Post-traumatic coccydynia

Post-traumatic coccydynia is caused by the development of pain in the coccyx after injury to the spine or pelvic floor area. This condition can have varying degrees of severity, depending on the severity of damage to nerve tissue. It can be accompanied by significant discomfort and impair a person's quality of life. Its treatment should not be delayed, as the pain may only get worse over time. High-quality medical care for post-traumatic coccydynia is provided in the coloproctology department of the Yusupov Hospital. Doctors of the highest category who have extensive experience in eliminating this pathology work with patients.

General information

The coccyx is four to five fused vertebrae and makes up the lower part of the spine. The coccyx is considered a vestigial organ (vestigial tail), although it continues to perform important functions in the body:

The muscles and ligaments of the large intestine are attached to it;
Plays an important role in the functioning of the genitourinary system;
Participates in distributing the load on the pelvic structures;
It is a fulcrum when sitting with your back tilted back.

Coccydynia is a collective name for pain in the coccyx area that was caused by various reasons. The pain is caused by damage to the nerve endings of the sacrococcygeal region or various parts of the spine. In the International Classification of Diseases (ICD-10), coccydynia is classified in the class “Other dersopathies M53” and has code M53.3 “Sacrococcygeal disorders not classified elsewhere.” That is, the disease is associated with pathologies of the spinal column, which can be caused by injuries or degenerative-destructive processes in its tissues.

Coccydynia may be accompanied by anorectal pain and disturbances in the genitourinary system or intestines. There is also such a thing as pseudococcydynia. In this case, pain in the coccyx is caused by proctological, urological or gynecological diseases.

At the Yusupov Hospital, patients with pain in the coccyx are prescribed a differential diagnosis to determine the exact cause of the pathology. For effective treatment, it is important to know the root cause of the disease, so patients are provided with consultations from various specialists to clarify the diagnosis:

Coloproctologist;
Gynecologist;
Urologist;
Traumatologist;
Surgeon.

Pain in the tailbone

Pain in the coccyx or, scientifically, coccydynia is the name given to unpleasant sensations localized in the lowest tip of the human spinal column. Most often, the main role in the occurrence of this condition is played by injuries: falls from a height onto the buttocks, external blows to the bones of the coccyx, etc. In this case, the injury can be received long before the onset of pain (from several months to several years) and women are 3 times more susceptible to the pathology more than men.

Anatomy

Despite the fact that the coccyx plays a rudimentary role in the human body, it has quite an important functional significance. The coccyx consists of 4-5 fused vertebrae, shaped like a bird's beak or a curved pyramid, inverted with the base up and the thin part down and forward.

The first coccygeal vertebra structurally carries modified superior articular processes that connect to the sacral bones and form the sacrococcygeal joint. Due to the natural characteristics of women, it is more mobile and, for example, during childbirth, the tailbone can lean back, expanding the diameter of the birth canal.

The anterior sections of the coccygeal bones serve for attachment of ligaments and muscles responsible for the activity of the organs of the genitourinary system and distal segments of the large intestine (coccygeal, iliococcygeus, pubococcygeus muscles, anal ligament, etc.). In addition, part of the muscle bundles of the gluteus maximus muscles, which are powerful hip extensors, is attached to the coccygeal spine.

In the anatomical structure of the musculoskeletal system:

the coccyx receives part of the load distributed along the spine during physical activity;
together with the pelvis, it participates in maintaining balance in a static vertical position of the body (center of gravity);
when a sitting person leans forward, the tailbone, ischial tuberosities and lower parts of the ischial bones act as an important fulcrum;
when the body is tilted back, most of the load of the spine is transferred to the coccyx.

Causes of the disease

There are many reasons for the development of coccydynia, but the main one is traumatic damage to the bones themselves, ligaments attached to them, muscles, nerve endings (cauda equina), myositis of soft tissues or the growth of scar fibers at the site of injury.

Other risk factors include:

osteochondrosis disease or various arthrosis affecting cartilaginous tissue, especially in the area of old bruises, fractures or subluxations;
pinching, inflammation or other damage to nerve fibers in the area of the coccyx and sacrum;
staying in a sitting position for a long time on a hard chair (for example, at work) or in a sacred pose (pulling your legs to your stomach, when the entire load of the body falls on the tailbone and sacrum).

