Q: I am a 37-year-old female. Ever since my last trimester of my pregnancy back in ’07, I have had pain when I sit on my tailbone. I have had several steroid injections in my tailbone to help with the pain. The first one brought relief for 9 months but each injection after that hasn’t lasted as long. I have also had Women’s Health physical therapy that only brought temporary relief. I have had an X-ray but never an MRI or CT scan. I did, however, just have surgery for stage 3 endometriosis which I never had any symptoms of. After the surgery the tailbone pain was gone but slowly returned.
Can you recommend any other treatment or do you have any thoughts on what could be going on? I am not sure if a chiropractor or acupuncture will be able to help me.
A: Coccydinia is pain and tenderness of the tailbone which are exacerbated when the patient attempts to sit down. It is often caused by injury, but can also be the result of a fracture, sciatica, or less commonly, a tumor or infection. The act of child-bearing can actually result in injury to the coccyx or in the area where the coccyx attaches to the sacrum, the large triangle-shaped bone at the upper portion of the pelvis.
Diagnosis begins with a medical history and rectal examination. X-ray or MRI testing can rule out other possible causes for the pain such as a pilonidal cyst. Dynamic radiographs obtained in both sitting and standing positions may actually provide more information than will static X-rays, since they allow for measurement of the rotation of the pelvis and the coccygeal angle of incidence. However, in up to 50% of cases reported, the dynamic X-ray will fail to demonstrate a problem! The coccyx of a healthy individual normally rotates between 5 and 25 degrees with sitting, returning to its original angle upon standing. The individual with coccydinia may exhibit displacement of minus 5 degrees with motion or and greater than 25 degrees with hypermobility.
Non-surgical strategies remain the gold standard with initial treatment starting with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen and COX-2 inhibitors to reduce inflammation. For new cases, an ice pack applied to the area might be applied for the first few days, followed by a hot pack for several days. Physical therapy and massage might also be prescribed. Special donut-shaped pillows work well for many sufferers. Some patients, however, find they still experience pain and pressure on the coccyx from the pillow. For them, a U-shaped foam pillow might be the better choice. If overweight, weight loss may also be recommended.
In extreme cases, surgery may be appropriate when non-operative treatment fails to provide relief; however this is reserved for patients with advanced degeneration such as subluxation or hypermobility. The most frequent complaint of surgery is wound infection. This can be the result of a patient being unable to visualize the site of surgery who cannot, therefore, keep the wound clean, because there is abundant perineal skin flora causing local contamination, and from wound tension caused by sitting.
Cortisone injections are similar to those given for tennis elbow. The level of pain might elevate for a brief period prior to relief that can occur in as much as 14 days. Sadly, that pain relief may not take the pain away completely, nor will it be a permanent solution. Physicians vary on their views for frequency of injections – essentially because they don’t have statistics on long-range results.
Your stage 3 endometriosis indicates a moderate amount of disease in areas around the pelvic cavity.
Not only is infertility common, so is pain. Pelvic or low back pain can occur at any time throughout the menstrual cycle; this certainly could appear to exacerbate your coccydinia.
On the home front, you might consider hot Epsom salt baths, treating any possible constipation with a high fiber diet, wearing loose-fitting clothing, sleeping on your stomach, using a stool softener, doing muscle and ligament stretching exercises, and reducing stress.
I recommend you speak with your primary care physician or orthopedic specialist regarding his or her views on acupuncture, chiropractic or a pain clinic. If you aren’t getting pain relief through the conventional methods used thus far, either might be an appropriate next step.
Readers who would like related information can order Dr. Gott’s Health Report “Managing Chronic Pain” by sending a self-addressed, stamped #10 envelope and a $2 US check or money oder to Dr. Gott’s Health Reports, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
