Coccydynia (pain in the tailbone). Treatment of coccydynia

Coccydynia is called pain in the coccyx - this is a rather rare and not entirely studied pain syndrome, which manifests itself as constant pain in the very lower part of the spine. The pain is usually clearly localized and worsens when sitting or when putting pressure on the lower spine. This syndrome is much more common in women than in men. Typically, the cause is injury (fall) or childbirth. In rare cases, infection or tumors may be the cause. The term coccydynia has a long history as a poorly understood syndrome. At the beginning of the 20th century, this diagnosis was very popular and designated all pain syndromes in the lumbosacral spine. And, Alas, surgical treatment methods (removal of the coccyx - coccygectomy) were quite often used to treat pain syndromes in the lumbosacral region.

The results of surgical treatment were different. Then the pendulum of medical opinion swung in the other direction and, as was mainly observed in women, it began to be considered a neurosis. Due to the fact that the operation often had no effect, it was decided that the pain was psychogenic in nature and operations were stopped for a long period of time. Currently, these two extreme points of view do not exist in the medical community. It is generally accepted that coccydynia exists as a real syndrome.

The tailbone is the lowest part of the spine. It is a vestigial tail and consists of 3-5 small bones. Essentially these are underdeveloped vertebrae connected to each other. It was initially assumed that the components of the coccyx were completely fused and devoid of any mobility in relation to each other. It turned out that the coccyx is not a single bone formation and there is a very small range of motion between its component parts due to fibrous joints and ligaments. The coccyx is connected to the sacrum by a rudimentary disc and ligaments. There is also a limited range of movement between the sacrum and coccyx. The more frequent presence of coccygodenia in women is explained by several factors: greater rotation of the pelvis and a wider pelvis, which increases the risk of injury to the coccyx.

Causes of coccydynia

It is still not clear which anatomical part is responsible for the pain. In many cases, the cause of the pain cannot be determined (idiopathic coccydynia). Basically, the pain can be caused by injury or overuse of the area, which causes the tailbone bones to move slightly, resulting in inflammation and pain. The main possible causes of coccydynia:

• Local injury. A fall on the tailbone can cause injury to the ligaments of the tailbone itself or the area connecting to the sacrum. This is the most common cause of coccygodenia.
• Childbirth. During childbirth, the baby's head, emerging from the pelvis, puts pressure on the tailbone and injures the ligaments and sometimes leads to fractures of the tailbone.
• Overpressure. Certain activities that place prolonged pressure on the tailbone, such as riding a horse or sitting on a hard surface for long periods of time, can cause tailbone pain. In such cases, the pain is usually not constant. But, if the influencing factors persist and no treatment is carried out, the pain can become chronic.
• Tumor or infection. Very rarely, the cause of pain in the tailbone can be infections or tumors in the tailbone area, which put pressure on the tailbone and cause pain.

Symptomatic treatment

Treatment tactics are determined individually, taking into account the identified causative pathology. A common measure to reduce tailbone pain is rest. You should avoid sitting and, if possible, limit physical activity, especially bending forward, lifting heavy objects, and brisk walking. It's better to lie on your stomach. For short-term relief of severe pain after injury, chloroethyl can be used. Moderate pain is eliminated with tablets and local forms of analgesics; for intense pain, drugs for intramuscular administration are used. It should be remembered that painkillers eliminate pain, but do not affect the cause of its occurrence, they cannot be used constantly and uncontrollably.

Before visiting a doctor, the tailbone should not be massaged, heated or steamed in a hot bath - this can stimulate the development of inflammation, accelerate tumor growth, or increase hemorrhage during injury. The presence of increasing or persistent pain, the appearance of a painful swelling, fistula or tumor-like formation in the coccygeal region, disruption of the act of defecation, detection of pathological impurities in the feces, increased body temperature and signs of intoxication for pain in the coccyx are indications for urgent consultation with a specialist.

Diagnosis of coccydynia

The diagnosis of coccydynia is made based on the history and physical examination. Instrumental examination methods are used in cases where it is necessary to exclude other possible causes of pain.

Physical examination. A rectal and vaginal examination is performed to palpate to determine the possible presence of a tumor that may be causing pain. In addition, palpation is necessary for the presence of local soreness of the coccyx. The absence of pain when pressing on the tailbone indicates that the pain has a different origin (lumbosacral disc herniation or osteochondrosis). Among the instrumental research methods, radiography is used (radiography of the coccyx and sacrum allows us to see the presence of fractures or large tumors) and MRI (allows us to diagnose infections and tumors). As a rule, CT and scintigraphy are not used, due to the lack of information in this syndrome.

