Fluid Collection After Coccygectomy, Fluid after Coccyx - Tailbone Removal

  • Coccygectomy is the surgical amputation, or removal, of the coccyx (removal of the tailbone).
  • After a coccygectomy, it is relatively common to develop a fluid collection at the surgical site.
  • I spoke with a group of European coccygectomy surgeons about this topic when I lectured at the International Coccyx Pain Symposium in 2016 and again in 2018. None of the surgeons were entirely sure of exactly why the fluid collection happens, or how best to treat it.
  • The best we can explain it is that after the coccyx is removed there is some space present where the tailbone used to be, and inflammation/fluid after the surgery sort of fills that area. I compare this to removing a few shovels full of dirt from the ground in your backyard, and before long it will fill with water and you will have a puddle.
  • After a coccygectomy, the fluid would mainly be seen on imaging studies such as MRI.
  • On MRI, the doctors can carefully look to see if the fluid contains any retained bony fragments from the coccyx, which may have been accidentally “left behind” at the time of surgery.
  • Sometimes the fluid collection will persist for many months after the coccygectomy.
  • In some instances the fluid may resolve over time.
  • There is no officially established protocol for how to deal with the fluid or whether anything should be done with it at all.
  • If the patient is having substantial symptoms, then treatment is reasonable.
  • One consideration would be to put a needle into the fluid in order to send a fluid sample for testing.
    • Specifically, the testing of the fluid would be to look for any infection. So the testing of the fluid could include looking for bacteria by doing a gram stain and then looking for bacteria under a microscope. Testing could also include a bacterial culture/sensitivity, where the doctors try to grow whatever miscro-organisms were found in the fluid. Testing could also include looking at the white blood cell count [WBC count] within the fluid, because infection is often associated with a high WBC count.
  • Certainly if there is redness and warmth at the skin over the fluid collection, or if the patient has a fever, those things would be clinical signs concerning for infection within the underlying fluid. The higher the clinical suspicion for infection, the more likely that the doctor will want to test for infection and/or start antibiotics to treat the infection.
  • A localized collection of infection like this is often referred to as an “abscess.” If it looks like there is a local infection at the site, then typically the doctor would NOT want to inject any steroid at that area, since injecting a steroid into an active infection could make the steroid worse.
  • Using a needle to remove the fluid might potentially be helpful at relieving the fluid pressure/pain in the area, although it is certainly possible that some or all of the fluid might just re-accumulate.
  • In rare cases, a fluid collection might be due to prolapse (sagging) of the rectum. Rectal prolapse means that the rectum has moved out of its normal position and has instead moved into a different area. (In this case, it could be that the rectum is moving into the area where the tailbone used to be.)
  • In general, make sure your physicians are assessing the skin for redness/warmth to make sure there is no sign of infection.
  • Also, ask your local physicians whether they have anyone local to you who would be able to look at this under ultrasound and see if the area where the fluid is located may match the area where you are having your symptoms. They could also consider removing the fluid by inserting a needle under ultrasound guidance.
  • Also, please make sure that your coccygectomy surgeon sees the MRI report and the CD images of the fluid, and ask for his/her thoughts and advice on this issue.

GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

- Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.

Rehabilitation Institute of Chicago is now the Shirley Ryan Ability Lab

I completely loved doing my residency in Physical Medicine and Rehabilitation (PM&R) at the Rehabilitation Institute of Chicago (RIC), from 1993 to 1996.

Roughly a quarter century later, in July 2019, I was happy to be back to give a Grand Rounds lecture on Coccyx Pain (Tailbone Pain).

There is a totally new and beautifully modern building (the Shirley Ryan Ability Lab) just 2 blocks from where the former RIC building still stands.

Some items from RIC are still found in the new building, such as:

  • the huge Marc Chagall’s Tapestry, depicting the biblical story of “Job”, which formerly hung in the lobby of RIC.
  • the bust/statue of Henry B. Betts, M.D., (Dr. Foye’s former Chairman at RIC). The statue was created by Yeongchi Wu, M.D., who was famous for his global contributions to amputee care via the invention of the rigid removable dressing (used after amputation, before a patient is fitted with an artificial limb).

 

Dr Patrick Foye MD, at the Shirley Ryan Ability Lab, (Rehabilitation Institute of Chicago: RIC) to Lecture on Coccyx Pain, Tailbone Pain, Coccydynia

Dr Patrick Foye MD, at the Shirley Ryan Ability Lab, (Rehabilitation Institute of Chicago: RIC) to Lecture on Coccyx Pain, Tailbone Pain, Coccydynia

Marc Chagall's Tapestry, "Job", at the Shirley Ryan Ability Lab (formerly the Rehabilitation Institute of Chicago), with Patrick Foye MD

Marc Chagall’s Tapestry, “Job”, at the Shirley Ryan Ability Lab (formerly the Rehabilitation Institute of Chicago), with Patrick Foye MD

Patrick Foye MD, with statue of Henry B. Betts, MD, (Dr. Foye's former Chairman at RIC: the Rehabilitation Institute of Chicago)

Patrick Foye MD, with statue of Henry B. Betts, MD, (Dr. Foye’s former Chairman at RIC: the Rehabilitation Institute of Chicago)

Dr. Patrick Foye M.D., Lecturing on Coccyx Pain (Tailbone Pain), at the Shirley Ryan Ability Lab, (formerly RIC: Rehabilitation Institute of Chicago), July 24, 2019.

