Midwifery 2000 Jun;16(2):155-60
Ryder I (firstname.lastname@example.org), Alexander J.
University of Portsmouth, St. George's Building, 141, High Street, Old Portsmouth, Hampshire PO1 2HY, UK.
OBJECTIVE: To review the literature on coccydynia with specific reference to those cases of pregnancy and birth-related onset.
METHOD: Databases (Medline, CINAHL, MIDIRS) were searched using the keywords coccydynia, coccygodynia, coccyx, spine, pelvis, injury, and trauma. The references contained within this review are those which give clear information about clinical cases and are least anecdotal.
FINDINGS: Much of the literature is of poor quality when judged by current standards. Where there is no other literature older references remain of interest. There is little information about incidence, prevalence, pathophysiology, methods of differential diagnosis and efficacy of treatment for these women. No qualitative data from women with pregnancy or birth-related coccydynia were identified.
KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Research into this topic needs to be undertaken if midwives are to be enabled to facilitate early diagnosis and provide care and advice for women with pregnancy and birth-related coccydynia.
Abstract by Jon Miles:
The pain of coccydynia is probably caused by disruption of the joint between the coccyx and the sacrum, which is formed of cartilage. Some cases may be caused by spasm of the muscles around the coccyx or by osteoarthritis. Most cases occur in women. It has been suggested that this is due to differences in anatomy - for instance, the sit-bones (ischial tuberosities) are about 40% further apart in women than in men, and this may leave the coccyx more exposed and vulnerable. But cases can be caused by pregnancy and childbirth, so it is not possible to be certain that the greater frequency in women is not due to this factor.
The cause of injury is commonly a fall into a sitting position or a direct blow to the coccyx. Different studies suggest that between 3% and 15% of cases are caused by childbirth. Spinal surgery, pilonidal cysts, anal intercourse and infection have also been given as causes of coccydynia.
Pain is especially severe when sitting or rising from sitting. It may be aggravated by cycling or rowing or other exercise which puts pressure on the area.
It is important to distinguish coccydynia from pain in the perineum (the area between the anus and the genitals). If the cause of the pain is trauma, the initial treatment should be NSAIDs (see the Drugs page). Sitting upright on an appropriate cushion can reduce the pain. If the pain persists, injection with steroids and anesthetics can bring relief. If this is unsuccessful, the coccyx may be removed. This is highly successful in some, carefully selected, cases. Surgery should not be used if the pain is referred from the spine. If the pain is caused by spasm of the muscles, massage may be successful in relieving the pain.
There is a lack of information about the incidence of coccydynia, factors which make it more likely, and the comparative benefits of different treatments. The authors (a lecturer and a reader in Midwifery) are carrying out research on coccyx injury in pregnancy and childbirth.