Tailbone injury during childbirth

How does the tailbone get injured during childbirth?

Coccyx (tailbone) pain is mainly caused by childbirth. Coccyx is forced back when baby is being born, damaging the joint. Mothers often told by the doctors that their tail bone has been broken, which is not exactly true; because it’s not the bone which have been broken but it is one of the joint of the tailbone which has been broken. Coccyx is mainly made up of the three small bones in between the coccyx and sacrum. When the mother is about to deliver the child or when the baby is passing through birth canal, it puts pressure on the joints and open those joints. The joints may heal after some time but it may remain loose and can cause pain while sitting or coming to a standing position from sitting.

An earlier injury can also cause tailbone pain, which can leave a coccyx of a mother sharp pointed. In such conditions, the childbirth is even more painful and even it can reinjure the coccyx. In very rare cases the pressure from the baby can make the coccyx break through into the rectum. One woman also spotted that her during childbirth, her forward pointed tailbone caused her agony. She also stated that her forwarded tailbone also marked her baby during childbirth. Fecal incontinence also caused by other trauma caused by child birth. Childbirth can cause bruise, dislocation, or even fracture your tailbone. Some women can actually hear a crack when their tailbone breaks.

Is it possible to break your tailbone?
Is it possible to break your tailbone?

The pressure of a baby passing through the birth canal can bruise, dislocate, or even fracture your tailbone. Fractures aren’t common, but some women actually hear a crack or pop when their tailbone breaks. For most people tailbone (coccyx) is made up of four last vertebrae of spinal column. The topmost vertebra of the coccyx may or may not be fused with the one below it, but the lower three vertebrae are usually fused together. Some pelvic muscles and ligaments attach to the coccyx.

When your baby is very large or in odd position or if your pelvis is of odd shape, you are more likely to injure your tailbone during delivery. The shape and mobility of the coccyx may play a role, too. Women who have previously injured their tailbone have a greater risk of injuring again during a vaginal delivery.

How tailbone injury feels like?

You may feel general tenderness in the area and pain when you get injured. You may feel that your pain gets worsen with your sitting. You may also feel a shooting pain when you stand from a sitting position or if you put strain while passing stools or during a bowel movements.

What is the etiology of tailbone injury?

Tailbone pain is also called as coccydynia and the exact cause of coccydynia has not been reported. However, the obesity and female gender are the main risk of developing coccydynia. Men are less like to suffer from coccydynia as compare to women. Adults are more likely to suffer from coccydynia as compare to children. Due to loss of mechanical cushioning, the rapid weight loss can also be a risk factor. The most common cause of coccydynia is trauma which can be external or internal.

  • Backward falls which can cause bruised, dislocated or broken coccyx are known as external trauma
  • Whereas the internal trauma can be generally caused by complicated vaginal delivery. The location of the coccyx makes it particularly susceptible to internal injury during childbirth, especially during a difficult or instrumented delivery.
  • Prolonged sitting on hard or uneven surfaces can also cause minor trauma.
  • A number of causes such as degenerative joint, disc problems, hyper or hypo mobility of sacrococcygeal joints, infections, and variants of coccygeal morphology can be responsible for nontraumatic coccydynia.
  • Neoplasms can also be associated with coccydynia but very less commonly.
  • Other non organic causes of coccydynia are somatization disorder and other psychological disorders.

What are the symptoms of tailbone pain?

When your baby is very large or in odd position or if your pelvis is of odd shape, you are more likely to injure your tailbone during delivery. The shape and mobility of the coccyx also play a role, too. The main symptom is pain and tenderness in the area just above the buttocks.

The pain may:

  • be dull and achy most of the time, with occasional sharp pains
  • be worse when sitting down, moving from sitting to standing, standing for long periods or  having sex
  • make it very difficult to sleep and carry out everyday activities, such as driving or bending over

Some people also have back pain, shooting leg pains (sciatica) and painful buttocks and hips.

When to get medical advice for tailbone injury?

Coccydynia will often improve on its own after a few weeks and there are some simple treatments you can try at home.

