Sacral Dimple: Understanding Its Causes, Symptoms, and Treatment

What is a Sacral Dimple?

Sacral dimple is a shallow pit or depression of the skin positioned on the lower back just above the crease of the buttock. It usually presents itself at the sacrum, a bony structure at the base of the back. Sacral dimples are usually inborn and can be noted frequently in infants and young children.

Although the majority of sacral dimples are not dangerous and they do not cause any health issues, in certain situations, they can be signs of a spinal defect or any other health condition. One should draw the line between the innocent dimples and those that might need further consideration.

Causes of Sacral Dimple

Sacral dimples are caused in the development of the fetus when the skin fails to cover the spinal cord and other structures around the spinal cord. This partial closure leaves a little hole on the skin. This developmental variation has not always been known to be due to a specific cause but can be attributed to:

• Normal Developmental Variation: The majority of sacral dimples do not have any health issues and are just a normal anatomical feature. They arise due to the normal development process of the skin and spine in fetus growth.
• Genetics: There are cases where sacral dimples are familial implying a possible genetic element. This does not however imply that they are necessarily a manifestation of a genetic disorder.
• Spinal Cord Abnormalities: Sometimes the spinal cord has a rare condition, which is related to a sacral dimple, including tethered cord syndrome. It happens when the spinal cord is attached irregularly to the nearby tissues and as a consequence, the movement is restricted and other neurological symptoms appear.
• Other Birth Defects: Sacral dimples may also occur along with other birth disorders, including spina bifida or a malformation in the formation of the spinal column.

Symptoms of Sacral Dimple

Sacral dimples in the majority of cases show no symptoms and cannot be seen after birth unless one pays attention during a regular physical check-up. Nonetheless, some indicators that can suggest the necessity of the further investigation can be found:

Size and Depth

A small, shallow dimple normally is harmless. A more pronounced or bigger dimple, or one with accompanying signs, like a tuft of hair or red or swollen spot, can be a cause of concern though.

Associated Symptoms

In case the sacral dimple is associated with some underlying condition, the child might experience other symptoms, including:

• Lower back pain or buttock pain.
• Feebleness or numbness of legs or feet.
• Inability to walk or crawl (in an infant)
• Bladder or bowel loss of control.

Abnormal reflexes

Hair or Skin Tags: In some cases a dimple of the sacrum may be accompanied by a small tuft of hair, skin tag, or discolouration at the dimple. Such characteristics are not necessarily problematic but may be discussed by a healthcare provider.

Diagnosis of Sacral Dimple

A sacral dimple is normally diagnosed during physical examination especially in babies. Nevertheless, additional testing might be required in order to exclude the possibility of any underlying conditions, particularly when the dimple has alarming characteristics.

• Physical Examination: A health care provider will look at the dimple, including the size, depth and any other characteristics, including hair, skin tags or discoloration. Associated symptoms will also be observed.
• Ultrasound: An ultrasound can be done in instances where the dimple seems to be deeper than usual or in instances where there is a suspicion of tethered cord syndrome. Ultrasound is a safe and efficient technique of imaging the spinal cord and other structures.
• MRI or CT Scan: Sometimes MRI or CT scan can be ordered to get specific images of the spine and spinal cord, particularly when there are indications of neurological involvement, or abnormal development. Such imaging methods might be used to identify tethered cord syndrome or other malformations of the spine.
• Neurological Assessment: In case the child has neurological symptoms, e.g., weakness or a lack of coordination, the neurological evaluation can be conducted to evaluate reflexes, strength, and sensory reactions.

Treatment of Sacral Dimple

Sacral dimple needs no treatment in most instances and does not lead to any complications. Nonetheless, in cases where a medical professional believes that the dimple is linked to some underlying spinal disorder, additional management can be required.

• Observation: In most of the cases, and more so when the sacral dimple is small and does not have any related symptoms, the child can be followed up. Physical examination and periodic check-ups will aid in making sure that no complications and alterations occur.
• Surgical Intervention: Rarely, in the presence of a spinal abnormality, including tethered cord syndrome or spina bifida, a sacral dimple can be associated with this abnormality and surgery may be needed. This can be by removing the spinal cord from its attachment to other tissues or treating other structural problems.
• Physical Therapy: In case the dimple has been related to the impairment of the nervous system, physical therapy can be prescribed in order to enhance movement, coordination, and strength, especially in tethered cord syndrome.
• Surveillance of Complications: In case of the presence of the sacral dimple with other birth defects or spinal abnormalities, it can be recommended to monitor and treat the condition and avoid complications.

Complications of Sacral Dimple

Although the majority of the sacral dimples are not harmful, there are certain complications that may occur in case the condition is related to another underlying disorder. These complications include:

• Tethered Cord Syndrome: This is a syndrome that develops when the spinal cord is abnormally tethered or attached to the surrounding tissues causing neurological problems that include weakness, sensory problems, and bladder or bowel dysfunction.
• Spina Bifida: A more severe disease, in which the spinal column does not close fully which may result in paralysis, incontinence and many other severe complications.
• Neurological Problems: In uncommon cases, a sacral dimple may indicate neurological impairments, such as abnormal reflexes, motor difficulties and walking problems.

When to See a Doctor?

Although the majority of sacral dimples are not dangerous, one should find medical help in case of the following situations:

• The dimple is big, profound, or possesses related skin defects (e.g., tuft of hair, discolouration).
• The child will have such symptoms as pain, weakness, numbness, or walking difficulties.
• There are signs of bowel or bladder problems.
• The child is showing developmental delay or other neurological symptoms.

Conclusion

Sacral dimple is most commonly an anatomical variation that is harmless, and most commonly observed in newborns. Although most of these dimples do not lead to any form of health complication, they ought to be observed particularly when they are accompanied by other alarming signs or symptoms. Should you observe some abnormalities in the sacral dimple of your child or there are any neurological issues, then you should consult a doctor to eliminate the possibility of any underlying disorder. Check-ups and early intervention where required can be done regularly to ensure optimal results of the health and development of the child.

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