Sacrococcygeal symphysis - Wikipedia

The coccygeal vertebrae are partially mobile only in the early stages of development of the body; in an adult, they grow together into one whole and cannot move. The upper vertebra is the largest, the dimensions decrease towards the legs; due to this design, the tailbone has the appearance of an equilateral triangle with the apex pointing downwards. Vertebrae have only bony bodies. On the largest first one, the remains of processes found in ordinary vertebrae, which are associated with the sacral ones, are clearly visible. With this structure, a special connection is formed. In women, this connection is mobile and plays an important role during childbirth. As the baby passes through the birth canal, the tailbone bends back, which increases its size and facilitates the appearance of the newborn.

Coccygeal vertebrae

Anatomy and structure

The coccyx (os coccygis) is located at the very bottom of the spine and is considered a vestigial (unnecessary) organ. Depending on the anatomical features, it can have from three to five vertebrae; therefore, there is no stable number of vertebrae in the entire spine. 25% have three coccygeal vertebrae, only 10% have five and 75% have four coccygeal vertebrae. It appeared as a result of human evolution; it is an underdeveloped tail. Due to upright walking, such an organ has become unnecessary; nature no longer uses it for its original purpose.

Coccyx

But the coccyx retained some important functions in life.

1. Ligaments and muscles are attached to the anterior sections and take part in supplying the genitourinary organs and the lower part of the large intestine. There are three muscles, they are called the coccygeus (attached from below), the iliococcygeus (attached to the sides) and the pubococcygeus (attached from the front). They form an important muscle that lifts the anus and prevents it from falling out during heavy physical exertion. In addition, the coccygeal ligament is responsible for the process of defecation.

   
   Muscles and fascia of the male pelvic floor

   
   Muscles of a woman's perineum

2. The muscles of the buttock are attached to the lateral surfaces of the coccyx. These are one of the largest muscles in humans and are responsible for hip movements. Withstands significant loads, plays a decisive role during walking and running, flexion and extension of the body.
3. Optimally distributes loads across the pelvis. When bending forward, the lower branches of the bones and the ischial tuberosities are used as points on which the body rests. When he leans back, a significant part of the resulting loads is transferred to the tailbone. Due to this, the balance of the body is maintained and the risks of critical loads are reduced.

The coccyx is considered a vestige of the tail

The sacrococcygeal area quite often fuses; the connection of the bones can be unilateral or bilateral. There are options for cartilaginous joints. Nerve plexuses are located on the anterior surface of the bones.

Preparation for CT scan of the sacrococcygeal region

No special preparation is required for the procedure without contrast. On the eve of a CT scan of the sacrococcygeal region, you can take medications; you do not need to refuse food. You should arrive for diagnostics approximately fifteen minutes before the appointed time to sign the contract and fill out the form. You must have your passport, a doctor’s referral, and the results of previous examinations with you.

If, according to indications, a computed tomography scan of the sacrococcygeal region with contrast is prescribed, the patient must donate blood for creatinine. Some centers do a rapid test on site. Exceeding the permissible limits is a contraindication for the procedure.

Before the examination, mothers with infants are advised to prepare food for their babies: after contrasting, the milk will have to be expressed twice and poured out.

Intraosseous pneumocyst of the sacrum on a computed tomogram

Mechanical damage to the coccyx

Most often, bruises occur, and fractures are much less common, but patients do not always visit medical institutions to make an accurate diagnosis. The damaged areas heal independently, which may cause a violation of the spatial position of both the coccyx as a whole and its individual sections. Depending on the force of the impact, fractures may be displaced or non-displaced. Accordingly, displacement injuries require much more time to heal; in addition, there are risks of improper fusion with all the negative consequences. In addition to fractures, mechanical injuries can result in dislocations of the joints in the coccyx and ruptures of the cartilage tissue between the vertebrae and the coccyx.

Symptoms of a tailbone injury

What is coccydynia

The second name is anococcygeal pathology. This disease causes many problems for the patient, he is limited in movements, rapid bending causes acute pain, which often turns into chronic pain. If measures are not taken to treat the pathology, the pain syndromes spread wider and cover the perineum, lower abdomen and thighs.

