Pain when seated

introduction

Sitting pain is an extremely common phenomenon that affects patients of all ages. Since the symptom can occur in many different parts of the body, it is part of a particularly complex disease with a variety of manifestations and possible causes.

If you suffer from pain when sitting, it can be helpful to first be aware of where exactly this pain occurs, whether it only occurs while sitting or in other body positions and whether the pain is associated with other accompanying symptoms . The consideration of which (often unconscious) measures lead to an alleviation of the symptoms can later possibly help the consulted doctor to find the cause.

Possible causes

The causes of pain while sitting can be very diverse, so that it can occur in different parts of the body. Basically, orthopedic-occupational medical, gynecological-urological and internal-visceral surgical causes can be distinguished.

The first group of possible causes includes, for example, overloading or incorrect loading of the ischium or coccyx due to sitting for too long or inappropriately, e.g. in the office. Other possible triggers from the orthopedic field are herniated discs or joint wear.

The gynecological or urological group mainly includes inflammatory diseases of the fallopian tubes or ovaries or the testes and the urinary tract (especially cystitis).

The internal and visceral surgical causes include the inguinal hernia and hemorrhoids.

You might also be interested in this topic: Periosteum inflammation on the coccyx

Concomitant symptoms

Depending on the location and the trigger, the pain can be accompanied by other symptoms. These can occur in parallel or at different times to the pain and are often very helpful in identifying the cause. Due to the immense range of the clinical picture “pain when sitting”, only a few important accompanying symptoms are described in this section in order to illustrate the importance they can have for the diagnosis.

A herniated disc is one of the most important possible causes of back pain. It is often difficult to differentiate it from spinal stenosis (narrowing of the spinal canal) based on the symptoms. The question of whether the pain is reduced when bending over can help here. This would rather speak in favor of spinal stenosis, which requires a different therapy than the herniated disc.

If the pain occurs in the abdomen when sitting, cystitis is one of the most common causes. The suspicion of such a disease is confirmed if the pain in the abdomen when sitting is accompanied by burning or itching when urinating or even seeing blood in the urine is.

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diagnosis

Depending on the location and a detailed anamnesis (questioning) of the person concerned, the specialist can often make an initial suspected diagnosis of the cause of the pain when sitting. In order to be able to confirm or reject these, different examinations are available depending on the case.

E.g. if a urinary tract infection is suspected, a "U-Stix" can be made, in which a special strip of paper is dipped into the patient's urine and can confirm or rule out an infection with relative accuracy. In the event of an infection, a urine culture can then be made that identifies the causative agent and thus enables targeted antibiotic treatment.

If the cause is more likely to be in the orthopedic / trauma surgical area, the diagnosis is usually based on imaging (X-ray, MRI) in addition to the medical history and physical examination. This can not only confirm or refute the suspected diagnosis, but also serve as a preparation for the possibly necessary surgical intervention.

Gynecological (e.g. adnexitis) or urological causes (e.g. orchitis), on the other hand, are usually diagnosed with the help of a palpation examination and ultrasound.

treatment

Treatment options obviously vary widely depending on the cause of the pain when sitting. Basically, a distinction can be made between conservative (especially medicinal) and surgical therapy.

If the symptoms are caused by an inflammatory process (e.g. urinary tract infection or chronic prostatitis), conservative therapy using medication is usually initiated. On the one hand, this should include a pain reliever and anti-inflammatory component (e.g. ibuprofen, diclofenac) and, if necessary, a component directed against the respective pathogen (e.g. antibiotics). The latter should of course only be taken after consulting a doctor.

Conservative treatment is also the method of choice for inappropriate or excessive stress (e.g. coccygodynia). Occupational medicine (e.g. ergonomic office chairs) or orthopedic (e.g. insoles to compensate for knee misalignments) as well as physiotherapeutic (e.g. compensation for a shortening of the thigh muscles) are effective.

