Ian Hobson - email@example.com
I'm male, 51, had coccyx pain for almost two years, no known cause (perhaps an old injury). I've had several types of steroid injection:
1. The 'Quickie in the office'
This was over very quickly and was no more painful than a tetanus injection. The doctor was reluctant to get too close to the tip of the coccyx, where the pain radiates from (in my case) as the tip of the coccyx is very close the 'waste disposal unit'. I was advised to wait an hour before driving home.
Result: The pain seemed to increase over a number of days and then recede. Days 18 to 22 approx. the pain was significantly reduced. But then after that, the pain returned to pre-injection levels.
Conclusion: It didn't work.
2. Caudal epidural injection of hydro-cortisone plus local anaesthetic
This required a hospital appointment, with instructions to have only a light breakfast. I arrived at 9.30 am and was taken to a bed and asked to sit and wait. After 1 hr I was offered coffee and told I could lie on the bed if that would be more comfortable. I was tagged and had my blood pressure taken. About 11 am I emptied my bladder (fortunately). At about 11.30 am I was asked to change into a theatre gown and some paper underpants (to stop the iodine staining mine, apparently). Shortly after, I climbed onto a trolley and was wheeled into what seemed to be an anti-room to an operating theatre.
I lay on my side and relaxed (the best thing to do when having an injection) and chatted with both the doctor and the nurse, whilst the doctor gave me an "instant suntan" with the iodine. I felt the needle going in but only just. Then it got quite painful, perhaps twice as bad as a dentists injection and taking twice as long, but it was soon over and I wouldn't worry about having another one. I was wheeled into another room, had my blood pressure taken again, then returned to my bed in the ward.
I rested, as best I could (hospital beds are rather hard), had another coffee and later a sandwich and a cup of tea. I had been warned earlier that my legs might feel numb and that I might have temporary incontinence. At about 2 pm I asked if I could get up and walk about. The nurse walked with me to the toilet. My legs seemed OK. In the toilet I got a shock. I hadn't been warned that other things would go numb, and my 'things' were as numb as numb could be, and totally useless. I wasn't incontinent, quite the reverse, my plumbing had shut down completely. I tried again later, still no luck, I was encouraged to drink more. Patients are not allowed to go home until they have passed water.
By 4 pm I was in a lot of pain (caused by a full bladder). It had started in the groin and was working it's way up into my stomach. I was told I may have to stay in overnight and was transferred to another ward, where I was told that if I didn't empty my bladder they would have to insert a tube. I hobbled painfully to the toilet and sat on my numb-bum and waited. After a few minutes I felt better but was unsure why, until I realised that I was leaking. Two hours later, after a meal and two more visits to the toilet for a 'leak', I was allowed home. The numbness took about 18 hours to completely wear off. The next day I stayed at home to rest, as instructed, and everything was as it was before the injection. The doctor had said "It can take up to 28 days for the injection to work".
Result: I waited patiently for 28 days. The injection certainly did not make things worse. I had a lot of good days, plus a few poor but not bad days (though I'd had several good days before the injection). Some days were so good I thought the injection might be working, but I never really tested myself by sitting for very long periods or sitting without the aid of my coccyx cushion. I had two poor days (days 23 & 24) and decided that the injection had not worked. Then I had about 6 good weeks before returning to 'normal'.
Conclusion: Maybe it helped a little - I'm not sure.
3. Another Caudal epidural injection of hydro-cortisone plus local anaesthetic
I had the first of what was planned to be three caudal injections (different doctor and different hospital to last time). She actually gave me three injections. The first one was the anaesthetic - to stop the others from hurting - it hurt (kind of defeats the object really). Butt it wasn't that bad, and my posterior soon went numb - not as numb as last time though - she'd suggested using less to avoid anymore 'plumbing' problems.
Because I'd just had an x-ray at another hospital that showed a probable arthritic joint half way down the coccyx, she decided to give me first the caudal, then another injection closer to the arthritic joint. She seemed to struggle as though the needle wouldn't go in where she expected it to, but I felt only a little pain. Also she suggested that the next injection be administered under fluoroscope, aiming for the arthritic joint. After half an hour I was sent home. No fuss. No blood pressure checks.
Result / Conclusion: That night I was quite sore and slept badly. For 2 weeks the pain was worse and longer lasting. Lying down as well as sitting brought it on. But then it gradually went back to 'normal', and at just short of three weeks I noticed a slight improvement. Just in time for my next injection.........
4. Injection(s) under fluoroscopy (live x-ray)
As promised, I had injections under fluoroscopy. This time I had my blood pressure checked before being walked down to the x-ray department. The doctor explained that she was abandoning caudal injections (in my case) in favour of coccygeal injections and that this and the next would be done under fluoroscopy.
I lay on my stomach and was x-rayed from above and from the side. They seemed to have problems getting a clear picture. The results were shown on two monitors that I couldn't see. I had the bum-numbing injection to start with. Then she inserted the needle and stood back whilst the radiographer x-rayed me again. Then she adjusted the needle and stood back for another x-ray, and when she was happy she injected the cortisone. To my surprise she injected several coccyx joints and also both sides of the coccyx. The first two hurt a bit, but after that there was no pain and I lost count of how many injections I had - at least five. When all was done I was shown the last two x-rays, still on the screen. I could clearly see the needle. It looked very long. I was wheeled back to the ward and sent home after about 3/4 hour.
Result: My bum stayed numb until long after I arrived home, but by bed-time I felt very sore indeed and didn't get to sleep until 6 am. The soreness was like having an open wound and together with increased coccyx pain it left me feeling very sorry for myself, mostly because I now had pain from lying down as well as sitting, and found it impossible to get comfortable. This lasted for over two weeks and during that time I decided NO MORE INJECTIONS! Butt then, on day 18 the injection began to work. I found I could drive without much pain, and no lingering pain afterwards. And at work I was able to sit at my computer for short periods. I hadn't done that for a while.
Butt, it only lasted for 2 or 3 weeks.
Conclusion: Injections done under fluoroscopy seem to work best. But they don't necessarily last that long.
Footnote: In the end I opted for surgery. (See 'My Surgery')