Coccydynia (pain in the tailbone area)

It is very difficult to determine the specific causes of the disease; a lengthy examination is required using the most modern medical devices. A full examination includes a consultation with a psychiatrist. There are cases when the cause of unpleasant sensations lies in the patient’s mental disorders. But most often this is a consequence of previous injuries, combined with age-related changes in the body. Treatment is individual and long-term. The use of medications is combined with physical therapy.

Table. Symptoms of the disease.

What is coccydynia

Often, as a result of falls on the buttocks, subluxation of the coccyx occurs; these are not cracks in the bone tissue, but a slight displacement of the vertebrae in relation to the physiological position. The procedure for correcting pathology occurs in several stages.

Is contrast necessary?

If it is necessary to confirm or refute the presence of tumors, a CT scan of the coccyx is performed with the use of additional radiocontrast agents - special preparations containing iodine, which, when administered intravenously, stain the vessels. Tumors have their own blood supply network, so pathologically altered areas begin to stand out clearly in the photographs. Thanks to this, the doctor can see the location, size of the space-occupying lesion, the degree of destruction of bone tissue and other parameters.

A CT scan of the sacrococcygeal region with contrast is performed for the purpose of differential diagnosis of tumors and cysts.

Computed tomography of the sacrum and pelvis with contrast

After injection of an iodine-containing substance, side effects may appear:

• pain at the injection site;
• metallic taste in the mouth;
• flushes of heat in the body.

These symptoms are not life-threatening and do not require medical attention.

Indications for stopping the procedure are:

• nausea, vomiting;
• itching;
• hives;
• swelling of the ears, face;
• difficulty breathing;
• bronchospasm;
• lowering blood pressure.

Any sign of a complication should be reported to the radiologist via a voice communication device.

Sacral osteosarcoma on CT scan

Causes of sacral injuries

In addition to mechanical ones, there are other reasons for the appearance of coccyx pathologies.

1. Congenital pathologies or birth injuries . The first are explained by various genetic failures of one or both parents. They are not diagnosed in the early stages; treatment is long and not always effective. Complex surgery is often required. Treatment must be carried out in modern, well-equipped clinics.
2. With abnormal development of the pelvic organs. A disproportionate increase in the size of the pelvic organs provokes situations where the blood vessels leaving the sacral canal are compressed. As a result, insufficient tissue nutrition and stagnation occur. All of them cause pain syndromes of varying intensity. In particularly difficult cases, soft tissue necrosis may develop. Treatment becomes more complicated, and the prognosis for the outcome is unfavorable.

   
   Pelvic organs in women

   
   The structure of the male pelvic organs

   Read also:  Cruciate ligament rupture: surgery, rehabilitation, costs
3. Chronic increase in load on the sacrum . This situation occurs with disorders of the development of the spine, scoliosis, etc. The redistribution of efforts is chronic, which negatively affects the development of the coccyx. The vertebrae become curved, injure nearby tissues, and irritate the nerves. In this case, the pathology of the coccyx is a consequence, not a cause. Doctors direct all their efforts to treating the main disease; subsequently, the pain in the tailbone goes away on its own as soon as the irritants that cause it disappear.

Bruises

Unlike fractures of varying complexity, with such injuries the organ remains intact. After bruises, hematomas and minor hemorrhages into soft tissues form. Subsequently, taking into account the intensity and characteristics of the body, the hematomas disappear without a trace or degenerate into formations in the form of small thickenings. Neoplasms are benign in nature, but with a combination of unfavorable factors they can degenerate into malignant ones. As a result of bruises, myositis often develops, and it is accompanied by severe pain. Further, there may be a sharp deterioration in the quality of life, restrictions in movements and exercise.

Bruises of the sacrum and coccyx most often occur as a result of a fall, and women suffer from such injuries 4 times more often than men

At the very moment of the bruise, the patient feels severe pain, but over a short period of time it fades and then disappears completely. This situation does not encourage visiting a doctor, which can have adverse consequences. If pain after a fall periodically appears during movements or exertion, then this is a signal of the development of pathology. An immediate visit to a medical facility for an in-depth examination is required.

