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Coccygodynia (tailbone pain)

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Coccygodynia (tailbone pain)

Coccygodynia is pain in the coccyx of a persistent or paroxysmal nature. Coccyx pain occurs mainly in females. The coccyx in women is mobile relative to the sacrum, in contrast to men. This is due to the mobility of the coccyx in connection with the reproductive function.

Coccygodynia occurs as a result of traumatic and inflammatory damage to the coccyx, as well as the sacral and coccygeal nerve plexuses. A certain connection with diseases of nearby organs (pelvic bones, rectum, pelvic tissue, pelvic floor muscles, etc.) is also possible.

Coccygodynia (pain in the tailbone) appears when falling on the tailbone.

The clinical picture of coccygodynia is characterized by constant or paroxysmal pain in the coccyx region, which intensifies when sitting, standing up, defecating, often radiating to the perineum, gluteal region, genitals, inner thighs. Pain in the tailbone is aching, burning, boring in nature, sharply limits the physical activity of patients, prevents them from sitting.

When examining the patient, soreness is determined with pressure on the tailbone. In some cases, traumatic coccygodynia can disappear spontaneously, which is explained by the resorption of hematoma and scars. However, in most cases, it proceeds for a long time and persistently, and remissions are replaced by exacerbations.

Wearing a lumbosacral brace helps in the treatment of pain in the sacrum with sacroiliitis and arthrosis of the sacroiliac joint in pregnant women.

Wearing a lumbosacral brace helps in the treatment of pain in the sacrum with sacroiliitis and arthrosis of the sacroiliac joint in pregnant women.

Perhaps, patients with this syndrome are the majority of humanity, patiently looking for their doctor and often finding "comfort" after visiting psychiatrists, psychic doctors. The problem is that a representative of a medical specialty who has an interest in the zone of the spread of painful sensations necessarily finds any pathological change in the organs that make up the totality of the pelvic cavity.

Bending, even dislocation of the coccyx, varicose veins of the rectum, bending of the uterus, residual effects of inflammatory processes, prolapse of the pelvic organs, etc. are often determined.

The tailbone in men is not mobile relative to the sacrum, in contrast to women.

Since the condition of the pelvic organs plays a significant role in the formation of the patient's emotional background, depressive reactions are an obligatory companion of coccygodynia syndrome.

 

Diagnosis of coccygodynia (tailbone pain)

The presence of pain in the coccyx area requires a digital examination of the rectum. Objectively, when examining with a finger through the rectum (per rectum), there is always a significant soreness in the coccyx area, painful compaction in the form of a radial cord along with the posterior sector of palpation. The pressure on this cord is accompanied by a significant increase in pain in the coccyx. According to the patients, the pain is deep, "acting on the nerves", "boring." Sometimes it is possible to palpate the painful sacrospinous ligament in the form of a very tight cord.

The presence of pain in the coccyx area (coccygodynia) requires a digital examination through the rectum.

The pathogenesis of coccygodynia syndrome is caused by the local spasm of a part of the perineal muscle and the shortening of the pelvic ligaments. Local hypertonicity of the perineal muscle does not represent any feature in its origin, it arises according to the laws of the formation of trigger points of skeletal muscles. In an isolated form, the hypertonicity of this muscle creates the appearance of an independent disease that does not fit into the framework of classical diseases of the pelvic organs.

In addition to digital examination of the coccyx through the rectum, an X-ray of the sacrococcygeal spine is also performed, and, if necessary, sigmoidoscopy, orthopedic, urological, gynecological examinations.

In addition to digital examination of the coccyx through the rectum with coccygodynia (pain in the coccyx), an X-ray of the sacrococcygeal spine is also performed.

Standing and sitting X-rays of coccygodynia patients

 

Treatment of coccygodynia (tailbone pain)

To weaken the negative emotional background with pain in the coccyx, neuropsychotropic drugs can be prescribed.

In the treatment of pain in the coccyx, elimination of puffiness, inflammation, soreness, restoration of range of motion is accelerated with the use of physiotherapy.

In case of severity of the pain symptom, blockages can be performed (with lidocaine, hydrocortisone, diprospan, kenalog, etc.).

Manual therapy is mandatory (if the patient has no other contraindications), which improves regional blood circulation and sometimes completely restores the lost range of motion of the injured coccyx in women. Post-isometric relaxation of the pelvic floor muscles is not only a therapeutic but also a diagnostic technique that relieves the patient from the fear of the unknown.

Also, for pain in the coccyx, physiotherapy is prescribed - UHF, TENS, and infrared radiation therapy.

Depending on the severity of the manifestations of pain, the following therapeutic actions are possible:

  • drug therapy (NSAIDs, analgesics, hormones)
  • therapeutic injections - injections of drugs into the cavity of the sacroiliac joint (joint), spinal canal, trigger points in the muscles
  • manual therapy (muscle, articular and radicular technique)
  • physiotherapy (UHF, CMT, etc.)
  • acupuncture