How the coccyx works and what happens to it during injury
The tailbone is several small vertebrae fused together at the end of the spine. The pelvic floor muscles, ligaments and part of the gluteal muscles are attached to it. When falling on the buttocks, the impact falls exactly on this protrusion. There is a bruise of the periosteum, hemorrhage into the surrounding tissue and sprain of the sacrococcygeal ligaments. If the impact force is higher, the ligaments may be torn, and the tailbone itself may be displaced or broken. Externally, these injuries look the same.
- Contusion of soft tissues and periosteum
- Hemorrhage into the subcutaneous tissue
- Sacrococcygeal ligament sprain
- Subluxation or dislocation of the coccyx
- Fracture of the coccyx due to a strong blow
Symptoms
The pain appears immediately after a fall and is localized exactly between the buttocks, above the anus. It sharply intensifies when trying to sit on something hard, when moving from a sitting position to a standing position, and when bending forward. Many find it easier to sit on one half of the pelvis or on a soft pillow. Swelling and bruising are often noticeable and appear within a day or two. Sometimes the pain radiates to the sacrum, thigh or rectum and intensifies with defecation.
- Pain in the coccyx area that gets worse when sitting
- Sharp pain when getting up from a chair
- Swelling and subcutaneous bruising
- Pain on pressure
- Discomfort during bowel movements
- Difficulty bending
Bruise or fracture: how to distinguish
They can only be reliably distinguished from a photograph. The warning signs should be very severe pain, the inability to sit even on soft things, a feeling of crunching at the time of injury, noticeable deformation or pain that does not subside after two weeks. A displaced fracture may require examination through the rectum and observation by a traumatologist. It is important to remember that even with a fracture of the coccyx, treatment is often conservative - operations are rarely performed.
- X-ray of the sacrococcygeal region in two projections
- Computed tomography with an unclear picture
- Digital examination of the rectum according to indications
- Signs of a fracture: crunching, deformation, unbearable pain
- Tactics for most fractures are also conservative
What to do immediately after an injury
In the first two days, apply cold through the cloth for 15 minutes several times a day - this will reduce swelling and pain. Do not sit on anything hard: use a ring pillow or two pillows on the sides so that the tailbone remains suspended. Try not to sit for long periods of time, get up and walk more often, and preferably lie on your side or stomach. To prevent constipation, which can make pain worse, drink enough water and eat fiber. The doctor selects painkillers.
- Cold in the first 48 hours
- Ring cushion or soft cushion for sitting
- Sleep on your side or stomach
- Avoid sitting for long periods of time and driving on uneven roads
- Soft stools: water, fiber, if necessary, laxatives as prescribed
- Pain relief as recommended by a doctor
Treatment and if the pain persists
Usually a gentle regime, pain relief and time are enough. After the acute phase subsides, physiotherapy, exercises to relax the pelvic floor muscles and work with posture when sitting are included. If the pain persists for more than two months, they speak of coccydynia - chronic pain in the tailbone. In this case, the doctor may suggest therapeutic blockades, manual techniques, and in rare cases, removal of the tailbone is discussed. Chronic pain requires exclusion of other causes: fistula, coccyx cyst, rectal problems. The doctor selects the treatment.
- Gentle mode and correct fit
- Physiotherapy after the acute period
- Exercises for the pelvic floor muscles
- Therapeutic blockades for persistent pain
- Exclusion of coccyx cysts and rectal diseases
- Surgical treatment is a last resort