In: A practical treatise on the diseases of women
T. Gaillard Thomas
Publisher: Philadelphia, H. C. Lea
Text copied from the Internet Archive
Definition and Frequency — This affection consists in a peculiar condition of the coccyx, or the muscles attached to it, which renders their contraction, and the consequent movement of the bone, very painful. It is of frequent occurrence, numerous cases having been observed, since attention has been called to it, by practitioners who saw it previously without regarding it as a special disorder.
History — Coccyodynia was first described in 1844, by Dr. J. C. Nott, formerly of Mobile and now of this city. Under the name of neuralgia of the coccyx he described a case which so fully embodies the symptoms and treatment of the affection, that I cannot refrain from a free quotation of it. [See Extirpation of the Os Coccygis for Neuralgia for the original paper quoted here.]
About the year 1860, Profs. Simpson and Scanzoni had their attention attracted to it, and the appellation which I have employed was applied to it by the former.
Anatomy — The coccyx serves as a point of attachment for the greater and lesser sacro-sciatic ligaments, the ischio-coccygei muscles, the sphincter ani, levatores ani, and some of the fibres of the glutei muscles. These are thrown into activity by certain movements, as rising from the sitting into the standing posture, the act of defecation, &c., and in such acts the existence of the disorder which we are considering is revealed.
Pathology — The pain which characterizes it is probably due to a hypersensitive state of the fibrous tissues surrounding the coccyx, or of that making up the tendinous expansions of the muscles. So long as the bone is uninfluenced by contraction of the muscles attached to it, no pain is experienced, but as soon as contraction produces motion it is excited.
Causes — It occurs most frequently in women who have borne children, but it is by no means confined to them. I have on two occasions met with it in young, unmarried ladies, and Herschelman reports two cases in children from four to five years of age. The chief causes of it are the following :
Symptoms — The patient upon sitting down, rising to stand, making any effort, or passing faeces through the rectum, experiences severe pain over the coccyx. In some cases this is so severe as to cause the greatest dread of sudden or violent movement. In others, the patient is unable to sit on account of the discomfort caused by pressure on the bone. The most trying process is that of rising from a low seat, and, to accomplish this, the sufferer will obtain all the aid that is practicable, by assistance with the hands, which will be placed as auxiliary supports upon the edges of the chair or stool upon which she rests.
Differentiation — The only conditions with which this may be confounded are painful haemorrhoids, fissure of the anus, and a spasmodic condition about the muscles of this part, due to ascarides in the rectum. From these a careful, rational, and physical examination will always readily distinguish it.
Prognosis — Coccyodynia often lasts for years, annoying and distressing the patient, but never to any degree depreciating her health or constitutional state. If left to nature, it may wear itself out, but it is probable that it would generally remain for a long time, if not relieved by art.
Treatment — Counter-irritation, opiates by the mouth, rectum, skin, and hypodermic injection have all been tried in vain in aggravated cases. In slight cases, blistering and the endermic use of morphia may effect a cure, but should they not do so promptly, no great length of time should be consumed in efforts of this kind. Recourse should at once be had to one of two radical methods of cure, — section of the diseased muscles, or amputation of the bone to which they are attached. The first, placed at our disposal by the ingenuity of Prof. Simpson, consists in severing the attachments of all the coccygeal muscles; the second in amputating the coccyx itself, after the plan of Dr. Nott.
The first operation is performed subcutaneously by an ordinary tenotomy knife. This is passed under the skin at the lowest point of the coccyx, turned flat, and carried up between the skin and cellular tissue until its point reaches the sacro-coccygeal junction. Then it is turned so that in withdrawing it an incision may be made which entirely frees the coccyx from muscular attachments. The knife is then introduced on the other side so as to repeat the section there. As is usually the case in subcutaneous operations, no hemorrhage occurs unless some large vessel be injured. Complete convalescence is rapid.
In fat women subcutaneous section of the muscles attached to the coccyx is by no means so easy a matter as one would suppose who has not made the experiment. Under these circumstances the operation is simplified and rendered more certain by making an incision down upon the coccyx, lifting the exposed extremity of this bone with the finger, and then with a pair of scissors severing the muscles. This procedure is both easy of performance and certain as to result.