In addition, pain in the coccyx can occur due to gynecological, proctological or urological diseases, congenital or acquired anomalies in the development of skeletal and pelvic bones. For example, the formation of hemorrhoidal scars, lumps after prolonged constipation, diarrhea or surgical interventions on the rectum can be complicated by anorectal pain. Prolapse of the uterus or perineum in women after childbirth can also cause discomfort in the bones of the tailbone.

Muscle spasms, hypertonicity of the muscles of the perineal area, contractures and contractions of the pelvic ligaments often cause the development of pain syndromes, but are rarely associated with diseases of the internal organs of the pelvis located near the tailbone. Therefore, quite often coccydynia is considered as an independent disease without suspecting that the root cause of its development lies in something completely different.

Symptoms

Despite the various causes of the disease, the symptoms in all cases are almost the same: pain in the area of the coccyx and rectum. The pain intensifies and becomes aching with prolonged sitting, and becomes sharp when a person rises from a chair or walks up the stairs. Such people are forced to refuse to visit public places where they need to sit for a long time (cinemas, cafes, concerts), and at work put a cushion or special rubber or silicone circles on a chair.

Sometimes coccydynia can be felt at the time of defecation, less often - urination, making a person’s existence unbearable. In some cases, prolonged sitting causes spasm of the perineal muscles with irradiation (spread) of pain to the groin and entire groin area.

In order to somehow alleviate the condition and relieve the load on the tailbone, a person tries to sit sideways (on one of the buttocks), but such actions do not lead to anything good. An unusual curvature of the spine in the lumbar region develops into fatigue and spasm of the back muscles, curvature of posture, and back pain is added to the pain in the tailbone. Any physical activity also causes discomfort, and the person subconsciously tries to limit the mobility of the sacral bones, which further aggravates the situation.

Vegetative symptoms are often added to the main signs of the disease: excessive sweating, dizziness, pallor or redness of the skin, nervous, depressive or emotional states. In some cases, post-traumatic pain in the coccyx goes away on its own without treatment, sometimes such a disease accompanies the patient for a long period of time, replacing remission with exacerbations.

Treatment

Treatment methods for coccydynia are determined depending on the causes of pain, the location of the pathology, and the general health of the patient.

Medicines are prescribed mainly to eliminate the root causes of the disease, relieve inflammation, swelling or pain if they are caused by diseases of the spinal column. In some cases, manual therapy (reduction of vertebrae or intervertebral discs), traction (spinal traction), corset therapy or other specific treatment methods are recommended.

Therapy for pain in the coccyx itself consists of a set of conservative physiotherapeutic measures and procedures:

rectal darsonvalization (irradiation of the mucous membranes of the rectum with pulsed high-frequency currents);
exposure to diadynamic currents (constant pulsed currents of low voltage and frequency);
ultrasonic or laser irradiation;
UHF procedures;
paraffin or ozokerite applications;
balneotherapy or mud therapy, etc.

Surgical treatment of coccydynia is carried out only in cases where conservative methods of therapy have not proven effective for a long time or pathological mobility of the coccygeal segment after injury (dislocation or fracture) is detected and this interferes with the normal functioning of internal organs.
The most optimal operation in such a case is considered to be the removal of the coccygeal bones; stabilization of the joint with special systems is used much less frequently, but surgical intervention does not always guarantee a complete recovery for the patient. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Causes

Post-traumatic coccydynia develops as a result of injury to the coccyx (bruise or fracture), spine, or surgery in the sacral area. The injury occurs after a fall or direct blow to the tailbone. Moreover, the first signs of pathology may appear a long period after the episode - several weeks or even several months.

In women, post-traumatic coccydynia can develop as a result of difficult childbirth or complicated pregnancy. This condition in women requires special attention from a gynecologist. In some cases, to avoid the development of complications, a woman may be prescribed a cesarean section.

Another risk factor is undergoing surgery in this area, as well as on the spine. During the operation, some nerve tissue may be affected, which as a result provokes the occurrence of coccydynia.

People over 40 years of age are at greatest risk. In this case, the disease is most often observed in women.

What happens when a coccyx injury occurs

Damage to the sacrococcygeal area is a condition in which compression occurs between the traumatic factor and the bone. As a result, pathological changes in tissues develop. Their formation can result from:

straight blow with the tailbone;
labor activity;
falling on the gluteal area, the likelihood of which is especially high in winter or during winter sports;
riding a bicycle equipped with a hard seat;
childhood, when the risk of injury is increased due to insufficiently strong bones;
the presence of bone processes, compressed nerve roots, local infections and tumors.

