Injured coccyx during childbirth; some relief found from injections

Rachel in So CA - mizaqua@gmail.com

Posted 2011-01-16

Nov 2009, I gave birth to my first child at the age of 36 and had an epidural. I am 37 years old, living in So California, and have Kaiser HMO insurance. I did not know my coccyx had been injured until the epidural wore off. Trying to comfort and breastfeed my baby was difficult to say the least. My OB said there was nothing that could be done medically, and told me to wait it out and it would heal on its own. No x-rays were done. I decided to try a chiropractor after 4 months of pain; this did not help. I told my OB that I was still in lots of pain. I went back to work when my baby was 5 months old. My job involves working at my laptop and cross-country flights a couple times a month. Flying was excruciating, but I figured it was just a matter of time before I was healed. I had another friend who had a coccyx injury after childbirth, and she was healed after 6 months, so that was what I figured mine would take. My OB said these injuries happen in 5% of regular deliveries (non-cesarean). My chiropractor ordered some x-rays, which showed a fracture. Since coming home from the hospital with the baby, I tried every kind of donut pillow I could get my hands on. While they were better than not using them at all, I was still in tears by the end of most days.

After 9 months, and several cross-country flights, I was in a lot more pain, and I got my OB to prescribe Vicodin. She also referred me to Physical Therapy, which had no effect. The PT massaged the tissues around the coccyx. I tried Acupuncture as well, with no effect. My physical therapist wanted to see if there was still a fracture; if not, she wanted to do some manual manipulations (although she admitted that she had no experience; she was a pelvic floor specialist). The x-ray showed no fracture this time, but I decided to decline the manual manipulations. It sounded too painful!!

My chiropractor recommended I see a neurologist, to see if there was any nerve damage. I went to see a neurologist, and he diagnosed me with coccydynia. He said that I wasn't healing because I continued to injure the tailbone with repeated sitting (despite use of donut pillows), and that I should take 6 weeks off work and not do ANY sitting/driving/flying. He also referred me to the Pain Management department.

Pain management recommended a cortisone injection into the joint under fluoroscopic [x-ray] control. I was able to get scheduled for the injection 3 weeks after seeing the Pain Management doctor. He advised starting the 6 week LOA after the injection, so I continued to work with significant pain until the injection on 11/6/10, nearly a year after the injury. The actual injection was not a big deal at all. Afterwards, I was in more pain for about 2 weeks. The Vicodin made me nauseous, so I tried to take the least amount possible. During the 3rd week, I thought I was feeling some relief, but it was short-lived and the pain is still there, as before. I had my follow-up appointment 6 weeks after the injection, and they did not recommend doing another injection as the first one had been unsuccessful.

Because of this site (thank you, Jon!), I learned about Dr. Lau in Anaheim, CA, who is part of the Kaiser network (see Doctors and specialists in the USA, California). I was finally able to get a referral from my primary care doctor to see him, despite her perception (for some unknown reason) that an orthopedist could not help me. Dr. Lau said I would be a good candidate for a coccygectomy, as he believes the coccyx is dislocating when I sit, and I am scheduled for surgery next week on Jan 17th! Dr. Lau says he has done about 50 60 coccygectomies, and over 80% of the patients have experienced significant relief. My main concern is the recovery time, as well as the risk of infection. I have been out on disability for 2 months, and it looks like I will be out through February. I am anxious to get on with my work and my life; I can imagine the day that I will sit pain-free and read stories to my baby!

I am so thankful to Jon for this website, and have been doing my part to educate the doctors who I've seen along the way (as well as all my friends and relatives).

Please feel free to write me if you have any suggestions / thoughts / words of encouragement about the upcoming surgery.

Thank you,

Rachel

Update, 2011-02-20

I was scheduled for a coccygectomy on January 17, but had an appointment with a Physical Medicine specialist on January 14 who thought it was too soon for surgery, and that I should try a nerve block first. I decided I was rushing into the surgery due to pressure to go back to work and my desire to be well (and pain med-free) so I could think about having another child (c-section this time!), so I decided to cancel. He didn't understand why the Pain Management group in West LA hadn't recommended a nerve block (he specifically mentioned a Ganglion Impar Block) and referred me to the Kaiser Sunset Los Angeles offices, which have a larger pain management group. I also asked him if he could send me for a dynamic x-ray.

I got my dynamic x-ray on January 17 (below) and it looks like my coccyx is not curving in correctly when I sit, particularly the last segment. I had to show the radiologists pictures from this site in order to get them to do the x-ray correctly, as they didn't seem to know what I was talking about.

I met with another Pain Management doctor, who said she had some success (Dr. Patricia Harrison, Pain Management Dept., 323-783-0567, Kaiser Sunset 4760 Sunset Blvd, Los Angeles, CA) treating coccydynia with cortisone and caudal epidurals. She saw that the previous injection I had on November 6 2010 was done to the joint between the coccyx and the sacrum and after doing an exam, felt that it was probably done at the wrong place since my pain is in the tip and last joint of my coccyx. I had my cortisone injection (all around the coccyx and in each coccyx joint, as well as the Ganglion Impar) and caudal epidural on February 2 2011. I was in more pain that before the injection for about a week, and had bruising at the injection sites. Now, 1.5 weeks after, I am feeling about 25% better. I also started seeing a new chiropractor, who is using the Activator tool on my and doing ultrasound therapy. I am planning a scheduling another nerve block/cortisone injection and continuing chiropractic treatment, and I am returning to work next week. I am still taking NorCo pain medication, but less than before.

Rachel in So CA

coccyx while standing coccyx while sitting

STANDING -------------------------------SITTING

Update, 2013-01-20

Still searching for relief. It has been over 3 years since I gave birth to my daughter and traumatized my coccyx. In March 2011 we moved from Los Angeles to Orange County. I had another caudal epidural / Ganglion Impar nerve block in July 2011, this time with no notable relief after the pain from the injections subsided. I was hopeful that the move would lead to some new doctors with new ideas. I had another GI and Sacroiliac injection from a couple different pain management docs in Dec 2011 and July 2012, with no notable relief. I was taking Methadone and Norco for the pain in order to continue working full time.

We moved to the San Francisco Bay Area Nov 2012, and I am due in March 2013 (2 months from now) with baby #2. I have had to go off the opioids since December 2012 due to the stage of pregnancy I am in (3rd trimester), and have been thinking that a C-section would be the best mode of delivery for this 2nd baby as to not cause further injury to myself. I have not been able to get any good advice on whether another vaginal delivery would potentially worsen my situation. The various OB doctors in the practice I am going to have not been helpful at all, and just try to talk me out of the C-section since it is a major surgery. I would love to hear from anyone who might have any experience or advice on my delivery options.

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