DR ELLIE CANNON: Why does my coccyx hurt even when I sit down with a cushion?

Every time I sit down, I experience pain in my coccyx, even when sitting on comfortable chairs or using a pillow. I’m embarrassed to go to my doctor because they’ve never encountered such a problem. What can I do to stop the pain?

Pain in the coccyx, or the “tailbone” at the base of the spine, can be debilitating. It is known as coccydynia and usually occurs when making simple movements, such as sitting, standing up or bending over.

We don’t always know what causes coccydynia, but it is likely that prolonged sitting over many years is a factor. It can also be caused by an injury to the area or by pregnancy, due to the combined effects of hormones that make the joints and pelvic ligaments weak and the pressure exerted by the growing baby.

It is also commonly seen in people with flexible joints, also known as hypermobility.

Sitting on a donut-shaped cushion can be helpful in reducing pressure on the coccyx. Other remedies include sleeping on your side and sitting on an exercise ball instead of a chair. It is also important to avoid constipation, as pressing down makes the pain worse.

Coccydynia is not something to be ashamed of; It is important that you get a good assessment from a GP or physiotherapist to find the best treatment. This may include X-rays, blood tests and MRI scans. At the very least, take anti-inflammatory painkillers such as ibuprofen.

Physical therapy can help, as can injections of local anesthetic or steroids to control inflammation in the area. Surgery can also be used as a last resort.

A few years ago I was diagnosed with the human papillomavirus (HPV). I have pelvic pain and bleeding between periods, which means I have to wear pads all the time. Recently I noticed that my vaginal discharge is watery and contains blood. I’m afraid I might get cancer, but I struggle with anxiety and am extremely nervous about seeing a doctor. What should I do?

Pelvic pain, bleeding between periods and bloody discharge can indicate an infection, a polyp or even cervical, endometrial or uterine cancer.

It is essential that such serious symptoms are assessed by a doctor. It can be scary, and if so, bringing a friend along for support can help.

For people who have difficulty leaving the house, transportation to and from a hospital appointment can sometimes be arranged.

Although an initial consultation with a GP may be done by telephone, investigations for abnormal bleeding and pelvic pain usually begin with a vaginal examination or with swabs taken from the inside of the vagina and cervix. Blood tests and a pelvic ultrasound would also be wise.

A GP must then arrange a referral to a gynecologist, for example colposcopies – an examination of the cervix – or more extensive imaging, including CT or MRI scans.

It would be worth doing some research on the NHS (nhs.uk) or Cancer Research UK (cancerresearchuk.org) websites to understand what these tests entail, as knowing what to expect can make the experience less overwhelming to make.

I’ve been on hormone replacement therapy (HRT) on and off for almost 30 years after a hysterectomy, and have never felt better. But my blood pressure has been rising and is now considered high. My nurse says I may have to stop taking HRT, which would be awful. Can I just keep taking my HRT and hope my blood pressure drops?

Blood pressure is an important tool in the safe prescribing of HRT. There is no evidence that these medications increase blood pressure; some variants can even lower it. This depends on which hormones a woman uses and in what dose.

We do not give HRT to women who have uncontrolled high blood pressure, but as long as it is under control you can continue to use the treatments.

Some people make the mistake of taking their blood pressure when they’re not feeling well or when they’re consciously thinking about it, sometimes causing inaccurate results due to stress and anxiety – which in turn makes your blood pressure even higher.

The problem can be especially serious if there are serious consequences for a patient’s high blood pressure, such as having to take medications or being at risk of disease.

To alleviate this, doctors offer a range of solutions. One of these is the suggestion to measure your blood pressure regularly, regardless of how you feel, for example twice a day for a week, or twice at fixed times of the day. The other option is for the GP to arrange a portable blood pressure monitor that takes many measurements over 24 or 48 hours to get a clear picture of what is going on.

It’s also worth checking the instructions on your blood pressure monitor to make sure you’re using it correctly. Please note that the cuff should be on the upper part of the arm for the most accurate measurement.

Have you had uterine pain without a diagnosis?

Padma Lakshmi at the 75th Emmy Awards held at the Peacock Theater on January 15, 2024 in Los Angeles, California

Women who suffer monthly pain are still told by some doctors that it is normal – which of course it is not. So I was pleased that this, and the condition endometriosis, were major topics at the Women’s Health Summit I attended last week.

Endometriosis, where abnormal uterine tissue grows in the pelvis and causes pain, affects around 1.5 million British women. Yet many suffer for years before receiving a diagnosis, by which time they may need surgery and be left with lifelong problems. A host of celebrities have spoken openly about the issue, including actress Padma Lakshmi above, who I saw during Emmy Award red carpet coverage last Tuesday. This helps shed light on the problem – but real change must also come from within medicine.

A major problem is that diagnosis requires surgery, which is serious and carries risks. We have new ultrasound techniques that allow us to determine which patients need the diagnostic surgery and which do not. However, I have been told that these are often not offered and not all doctors are aware of the option.

Have you waited years for an endometriosis diagnosis? Write to me at the email address below and let me know.

It is best to keep the hospital stay short

Amid the concern for the Princess of Wales following abdominal surgery, virtually everyone I know in the medical community was surprised that she is expected to spend two weeks in the hospital recovering.

Doctors try to discharge patients as soon as possible after surgery, and routine pelvic and abdominal procedures – such as a hysterectomy – require only a few days of hospitalization, although they may take longer.

People recover better at home, where they can eat, sleep and roam around well. Although there is no suggestion that this is the wrong decision for Kate, we try to avoid long hospital stays, especially for the elderly, as this can hinder recovery. One week in the hospital can lead to a ten percent loss of muscle strength and a 25 percent reduction in blood circulation. The sooner people get home, the better.