Shivam
Pain Management
Centre
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Coccycodyania
 
Pain in or around the coccyx, or tailbone is called coccygodynia, or tailbone pain. The pain usually radiates to the lower sacral and perineal areas of the body. Frequently affecting women more than men, the condition has both acute and chronic forms. 
 Anatomy of the sacrococcygeal structure
Tailbone is the last bone of the vertebral column. It is a tiny triangular bone, which is usually made of 3 to 5 vertebrae that are fused together. There is a joint where this part is connected to the sacrum, a part of pelvis,. The movements of the coccyx are restricted to flexion and extension. Range of motion of the coccyx is measured in degrees.
 
Flexion larger than 25-30 degrees represents hypermobility and slipping larger than 25% represents luxation.
 
The levator ani muscle, the anococcygeal and sacrotuberal ligaments, the sacrospinal ligament, and the gluteus maximus muscle of the buttock all play a very important role in the movement of the coccyx.
How does coccygodynia or tailbone pain develop?
Coccygodynia can be caused by a number of factors. Usually, patients report pain after a fall onto their buttocks. This is referred to as acute coccygodynia.
 Chronic coccygodynia, on the other hand, usually occurs after damage to the sacrococcygeal ligaments due to a difficult pregnancy, delivery, repeated trauma, or from repetitive strain from rowing, cycling or faulty posture while sitting. Some also cite anal intercourse as the cause of pain. In many cases, pain derives from a malformation of the coccyx itself.
 Other causes of coccygodynia include cancer or damage to the sacrum that generates referred pain, meaning pain that appears in one region but originates from another. Muscle strain or tension, pinched nerves or damaged nerves, or dislocation of the coccyx due to gross obesity are additional causes.
What are the symptoms of coccygodynia or tailbone pain?
The most common symptom of coccygodynia is pain when sitting, or when rising from a seated position. It is often experienced as a burning pain in the rectal area. If the condition lasts long enough, the patient may even experience pain when standing or lying down. Numbness occasionally occurs in the lower part of the spine. Some patients may experience pain during bowel movements, sexual intercourse or menstruation. Secondary symptoms include back pain from sitting in odd positions in order to relieve pain, and painful feet from standing too much, because patients avoid sitting. Sometimes the entire buttocks experience pain. In rare cases, exhaustion, depression and lack of sleep can also result.
Conventional medical treatments may help relieve the symptoms of coccygodynia, but they do not address the root of the problem. By strengthening structural weaknesses in the body, as natural medicine treatments like Prolotherapy do, pain associated with coccygodynia may be alleviated permanently.
 
Differentialdiagnosis
 
   1. The cause of pain could be intradiscal inflammation. This could be tested easily with application of intradiscal injection. If the pain disappears after it, the cause is definitely a chronic joint inflammation
   2. Chronic bursitis, inflammation of subcutaneous tissues could also be the cause. It can also be treated with subcutaneous injections.
   3. Psychogenic pain is also a very common cause of pelvic pains. Hysteria, neurotic pain or depression are the most common causes among these. This could be easily distinguished from coccygodynia because in most cases the pain is permanent and not enhanced by sitting.
   4. The sacroiliac joint or the lumbosacral area can sometimes radiate pain into this area making the diagnosis much more complicated.
 
Abnormality in the form of a small bony excrescence on the dorsal aspect of the tip of the coccyx is called coccygeal spicule..
 
Treatment of coccygodynia
 
There are many different approaches to the treatment of coccygodynia including various applicable remedies, sitting in a tub of hot water, local anesthetic creams, massage, muscle relaxants, electric stimulation devices, counseling, biofeedback and sometimes even anti-depressants. However, there are three major types of the most effective treatments:
 
MANUAL TREATMENTS
 
This is a classic treatment of coccygeal disorders, which consist of manual manipulations of the coccyx or massages of the pelvic muscles.
Before the treatment, patient can gets an intraregional injection that should cause 25% increase in the rate of satisfactory results. All the manipulations of the coccyx in joint and stretching of the coccyx could be performed with the rectal finger. Although the treatment is rather unpleasant, it can relieve most of the problems related to muscles stretching.
 
According to some researches made in the past, results of the manual treatments are satisfactory in 25% of cases at six months, and in 24% at two years after it.
Drugtreatment:
In most cases, the treatment begins with non-steroidal anti-inflammatory drugs, which are being used to reduce inflammation and pain around the joint. 
Ganglion impar block:
 
This technique is being done with the help of x-rays imaging. When the doctor chooses the adequate disc, considering radiological abnormalities or tenderness at this level he will insert a 25mm needle under aseptic conditions into the lesion.
 
Prolotherapy
 
Many experts claim that the safest and most effective natural medicine treatment for repairing tendon, ligament and cartilage damage is Prolotherapy. 
Prolotherapy is an attractive form of therapy whose primary role is to stimulate the body to repair painful areas itself. Doctors are inducing a mild inflammatory reaction in the weakened ligaments and cartilage. Prolotherapy is performed by frequent inserting of the needle into the joint, causing a chronic inflammatory reaction, which will eventually join the damaged ligaments!
 
SURGICAL APPROACH
 
 
There were many talks and controversies about correct surgical approach to the problems related to chronic pelvis pain. If the pelvis pain is long lasting and unresponsive to treatment, it may result in the surgical removal of the coccyx.
 
Complications and prognosis
 
The most common complication of this operation is infection caused by the violation of the rectal vault. Many surgeons have also described problems with healing and scarring of the both superficial and deep wounds.
The key of a good therapy is to allow enough time for the symptoms to respond to it before the operation because pain is usually managed with conservative measures. Patients should also know that, it may take 6 months to 1 year after the operation until they are completely pain free.