Survey

Initially, patients usually turn to a traumatologist, orthopedist or rheumatologist. Depending on the nature of the pain syndrome, the circumstances of its occurrence and the data obtained during the examination, the doctor may refer the patient for consultation or examination and treatment to an oncologist, gynecologist, urologist or proctologist. The list of diagnostic techniques for pain in the tailbone usually includes the following procedures:

• General inspection.
  The specialist detects crepitus in fractures, signs of inflammation (edema, hyperthermia and hyperemia), fluctuation indicating fluid accumulation, space-occupying formations and fistula tracts. The doctor determines the exact location of the pain, specifies which structures it is associated with - the tailbone itself or the soft tissues.
• Rectal examination
  . It is performed in the absence of intense pain caused by suppuration in the area of ​​the rectum and nearby tissues. During a rectal examination, tumors and infiltrates in inflammatory diseases are identified, the location and structure of the coccyx is assessed, and compacted ligaments in coccydynia are determined.
• X-ray examination.
  X-ray of the coccyx is a basic diagnostic technique and is recommended for all patients with pain of characteristic localization. To improve visualization, images are taken after colon cleansing. In the presence of fistulas, contrast fistulography is indicated.
• Ultrasonography
  . Ultrasound of the soft tissues of the coccygeal region is an inexpensive, accessible diagnostic method that allows one to assess the condition of soft tissues, identify areas with altered structure, cysts, abscess cavities and inflammatory infiltrates.
• CT and MRI
  . In case of uncertain radiographic data, to clarify the condition of solid structures, patients with suspected traumatic injury, neoplasm or degenerative process undergo a CT scan of the coccyx. For an in-depth study of soft tissues in inflammatory processes and tumors, MRI is performed.

The list of other methods varies significantly. The diagnostic search may include sigmoidoscopy, ultrasound of the abdominal cavity and pelvis, irrigoscopy, proctodedecography and electrophysiological studies. If tumors are detected, a biopsy is required. According to indications, general blood and urine tests, blood biochemistry and other studies are prescribed.

CT coccyx

What diseases can cause pain

Aching or other pain in the lower back appears for the following reasons:

• hemorrhoids, when the rectum descends, its microflora is disrupted, lesions and micro-tears occur;
• sciatica (lumbosacral radiculitis);
• anal fissure;
• paraproctitis;
• arthrosis;
• arthritis;
• intervertebral hernia;
• displaced vertebrae in the spine.

The disease cannot be determined by its symptoms, so a whole range of studies may be required to determine the exact cause of the pain.

Who should I contact if I have pain?

My tailbone hurts, what should I do in this case? Coccydynia often has a history of a large number of different pathological processes, so the choice of a specialist to whom you should immediately contact should be made taking into account the source of the problem:

• traumatologist - provides assistance when the tailbone hurts;
• You can also contact a surgeon for help in case of injuries or manifestations of coccydynia during pregnancy and after childbirth;
• a gynecologist and urologist specialize in diseases of the genitourinary system leading to coccydynia;
• a proctologist treats diseases that provoke coccydynia, such as pathologies of the rectum (hemorrhoids, proctitis, colitis, etc.), anal deformity;
• An osteopath, a vertebrologist, and a chiropractor work with the unknown factor of the presence of pain and its absence when you relax.

You can contact specialists at the Aspect of Health neurology and neurorehabilitation clinic in Ufa. In our clinic, consultations are conducted by highly qualified specialists who will help localize the source of coccydynia and draw up a plan for what to do if the tailbone hurts, avoiding unnecessary medications and surgeries.

Troubleshooting

First of all, therapy is aimed at eliminating the disease that caused pain in the tailbone. If the cause is established, your doctor will recommend what to do next. Drug treatment is prescribed for diseases of the internal organs, and for osteochondrosis, therapeutic exercises and proper nutrition are necessary.

Therapeutic exercise is mandatory in the complex treatment of spinal diseases

Diagnosis of pain in the coccyx

For many people, coccydynia is not a reason to seek medical help. They simply do not pay attention to its clinical manifestations or try to eliminate them using folk methods. However, pain can be caused by life-threatening diseases, including malignant tumors, the treatment of which is successful only in the early stages.

A specialized specialist will conduct a diagnosis, find out why the tailbone hurts and prescribe the optimal treatment regimen.

If you experience pain in the lower spine, you should consult a neurologist. At the first appointment, the specialist’s task includes examining the patient and palpating the affected area. It is also necessary to collect an anamnesis by asking a person about past illnesses, surgical interventions, and traumatic injuries.