Dr. Patrick Foye M.D., Lecturing on Coccyx Pain (Tailbone Pain), at the Shirley Ryan Ability Lab, (formerly RIC: Rehabilitation Institute of Chicago), July 24, 2019. The building in the background is the former RIC: the Rehabilitation Institute of Chicago.

 

 

Midwest Tailbone Pain Lecture was in Chicago, July 24, 2019

On July 24, 2019, Dr. Patrick Foye, MD, gave a Grand Rounds lecture on Tailbone Pain (Coccyx Pain, Coccydynia).

The audience included: Physicians, Pelvic Floor Physical Therapists, people suffering from tailbone pain, and others.

Dr Patrick Foye MD, at the Shirley Ryan Ability Lab, (Rehabilitation Institute of Chicago: RIC) to Lecture on Coccyx Pain, Tailbone Pain, Coccydynia

Dr Patrick Foye MD, at the Shirley Ryan Ability Lab, (Rehabilitation Institute of Chicago: RIC) to Lecture on Coccyx Pain, Tailbone Pain, Coccydynia

Dr. Patrick Foye M.D., Lecturing on Coccyx Pain (Tailbone Pain), at the Shirley Ryan Ability Lab, (formerly RIC: Rehabilitation Institute of Chicago), July 24, 2019.

Dr. Patrick Foye M.D., Lecturing on Coccyx Pain (Tailbone Pain), at the Shirley Ryan Ability Lab, (formerly RIC: Rehabilitation Institute of Chicago), July 24, 2019.


GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

- Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.

 

Midwest Tailbone Pain Lecture, in Chicago, July 24, 2019

Tailbone Pain: Lecture in Chicago, Illinois.
  • I’m looking forward to lecturing on Coccyx Pain (Tailbone Pain),  in Chicago, Illinois.
  • Grand Rounds Lecture: “Coccyx Pain: Pearls and Pitfalls from Treating Thousands of Patients with Tailbone Pain.” 
  • When: Wednesday, July 24, 2019, from 12-noon to 1pm, central time.
  • Where: Shirley Ryan AbilityLab (formerly R.I.C.: The Rehabilitation Institute of Chicago), 355 E. Erie St., Chicago, IL 60611, 10th Floor Auditoriums A/B
  • Speaker: Patrick Foye, M.D., Professor of Physical Medicine & Rehabilitation, and Director of the Coccyx Pain Center at Rutgers New Jersey Medical School. Former Chief Resident at RIC, 1996.
Midwest Tailbone Pain Lecture, Chicago, RIC SRALab, 2019, Patrick Foye MD

Midwest Tailbone Pain Lecture, Chicago, at RIC SRALab,  on July 24, 2019, Patrick Foye MD


GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

- Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.

Interview of Patrick Foye, M.D., on Tailbone Pain, by a Pelvic Floor Physical Therapist

I was very happy recently to have been interviewed by a Pelvic Floor Physical Therapist, Michelle Dela Rosa, PT, from Connect Physical Therapy in New Jersey, United States.

Interview by Patrick Foye MD, Tailbone Pain Center, Coccyx Pain Center

Interview by Patrick Foye MD, Tailbone Pain Center, Coccyx Pain Center

You can read the full interview here: 

https://www.connectpt.org/blog/interview-with-dr-patrick-foye-on-tailbone-pain


GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

- Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.

Great Educational Session on Pregnancy & Childbirth by Ashley Brichter @birthsmarter @beyondbasicspt

Yesterday I attended a great educational session on #Pregnancy & #Childbirth by Ashley Brichter

Ashley is a Certified Cooperative Childbirth Educator, a birth and postpartum doula, and a pelvic health and body-alignment enthusiast. 

The talk included discussion of how the position of the coccyx (tailbone) can create problems during childbirth (labor and delivery).

For an online article by Ashley on optimal pelvic positioning for giving birth, read here: http://overwhelmingmoments.com/blog/2019/1/21/questioning-childbirth-status-quo-part-one-common-labor-positions

You can find Ashley here: @birthsmarter in NYC.

The talk was given here: @beyondbasicspt in NYC.

Photos:

Ashley Brichter (after her Lecture on Pregnancy and Childbirth) with Patrick Foye, MD

Ashley Brichter (after her Lecture on Pregnancy and Childbirth) with Patrick Foye, MD

Ashley Brichter Lectured on Pregnancy and Childbirth

Ashley Brichter Lectured on Pregnancy and Childbirth

Pelvic Health 101, Lectures for 2019, Beyond Basics Physical Therapy, NYC

Pelvic Health 101, Lectures for 2019, Beyond Basics Physical Therapy, NYC


GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

- Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.