Some other causes (e.g. inguinal hernia or herniated disc in the lumbar spine) may require surgical therapy. This is particularly the case when there is a risk of dangerous complications, such as loss of urinary and stool continence or paralysis of the leg in the example of a herniated disc.

Duration of pain

Depending on the severity and location, the estimated duration of the pain when sitting varies considerably. For this reason and because of the individual differences in the healing process, it is hardly possible to make general statements about the overall duration, even if, for example, inflammatory processes often show shorter courses than those causes of pain that are orthopedic in nature.

In general, however, those affected should bear in mind that the duration of the symptoms depends to a large extent on the discipline with which they pursue the respective therapy (even if it is only largely gentle). Inadequate adherence to therapy can significantly slow down the healing process or even make the symptoms chronic.

Localization of the pain

Tailbone pain

Pain in the tailbone is known as coccygodynia and, due to the location of the tailbone, occurs primarily when sitting. Possible causes are a bruise or even a fracture from a fall, a coccyx fistula or a pinched nerve.

By far the most common trigger of tailbone pain, however, is sitting for too long on an inadequate seat. A significant proportion of workers complain of tailbone pain when sitting, especially in professions where the work is mainly sedentary. The pain is triggered by so-called microtraumas (smallest injuries) and by the atrophy of the holding muscles of the trunk. If you have such a professional activity, it is advisable to take regular "sitting breaks" in which you work while standing or walking. Special tailbone pillows can also help to alleviate the symptoms. Stabilization exercises can strengthen the muscles that hold the trunk and in this way lead to a reduction in pain.

Read more about this under: Pain in the tailbone - these are the causes

Knee pain

If knee pain occurs when sitting, it is pain at rest (as opposed to stress pain), which must generally be interpreted as warning signals from the body.

In older patients, pain at rest and exertion pain in the knees often occur side by side. Over the course of months and years, the patients initially experience pain when walking and later also when sitting. This pain when sitting is accordingly to be regarded as a sign of further progression of joint wear (osteoarthritis) and should involve the consultation of an orthopedic surgeon. This can quantify the extent of joint wear by means of an X-ray and explain the therapy options that are available.

The most common cause of knee pain when sitting in adolescents and younger adults is chondropathia patellae. This technical term describes in and of itself only a "cartilage disease on the kneecap". This clinical picture is often referred to simply as anterior knee pain syndrome. It occurs after long periods of sitting with knees bent (e.g. in the cinema, car or plane) and is perceived as bilateral pain in the area of ​​the kneecaps. The anterior knee pain syndrome is usually triggered by a malfunction (shortening) of the thigh muscles, which create a continuous pull on the kneecap, or by a malposition of the kneecap. However, previous knee injuries are of course a possible cause. Depending on the cause, anterior knee pain syndrome can be treated effectively in most cases; however, the symptoms often disappear on their own after a few months. Nevertheless, going to the orthopedic surgeon is recommended, as he can identify the exact causes and in this way minimize the risk of long-term consequential damage.

Read more about this under: Knee pain - what do I have?

Testicular pain

Testicular pain when sitting can have very different causes. These include an inguinal hernia, inflammation of the testicles (orchitis), or twisted testicles (testicular torsion). In adolescents in particular, occasional moderate testicular pain also occurs in connection with puberty and should not be interpreted as a symptom per se. In addition, testicular pain occurs more frequently even after intense sexual activity, although it is usually relatively weak and disappears by itself after a few hours.

In all cases, the pain can be position-dependent, for example it disappears when standing and only occurs while sitting, or it can only occur when walking and disappear at rest. For this reason, it is not easy to infer a specific cause in patients who only complain of testicular pain while sitting. Even if testicular inflammation seems rather unlikely in this case, since the relief of the testicles achieved by sitting usually leads to an alleviation of the symptoms. Therefore, in the event of severe pain, a doctor should be consulted immediately or even if the pain has not subsided by itself after several days. With the help of an ultrasound examination, he can clarify the possible triggers and, if necessary, initiate necessary therapeutic measures.