Due to bruises, the patient cannot sit with emphasis on both buttocks; the pain disappears only after he sits with one buttock, and the tailbone is completely freed from stress. There are cases when problems arise during bowel movements and sexual intercourse.

How to fall correctly

According to severity, bruises are divided into two categories.

1. Lungs . At rest there are no unpleasant sensations; pain appears only after mechanical pressure is applied to the bruised area. A special sign is that after standing for a long time, difficulties arise when trying to bend over or sit down. But after changing the position, the pain subsides after a few minutes, the intensity is tolerable, and does not require the use of painkillers. The bruised area swells and becomes red or bluish.
2. Heavy . A very unpleasant situation that can have serious consequences. Painful sensations are constant; changing posture can only intensify or weaken them. The mobility of the hip joint is very limited; it is difficult for a person not only to make any movements, but also to sit or stand quietly. After a severe injury, deep hematomas can form, located in the muscles or nearby tissues. Immediately after a strong blow or a fall from a great height, pain that is difficult to bear is felt; after 5–8 minutes it subsides a little, but then increases again. Sometimes such conditions cause a frequent urge to urinate or, conversely, delay it for a long period of time. The temperature rises, which indicates the onset of pathological inflammatory processes in the tissues. Not only the tailbone hurts, but also the head and pelvic organs.

Condition of the coccyx and dura mater with bruises

Where is the sacroiliac joint located?

The anatomical formation located at the base of the human skeleton is called the pelvis. Consists of two bones, the sacrum and coccyx. The above elements form a ring that serves to attach the lower limbs to the body and contains a number of vital structures: reproductive organs, bladder, parts of the colon, lymph nodes, blood vessels.

The pelvic bone is a fusion of the ilium, ischium and pubis, which join to form the acetabulum. The latter is the site of attachment of the lower limb.

The connection between the ilium and the sacrum is called the sacroiliac joint. This is the largest paired joint in the human skeleton, held in place by the strongest ligaments. The SIJ interacts with many muscles: the gluteus maximus, piriformis and latissimus dorsi. The range of motion in the joint is small; its main tasks are to support the body and reduce the load when walking.

The main functions of the joint are:

• bends;
• fixing the body in a sitting position;
• depreciation of the lower limbs and torso when running and jumping.

A disturbance within the sacroiliac joint leads to dysfunction of the entire biomechanical line of the pelvic ring. Subsequently, deformation of other joints of this complex occurs, which irreversibly impairs the ability to move.

Model of the pelvis. KPS are indicated in green.

Critical coccyx fractures

The most complex mechanical injuries cause damage to internal organs. What are the consequences of critical coccyx fractures?

1. Bladder bruise, in severe situations there may be a rupture. Characterized by severe pain, blood in the urine, difficulty urinating, fever - clinical signs of bladder problems.

   
   Bladder rupture is accompanied by characteristic symptoms

2. Damage to the uterus. Blood clots are released, aching pain around the pubis. The genitals are bursting, there is a feeling of tension and pressure.
3. Damage to the rectum. Red or brown stool, pain during bowel movements. Constipation may occur regardless of the food consumed.
4. Irritation of nerve endings. Fractures can cause not only irritation, but also damage or rupture of nerves. The pathology is characterized by very strong pain, the patient may experience painful shock. The functionality of the pelvic organs and lower extremities is impaired. Sensitivity decreases, visible deviations in physiology are noticeable.

Consequences and symptoms of a coccyx fracture

In all cases of internal bleeding, you should consult a doctor as soon as possible. Only after diagnosis is the optimal treatment regimen prescribed; in particularly difficult cases, it is necessary to stay in a medical facility under the constant supervision of doctors.

Diagnosis of coccyx pathology

At the initial stage of diagnosis, an anamnesis is taken. The doctor asks the patient about possible falls on the tailbone, injuries, and critical physical activity. He is interested not only in complaints of pain, but also in the probable cause of their occurrence. If the medical history is not sufficient to make a diagnosis, then additional examinations are prescribed. As a rule, this is an ordinary radiography. Modern devices and high-quality films provide a clear picture of the condition of all the vertebrae of the coccyx and allow a final diagnosis to be made. If no pathologies are detected on x-rays, then the cause of the pain lies in the soft tissues. Their standing can only be determined after an MRI examination.

