Diseases of the Colon & Rectum
1963. 6: 422-436
Kansas City, Missouri
The most common causes of coccygodynia in 324 patients were anorectal infection, 45 per cent; chronic trauma involving poor sitting posture, 32 per cent; acute trauma, 20 per cent, and parturition, 4.4 per cent.
With the exception of cases of acute trauma, the coccyx is not tender and is not the source of the pain called coccygodynia; the pain originates in spasm of the levator ani and coccygeus (and, at times, in the medial fibers of the gluteus maximus) muscles, and is referred to the coccygeal area; and the size, shape and position of the coccyx bear no relationship to coccygodynia.
X-ray examination is of diagnostic value only in cases of suspected fracture or dislocation.
Coccygectomy too often yields disappointing results, but is most likely to be of value in patients in whom coccygodynia was caused by acute severe trauma.
Gross and microscopic examination of coccyges removed in an attempt to relieve coccygodynia have failed to reveal any disease of the coccyx or contiguous ligaments and tendons.
Relief obtained by injections of alcohol, or of various anesthetic agents, with or without cortisone, is accomplished through resultant relaxation of the spastic levator ani and coccygeus muscles.
Treatment by properly applied massage of the levator ani and coccygeus muscles, and at times, of the mesial fibers of the gluteus maximus muscle, cured or satisfactorily relieved 91.7 per cent of patients treated.