What happens when a coccyx injury occurs
When falling on the buttocks, the entire force of the impact falls on the tailbone, sandwiched between the surface and the weight of the body. It can break, fracture, or become dislodged at the sacrococcygeal joint—the latter being more common than a fracture. The surrounding ligaments and muscles become injured, swelling develops, and any pressure on the area causes pain. In women, the tailbone is more open and mobile, so injuries occur more often. Another option for damage is birth trauma, when the baby’s head deviates the tailbone excessively backwards.
- Fracture of the body of the coccyx
- Dislocation or subluxation in the sacrococcygeal joint
- Bruise with ligament damage
- Birth injury to the coccyx
- Chronic microtrauma during cycling and horse riding
Symptoms: fracture or bruise
The main symptom is a sharp pain in the lower back immediately after a fall, which intensifies when sitting on something hard, getting up from a chair, bending over and straining in the toilet. Swelling and bruising appear, and touching the area is very painful. With a fracture, the pain is usually stronger and lasts longer, but injuries can only be reliably distinguished from an image. Warning signs that require immediate examination are numbness in the perineum, problems with urination and bowel movements: these indicate damage to the nerves or the sacrum.
- Pain in the coccyx area, worse while sitting
- Sharp pain when standing up and bending over
- Swelling and bruising above the tailbone
- Pain during bowel movements
- Difficulty driving and working at a desk
- Pain during digital examination through the rectum
Diagnostics
X-ray of the sacrococcygeal region in two projections remains the main method, although the coccyx is not always clearly visible on the images due to gas in the intestines and tissue overlap. Therefore, the doctor must conduct an examination and digital examination through the rectum: this way you can assess the mobility of the tailbone and pain. A CT scan is prescribed for suspected fractures of the sacrum and pelvic bones, an MRI for persistent pain to rule out inflammation, a coccygeal cyst, and a tumor. Without a history of trauma, the examination should be broader.
- X-ray of the sacrococcygeal region in two projections
- Examination and digital rectal examination
- CT scan of the pelvis for severe trauma
- MRI for pain longer than two months
- Exclusion of epithelial coccygeal tract and paraproctitis
Treatment and pain reduction
The coccyx is not fixed: healing occurs under conditions of rest and unloading. In the first two days, cold through a cloth helps, then dry heat. It is recommended to sit on a special pillow in the shape of a ring or horseshoe, with the pelvis tilted forward, and it is better to avoid prolonged sitting on hard surfaces. Painkillers are taken in a short course as prescribed by a doctor. It is important to avoid constipation: straining increases pain and interferes with healing, so increase the amount of fiber and fluid, and if necessary, the doctor adds a mild laxative. If pain persists for more than two months, physical therapy, therapeutic blockades, and, in rare cases, removal of the coccyx are discussed.
- Rest, avoidance of prolonged sitting in the first days
- Ring pillow and forward tilt when sitting
- Cold for the first 48 hours, then warm
- Short course painkillers
- Soft stools: fiber, water, laxative if necessary
- Physiotherapy and exercise therapy after acute pain subsides
- Blockade or surgery for persistent coccydynia
Timing and possible consequences
Pain after a bruise usually decreases noticeably within 2–4 weeks; after a fracture, discomfort when sitting can persist for 6–12 weeks. The tailbone heals more slowly than many bones due to the small blood supply and constant tension of the pelvic floor muscles. Some people develop coccydynia - chronic pain in the tailbone, which lasts for months and requires separate treatment with the participation of a neurologist and a rehabilitation specialist. To reduce the risk, you should regain mobility gradually and avoid spending the entire day sitting without breaks.
- Bruise - improvement in 2-4 weeks
- Fracture—discomfort for up to 2–3 months
- Coccydynia with prolonged course
- Increased risk of re-injury in osteoporosis
- Seating breaks every 30–40 minutes