Pain in the coccyx is a manifestation of pathological processes in the coccyx, sacrococcygeal joint and surrounding tissues. The cause of the pain syndrome is inflammatory or degenerative changes, traumatic injury, developmental anomaly, or neoplasm. Pain in the coccyx often has a reflected character, provoked by pathologies of the overlying sections of the spine and diseases of the pelvic organs. The pain may intensify in a certain position of the body or when performing any actions, sometimes radiating to the buttocks, lower back, perineum and internal organs. The cause of pain is established using external and rectal examination, hardware studies (radiography, CT, MRI, ultrasound, etc.). Until the diagnosis is clarified, rest, unloading of the coccyx, analgesics are recommended.
Causes of pain in the coccyx
Traumatic injuries
Usually occur in everyday life as a result of falling on the buttocks from a standing position. They can be diagnosed in all categories of the population, but are more often detected in middle-aged and elderly women. The amount of damage increases sharply in winter, especially during the period of ice. They present with severe pain when falling. Subsequently, the pains become less intense, acquire a diffuse character. Sometimes bruises, swelling of soft tissues are found in the buttocks and coccyx. A separate category of coccyx injuries are injuries during childbirth.
- Coccyx injury. At the moment of injury, the victim feels a sharp shooting or burning pain in the bruised coccyx. Within a few hours, the pain subsides. For 1-2 weeks, a person may be disturbed by gradually subsiding moderate, dull, pressing or arching pains during movements, an attempt to sit on the buttocks, sexual contact, and the act of defecation. Pain can radiate to the perineum, rectum, buttocks and lower limbs. Often the patient tries to sit "sideways" to reduce pain. When probing the coccyx, a strong, but usually bearable pain is felt, sometimes a slight or moderate local edema is determined.
- Fracture of the coccyx. According to the manifestations, a tailbone fracture resembles a bruise, but the symptoms are more pronounced. During the fall, the pain can reach such intensity that the victims describe it as “something exploded”, “shot so that it darkened in the eyes”. Then the pain syndrome decreases somewhat, but remains intense enough to significantly limit the patient's activity. Because of the pain, a person cannot sit, walk, bend over and turn slowly, carefully, sometimes refraining from the act of defecation. When feeling the coccyx, the pain is sharp, often unbearable, the slightest touch to the damaged area makes the patient pull back or take the doctor's hand away. Swelling of the surrounding tissues is usually moderate.
- Dislocation of the coccyx. The same symptoms are noted as with a fracture. At the time of the fall, the pain is sharp, piercing, shooting or burning, sometimes unbearable, then moderate, but quite intense, sharply increasing when trying to sit down, defecation, any kind of physical activity. Since the coccyx is small, located deep in the soft tissues, its displacement relative to the sacrum cannot be determined by palpation. The only sign of injury, in addition to the characteristic pain syndrome, is swelling of the soft tissues.
- Coccyx injury during childbirth. During the movement of the fetus through the birth canal, the coccyx first fits anteriorly, then backwards. With rapid childbirth, a narrow pelvis, a large fetus and insufficient mobility of the coccyx, injuries are possible: fractures, dislocations, sprains. Clinical manifestations are similar to ordinary household injuries - there is a burning or arching pain in the coccyx, accompanied by swelling, aggravated by sitting, moving, defecation. The pain syndrome gradually disappears a few weeks after birth.
Inflammatory processes
Usually they are infectious in nature, they can affect the coccyx itself or nearby soft tissues, and can be acute or chronic. More often, the penetration of pathogenic microorganisms into the coccyx area occurs by contact (outside through a defect in the skin or from neighboring structures), hematogenous spread of infection is less common. The rich innervation of this zone explains the severity of the pain syndrome. Due to the proximity of internal organs, primarily the rectum, the spread of the inflammatory process can be fraught with dangerous complications.
- Festering epithelial coccygeal passage. ECX is an asymptomatic congenital fistula in the coccygeal tissue, more common in men. When the fistula is blocked, inflammation develops in its cavity, an abscess forms. Initially, a pressing or bursting pain appears in the intergluteal region. Its intensity increases, the pain becomes twitching or throbbing, increases with the slightest movement, deprives sleep, accompanied by weakness, weakness and fever. The coccyx area is edematous, hot, sharply painful. When an abscess breaks, purulent contents are released, all symptoms subside.