Read more about this under Pain in the testicle

Pain in the abdomen

Abdominal pain is generally regarded as a "woman's story", but it can of course also occur in men, as they can not only originate from the uterus and ovaries, but also from the urinary bladder, urethra, genital organs or the lower parts of the intestine. All diseases that can be the cause of abdominal pain can occur depending on the position - for example, especially when sitting. For this reason, the fact that abdominal pain occurs mainly when sitting does not exclude any of the possible causes. Nevertheless, there are various diseases for which the pain when sitting is particularly typical.

These include, for example, varicose veins in the pelvis, which, in addition to abdominal pain when sitting, often also cause a feeling of heaviness in the legs.

Cystitis (urinary tract infection) is a very common disease in which abdominal pain mainly occurs while sitting.

The main gynecological causes of abdominal pain when sitting include diseases of the ovaries, such as inflammation or cysts.

Furthermore, an inguinal hernia can manifest itself in the form of abdominal pain and be particularly intense when sitting if the seat pad presses on the hernial sac or the hernial sac is trapped between the legs.

The fact that the pain predominantly occurs when sitting and decreases or even disappears in other body positions should not hide the fact that a serious illness can be the underlying cause, especially in the case of very intense symptoms or symptoms lasting several days. Therefore, in these cases, a doctor should be consulted who can quickly and effectively rule out the most urgent causes with the help of blood parameters, an ultrasound examination and, if necessary, a palpation examination.

Read more about this under Abdominal pain

Pain in the groin

There are essentially two common triggers for groin pain when sitting: a hernia or hip osteoarthritis.

The inguinal hernia can be felt on the spot (i.e. the groin) as pain, but sometimes more as a diffuse abdominal pain. Sitting down leads to the build-up of pressure on the hernia, which is why the symptoms often increase when sitting.

In the more advanced stages of osteoarthritis of the hip joint, pain in the groin often occurs after long periods of sitting. The pain can be relieved by a little movement, which is why it is also known as "initial pain". Typical for hip osteoarthritis is groin pain radiating to the thigh and knee.

The hip impingement syndrome is a rarer reason for groin pain when sitting. In this case, the head of the femur hits the socket of the hip joint, usually due to signs of wear and tear. In addition to sitting, the pain typically occurs when the hip joint is strongly flexed and / or rotated.

If the pain is severe or if pain persists (over days to weeks), a doctor should be consulted, who in most cases can confirm or rule out the hernia as the most common cause with the help of a palpation examination.

Read more about this under: Pain in the groin - These are the most common causes

Pain in the thigh

If thigh pain occurs mainly when sitting, the primary cause is irritation of the sciatic nerve or the muscle tendon attachments of the rear thigh and gluteal muscles.

An irritation of the sciatic nerve caused by compression manifests itself as shooting unilateral loin pain that radiates into the thigh. The compression is often triggered by a herniated disc in the lower part of the spine.

Another, often neglected explanation is a spasm of the piriformis muscle. This is a muscle in the lumbar region that is only about the size of a finger and is responsible for the external rotation of the hip joint. It can especially develop with prolonged pressure (e.g. from sitting for a long time; more common in men who carry the wallet in their back pocket) or one-sided strain (e.g. heavy asymmetrical lifting of weights or runners with a leg length difference).Due to its anatomical proximity to the sciatic nerve, it can compress it in the event of a spasm and thus imitate the symptoms of a herniated disc. Since this cause requires a completely different, namely conservative therapy (restraint, heat treatment) than the herniated disc, it should at least be considered in those patients in whom no herniated disc matching the symptoms can be found on the radiological images.

The tendons of the thigh and gluteal muscles are irritated, especially in active patients who have only recently increased their workload. Because not only muscles and the cardiovascular system need time to adapt to higher performance requirements, but also the musculoskeletal system. The tendon attachments as the interface between muscle and bone are particularly susceptible to overload reactions. A temporary reduction in the training workload followed by a moderate, gradual increase is recommended in order to give the tendons the time they need to adapt to the increased training workload.

