Coccyx injury during childbirth

Natalie, Australia - nat_coccyx@outlook.com

Posted 2010-02-21

I sustained a coccyx injury during childbirth last year and had a lot of trouble finding someone to treat it successfully. After 5 months of no improvement, my doctor arranged X-rays & CT scans which showed nothing. I found that physio was of little help - she just did heat therapy using the ultrasound device. She did recommended getting a special cushion with a semi-circle cut out at the back (where your coccyx would be) and that did assist in avoiding any further aggravation to it when sitting (especially with breastfeeding when you are sitting a lot).

I did some research online and read about a myotherapist who had treated someone with this problem, Carissa Stewart (see Doctors and specialists in Australia). Went to see her and she did trigger point therapy and some stretching on the area and gave me exercises to do at home, and also urged me to use a heat pack for 15 mins every night on the area (and you really do have to do this). It took about 3 treatments with her (on the 3rd one is when she does it quite firmly) to see improvement but it would have been about 30% (by this time, about 6 months after the birth). After another 2 sessions, about 70% better which brings me to now (9 months after the birth). Rather than being in constant pain as I was before the myotherapy, I now only really notice the pain when I have been sitting for long periods, which is much better than always feeling it!

She also has some adhesive heat pads that stick to your undergarments which helped me on a 8 hour car trip and last up to 12 hours. They can only be used once but were only a couple of dollars each.

Update, 2011-07-24

Whilst I did have some success through the myotherapy, the relief was only short lived. I have since seen three more physiotherapists before deciding I needed to see someone more serious, and this is when I decided to bite the bullet and try cortisone injections. If it didn't work, at least it was something else I could rule out. I should add first that one of the physios that I saw practiced internal massage of the muscles around the coccyx. As you can imagine this is a fairly intrusive procedure, one I wasn't particularly fond of. She did find that my muscles were incredibly tight and knotted, and did what she could to stretch them out. Again, just short term relief. She also recommended having regular massage particularly around the glute muscles, as whatever was wrong with my coccyx was causing them to be incredibly tight. Keeping on top of this definitely helps.

So I had my first appointment with a specialist who deals in musculoskeletal pain on 15th February 2011 and he discussed my options. He said the only thing that could really be done was cortisone (and various other injections such as glucose), and if all that fails, a coccygectomy. I was a bit shocked that I would have to consider something so drastic, but on the other hand it was coming up to 2 years since the injury and it was clear it wasn't going to heal up on its own. He convinced me to have a cortisone shot whilst I was there, so I did. It is done with a local anaesthetic. Needless to say it still hurt, but sitting down straight after didn't. I was to keep a record of my pain level (out of 10) for the next 6 hours and then daily for 2 weeks. Once I got home though, my pain shot up to an 8/10 which I wasn't expecting – I guess the local wore off. Unfortunately it was like that for the next 48 hours, and I really regretted having it. However after the 48 hours the pain decreased rapidly, and got as far as a 1/10 (I would estimate I was a 4-5/10 before the cortisone). The effects lasted about 6 weeks in which I went back for another, except this time I felt no initial pain (but still the coccyx pain), and it took a good 2 weeks for the cortisone to set in.

Once that wore off, my specialist suggested performing a cortisone injection under x-ray guidance a) to get a better and more accurate result and b) to have a look at the coccyx at the same time. Whilst under x-ray, he said there was no obvious problem with the coccyx such as it pointed the wrong way or something – that is, it was straight. But when he tried getting the needle into the joint (where my pain is), he could not. He said it was as if something had fused over the joint. I asked what that meant and he said he didn't know. He proceeded to inject the cortisone all around the joint, as it was the best he could do. Needless to say I was a bit alarmed. I was hoping that after 2 years I might actually have some concrete answers. All he could say was that I should give it two weeks and get in touch with him and report on the pain level. He said 'I wouldn't remove it at this point – I can, but I wouldn't yet'. I don't want to have it removed, but if that's what's eventually going to happen I'd rather do it sooner rather than later. It's now been 1 week since that injection and the pain is still a 6/10, so I am going to give it one more week and then call him.

We were hoping to be pregnant with our 2nd child by now (needless to say I am going to have a caesarean!) but we have put those plans on hold. I don't fancy being pregnant and having the baby pressing right down onto the coccyx constantly. At the moment I get relief when standing but being pregnant, that wouldn't be the case. Also if I plan to go down the path of surgery, I will need to get that well and truly out of the way before becoming pregnant.

Update, 2012-04-22

The cortisone done under x-ray lasted 8 months, enough for me to (foolishly) believe my injury had healed. Alas, it has finally come back as bad as it was before the injection. I've had another shot today (not under x-ray), but I have also decided to book into the surgery. The pain specialist who does the cortisone refers you on to an orthopaedic surgeon with whom I met last year. He was positive about surgery for me and said there is a 70% success rate where the injury was sustained in child birth. Where it is a result of car accident or fall, there can often be other factors and things wrong which don't necessarily get fixed with coccyx removal.

I am booked in with Dr Andrew McQueen for June 4th (see Doctors and specialists in Australia). He's performed several of these so Jon it may be worth while putting him into the list of practitioners. The surgery is performed across the road at the Avenue Hospital and the quote was roughly $2300 Australian + anaesthetist and whatever else (hospital excess for private health insurance holders).