- Retrorectal paraproctitis. A rare form of paraproctitis with damage to the fiber located on the posterior surface of the rectum. Manifested by severe deep pain in the coccyx, rectum. The pain is initially bursting, then jerking, throbbing, its intensity rapidly increases. Pain exhausts the patient, disrupts sleep, sharply increases during defecation and in a sitting position, accompanied by an intoxication syndrome. External signs of paraproctitis (sharp swelling and hyperemia in the perineal area) are determined only in the later stages of the disease.
- Osteomyelitis. Hematogenous osteomyelitis occurs in children after a bruise or without previous trauma. Usually affects the coccyx, sacrum and sacrococcygeal joint. Manifests with symptoms of general intoxication, severe pain in the sacrum, coccyx. The intensity of pain decreases 1-2 days after the breakthrough of the abscess into the subperiosteal space. Post-traumatic osteomyelitis can develop in people of any age after open injuries of the sacrococcygeal zone. It is manifested by increased pain in the wound area, an increase in edema and signs of intoxication, the formation of a dense focus in the affected area. After the end of the acute period and the formation of a fistula, the pain is aching, pressing or bursting of moderate or slight intensity.
Pain in the coccyx can be caused by cysts, benign and malignant tumors of the coccyx and surrounding soft tissues. Primary neoplasms of the coccygeal region in children (with the exception of newborns) and adults are rarely found, usually have a benign course. Malignant lesions of the coccyx are more often due to the local spread of neoplasia of neighboring organs.
- Embryonic tumors . Sacrococcygeal teratomas occur in utero, in most cases are diagnosed at birth. Small teratomas may go undiagnosed and are asymptomatic for a long time. With the growth of the tumor, there are slight dull pains in the sacrum and coccyx, combined with pain sensations of indistinct localization in the perineum and lower abdomen. As the neoplasia increases, the pain syndrome increases, constipation and / or frequent urge to defecate, urination disorders appear. If left untreated, suppuration and the formation of a fistula that opens onto the skin, into the rectum or vagina are possible.
- benign tumors. They are mainly represented by lipomas, chondromas and glomus neoplasias (clusters of irregularly shaped vessels). Prone to prolonged asymptomatic course. With an increase in the size of the tumor, non-intense and intermittent pain occurs in the coccyx or coccygeal region. As the neoplasm grows, the pain becomes more prolonged, which is due to compression of nearby nerve fibers, a dense (chondroma) or elastic (lipoma, glomus tumor) formation is felt in the affected area.
- Malignant tumors. Osteosarcomas and chondrosarcomas may be found. In some cases, malignancy of previously benign teratomas is observed. It is possible to spread the tumor process from neighboring anatomical structures (rectum, sacrum). At first, the pain sensations are unclear, dull, inconsistent, sometimes aggravated at night. Subsequently, the intensity and duration of pain increases rapidly, the pains become diffuse, burning, baking, cutting or twitching, accompanied by weakness, lack of appetite, weight loss. At a late stage, the pain syndrome is debilitating, unbearable, sleep depriving, not stopped by conventional painkillers.
Pain with coccygodynia
Coccygodynia is the general name for a group of conditions in which there is persistent chronic coccygeal pain. Pathology often affects women aged 30-6 years. The immediate causes of the development of pain in coccygodynia are inflammatory and degenerative changes in bone and cartilage structures, insufficient blood supply and mechanical compression of the nerve plexuses, and reflex muscle spasm. Due to the general mechanism, the nature of the pain does not depend on the pathology that provokes coccygodynia, which makes it impossible to determine its root cause based on the patient's complaints.
The cause of constant pain in the coccyx can be an old injury (pain syndrome usually occurs after a pain-free interval lasting several months or years), including trauma during childbirth. Due to the violation of the relationship between parts of the skeleton, coccygodynia is provoked by osteochondrosis, post-traumatic deformities, congenital anomalies of the spine and pelvis. In some people, pathology develops due to prolonged compression of the coccyx during sedentary work. More than half of the cases of pain in the coccyx area is potentiated by proctological, urological and gynecological diseases. Some researchers note a connection with psycho-emotional disorders.