Pathological changes in injury to the sacrococcygeal region are characterized by the following manifestations:

disruption of the layer of subcutaneous and fatty tissue, since they are the first to be affected by the traumatic factor;
the presence of foci of hemorrhage that are associated with rupture of small vessels;
muscle breakdown;
the appearance of hematomas between tissues is a localized accumulation of blood. There is a high probability of hematoma suppuration, since blood is an excellent nutrient medium for the formation and growth of pathogenic microorganisms.

Depending on the traumatic factor and the intensity of the impact force, an injury to the coccyx can be combined with conditions such as sprain and rupture of the ligamentous apparatus in the sacrococcygeal joint.

Symptoms

The main symptom of post-traumatic coccydynia is pain in the coccyx. It can be paroxysmal or have a constant aching character. Pain syndrome can spread to other parts of the pelvic area:

Anorectal opening;
Crotch;
Genital organs;
Hips;
Small of the back.

Pain may intensify during sexual intercourse, with prolonged sitting, with a sudden change of position, during bowel movements. In the latter case, there is a risk of developing constipation based on fear of pain during bowel movements. “Psychological” constipation can lead to serious bowel problems that will require additional treatment.

Coccydynia significantly impairs a person's quality of life. If it lasts for a long time, the patient may develop:

Depression;
Sleep disturbance;
Anxiety;
Decreased performance.

Diagnostics

The diagnostic examination, which is prescribed by doctors at the Yusupov Hospital, is aimed, first of all, at establishing the actual causes of pain in the coccyx area. For this purpose, several methods of laboratory and instrumental research are used. When a patient first seeks medical help, the doctor at the coloproctology department will carefully listen to complaints, clarify the nature of the pain and examine the patient’s medical history. The doctor will conduct a physical examination and prescribe the necessary tests. Post-traumatic coccydynia can be identified if the patient has had episodes of injury to the coccyx in the relatively recent past.

The diagnosis of “coccydynia” will be established based on the results of the following study:

General and biochemical blood test;
Analysis of urine;
Coprogram;
Colonoscopy;
X-ray examination;
Ultrasound;
CT.

The Yusupov Hospital uses modern equipment, which ensures a high level of reliability of the results.

During diagnosis, the patient excludes diseases of the genitourinary system, proctological diseases (such as anal fissures, hemorrhoids, etc.), the presence of tumors in the pelvic area, and neurological diseases. At the Yusupov Hospital, the patient will be able to receive advice from the necessary specialists to clarify the correct diagnosis.

Treatment

The main factor in eliminating an unpleasant disease is treating the root cause of the pathology, if possible. Treatment tactics are determined based on the diagnosis and are compiled individually for each patient.

At the beginning of treatment for coccydynia, doctors at the Yusupov Hospital use conservative therapy, which is aimed at eliminating pain. The patient is prescribed painkillers and non-steroidal anti-inflammatory drugs. They can be used in the form of tablets or ointments. In severe cases, with severe pain, the hospital will inject anesthetic drugs. The patient's course of therapy will consist of medication and physical therapy.

If the pain cannot be eliminated and coccydynia does not subside after conservative therapy, surgical intervention is prescribed. The patient may be advised to remove the coccyx. At the Yusupov Hospital, the manipulation is carried out in operating rooms equipped with the latest technology, which significantly reduces the duration of the intervention itself and reduces the risk of complications.

After the operation, the patient’s recovery takes place in the rehabilitation department of the Yusupov Hospital. Experienced rehabilitation doctors prescribe a course of therapy, including massages, training on exercise machines, physical therapy, etc. The methods used contribute to a speedy recovery and restoration of the body.

Coccyx injury: treatment with osteopathic methods

Unlike a highly specialized doctor, an osteopath determines the root cause of the formation of this manifestation. With timely diagnosis, it is possible to relieve the patient from pain and discomfort once and for all or for a long time.

During an appointment, an osteopathic doctor faces a huge number of important tasks.

The specialist conducts a thorough examination of the patient, comprehensive diagnostics, establishes the main causes of pathological changes and the main links of negative processes;
Finds out whether in a given situation there are indications for osteopathic treatment and the degree of its effectiveness;
performs treatment of coccyx injury, which consists of the following main points:
helping to ensure that the anatomical formations and the sacrum take the correct position;
stabilization of blood supply and innervation;
normalization of the tone and condition of the pelvic floor muscles;
increasing the body's ability to self-heal and resistance.