Kabooti Cushion, for Coccyx Pain, Tailbone Pain, Coccydynia

Kabooti Cushion, for Coccyx Pain, Tailbone Pain, Coccydynia
  • Many of my patients with coccyx pain (tailbone pain, coccydynia) ask me what cushion is best to decrease their pain while sitting.
  • There is no perfect answer for all patients.
  • There are many different cushions to consider or try.
  • Recently, I was in a store that sells the Kabooti cushion, which a number of my patients have used and found helpful.
  • So, I did this short video about the cushion.
  • This is not an official endorsement or advertisement, but rather just an educational discussion about this cushion.
Here is the Video:

Here is the video link: https://www.youtube.com/watch?v=z3JIsrmXz0o

Photos related to this videos:
Kabooti cushion, for Coccyx Pain, Tailbone Pain

Kabooti cushion, for Coccyx Pain, Tailbone Pain

Kabooti cushion, Dr. Foye,, for Coccyx Pain, Tailbone Pain

Kabooti cushion, Dr. Foye,, for Coccyx Pain, Tailbone Pain


GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

- Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.

Toilet Seat Cushion for Tailbone Pain, Coccyx Pain, Coccydynia, Pudendal Nerve Pain, Pudendal Neuralgia.

Toilet Seat Cushion for Tailbone Pain, Coccyx Pain, Coccydynia, Pudendal Nerve Pain, Pudendal Neuralgia.
  • Some patients find that the most comfortable place to sit is to sit on a toilet seat.
  • This is true for some patients with coccyx pain (tailbone pain, coccydynia).
  • This is also true for many patients with pudendal nerve pain (pudendal neuralgia).
Where can you get a  Toilet Seat Cushion?
  • You can buy a toilet seat at many hardware stores or home improvement stores.
  • Some patients will add additional padding to make the seat more comfortable.
  • Some patients will add fabric or another covering, so that cosmetically  it does not look like a toilet seat.
Here is a video where Dr. Foye  displays a Toilet Seat Cushion and talks about why it can be helpful for some patients with Tailbone Pain, Coccyx Pain, Coccydynia, Pudendal Nerve Pain, Pudendal Neuralgia.

Video:

Here is the Link to the video: https://www.youtube.com/watch?v=y24j0nXZ9V0

Here are some screenshots from the video, and photos of a Toilet Seat Cushion:
Toilet seat cushion, Dr Foye, for Tailbone Pain, Coccyx Pain, Pudendal Nerve Pain

Toilet seat cushion, Dr Foye, for Tailbone Pain, Coccyx Pain, Pudendal Nerve Pain

Toilet seat cushion, for Tailbone Pain, Coccyx Pain, Pudendal Nerve Pain, 2-views

Toilet seat cushion, for Tailbone Pain, Coccyx Pain, Pudendal Nerve Pain, 2-views


GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

- Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.

Sitting on a Couch causes Coccyx Pain, Tailbone Pain, Coccydynia

  • Many people with coccyx pain find that couches are terrible for sitting, because even with a cushion the cushion just sinks into the softness of the couch and your tailbone still ends up contacting the sitting surface.
  • So, many people with tailbone pain will avoid couches or sofas.
  • Some people with tailbone pain will use a firm-plastic-shell type of cushion, since even if it sinks down the shell maintains it’s shape including the indentation creating a gap space below the coccyx.
  •  Relaxobak and BackJoy are two manufacturers that make these “shell” types of seats.

GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

- Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.

Pelvic Pain Lecture by Stephanie Stamas, Pelvic Floor Physical Therapist in NYC

I attended a fantastic lecture on Pelvic Pain this week in NYC by pelvic floor physical therapist Stephanie Stamas, PT, DPT, at Beyond Basics Physical Therapy in NYC.

They have upcoming lectures on related topics over the next few weeks.

I definitely recommend attending these if you are in the NYC area and interested in P.T. insights and treatments for issues in the pelvic, bladder, bowel, genital regions.

Stephanie Stamas PT with Patrick Foye MD, after her Pelvic Pain lecture, 3-19-18

Stephanie Stamas PT with Patrick Foye MD, after her Pelvic Pain lecture, 3-19-18

Stephanie Stamas PT, Title Slide from her Pelvic Pain lecture, 3-19-18

Stephanie Stamas PT, Title Slide from her Pelvic Pain lecture, 3-19-18

Pelvic Health 101, Lectures for 2019, Beyond Basics Physical Therapy, NYC

Pelvic Health 101, Lectures for 2019, Beyond Basics Physical Therapy, NYC


GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com  or go to Amazon.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com

- Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.

Book Now Available! Click on the book to get it now:


Get the Book at www.TailbonePainBook.com