What is coccydynia
The coccyx is the lower part of the spine made up of several fused vertebrae, to which the pelvic floor muscles, ligaments and tendons are attached. In a sitting position, it takes on part of the body weight. If the tailbone is injured, excessively mobile or displaced, ligaments and nerve endings are irritated with each landing. Doctors distinguish between coccydynia proper, associated with the coccyx, and anorectal pain syndrome, in which the source of pain is the pelvic floor muscles or pelvic organs. This division determines which treatment will help.
- Post-traumatic - after a fall on the buttocks
- Postpartum - due to overload of the coccyx during childbirth
- With excessive mobility or dislocation of the coccyx
- Idiopathic - without obvious cause
- Referred pain in diseases of the rectum, pelvic organs, lumbar spine
Causes and risk factors
Pain most often occurs after a direct blow - a fall on ice, on the steps of a ladder, on the buttocks. An acute injury can result in a bruise, crack or dislocation of the tailbone. In women, the risk is associated with a wider pelvis and childbirth, especially a larger fetus and operative vaginal birth. Chronic microtraumatization is observed during prolonged driving, cycling, and working while sitting on a hard surface. Excess weight increases the load on the tailbone, and with sudden weight loss, the fat layer that protects it decreases. In some patients the cause cannot be determined.
- Falls on the buttocks
- Childbirth
- Sitting for long periods of time, especially on hard ones
- Cycling, horse riding
- Excessive or too low body weight
- Arthrosis of the sacrococcygeal joint
Symptoms
A typical complaint is local pain in the coccyx area, which intensifies when sitting, especially when leaning back, and when standing up. Many people begin to sit on one buttock or put their hands on it. The pain can radiate to the perineum, buttocks, anus and intensifies during bowel movements or sexual intercourse. It usually decreases in standing and lying positions. Sometimes pain does not appear immediately after the injury, but several days or weeks later. Persistent pain not related to body position requires exclusion of other causes.
- Pain in the tailbone when sitting
- Sharp pain when getting up from a chair
- Pain when pressing on the tailbone
- Pain during bowel movements
- Discomfort during intercourse
- The habit of sitting on one buttock
Diagnostics
The doctor asks about injuries and childbirth, examines the sacrococcygeal region, excluding the epithelial coccygeal tract and abscess. Digital rectal examination allows you to evaluate the mobility of the tailbone, soreness and tension of the pelvic floor muscles. X-rays of the sacrococcygeal region reveal fractures and displacements, and comparative photographs in a sitting and standing position reveal excessive mobility. MRI or CT is prescribed to exclude tumors and inflammation. If diseases of the rectum and pelvic organs are suspected, a proctologist and gynecologist are contacted.
- Inspection and palpation of the coccyx
- Digital rectal examination
- X-ray of the sacrococcygeal region
- Comparative x-rays while sitting and standing
- MSCT of the lumbosacral region covering the coccyx
- MRI of the pelvic organs
- Sigmoidoscopy and gynecological examination according to indications
Treatment
In most cases, coccydynia resolves with conservative treatment. It is important to unload the tailbone: use a pillow with a cutout at the back or in the shape of a wedge, lean forward when sitting, change position more often. To reduce pain and inflammation, the doctor may prescribe nonsteroidal anti-inflammatory drugs and physical therapy. Relaxation of the pelvic floor muscles and manual therapy help. It is also important to avoid constipation so as not to increase pain during bowel movements. For persistent pain, therapeutic blockades with local anesthetic are performed. Removal of the coccyx (coccygectomy) is considered only if long-term treatment is ineffective.
- Pillow with tailbone cutout
- Don't sit for long periods of time, take breaks
- Gentle heat if there are no signs of inflammation
- Therapeutic exercise for the pelvic floor muscles
- Nutrition and drinking regimen to prevent constipation
- Blockades and manual therapy as prescribed by a doctor