Hi,

Thanks for this query.

I understand you are suffering with multiple painful symptoms at 41 years of age; hence you posted a lot of questions. I shall try my best to answer each of it.

Well, at my clinic when I see patients with multiple site pains, most often I find that there is an element of stress, anxiety and psychological fact contributing. However I do see other organic pathologies found on tests contributing to the disturbing symptoms. You have undergone some tests which suggest the following:
- CT scan revealed dislocated tail bone
- Non alcoholic fatty liver and mildly inflamed appendix
- Hiatus hernia on endoscopy

Accordingly, my comments are as follows:

1. Dislocated tail bone usually cause pain at the tail bone. However I would not be surprised if the hip and anal region pain may be related to this. You need to consider discussing with your orthopedician and plan treatment for it. The treatment could be conservative in the form of occasional pain killers, warm compresses and physiotherapy. Surgical treatment can be planned otherwise if conservative management isn't helpful.
You did not mention any issues with bowel movements. If stools are frequently hard and painful, recurring fistula need to be considered.

2. Appendix inflammation is concerning when the features represent acute or chronic inflammation. As the report does not reveal any such features, this could be benign self limiting condition.

3. Non alcoholic fatty liver is often related to overweight and high cholesterol levels. Re asses your cholesterol and weight and plan its treatment if needed. Besides the weight and cholesterol infective viral causes need to be excluded by your doctors.

4. Right abdominal pain, bloating and gas are unrelated to hip pain. These could be features of dyspepsia (indigestion) associated with hiatus hernia. Liver and bile disturbances and gastric issues need to be assessed with specific tests.

5. Abdominal ultrasound, transrectal ultrasound, endoscopy, colonoscopy, CT and MRI scans are sensitive and specific tests. The test is accurate. That being said, as the results are interpreted by individual radiologist/specialist wrong results are entirely based on subjective biases. You may always consider a repeat test from a different specialist / radiology institute if you strongly suspect the results to be wrong.
The test in all means is not harmful.

In brief, all your test reports except for fatty liver and dislocated tail bone seem normal. Both fatty liver and dislocated tail bone may be causing most of your symptoms. Stress and pschological issues (if any) may also have a role to play. You will need work together with a competent gastroenterologist and orthopaedic surgeon to plan the right treatment.

Hope this answers all your questions. Will be glad to add further comments if you need clarifications.

Good luck!!

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Specific answers to your questions are as follows:

1. Colonoscopy is a very useful tool to diagnose colon cancers. Since it was normal, I am very much sure that you do not suffer from anal / bowel cancers. Moreover you are able to pass stool normally. In the presence of colon and bowel cancer, you invariably would find difficulties to pass stools; you also would have significant bloody stools. So stay reassured; you do not have cancers.

2. Sciatic nerve radiculopathy is not uncommon condition. Here the pain is more at the back and spread behind your hip - thigh - leg and feet. What you described is not classical representation. Therefore it is less likely to be sciatica.

3. Transrectal ultrasound needs to be repeated if we strongly suspect a prostate problem which you do not have. Therefore I do not feel you need to repeat it.

4. Based on your description and the fact that you have normal bowel movement, the anal and hip pain may be related to tail bone dislocation or coccydynia. You might consider re-evaluation from an orthopedic surgeon in these lines. Repeating radiological tests (X-rays and spine MRI scan) is an option after the initial work up. And yes, radiological tests look at bony structure and spinal nerve pathology.

5. Dyspepsia combined with hiatus hernia can explain the right abdominal pain. Proton pump inhibitors drugs may be used briefly to take care of it. I do not feel abdominal MRI will add any value here.

6. MRI and ultrasound scans are completely harmless even if repeated "n" number of times.

In brief, there may be a strong relation between coccydyna and anal / hip pain if tail bone dislocation is proved to be stable and not causing this pain. Careful clinical examination by an orthopedic and if needed repeat radiological test can be useful. Besides that, abdominal pain seems to be related to digestive issues. MRI scan may not help in this case.

I hope I have answered all your questions to your satisfaction this time. Let me know if I have missed any.

Regards

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Dear Sir,

I am glad to know that you met an orthopedic surgeon and bony/structural problems are excluded. That leaves us with only function problem such as coccydnyia problem to ponder. Positive intent, exercise and physiotherapy are good options. Please continue; it will help you.

Though I will be more than happy to assist you further if needed in future, I pray to thee that you are blessed with good health and you have no more problems to write.

Good luck.... Please close this discussion and rate your experience.

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