Diagnostic features

Causes of pain

You should know that women suffer from this problem much more often than men. The fact is that their center of gravity, due to the peculiarities of their anatomical structure, is placed low at the level of the hips, and the fall occurs on the buttocks. As a result, the tailbone is injured. In men, the center of gravity is much higher, they fall on their back, and the tailbone suffers much less often.

1. Trauma . Tear or rupture of soft tissue of varying degrees, damage to the circulatory system and hematoma. The tissues become inflamed, swollen, and painful.
2. Irritation of nerve bundles . These syndromes are more difficult to diagnose due to the fact that pain may appear in the organs with which they are associated. An injury to the coccyx is felt in the limbs, internal organs, etc.
3. With severe dislocations, the last vertebra of the coccyx can directly irritate the intestine . Without an x-ray, a diagnosis cannot be made; self-medication can have extremely serious consequences.

Coccyx dislocation

Help for a bruised tailbone

The first rule is to not panic, touch the tailbone and check its integrity. Doctors recommend lying on your stomach or side and applying a heating pad with cold water to the damaged area. Low temperature helps to quickly stop bleeding, due to which the hematoma decreases in size. The smaller the hematoma, the faster it will resolve in the future.

In the first hours after the injury, ice is applied to the site of the bruise to relieve pain and prevent the hemorrhage from expanding.

If the pain is very severe, then you need to use any painkiller and visit the hospital as soon as possible. It is better to have an assistant, and transportation is carried out in a supine position. Such precautions prevent deterioration of the situation due to further displacement of the injured areas of the coccyx.

The treatment method is chosen by the doctor taking into account the degree and danger of the damage, the patient’s standing and the existing risks of complications. In all cases, a set of special measures is taken to reduce pressure on the damaged tailbone: sitting circles, lying on the stomach or side, orthopedic pillows for lining the spine. In the first days, it is often recommended to take laxatives to reduce pain during bowel movements. Food should be liquid and not cause constipation.

Treatment of bruises of the coccyx and sacrum

Therapeutic gymnastics is aimed at restoring blood supply to damaged tissues and accelerating their regeneration. Before classes, it is recommended to obtain qualified medical advice.

UHF, electrophoresis with anesthetics and anti-inflammatory drugs, fibrinolysin, trypsin, aminophylline are prescribed

Video - Exercises for pain in the tailbone

Notes

1. ^ a b c d f g gram h
   Morris (2005), p. 59
2. ^ a b c d e
   Palastanga (2006), p. 334
3. ^ a b c
   Huijbregts (2001), p.13.

Consequences of bruises

Negative consequences occur rarely and only after very significant mechanical damage to the coccyx. If you do not undergo special treatment, pain can become chronic, be constant, and occur not only when sitting or while moving, but also at rest. In advanced forms, the pain does not disappear at night and becomes aching. The quality of life noticeably deteriorates, treatment of complications takes longer and requires more effort and financial resources.

Sometimes doctors make a diagnosis of post-traumatic coccydynia. Treatment is complex and includes taking certain medications, physiological procedures and physical therapy.

Post-traumatic coccydynia

Injuries to the sacral plexus can cause a decrease in the sensitivity of the lower extremities; they provoke problems during sexual intercourse, urination, and defecation. Sometimes they complicate the birth process.

Recommendations

This article incorporates public domain text from page 309 of the 20th edition

Gray's Anatomy
(1918)

• Morris, Craig E. (2005). Low back syndromes: integrated clinical management
  . McGraw-Hill. ISBN 0-07-137472-8.
• Huijbregts, Peter A. (2001). "In the book: Modern concepts of orthopedic physiotherapy." Lumbopelvic region: anatomy and biomechanics
  (PDF). APTA.
• Masquelet, Alain S.; Christopher J. McCullough; Ian S. Fife; Raul Tubiana (1993). Atlas of surgical interventions on the lower limb
  . Taylor and Francis. ISBN 1-85317-003-8. (Nice illustration of the posterior and lateral ligaments.)
• Palastanga, Nigel; Field, Derek; Soames, Roger (2006). Human Anatomy and Movement: Structure and Function
  . Elsevier Health Sciences. ISBN 0-7506-8814-9.