The patient is then referred to:

• laboratory tests (blood, urine);
• radiography to detect changes in bone structure, fractures, bruises, cracks, separation of the coccyx from the joint, rupture of intervertebral cartilage and other injuries;
• computer and magnetic resonance imaging are the most effective methods that will help determine not only the condition of bones, but also soft tissues, blood vessels, cartilage, and intervertebral discs. The specialist has the opportunity to obtain clear information about all pathological changes, the presence of tumors, their exact location and impact on nearby structures;

• Ultrasound refers to a typical examination that is prescribed for the diagnosis of coccydynia.
• sigmoidoscopy is an endoscopic examination prescribed to detect hemorrhoids, polyps, and inflammatory processes.

Possible purpose:

• myelogram – morphological analysis of bone marrow cells in cases of suspected hemoblastosis and metastases of malignant tumors;
• densitometry - which allows you to determine the density and likelihood of damage to bone tissue;
• irrigography - X-ray examination of the intestines. When it is carried out, a contrast agent is used;
• evacuation proctography - x-ray examination for visual assessment of rectal emptying;

It is possible to schedule a consultation with a proctologist, urologist, gynecologist, oncologist, or traumatologist to identify pathologies in their area.

How to minimize the consequences of an impact?

The first thing to do when you bruise your tailbone is to minimize the load on the spine. If possible, you need to lie on your stomach and wait until the pain subsides. Then try to get up, listening to your feelings. Severe pain may indicate serious injury that requires immediate medical attention.

What to do if you have a severe bruise on your tailbone, if you can’t see a doctor right away? You need to try to minimize the consequences of the injury on your own. First, you should apply something cold to the bruised area to prevent swelling. Any analgesics, as well as various ointments and gels, can be used as painkillers, but provided that the skin at the site of the bruise is not damaged. First aid largely determines how long a bruised tailbone takes to heal.

What is the coccyx and why is it needed?

The tailbone is the final part of the spinal column. It consists of three to four (less often five) fused vertebrae and is connected to the sacrum via an intervertebral disc, which allows the coccyx to deviate. The coccyx has the shape of an inverted pyramid and looks like a bird's beak, with the width always exceeding the length.

The pubococcygeus, iliococcygeus and coccygeus muscles, the anal-coccygeal ligament, as well as part of the gluteal muscle bundles are attached to this organ. Although the coccyx is considered a rudimentary part of the spine, in fact it performs a number of important functions:

• Participates in uniform distribution of the load on the spinal column.
• Due to its displacement and expansion of the birth canal, it ensures the normal passage of the fetus during childbirth.
• Promotes normal mobility of the hip joint.
• Serves as an attachment point for ligaments and muscles that ensure the functioning of the pelvic organs and lower intestine.
• Participates in the implementation of the support function when squatting and bending the body.

Why does the tailbone hurt?

To understand why the tailbone begins to hurt when you sit and stand up, it is worth considering its function in the body. This is a rudimentary part of the spinal column, consisting of 3–6 vertebrae, to which muscles and ligaments from the pelvic organs are attached. Therefore, the coccygeal part of the spine is closely connected with these organs and reacts to any of their pathological conditions. The tailbone performs an important function - it partially distributes the load on the body and at the same time is its vulnerable part. If your tailbone hurts when you sit and stand up, a common cause is damage due to injury or disease.

Evidence base

• Stretching the piriformis and iliopsoas muscles, as well as Maitland rhythmic oscillatory chest mobilization for 3 weeks (5 sessions per week) showed a significant improvement in pain threshold.

• Extracorporeal shock wave therapy was more effective and acceptable in reducing the discomfort and disability caused by coccydynia than the use of other physical methods. Thus, it has been recommended as an alternative treatment option for patients with coccydynia.

• A combination of manipulation and corticosteroid injections was more effective in treating coccydynia compared with manipulation or corticosteroid injections alone. Patients who underwent treatment were completely free of pain at the end of the year.

• 16% of patients (Wray) had a positive effect from short-wave diathermy.

Why do you need to see a doctor right away?

If characteristic symptoms are present several hours after a tailbone injury, the consequences of the injury can be serious. A doctor’s consultation and diagnosis are necessary, because often we are talking about more than just soft tissue damage. Typical pathologies include:

• dislocations and subluxations;
• fractures;
• vertebral displacement;
• sprains, rupture of tissues and ligaments.

Without a medical examination, it is impossible to determine the consequences of the injury. If you don’t know what to do or how to treat a bruised tailbone, the doctors at our clinic will not only provide first aid, but also select the best rehabilitation options.