See your GP (general practitioner) if:

  • the pain doesn’t start to improve within a few weeks
  • simple home treatments don’t relieve the pain
  • your pain is very severe
  • you also have bleeding, a high temperature (fever) or pain away from your coccyx

In order to check more serious causes of your pain such as an infection or fracture, your doctor will carry out an examination. You may also be recommended some tests like X-rays or MRI (Magnetic Resonance Imaging) scan.

What makes the tailbone pain worse? 

  • Prolonged sitting, especially on a hard surface
  • Bending
  • Lifting
  • Climbing stairs
  • Opening bowels
  • Some women can feel increased pain during menstruation and sometimes with-

Other causes that can worsen the coccyx pain include:

  • Trauma/fall onto buttocks and coccyx
  • Repetitive micro trauma, for example from inadequate sitting posture or sports such as-
    • Cycling
    • Motor sports.

How long does it take a tailbone injury to heal?

A tailbone injury during childbirth or by traumatic means takes a lot of time to heal and is very painful too. Most of the time it depends upon the severity of the injury that how much time it takes to heal.

If may takes 8 weeks to 12 weeks to heal, if it is fractured by means of child birth or by trauma. If your tailbone injury is a bruise, the healing may takes about 4 weeks.

What are the risk factors associated with coccydynia?

Risk factors such as having a difficult delivery or use of forceps signal a patient history that may lead to coccyx pain. Coccydynia is one of the pain associated with peripartum pelvic girdle dysfunction and is treated by the pelvic rehabilitation providers. The risk factors responsible for coccydynia are:

Childbirth:

  • In a recent study, X-Rays were taken to access the mobility of the coccyx and delivery methods were collected.
  • The authors found that the women reported immediate postpartum pain in the coccyx with sitting.
  • When comes to instrumentation which is a common finding in regard to the patient deliveries, 50% of the deliveries were done using forceps whereas 7% were vacuum assisted.
  • The dislocation of coccyx was higher in patient who developed the coccydynia after childbirth (44%) was higher as compared to controls (17%).
  • A fractured coccyx occurred in 5.3 % of the women.

Higher BMI:

  • Higher prevalence of dislocation of coccyx is also observed in patient with Body mass index (BMI) of more than 27 and having 2 or more vaginal deliveries.

Long term sitting:

  • After childbirth, long term sitting in one position such as for feeding baby can also cause coccydynia.

It became very difficult for a new mother to sit comfortably after childbirth due to the limitations in activities like sitting to feed the baby. Other activities may also limit because of unable to sit comfortably.

The women in this study reported immediate tailbone pain with sitting, which can alert providers to a condition requiring both immediate and follow-up attention.

How to diagnose coccydynia?

You’re more likely to injure your tailbone during delivery if your baby is very large or in an odd position, or if your pelvis is very narrow or oddly shaped. The shape and mobility of the coccyx may play a role, too. Women who have previously injured their tailbone have a greater risk of injuring again during a vaginal delivery.

You may feel general tenderness in the area and pain when you get injured. You may feel that your pain gets worsen with your sitting. You may also feel a shooting pain when you stand from a sitting position or if you put strain while passing stools or during a bowel movements.

Imaging studies are valuable in evaluation and assessment of the coccydynia despite a fact that coccydynia is itself a clinical diagnosis. There are two types of radiographs single position radiograph and dynamic radiograph.

  • Single radiographs are not diagnostic because it hardly produces any definitive morphologic differences between normal individuals and patients with coccydynia.
  • Dynamic radiographs are more useful than X-rays in sitting and standing position as well because they allow complete rotation of the pelvis and coccygeal angle of incidence.
  • In around 70% cases of coccydynia, the comparison of sitting and standing films will be yielded.
  • The imaging can be helpful in a way that it defines the angle of the coccyx exactly and exhibit coccygeal displacement in immobility (<50 in motion) and hyper mobility (>250 of motion) which is normally in between 5 to 250 when coccyx rotates upon sitting and standing of a person.
  • Other advanced imaging techniques can also be used to diagnose coccydynia but such techniques are not as accurate as dynamic radiographs.
  • For demonstrating inflammation of sacrococcygeal area which represents coccygeal hypermobility, MRI (Magnetic Resonance Imaging) and technetium Tc-99 bone scans may be used.
  • The pain relief with an injection of local anesthetic under fluoroscopic guidance can be used for provocative testing of coccyx such as pressing on the region with a blunted needle to draw out the pain.

