoeles are very common and many disappear by one year of age. Those that persist beyond one year of age have a higher likelihood of being associated with a hernia, so surgical repair is recommended.
Sincerely,
Dr. Warren
Thanks for your help!
-RU
Dear RU: At 4 months, a baby who wakes for feedings, takes a few sips, and falls asleep, is a "trained night feeder." That means he uses his bottle to put himself to sleep because that is the only way he knows to go to sleep. To eliminate his waking you will have to eliminate the feedings at night. This will result in some crying, but that's okay. I'm reluctant to suggest letting him "cry it out" since that implies letting him cry indefinitely without any intervention. At first your child may need some soothing intermittently. Eventually you will decrease your intervention and leave him to fall asleep on his own. Please read my article on "sleeping through the night" at http://www.mindspring.com/~drwarren/sleep.htm.
Sincerely,
Dr. Warren
-AMB
Dear AMB: At 24 inches long your son's height is at the 90th percentile, which certainly makes him big. If his weight were in the 90th percentile he'd be well proportioned, but his weight is above the 97th percentile, so he is somewhat overweight. If his weight now levels off in the same percentile, i.e., if his weight gain continues along the same curve, that wouldn't be too bad; however, since he nearly doubled his birth weight in 2 months, there is some concern that he is getting too many calories. It might not be a bad idea to give your son another month of growth to see what happens to his weight and height before deciding to alter his diet. If his weight gain continues in excess, the best way to cut down his intake is to make each 8 ounce bottle with 6 ounces of formula and 2 ounces of water.
Sincerely,
Dr. Warren
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