What is the danger of not paying attention to such a problem as a bruised tailbone? In addition to serious injuries that can be hidden behind a banal fall into ice, dysfunction of the musculoskeletal system is possible, up to the development of paralysis of the lower extremities. Among serious pathologies, experts note problems with childbirth in women, loss of sensitivity in the intimate area due to compression of nerve endings. Over time, fistulas or bone calluses, benign or malignant neoplasms may appear at the site of injury.

Diagnostic and treatment methods

If your tailbone hurts when you sit and stand up, a comprehensive examination is necessary. The following are used today as effective diagnostic methods:

• X-ray
  : allows you to identify pathologies and injuries of the coccygeal bone;
• ultrasound examination: necessary to identify pathologies of organs and soft tissues of the pelvis;
• examination of the intestines using endoscopic and non-endoscopic techniques: this is an effective way to confirm the diagnosis with a proctologist;
• tomography: necessary for a detailed examination of already identified pathologies.

A patient with this symptom requires consultation with a number of specialists: proctologist, surgeon, neurologist, gynecologist
or
urologist
. How to treat the tailbone, which hurts when you stand up and sit, the doctor decides based on the diagnosis. The patient may be prescribed the following treatment methods:

• Medication: in this case, painkillers and anti-inflammatory drugs are prescribed to relieve swelling and spasms.
• Physiotherapy: gentle pressure on the muscles improves blood supply to the coccygeal area and speeds up recovery.
• Massage: aimed at improving blood circulation, suitable for chronic pain.
• Exercise therapy: helps not only to improve the patient’s condition, but also to prevent relapse of the disease.
• Surgery: performed only in extreme cases, when other treatment methods have not brought the expected result over a long period of time.

It is worth knowing that if the tailbone hurts when you sit and stand up, especially severely, and the disease is in the acute phase, some treatment methods are contraindicated. Therefore, using them without the knowledge and consent of a doctor is strictly not recommended.

Final indicators

Pain level assessment

• 4-dimensional pain intensity index (P4).
• Brief pain questionnaire.
• Numerical pain rating scale.
• Brief McGill Pain Questionnaire.
• Visual analog scale.

Level of function in daily life

• Pain Disability Index (Oswestry).

Specific questionnaires

• Pelvic floor questionnaire.
• Questionnaire for assessing the pelvic girdle.

How to avoid pain

If pain occurs in the lower back area, the first thing you need to do is find the cause and treat it.

. However, until therapy is started and completed, you can fight the aching feeling.

A few recommendations on how to avoid tailbone pain:

• Don't sit in one position for a long time
  . Get up every 30 minutes and stretch. Physical activity will help avoid increasing pain in the lower back;
• Watch your sitting position
  . Even if the pain occurs when straining, that is, standing up and trying to sit down, this is true. Lean forward periodically - this takes the load off your spine. Sit up straight;
• Take a course of massage sessions
  . If someone close to you can help, ask for a back massage every day in the morning and evening for at least 5 minutes. You can also do this yourself;
• Keep an eye on proctological problems
  . If there is discomfort in the rectum, if there are problems with stool, this may in the future cause pain in the tailbone when sitting. If there is already pain, then you can periodically stand up, bend over, and rotate your pelvis. This is also true for arthritis and arthrosis, and lack of intra-articular fluid.

Exercises to relieve pain

One of the simplest complexes for pain in the coccygeal area is gymnastics with a ball. Regular exercise allows you to get rid of pain and strengthen the pelvic floor muscles, including the pubococcygeus. If it hurts during exercise, then you must immediately stop doing gymnastics. The main part of the exercises is performed lying on the floor.

Approximate charging complex:

1. Lying on your back, pull your knees bent towards your chest. Then perform the fly-out 10-12 times, resting 10-15 seconds between sets.

2. Remaining in the same position, place a medium-sized ball between your knees. It is necessary to squeeze it for 5-7 seconds, then relax for 10-15 seconds. Repeat the exercise 6-8 times.
3. Straighten your legs, roll the ball to your feet and squeeze it with the inner surface of your ankle joints for 5-7 seconds. The number of approaches is 6-8 times, with a rest interval of 10-15 seconds between them.
4. In a lying position, bend your legs and place your feet as close to your buttocks as possible. Smoothly raise and lower your pelvis without putting pressure on your back. All the work falls on the gluteal muscles, back muscles, abs and pelvic floor (including the pubococcygeus).

5. The “boat” exercise, when lying on your stomach, the upper and lower limbs are raised as high as possible above the floor. Repeat 2-3 times with a five-second break between sets.
6. The final stage of charging will be smooth bends and turns of the body to the sides in a standing position.

After gymnastics, it is advisable to do a light massage of the coccygeal area.