Sacral Dimples: Advice for Referrers

RHC for Health Professionals
NHS GGC

A sacral dimple is an indentation in the lower back, present at birth, but sometimes not noticed until the infant’s 6 week check. Most are blind ending, just above or within the crease of the buttocks, and do not require investigation or treatment.

However, if referral is required please refer as soon as possible. Ultrasound is the initial investigation of choice, but after around 8 weeks of age (after ossification of the vertebral arches) an MRI is performed (either a feed-and-sleep, or with a general anaesthetic).

Refer if

  1. the base of the dimples cannot be visualised
  2. the dimple is >5mm in size
  3. the dimple is >2.5cm above the anal margin
  4. there are associated cutaneous marking, hairy patch, skin tag, or fatty lump
  5. there is a duplicated gluteal cleft
  6. there is more than one dimple
  7. the dimple lies outside the sacrococcygeal region
  8. there are any neurological abnormalities noted

The above may be associated with an underlying neurological problem, for example spinal dysraphism.

Who to Refer

Refer if:

  • the base of the dimples cannot be visualised
  • the dimple is >5mm in size
  • the dimple is >2.5cm above the anal margin
  • there are associated cutaneous marking, hairy patch, skin tag, or fatty lump
  • there is a duplicated gluteal cleft
  • there is more than one dimple
  • the dimple lies outside the sacrococcygeal region
  • there are any neurological abnormalities noted

 

The above may be associated with an underlying neurological problem, for example spinal dysraphism.

Information to Include - History

Is the child otherwise well, thriving and developing normally?

Information to Include - Examination

  • Can the base of the dimple be visualised?
  • Is the dimple greater than 5mm in size?
  • How far above the anal margin is the dimple?
  • Are there associated skin changes, hairy patch, skin tag or fatty lump?
  • How many dimples are there?
  • Is the dimple outside the sacrococcygeal region?
  • Can the infant move their legs normally?
  • Are there any problems with urination or stooling?
  • If you are sending in a photograph, please ask the parents to place a tape measure next to the dimple/lesion to the position of the anus, so that the reader can estimate the distance from the anal margin

Please state the concerning features leading to the referral.

Suggestions for management whilst waiting for outpatient appointment

Nothing specific.  Please refer as soon as possible so that an ultrasound may be requested before 8 weeks of age.

Useful resources for Parents

Nil specific.

Useful resources for Health Professionals

Zywicke HA, Rozzelle CJ. Sacral Dimples. Pediatrics in Review 2011;32;109.

Editorial Information

Last reviewed: 25/11/2024

Next review date: 30/11/2029

Author(s): Ruth M Bland, Consultant Medical Paediatrics.