Causes, Symptoms, and Treatment for a Protruding Sacrum

Understanding Sacral Dimples and Protrusions

The sacrum is a large, triangular bone at the base of the spine that forms the back wall of the pelvis. It is an important part of the body's weight-bearing structure. In some people, the sacrum may appear to "stick out" more than normal. This is known as a sacral dimple or protrusion.

What Causes the Sacrum to Stick Out?

There are a few possible reasons why the sacrum may appear more prominent:

• Shape and structure of the sacrum: The sacrum naturally varies in size and shape between individuals. Some people simply have a more curved or protruding sacrum.
• Posture: Poor posture such as excessive lumbar lordosis (swayback) can make the sacrum more visible. Pelvic tilts and muscle imbalances can also contribute.
• Body composition: Having less fat and muscle over the sacrum will make the bony structure more noticeable.
• Spinal conditions: Scoliosis, spondylolisthesis, and other spine conditions may alter the positioning of the sacrum and make it more prominent.

Signs and Symptoms

In many cases, a sacral protrusion causes no signs or symptoms. You may simply notice a bump or indentation at the base of the spine above the buttocks crease. The surrounding skin is usually normal. Sometimes, there may be:

• A dimple, pit, lipoma (fatty growth) or tuft of hair over the sacral area
• Asymmetrical buttocks due to uneven sacral positioning
• Mild discomfort or sensitivity over the sacrum
• Difficulty sitting or lying on your back

When to See a Doctor

Most of the time, a protruding or uneven sacrum is simply an anatomical variation. However, it's a good idea to get it examined, especially if you notice any of the following:

• Severe pain or numbness near the sacrum
• Weakness or tingling in the legs
• Bowel or bladder changes
• Skin discoloration over the sacrum

These can indicate an underlying spinal condition or nerve compression that may require treatment. See your doctor promptly if you have any worrying symptoms along with a prominent sacrum.

Diagnosing a Protruding Sacrum

To diagnose a protruding sacrum, the doctor will begin with a physical examination, inspecting the lower back while you stand and bend forward. They may gently palpate the sacrum to check for pain, masses or abnormalities.

You'll also be asked about any symptoms you've been having. Make sure to tell your doctor about any back pain, changes in gait, bowel or bladder problems, leg weakness etc. Let them know if you have a history of spinal disorders.

The following tests may be done to evaluate the sacrum and surrounding structures:

• X-ray - Checks the alignment and bone structure of the sacrum and pelvis.
• CT scan - More detailed images of the sacrum and nerves.
• MRI - Provides clear views of the soft tissues and spinal cord.
• Bone scan - Tracks bone metabolism to check for spinal abnormalities.
• Neurological exam - Tests reflexes, sensation and muscle function in the legs.

Sacral Dimples

Some babies are born with a small dimple or pit in the lower back overlying the sacrum. This is called a sacral dimple. It occurs when the skin over the sacrum fails to fuse together completely during fetal development.

Sacral dimples are common, occurring in 2-4% of infants. Most are shallow (less than 0.5 cm deep) and don't cause any health issues. However, a deep sacral dimple (>0.5 cm) may be a sign of an underlying problem such as:

• Spina bifida - opening in the spinal bones
• Tethered spinal cord - abnormal attachment of the spinal cord
• Cysts or sinus tracts

For this reason, deep sacral dimples require an ultrasound or MRI scan to look at the underlying spine and cord structures. Early diagnosis and treatment of any disorders can prevent future nerve damage.

Can a Protruding Sacrum Be Fixed?

If a protruding sacrum is simply due to your anatomy or posture, there are a few things you can try:

• Improve posture and core strength - Weak core muscles can contribute to swayback and sacral prominence. Pilates, yoga and core exercises can help.
• Pelvic tilts - Tucking your pelvis can rotate the sacrum and make it less prominent.
• Lose weight - Having extra fat over the sacrum emphasizes its protrusion.
• Back bracing - Wearing a supportive lower back or sacroiliac belt may help reduce discomfort.
• Massage therapy - Can help loosen tight muscles pulling on the sacrum.

If an underlying spinal condition is causing the protrusion, treatment will depend on the specific diagnosis. Options may include:

• Physical therapy to strengthen the back and improve mobility.
• Prescription medication such as muscle relaxants.
• Steroid injections to reduce inflammation.
• Surgery to repair a defect or decompress trapped nerves.

Preventing Sacral Discomfort

While some sacral protrusion is unavoidable, the following habits can help minimize discomfort:

• Maintain good posture, especially when sitting.
• Sleep on your side with a pillow between your knees.
• Wear shoes with good arch support.
• Exercise regularly to strengthen your back muscles.
• Avoid carrying heavy loads improperly.
• Manage your weight to reduce pressure on the sacrum.
• Stretch your lower back after long periods of sitting.

Use care when doing high-impact activities like running. Avoid falls, trauma or overextending your back that could injure the sacrum.

See your doctor promptly if sacral discomfort worsens or you develop any numbness, tingling or incontinence.

When to Seek Medical Care

In most cases, a visibly protruding or uneven sacrum is not a major concern if it's causing no other symptoms. However, it's always a good idea to mention it at your next doctor's visit.

See a doctor right away if you experience:

• Severe or worsening pain near the sacrum
• Numbness, tingling or weakness in the legs
• Problems controlling your bowels or bladder
• Change in gait or difficulty walking

These can indicate an underlying issue requiring prompt evaluation. Early treatment of spinal nerve compression can help prevent permanent damage.

Infants born with a sacral dimple should be evaluated by a pediatrician. Depending on the depth, neuroimaging tests may be done to look for spinal cord anomalies.

Living with a Prominent Sacrum

Having a visibly protruding or asymmetrical sacrum can understandably cause self-consciousness about your appearance. But try not to let it impact your confidence and body image.

Focus on the aspects of yourself that make you unique in a positive way. Wear clothing that flatters your overall shape rather than obsessing over hiding your sacrum specifically.

Practice self-care techniques such as mindfulness meditation to emphasize inner positivity. Surround yourself with supportive, body-positive friends and family who boost your self-esteem.

Keep your sacrum and back muscles strong through regular exercise. Maintain a healthy diet and lifestyle to prevent weight gain that could worsen sacral protrusion.

See a mental health counselor if you struggle with intense anxiety, depression or embarrassment over sacral appearance. There are many resources available to help promote healthy self-image.

With the right self-care strategies and medical care, you can manage sacral variations while thriving in all aspects of your life.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.