Differential Diagnosis for Postpartum Low Back and Buttock Pain
- Single most likely diagnosis
- Coccydynia: This condition is characterized by pain in the coccyx (tailbone) area, often caused by a fall or trauma, which in this case could be related to the forceps-assisted vaginal delivery. The patient's exquisite tenderness to palpation over the coccyx and the onset of pain after delivery support this diagnosis.
- Other Likely diagnoses
- Postpartum pelvic girdle pain: This condition is common after childbirth, especially after a prolonged labor or instrumental delivery. The patient's symptoms of low back and buttock pain worsening with sitting could be consistent with this diagnosis.
- Post-dural puncture headache (PDPH) with referred pain: Although the patient's epidural was removed, a dural puncture could have occurred, leading to a headache and potentially referred pain to the low back and buttock area. However, the lack of headache symptoms makes this less likely.
- Do Not Miss diagnoses
- Spinal epidural hematoma: This is a rare but potentially life-threatening condition that could occur after epidural placement or removal. Although the patient does not have neurological deficits, it is essential to consider this diagnosis due to its severity.
- Postpartum spinal infection (e.g., epidural abscess or discitis): Infection is a potential complication of epidural placement, and the patient's pain could be a symptom. However, the lack of fever, erythema, or other signs of infection makes this less likely.
- Rare diagnoses
- Postpartum osteonecrosis of the femoral head: This condition is rare but can occur after pregnancy, especially in patients with a history of prolonged corticosteroid use or other risk factors. The patient's symptoms could be consistent with this diagnosis, but it is less likely given the lack of other risk factors.
- Tarlov cysts: These are rare, fluid-filled cysts that can occur in the spine and cause pain. However, they are unlikely to cause acute onset pain in the postpartum period.