Read more about this under pain in the thigh

Ischial pain

Of course, pain in the ischium occurs primarily when sitting. In most cases, the cause of the symptoms can be assigned to one of the two complexes inflammation and trauma (injury).

The contact surfaces of the ischium and the attachment points of the muscle tendons are particularly susceptible to the development of inflammatory reactions. The former are particularly affected in patients who (mostly for work-related reasons) spend several hours a day in a sitting posture. The muscle tendons become inflamed primarily in patients who use the gluteal and thigh muscles associated with them during exercise (e.g. jogging, weight training). In both cases, the most promising treatment is obvious: more frequent breaks in sitting or better padded seats on the one hand, as well as an at least temporarily reduced amount of exercise, usually make the symptoms disappear surprisingly quickly.

Also read on this topic: Ischial tuberosity pain

If an injury is the cause of the pain in the ischium, finding the cause is usually relatively simple. In these cases it should be clarified whether it is just a bruise or a fracture, as the latter could, in rarer cases, require an operation.

Read more about this under: Pain in the ischium

Sacrum pain

In almost all cases, pain in the sacrum when sitting is caused by the sacroiliac joint (ISG). This is a joint between the sacrum and pelvic blades that is very strongly stabilized by muscles and ligaments and has little movement, which (since the sacrum is part of the spine) ultimately establishes the connection between the spine and the pelvis. The pain that occurs when the SI joint is diseased is particularly evident when bending over or sitting (especially when crossing the legs) and can radiate into the thighs. The possible causes of IGS pain are extremely diverse and range from injuries (falls) to incorrect loads (e.g. difference in leg length) to inflammatory diseases (e.g. ankylosing spondylitis) or joint wear (osteoarthritis).

Heat treatment, relaxation exercises and strengthening the gluteal and lower core muscles can alleviate the symptoms. Alternatively or in addition, an orthopedic and physiotherapeutic clarification or co-treatment is recommended.

Read more about this under: Pain in the sacrum

Pelvic floor pain

In most cases, pelvic floor pain is caused by tension in the pelvic floor muscles and occurs particularly when sitting. Bicycling is perceived by those affected as particularly uncomfortable, since an even greater proportion of the body weight rests on the pelvic floor than when sitting on a chair or similar.

The tension in the muscles mostly results from the fact that - often due to work - a large part of the day is spent in a sitting posture. It can be concluded from this that more frequent breaks and more dynamic sitting (e.g. on an ergonomic chair or an exercise ball) are the most effective measures for alleviating the symptoms. If the symptoms persist, so-called sensorimotor therapy can be considered, in which certain trigger points at the tendon attachments of the pelvic floor are treated in order to relieve the tension.

Pain in pregnancy

During pregnancy, many expectant mothers complain of abdominal pain, especially when sitting. In most cases, these can be traced back to the stretching processes caused by the growth or remodeling of the tissue as well as to a changed blood flow.

Physiotherapy treatment has proven itself here. An effective supplement is the intake of magnesium, also due to the virtually non-existent side effects.

Read more about this under: Lower abdominal pain during pregnancy

Pain in the ovaries

Because of its location in the lower abdomen, pain emanating from the ovaries usually develops its greatest intensity when sitting. In most cases, they are to be interpreted as cycle-related complaints, especially during menstruation and at the time of ovulation, and accordingly classified as harmless. Theoretically, however, they can also indicate a pregnancy that has occurred.

The third group of possible triggers are inflammatory processes in the ovaries. The most important representative is the chlamydia-triggered adnexitis (inflammation of the ovaries and fallopian tubes). The bacterial pathogens migrate upwards from the vagina in the direction of the ovaries and trigger severe pain there, which is not only, but often particularly severe, perceived when sitting. If the symptoms of the ovaries are particularly pronounced, the possibility of acute adnexitis should be considered and a gynecologist should be consulted. This can confirm the suspected diagnosis and initiate appropriate antibiotic therapy.

