American Journal of Physical Medicine and Rehabilitation
2008 Mar; 87 (3): S36
Patrick M. Foye, MD; Lisa Schoenherr, BA, CCRC; Jong H. Kim, MD
Director, Coccyx Pain Service, UMDNJ: New Jersey Medical School, 90 Bergen St., DOC-3100, Newark, NJ 07103-2499. Phone: (973)972-2802. Fax: (973)972-2825. tailbonedoctor.com/.
BACKGROUND: There are a relatively wide variety of traumatic and nontraumatic etiologies for coccyx pain (tailbone pain, coccydynia). Traumatic etiologies can include an isolated incident of blunt force on the coccyx (e.g., delivering a baby, falling directly onto the tailbone, being kicked at that site) or from repetitive trauma (e.g., with cycling, horse-back-riding, or prolonged sitting on hard surfaces). Iatrogenic etiologies for coccyx pain have rarely, if ever, been previously reported. A case where colonoscopy caused coccydynia has never before been documented in the medical literature.
CASE PRESENTATION: We present the case of a 25-year-old female who underwent colonoscopy to work up symptoms suggestive of irritable bowel syndrome (IBS). After she awoke from sedation, she reported severe pain at the coccyx. She had no prior history of coccydynia, coccygeal trauma, pregnancy, rape or sexual abuse. The colonoscopy had found no significant abnormalities and her IBS-like symptoms eventually resolved. But the post-procedure coccydynia persisted, prompting physiatric pain management consultation more than one year later. A computerized tomography scan of the sacrum and coccyx with reconstructions documented an abrupt anterior and right lateral angulation of the distal coccyx and a possible tiny fracture fragment. The coccydynia was felt to be have been caused by the colonoscopy, based on the positive imaging studies, the timing of the symptom onset, the lack of previous symptoms or injuries at that site, and the close proximity of the injured coccyx to the anal and rectal regions traversed by colonoscopy. We have subsequently learned of and evaluated other patients who have also noted new-onset coccydynia after colonoscopy.
CONCLUSIONS: We believe that colonoscopy can now be added to the list of traumatic etiologies for coccydynia. It may be one of the few iatrogenic causes for new-onset coccyx pain.