A characteristic feature of coccygodynia is a persistent pain syndrome, often difficult to describe. The most common are dull, pulling, aching or bursting pain, less often patients complain of burning or shooting pains. The pain can be localized deep or superficially, be clearly defined in the projection of the coccyx or be spilled, capture the groin, perineum, anus, lower back, posterior inner thighs.
Pain usually decreases or disappears in a standing position, increases in the supine position and sitting, walking, bending over, coughing, during bowel movements and sexual intercourse. People sit sideways, leaning on one buttock, moving smoothly, slowly. In severe cases, the intensity of pain in the coccyx is so great that patients cannot squat or spread their legs, move, bent over, in small steps. Seasonal exacerbations are possible, typically increased pain during overwork, hypothermia, stress, exacerbation of therapeutic pathology, after a proctological or gynecological examination.
Survey
Initially, patients, as a rule, turn to a traumatologist, orthopedist or rheumatologist. Depending on the nature of the pain syndrome, the circumstances of its occurrence and the data obtained during the examination, the doctor may refer the patient for a consultation or examination and treatment to an oncologist, gynecologist, urologist or proctologist. The list of diagnostic techniques for tailbone pain usually includes the following procedures:
- General inspection. The specialist detects crepitus in fractures, signs of inflammation (edema, hyperthermia and hyperemia), fluctuation, indicating the accumulation of fluid, volumetric formations and fistulous tracts. The doctor determines the exact localization of pain, clarifies with which structures it is associated - with the coccyx itself or soft tissues.
- Rectal examination . Produced in the absence of intense pain due to suppuration in the area of the rectum and nearby tissues. During a rectal examination, tumors and infiltrates are detected in inflammatory diseases, the location and structure of the coccyx is assessed, compacted ligaments are determined in coccygodynia.
- X-ray examination. Radiography of the coccyx is the basic diagnostic technique, recommended for all patients with pain of characteristic localization. To improve visualization, images are taken after colon cleansing. In the presence of fistulas, contrast fistulography is indicated.
- Ultrasonography . Ultrasound of the soft tissues of the coccygeal region is an inexpensive accessible diagnostic method that allows you to assess the condition of soft tissues, identify areas with a changed structure, cysts, abscess cavities and inflammatory infiltrates.
- CT and MRI . With uncertain X-ray data, to clarify the state of solid structures, patients with suspected traumatic injury, neoplasm or degenerative process perform CT of the coccyx. For an in-depth study of soft tissues in inflammatory processes and tumors, MRI is performed.
The list of other methods varies significantly. Diagnostic search may include sigmoidoscopy, ultrasound of the abdominal cavity and small pelvis, irrigoscopy, proctodefecography and electrophysiological studies. If tumors are found, a biopsy is required. According to indications, general blood and urine tests, blood biochemistry and other studies are prescribed.
CT coccyx
Symptomatic treatment
The tactics of treatment is determined individually, taking into account the identified causative pathology. A common measure to reduce pain in the coccyx is the rest mode. You should avoid sitting in a sitting position and, if possible, limit physical activity, especially bending forward, lifting weights and brisk walking. It is better to lie on your stomach. Chloroethyl can be used to temporarily relieve severe pain after an injury. Moderate pain is eliminated by tablet and local forms of analgesics, with intense pain, drugs for intramuscular administration are used. It should be remembered that painkillers eliminate pain, but do not affect the cause of its occurrence, they cannot be used constantly and uncontrollably.
Before a visit to the doctor, the coccyx should not be massaged, warmed or steamed in a hot bath - this can stimulate the development of inflammation, accelerate the growth of a tumor, or increase hemorrhage in case of injury. The presence of a growing or persistent pain syndrome, the appearance of painful swelling, a fistula or a tumor-like formation in the coccyx region, a violation of the act of defecation, the detection of pathological impurities in the feces, an increase in body temperature and signs of intoxication with pain in the coccyx are indications for an urgent specialist consultation.