I have been having my cortisone through Dr David Vivian (see Doctors and specialists in Australia).

I got a 2nd opinion on the coccyx and whilst my scans show nothing, the doctors are both happy to conclude it is a definitely coccyx injury since I've had positive experiences with the cortisone - makes me a good candidate. I preferred Dr McQueen as he does more in a year. Needless to say I am still apprehensive about the surgery but I've read enough positive stories and contacted a few people who have gone through with it, so I'm ready to do it.

Update, 2012-06-17

Day of Surgery:

I can't say that I wasn't feeling a bit apprehensive. I had to be at the hospital at 7 am and it was about 25 mins from our house, but being so early there was no traffic and we made it with time to spare. Was immediately shown to my room (gotta love private hospitals!) and had about a 2 hour wait until the surgery. In the meantime I had to put on the lovely hospital gown and really glamorous hospital underwear which were so gigantic they nearly fell down. I had never had any surgery before, not even a GA so I had no idea what to expect. Met the anaesthetist who explained his job and asked about my health (the first of many to ask me those questions for the day!). Then off I was wheeled in my hospital bed, up into the lift and into the theatre waiting area. There for about 30 mins (in which I heard the girl behind the curtain next to me in tears (nervous I suppose?) - for some reason I didn't feel the same, I was resigned to the fact now. My surgeon popped by to see if I had any questions - I just asked if I was going to need a catheter and he said not at all.

Off into theatre where all I remember is meeting the staff involved and having the needle inserted into my hand for the anaesthetist, and he said 'just going to put in some starters' and I was GAWNNNN!

Next time 'ok Natalie, that's all done now for you' and I was in another room (recovery) with 2 nurses. They wheeled my bed back to my room where hubby was anxiously waiting and that was that! Well, perhaps that was the easy part. That day I didn't feel much pain and was able to lie on my back would you believe, eat and watch TV. Next day, no such luck. Whilst I did have antibiotics & pain killers, I guess the anaesthetic had completely worn off. I did not feel constant pain but turning over or putting any pressure on the area was definitely sore. Pretty hard to avoid that in a hospital bed. You can lie on your side but you do have to give your thigh muscles a rest now and then too. I had to use a bedpan for the first 2 times (interesting experience) but after that was able to get up to use the bathroom. I didn't find the toilet seat too low or anything.

Day 2

Surgeon visited me to say the operation had gone smoothly and that my coccyx was very 'mobile'. He believed I'd make a full recovery. I threw up my lunch, I think that was from the intravenous antibiotics. They then gave me anti-nausea meds also via the drip and I was ok after that. I was able to have a shower as my dressing was water proof.

I think the times I felt worse were waking up from sleep in the morning because I guess maybe the pain meds had worn off and also even though you're on your side, it still seems to hurt a bit. The drip thing came out also on day 2 and I started having my antibiotics orally as that's what I'd have to do at home.

Day 3

I had 3 nights in hospital which I think I needed - we don't have an ensuite at home so the toilet would have been a bit of a trek. Plus that thing they have above the bed to hold on to whilst you get up or move, that's great too. Surgeon came to visit again and I mentioned I was still quite sore, and he said that's normal and I should 'turn a corner' tomorrow. Asked if ice had been helping, I said I hadn't been offered any ice. So then I got some. Not sure it really made any difference.

Home Day:

As I was about to be released, they suddenly remembered to ask me if I'd had a bowel movement, which I had not. So there was a mad rush to give me laxatives, then a suppository (lovely), none of which gave me any joy. So I went home anyway, and OMG, that afternoon trying to go to the toilet was real agony. Anyone having this surgery, start taking stool softeners/laxatives straight after the surgery! It's all the meds causing this. It was not pleasant and I didn't get any relief till that evening. I guess the tablets for that kicked in, and I was drinking pear juice which is meant to be good for it too. ANYWAY...

Subsequent Days:

It's been a week since my surgery and I would have to say I am still in a fair bit of pain. It is too early to tell if my coccygectomy has been a success (from a pain perspective) as the wound pain is too great. I am ok when standing but obviously you can't stand 24 hours a day. I am still on the pain killers and have finished my antibiotics. I am going to make an appointment with my GP tomorrow to have a look at the wound and perhaps get the dressing changed. My surgeon reckons he doesn't need to see my again unless I am having problems! In fact I would say he was pretty blasé about the whole thing, I suppose that's because in relation to other surgery he does (spinal fusions and metal rods being put in, etc) it probably is a trivial operation to him.

Anyway I understand that I have to give it a lot more time, it isn't a quick recovery and you really have to try and stay off it. You also need someone to be around to help you for awhile. I'll keep you posted.

Additional:

I am also taking a whole bunch of vitamins that are meant to be good for surgery and recovery. I had zinc, calcium & vitamin D leading up, and after I am taking fish oil, vitamin C with bioflavonoids, devil's claw (sounds scary) and arnica. Anything that helps!

Update, 2016-06-19

4 years on from my surgery and I am still glad I went ahead with it. Overall I'd say it's 90% sorted, very occasionally I feel some pain when sitting too long (like 4-5 hours, generally working at my desk) but the pain goes away after I am up and moving. That's still majorly better than before the surgery. Everyone is different though but I at least hope my story helps some people. Important to choose a good surgeon confident with this type of surgery I feel.

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