How can I ease the severe tailbone pain at home?

The tailbone can be caused by trauma to the coccyx during a fall, prolonged sitting for hours, degenerative joints, or vaginal childbirth. Tail bone pain is a kind of pain that occurs in coccyx a bony structure at the bottom of the spine.

This pain can be severe during some activities such as sitting, standing up from a seating position, or even prolonged standing can cause this pain. Usually this pain is dull and achy. Defecation and sex also might become painful. For women, tailbone pain can make menstruation uncomfortable as well.

Coccydynia also called as coccygodynia or tailbone pain usually disappears on its own within few weeks or months. You can reduce the intensity of pain in the meanwhile by:

  • Lean forward while sitting down
  • Sit on a doughnut-shaped pillow or wedge (V-shaped) cushion
  • Apply heat or ice to the affected area
  • Take over-the-counter pain relievers, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or aspirin

You should seek medical help if you are not able see any improvement in your coccydynia. You may also have to undergo a rectal examination in order to rule out any other condition. A MRI (Magnetic resonance imaging) can be also being done if you have a fracture or degenerative cases. In rare cases, it may be done to check if it is a tumor.

What is the nonoperative treatment approach for tailbone pain?

Gold standard treatments for coccydynia are nonsurgical strategies which are

  • Pain killers such as NSAIDs (Non steroidal anti inflammatory drugs)
  • Analgesics
  • Reduced Sittings & pillow use
  • Postural adjustments
  • Physical therapy

Patients with normal coccygeal mobility responded best to some initial modalities such as

  1. levator ani stretching (32%)
  2. levator ani massage (29.2%)
  3. Sacrococcygeal joint mobilization (16%)

Such techniques shows great response rates in normal coccygeal mobility (43%) as compared to those with immobile coccyx (16%) which shows poorest outcomes. Patients with hypermobility or subluxation (dislocated coccyx) demonstrated only moderate improvement of their symptoms (25 and 22.2%, respectively). Its comparison with standard treatment of NSAIDs and its success rate have not been evaluated. When coccydynia is refractory to other Nonoperative techniques, a local injection into the region of coccyx is given as another therapeutic approach. For this a mixture of steroid ((40 mg methylprednisone) and long-acting anesthetic (10 ml 0.25% bupivicane) is administered which may be repeated if needed.

If a patient shows persistent symptoms, he or she should be given third injection in conjunction with coccygeal manipulation under the effect of general anesthetic. The coccyx was repeatedly flexed and extended for approximately 1 min. The basis for this recommendation was the reported study success rates of 59% with injections alone and 85% for the combination of injections and manipulation. Some patients (21%) experienced recurrent symptoms, even after receiving injections and some patients (28%) those who are undergoing injections with concurrent manipulations. However, many patients were successfully managed with a prolonged course of therapy.

Another therapeutic protocol for acute coccydynia in which the pain in less than 2 months were stated, given by Fogel et al. which is as follows:

  • A rest of 8 weeks
  • Stool softeners
  • Adjustment in sitting position
  • NSAIDs (Non Steroidal Anti Inflammatory Drugs)

These therapies are effective in treating the chronic symptoms and acute coccydynia lasting greater than 2 months. The status of coccydynia is further evaluated with help of radiographs and MRI of coccyx. Massage, stretching, or injections are the other modalities which can be added as Nonoperative modalities can also be incorporated. Surgical intervention should be considered in the patients who fail to respond to such conservative therapies.

 What is the surgical management for tailbone injury?

Despite the implementation of various Nonoperative treatments, if a patient still continues to complain the coccygeal pain, the surgery may be implemented for such patients. Surgical management includes complete coccygectomy or excision of mobile segment of the coccyx. The patients with advanced degeneration such as coccygeal instability for example dislocation of coccyx or hyper mobility are given such special treatments. Because the patients shows great improvements after surgery with published success rates in between 60 to 91%. While the patients with normal coccygeal mobility, shows lesser favorable outcomes after surgery.

