Symptoms, treatment, the effects of the bend of the coccyx

Normal anatomy of the coccyx means the following the location: towards the top of the back anteriorly at an acute angle, the tip pointing down. A similar structure have approximately 70% of all people. However, in some cases, according to the radiographs the person revealed another direction coccygeal the top or changed the angle of tilt (the tailbone is curled, twisted). What are the causes of this phenomenon?

1. previous injuries to the Sacro-coccygeal region, and their consequences:

• Fractures.
• Dislocation and subluxation.
• Rupture of the Sacro-coccygeal ligaments.

2. an Innate feature of a particular person. According to foreign authors, about 30% of the population can have the following types of the structure of the sacrococcygeal region:

• About 15% of people have a tailbone that is bent forward more than usual, it's the tip of looking forward, not down.
• About 5% of people may have a sharp angle (almost straight) inside the pelvic cavity, between the 1st and 2nd coccygeal segments or between 2nd and 3rd.
• Also about 10% already have a subluxation of the coccyx anteriorly.

Studies have shown that among all patients with symptoms of chronic pain in the coccygeal region (coccygodynia) most common variants of anatomy 2.1, 2.2 and 2.3.

Complaints and diagnosis in pathology

If you have the person bend the coccyx into the pelvic cavity may occur following complaints and symptoms:

1. the main symptom is pain in the coccygeal region:
   • usually dull, rarely shooting;
   • with prolonged sitting, standing from a sitting position, deflection back to the sitting position, bending forward;
   • lying down and when walking pain may not be disturbed or there is a decrease in pain intensity;
   • possible radiating to the perianal area, groin, thigh (usually the inside).

2. Difficulty and pain in defecation, constipation, muscle tension of the pelvic floor.
3. Change of mental well-being, the person becomes suspicious, anxious, symptoms of depression.

some people with a deviated coccyx, to change the angle of it no complaints can not be externally observed clinical well-being.

Additional diagnostics of the position of the coccyx is simple:

1. Digital rectal examination ().
2. Radiography of the pelvis or sighting sacrococcygeal region, functional tests with the use of radiographs in the standing and sitting position.
3. Computed tomography in case of insufficient visualization of the bones of the pelvis on the radiograph.
4. Pregnant preferable MRI as an additional diagnostic is x-ray methods.

Below can be seen photos in different embodiments, the position of the coccyx.

figure 1 – location Option with a bend (arrow), coccygeal fragments are bent, the tip looking forward. Individual feature.

figure 2 – the location of the coccyx at an acute angle forward. Individual feature.

figure 3 – Radiographic signs of anterior dislocation of traumatic origin.

treatment Options

Treatment of the bend of the coccyx directly depends on the state requesting assistance of the person and the severity of his pain.

1. Fresh injury sacrococcygeal region require active treatment. The patient is the reduction of the coccyx when the dislocation or the reduction of the bone fragments at fracture. Further treatment is reduced to recommendations of bed/gentle treatment, taking NSAIDs orally, in the form of injections, suppositories, fiziolechenie and physical therapy. Treatment laxatives are added ("Duphalac"), rectal suppositories (with anestezin, glycerol, etc.). The time of disability depend on the type of injury: from 2 weeks to 2 months.
2. Old injuries that led to the formation of the curl of the tailbone inside, are conservatively provided a moderate reduction in the quality of life of the patient. Treatment is the same as in the treatment of coccygodynia. Main groups of medications prescribed for the treatment of coccygodynia, and methods of their use are given below:
   • analgesics and anti-inflammatories (NSAIDs selective and nonselective, depending on contraindications and the patient's age);
   • Central muscle relaxants ("Comparison", "Sirdalud");
   • candles with analgesics (anestezin), anti-inflammatory components (eg, ibuprofen), venotonics;
   • sacrococcyx blockade (novocaine, procaine + lidocaine, procaine + hydrocortisone and other combinations).

With the ineffectiveness of conservative treatment is recommended surgery: coccygectomy (resection, removal), rhizotomy (destruction of nerve plexus), new method – removal of the sacrococcygeal disc radiofrequency ablation. The best results onthe moment is marked only after coccygectomy.

According to some authors, while fractures, accompanied by displacement of the fragments forward at an angle of 90 degrees or more, as well as posterior displacement, needs urgent treatment by performing coccygectomy without attempting to lead the patient conservatively.

If the coccyx bent inwards and this is due to individual differences, the treatment depends on the presence or absence of clinical symptoms of coccygodynia. In pain the patient is on treatment coccygodynia, in the absence of symptoms no of steps "ahead" is not performed, the patient just need to watch.

Influence of the position of the coccyx at birth

The Most unpleasant consequences of malposition of the coccyx for women may be the disruption of the normal parturition process. As coccygeal apex is one of the points of education direct output size of the pelvic cavity, its sharp directivity forward the given size decreases. In this regard, perhaps the difficulty of the passage of the baby through the birth canal and may need an emergency C-section. Therefore, all women with a history of trauma to the sacrococcygeal region, can be recommended in preparation for pregnancy to perform radiography in two projections or CT scan to determine the location coccygeal the top.

during pregnancy x-ray methods of investigation it is better to replace MRI, although at the present stage of medical radiography carries minimal radiation dose. In identifying the symptoms of curvature of the coccyx anteriorly and the decrease in direct output size of the pelvic cavity recommended elective caesarean section.

Sources:

1. Modern approaches to the treatment of coccygodynia. A. V. Babkin, S. V. Egorova. The journal "ARS MEDICA", №4, 2012.
2. Instability of the coccyx in coccydynia. J.-Y. Maigne, D. Lagauche, L. Doursounian. The journal of bone and joint surgery.
3. Idiopathic coccygodynia. Analysis of fifty-one operative cases and a radiographic study of the normal coccyx. Postacchini F, Massobrio M. The Journal of bone and joint surgery. American volume. 1983.