Read more about this under: Ovarian pain - These are the most common causes

Pain in the prostate

Due to its anatomical position, the prostate also tends to develop pain, especially when seated. The most common trigger for prostate-related pain is prostatitis, i.e. the inflammation of the prostate. A distinction must be made here between chronic (= pelvic pain syndrome) and acute prostatitis, as well as bacterial (inflammatory) and abacterial, which is the most common form. In addition to the pain that occurs particularly when sitting and urinating, there is often residual urine (the person concerned may have an urge to urinate, but cannot completely empty the bladder) and sexual dysfunction. In more advanced cases, a fever can develop.

Other conditions that can cause prostate pain when sitting include enlarged prostate (benign prostatic hyperplasia) and malignant disease (prostate cancer). Accordingly, in the event of intense or long-lasting symptoms, a urologist should be consulted in order to identify the cause and initiate the best possible treatment.

Read more about this under: Pain in the prostate

Hemorrhoid pain

The term hemorrhoids describes a vascular complex made up of arteries and veins that sits just above the sphincter muscle and, together with it, seals the anus. Although everyone has hemorrhoids in the end, the term “hemorrhoids” is commonly understood to mean an expansion of this vascular complex.

Especially in more advanced stages, when the hemorrhoids are already visible to the naked eye and no longer spontaneously (ie by themselves) "jump" back into the rectum, pain occurs when sitting. These pains are often preceded by bleeding from the intestines or skin irritations (often with itching) due to the impaired barrier function of the vascular complex.

If there is pain in the rectum when sitting or if the hemorrhoids can be seen with the naked eye, a visit to the family doctor is recommended. He can either make the diagnosis himself or, depending on the degree of severity, refer it to a proctologist, who in turn can discuss the possible therapy options.

Read more about this under: How To Treat Hemorrhoids Successfully

Pain from lowering the uterus

A lowering of the uterus results in most cases from a weakening of the pelvic floor. This, in turn, is primarily based either on an age-related weakening of the muscles or a loosening of the connective tissue as a result of childbirth. In more severe cases, the uterus can even lower itself through the vagina, which experts then refer to as uterine prolapse.

The lowering of the uterus causes tension on the structures of the connective tissue that hold it, which can cause abdominal pain. Since this tension is relieved when sitting, the symptoms are often reduced in a sitting position. The situation is different with the maximum variant of uterine subsidence, uterine prolapse (see above): Here, pressure is exerted on the uterus by sitting, which is why the symptoms increase when sitting. In both cases, the pain can be accompanied by a feeling of foreign bodies in the genital area.

Read more about this under: Pain in the uterus

Pain from a herniated disc in the lumbar spine

A herniated disc in the lumbar spine (lumbar spine) often causes severe pain in the lower back area, which can radiate over the buttocks into the thighs and down to the hollow of the knee and calf. Due to the anatomical circumstances, the complaints often increase when the leg is raised to the upper body or the upper body is bent over, e.g. while sitting. This fact is an important way of differentiating it from spinal stenosis, which is often associated with similarly localized pain.

A specialist can differentiate the two diseases with the help of x-rays and discuss the necessary further steps.

Read more about this at: Herniated disc of the lumbar spine

Pain in the uterine ligaments

Pain in the abdominal region that occurs especially when sitting is not necessarily typical of the uterine ligaments. These can cause pain again and again in the course of a pregnancy, but they mainly occur when standing, as the uterus pulls particularly hard on the mother ligaments that hold it. When sitting and especially when lying down, there is usually an immediate immediate improvement in symptoms. For this reason, stretching pain in the uterine ligaments in the case of pain while sitting during pregnancy is rather unlikely.
In addition or as an alternative to lying down, special support belts can also relieve the mother ligaments.

Read more on this topic at: Pulling the mother ligaments