What are the complications after surgery of coccyx?

  1. Wound infection is the most frequent complication of coccygectomy.
  2. Patient is prone to high incidence of postoperative infections which has been attributed to the presence of abundant perineal skin flora that results in:
    • Local contamination
    • Inability to perform proper wound care
    • Difficulty in visualizing the surgical site thereby improper wound care
    • Excessive wound tension due to long hours of sitting
  3. Delayed healing and wound hematomas were also reported in few cases.
  4. Severe complications that include severe infections, injuries of intestinal tract, rectal prolapsed etc. have not been described.
  5. The local skin flora, proximity to the anus, and hygiene difficulties due to the anatomical location of the operative site increases the risk of contamination.
  6. The gram-negative rods are the common causative agents of post operative wound infection.

Infection rate can be reduced by the five day antibiotic course. In a study, post operative infections can be contributed by use of a topical skin adhesive on the post operative wounds.

How to prevent tailbone injuries?

  • Tailbone injuries cannot be avoided entirely because they are accidental such as slip on ice, childbirth.
  • In order to get protection to avoid any chance of injury, you should wear proper pads when playing some sports which can cause a potential injury to coccyx.

Should I follow up after a tailbone injury?

Follow-up is recommended at the discretion of your doctor and depends on the severity of the injury and the progress you are making with medical treatment.

  • If your coccyx injury is improving with medical treatment you are less likely to require follow up.
  • More frequent follow up is required in people with chronic tailbone pain, for whom medical therapy has not worked and may be referred to other medical or surgical specialists.
  • If your injury is healing as expected, your doctor may not need to follow up. If the injury is more severe, you will likely need to see the doctor.

Physiotherapy for tailbone injury pain:

In order to determine the triggers of coccydynia, a physiotherapy assessment can help.  The physiotherapist can teach you exercises to help strengthen the muscles supporting your coccyx, advise you on postural correction and lower back/pelvis.

What are some exercises for tailbone injury pain?

Pelvic floor exercises: Due to the attachments of your pelvic floor to the coccyx, pelvic floor exercises can help to relieve coccyx pain.

You should find a position that does not increase your pain and should try lying on your tummy, side lying or sitting on a soft cushion.

You can do pelvic floor exercises on your back with your knees bent, until it feels uncomfortable.

Contract the muscles of your urethra for as long as you can. Avoid the movement of your abdomen, buttocks and legs during exercise as it may aggregate the pain. Remember while you contract the muscles of urethra, you might not be able to control it for more than 2 to 3 seconds but you should keep on trying for doing this exercise for than 3 to 4 times a day. You can also try some fast pacing exercises for your pelvic floor.

Buttocks squeeze:

You should try squeezing your buttocks together even if lying or sitting, hold into this position for 30 seconds and relax. Repeat the procedure 10 times.

Transversus abdominis:  

  1. Be in a position which is comfortable for you.
  2. Take a deep breath.
  3. Draw your lower abdomen towards your spine, as you breathe out.
  4. Repeat the same for some time and practice daily for 3-4 times a day.
  5. Try to increase the hold until you can hold for the count of 10 and repeat 10 times.

Few points to remember:

  1. Keep breathing throughout the exercises
  2. Draw abdominal muscles in support while doing any activity that involves your back, for example: lifting, rising from sitting, getting out of bed and bending over.

Bridging:

  1. Lying on your back, tilt your pelvis backwards then lift your bottom in the air.
  2. Hold for 10 seconds, repeat 5 times.
  3. Lying on your side with knees and heels together.
  4. Lift the top leg off the other without rocking backwards.
  5. Repeat 10 times each leg.

Exercises for tailbone fracture

Hamstring stretches:

  1. Sit with your leg stretched and point your toes up towards the ceiling.
  2. Or stand, with one leg in front of the other, keep your front leg straight with toes pointed up to the ceiling.
  3. Lean forwards over your straight leg.
  4. You should feel a stretch down the back of your leg.
  5. Hold for 30 seconds. Repeat each side 3 times.

