A United States military veteran with tailbone pain (also called coccyx pain, or coccydynia) turned out to have cancer and infection (a pus-filled abscess) in the tailbone region.
This shows the importance of proper medical care and thorough medical work-up.
Surgical removal of the tailbone (coccyx) is medically known as coccygectomy.
In the United States the coccygectomy surgery would often be considered an outpatient surgery, meaning that you have the surgery in the morning and go home by that evening. But that may vary depending on how someone is doing in the recovery area after the surgery, etc.
Different surgeons use different approaches for handling the fluid drainage from the surgical site. Some surgeons will send the patient home with a drain in place. The drain lets fluid flow out from the surgical site so that it does not form a big collection at the site.
The rate of infection at the surgical site is unfortunately much much higher than it is for most other elective surgical procedures. So many surgeons doing tailbone removal surgery (coccygectomy) give the patient antibiotics even before there is any infection, to prevent an infection from taking hold. There is high variability on the details of how many doses to give and which antibiotics to use.
Regarding complications and side-effects from coccygectomy (surgical removal of the tailbone), please click on the links below:
I have treated many women whose tailbone pain began during pregnancy or while giving birth (during labor and delivery).
Some of these women ask me what they should do if they are considering another pregnancy.
I sometimes advise those patients to speak with their obstetricians/gynecologists regarding considering C-section for their next pregnancy. A cesarean section (C-section) delivers the baby through a surgical incision at the lower abdomen. This way, the baby does not need to pass through the pelvic birth canal.
The rationale for considering a C-section is that a repeat vaginal birth would probably exacerbate the woman’s coccydynia.
I would not be so dogmatic to say that any subsequent childbirth/delivery should ONLY be via C-section. But, I would say that delivery by C-section would be medically indicated and reasonable in hopes of minimizing the chance of childbirth/delivery-related worsening of her coccyx pain.
This is especially worth considering in cases where prior onset of coccyx pain was via childbirth/delivery.
Another factor is whether the woman has persistent anatomic abnormalities (such as unstable joint of the tailbone, diagnosed by sitting/seated x-rays of the tailbone).
Unstable joint of the tailbone may become worse during the increased ligament laxity (looseness of the ligaments) during later pregnancy.
Also, during labor/delivery the woman should avoid prolonged coccyx pressure (which often happens to a woman who spends significant time in the semi-reclined position during labor).
Tailbone Pain Tip 7, PREGNANCY and CHILDBIRTH Can Cause or Worsen COCCYX PAIN, Tailbone Pain, Coccydynia
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person by Dr. Foye’s Coccyx Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.
One complication of surgical tailbone removal (coccygectomy) is that infection may occur at the surgical site.
Part of the reason for the relatively high likelihood of infection at this surgical site (compared with others) is that the coccygectomy site is so close to the anus.
Superficial infections can happen at the skin, which is called cellulitis.
Much more problematic are deep infections within the remaining bones. Bone infection is called osteomyelitis. When there is an infection within the bone, this can sometimes smolder in the background, unrecognized for many weeks or multiple months. Because the bone is deeper than the skin, it may not be immediately obvious that there is an infection.
Symptoms may include persistent or recurrent fevers, chills, ongoing pain at the site of the bone infection.
Blood work: Medical tests for tailbone infections may include blood work, looking for:
elevated white blood cells,
elevated erythrocyte sedimentation rate [ESR],
elevated CRP,
etc.
Imaging studies: Medical tests for tailbone infections may also include imaging studies, such as:
x-rays,
MRI,
CT scans,
nuclear medicine bone scans,
etc.
Treatment typically includes a much more aggressive course of antibiotics, such as:
giving the antibiotics intravenously (IV),(instead of by mouth)
and giving these antibiotics for several weeks instead of just for several days.
Regarding complications and side-effects from coccygectomy (surgical removal of the tailbone), please click on the links below:
Many patients ask me what to do about tailbone pain that continues or returns despite the person having undergone surgical removal of the tailbone (coccygectomy).
Find the CAUSE of the ongoing tailbone pain after coccygectomy
In general, it is important for the treating physician to start by searching for an underlying cause for the current pain.
Imaging studies:
Often I find that despite many months and years of pain the treating physicians have failed to order any imaging studies of the surgical site.
This would be extremely uncommon in the other body regions. If someone had severe persistent or recurrent pain despite surgery at their lower back, shoulder, knee, etc., typically the treating physicians would obtain current, up-to-date imaging studies to try to find the cause of the pain.
Did the surgery address the specific problem?
Sometimes the pain may be caused by the surgery having failed to address the actual problem that was causing the pain in the first place. For example, perhaps the pain was being caused by an unstable joint at the upper part of the coccyx, but the surgery only removed the lower part of the coccyx. In that case, the problematic joint still remains, and so it continues to cause painful problems.
Or, perhaps a new problem has occurred. For example, sometimes there might be a bone infection (osteomyelitis) at the surgical site.
Last week I was a “Visiting Professor” speaking on the topic of “Tailbone Pain (Coccyx Pain): Causes and Treatments” at Carolinas Medical Center, in Charlotte, North Carolina.
Causes and Treatments for Your Sore or Injured Coccyx
I’ve worked on/off on this book for more than 10 years, and finally this past year I put in hundreds of hours to make it a reality.
I’ve never written an entire book before (only individual chapters or articles in other books or medical journals).
This was a big undertaking for me. But I know there is a need because although I publish and lecture for doctors and yet it never trickles down to enough of them.
So this book is written to empower the actual patients who are suffering with tailbone pain (coccyx pain). The goal is to help as many people as possible.
30 chapters, all about the coccyx, including causes of pain, tests, and treatments.
It is a shame when people are left suffering in pain for years without the doctor ever even getting imaging studies to look at the painful area.
For tailbone pain (coccyx pain), it is unfortunately very common that people suffer for years without their doctors getting any imaging test to look at the painful area.
Typically these medical imaging tests include x-rays and MRI.
The images help reveal the cause of pain: in some cases it is cancer, in other cases it’s excessive mobility, in other cases it’s a bone spur, in other cases it’s arthritis, etc.
The treatment for each of these would be different.
There are many reasons why tailbone pain (coccyx pain) can initially occur (or worsen if it is already present) during pregnancy.
The developing child in the uterus causes increased pressure within the pelvis. Some of this pressure transmitted to the tailbone.
The pregnant woman tends to be more sedentary (especially later in the pregnancy, due to fatigue, etc.). This typically results in more time spent sitting. And sitting puts pressure on the tailbone.
Pregnancy causes the release of hormones that promote laxity (looseness) of the pelvic joints, including joints of the coccyx. This is usually a good thing that helps make it easier for the baby to pass through the birth canal. But sometimes the joints of the tailbone can become to loose, resulting in excessive amounts of mobility (movement) of the coccyx. Dislocations can occur.
Tailbone Pain Tip 7, PREGNANCY and CHILDBIRTH Can Cause or Worsen COCCYX PAIN, Tailbone Pain, Coccydynia
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person by Dr. Foye’s Coccyx Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.