Hamstring stretches: for tailbone fracture

Prognosis of tailbone pain

The prognosis for tailbone discomfort depends on many factors.

  • The original cause of the problem (whether from a fall or other trauma, tumor, or infection)
  • If traumatic, the severity of the injury (a bruise, fracture, or dislocation)
  • Your ability to comply with medical treatment
  • Your natural ability to recuperate and heal

What is the outlook of the patient with tailbone injury?

With proper treatment, the majority of cases of traumatic coccyx injury get better within several weeks of the injury with proper medical treatment.

A few people suffer from chronic discomfort despite proper medical treatment. This can be an extremely frustrating and debilitating problem.

What should be the after care of the tailbone injury?

Coccyx is a small bone at the lower tip of the spine and is also called as coccyx. If you are treated for tailbone injury and you have to stay at home, you should take care of the wound caused by tailbone surgery. You should make sure to follow the doctor’s guidelines in order to heal your injury faster.

Pain and bruises are often followed after most tailbone injuries. Only in rare cases is there a fracture or broken bone. A sudden backward fall on slippery surface or a hard surface may lead to tailbone injuries.

Symptoms of a tailbone injury include:

  • Pain or tenderness in the lower back
  • Pain on top of the buttocks area
  • Pain or numbness with sitting
  • Bruising and swelling around the base of the spine

What are the outcomes of tailbone injury?

A tailbone injury can be very painful and slow to heal. The severity of the injury can describe the healing time for an injured tailbone.

  • If you have a fracture, healing can take between 8 to 12 weeks.
  • If your tailbone injury is a bruise, healing takes about 4 weeks.

You will see symptoms start improving, only in rare cases, symptoms does not improve. If the pain persists, you doctor may give a try to steroid injection. Surgery to remove part of the tailbone may be discussed at some point, but not until 6 months or more after the injury.

How to achieve symptoms relief?

Follow these steps for the first few days or weeks after your injury:

  • Rest is the key to get relief from the pain associated with tailbone injury. You should rest and stop any physical activity that causes pain. You can get quicker relief with ample rest.
  • You should do the Ice therapy for your tailbone injury. You can Ice your tailbone for about 20 minutes every hour while awake for the first 48 hours, then 2 to 3 times a day. Avoid direct application of the ice on the skin.
  • You should use a cushion while sitting. You should use a cushion with a hole in between as the hole in center of a cushion will take pressure off your tailbone. Such kind of cushions is available in the drugstore.
  • Avoid sitting a lot. When sleeping, lie on your belly to take pressure off the tailbone. You can use ibuprofen (Advil, Motrin, and others) or naproxen (Aleve, Naprosyn, and others) for pain. These medications are available over the counter.
  • Avoid using such medication within 24 hours of injury as they can cause bleeding. In case you have diseases such as high blood pressure, kidney disease, liver

Talk with your health care provider before using these drugs if you have heart disease, high blood pressure, kidney disease, liver disease, or have had stomach ulcers or internal bleeding in the past.

  • You should not take medication more than the amount recommended on the bottle or more than your provider advises you to take.

You may feel pain when go to the bathroom. Try eating plenty of fiber and drink plenty of fluids in order to avoid constipation. Your doctor may recommend you to take stool softener medicine if needed that you can buy at the drugstore.

What are the activities that I can resume after recovery of tailbone injury?

You can begin with the light physical activities as your pain goes away. You should always slowly increase your activities, such as walking and sitting. You should:

  • Continue to avoid sitting for long periods.
  • Not sit on a hard surface.
  • Keep using the cushion or gel donut when sitting.
  • When sitting, alternate between each of your buttocks.
  • Ice after activity if there is any discomfort.

The tailbone injury pain can be severe during some activities such as sitting, standing up from a seating position, or even prolonged standing can cause this pain. Usually this pain is dull and achy. Defecation and sex also might become painful. For women, tailbone pain can make menstruation uncomfortable as well. You should call your doctor if you have any of the following:

  • If you feel sudden numbness, tingling or weakness in one or both legs
  • Sudden increase in pain or swelling
  • Injury does not seem to be healing as expected
  • Prolonged constipation
  • Problems controlling your bowel or bladder

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