My Tailbone Hurts After Delivery—What is Coccydynia?

What is Coccydynia?

Coccydynia, is characterized by pain in the tailbone, or coccyx. 7% of mothers suffer from coccydynia, and women in general are four times more likely than men to experience coccydynia. Pain from tailbone injuries can radiate into the perineum (distance between the genital area and anus) and the sacrum. (1,2)


The two most common tailbone injuries occur in childbirth when:

  1. The tailbone is dislocated at the joint where it is attached to the sacrum.

  2. The tailbone is fractured. (3)

These injuries can occur during delivery when the baby’s head pushes back on the tailbone, fracturing the tailbone or straining the ligaments connecting the tailbone to the sacrum. (1,3)


Tailbone injuries are more frequent in particularly difficult deliveries. When assistance is required during delivery, forceps are used to guide the newborn through the birth canal. 50% of women who experience postpartum tailbone pain also had assistance from forceps during their deliveries. (1,2,4)

Symptoms of coccydynia versus normal postpartum pain

During pregnancy women can experience pain in their lower back and pelvic regions. After childbirth, too, there may be pain in the tailbone area. This is normal, as the ligaments loosen due to hormonal changes, muscles relax, and soft tissues naturally tear as the newborn enters the world. Just be cognizant of tailbone injuries, as the symptoms closely resemble the expected discomforts of childbirth. (1)


Lower back pain after birth is normal—pelvic floor tissues and stitches are painful—but it is important to be mindful of your pain. Tailbone stress fractures resemble the normal symptoms and pains after childbirth, so if you suspect your tailbone is damaged, be gentle on it and take measures—discussed below—to help it heal. (1)


Most common incidents of tailbone pain just after birth are:

  • Moving from standing to a seated position

  • Moving from a seated position to standing

  • Frequent need to defecate, or pain during defecation

  • Sharp tingling sensation towards the rectum (4,5)


How to diagnosis coccydynia

This is what you can expect when seeing a professional about coccydynia:

  • Intra-rectal manipulation

  • Lumbar, pelvic, and spinal examination

  • X-rays

The gold standard in diagnosing and treating coccydynia is vaginal or anal manipulation. This may sound scary, but it is actually the best and safest professional treatment. For example, intra-rectal manipulation could diagnose and repair a dislocated sacrococcygeal joint, or the joint that attaches the tailbone to the sacrum. Massage and manipulation can help reduce ligament pain and relax spasms. Stimulation of the transcutaneous electrical nerve can also help with pain, but if pain persists after treatment the pain may also be coming from another source. (8)


The first step in diagnosis usually involves an exam of the lumbar and pelvic regions. Ideally, the injury is confirmed by X-rays. If the image tests are negative but the lower back pain is intense, ask for higher-level imaging like lateral radiographs and dynamic radiological images. If you are pregnant or a new mother and are experiencing lower back and buttock pain, it is important to consider that a stress fracture may have occurred. (4,10,3)

Treatment of coccydynia

It is important to get treatment for coccydynia within the first year after birth, otherwise treatment may take longer and not be as effective. A functioning tailbone is crucial as it is connected to all other parts of the pelvic floor. (4)


Traditional treatments and home remedies for tailbone injuries are:

  • Rest

  • Reducing time spent sitting

  • Using a cushion with a hole in the center while sitting

  • Medications like Nonsteroidal Anti-inflammatory Drugs

  • Sitz baths

  • Maintaining a healthy diet and exercising regularly to avoid constipation

  • Injections

  • Massage

  • Physical therapy exercises (7,6,4,8)

Like any injury, rest and minimizing stress on the bone will help it heal. Naturally, it will be more comfortable to stand, but to be more comfortable while sitting you can use a donut-shaped cushion to relieve pressure on your tailbone. Talk to your doctor about what kinds of anti-inflammatory pain medication you can take to make you more comfortable. Otherwise, sitz baths might be a helpful home remedy—put a few inches of warm water in a bathtub—and sit comfortably on a ring-shaped towel or cushion 2-4 times a day to reduce pain.


Avoid constipation by drinking lots of water and eating plenty of fruits and vegetables, which are high fiber foods. Frequent exercise can also help prevent constipation. Constipation can be very painful with a tailbone injury. Similarly, avoid straining while defecating. The anal muscles can put pressure on the injured tailbone and cause more pain.


Massaging the surrounding muscles can relieve some tension, but be cautious not to manipulate your tailbone. Exercises and stretches, as directed by a physical therapist, could help the healing process.


Pain often improves from massage, stretching, and other forms of physical therapy, so it is encouraged to start there. If pain persists beyond these treatments, however, injections would be the next step. It is recommended that the use of injections is combined with the methods listed above. Injections alone have a success rate from 50-90%, but injections paired with other treatment methods have shown a success rate of 85%. Surgical removal of the whole or parts of the tailbone (coccygectomy) comes with high risk, low effectiveness, and is not recommended as many vital tissues and organs attach to the tailbone. (6,4,8)

Who is more at risk?

Because the tailbone is so close to the birth canal, a baby’s head during birth can put a lot of pressure on the bone. Below are details that could make some women more at risk of tailbone injury than others during childbirth:

  • Short perineum (distance between the genital and anal areas)

  • Large newborns

  • Lumbar lordosis during delivery (inward curve of the spine)

  • Fragile, pointed tailbone

  • Rapid weight gain during the third trimester

  • Intense sports activities during pregnancy, or other strenuous activity

  • Intravaginal contraceptive ring (pregnant or not) may lead to tailbone injury

  • Heparin injections (to reduce blood clots) during childbirth

  • Osteoporosis and arthritis

Be open and share your concerns early on with your doctor, midwife or doula and explore preventative measures.


Oftentimes small women have relatively short perineums (distance between the genital and anal areas). During birth, the vagina widens and the baby’s head may push against the tailbone. Strong pressure from the baby’s head may injury the tailbone. Similarly, large babies have big heads! Large heads can also cause additional pressure on the tailbone. If you are concerned about putting stress on your tailbone and causing injury during birth, have a conversation about alternative birthing positions with your birth facilitator. (1,5,2)


Another factor that could lead the baby to put additional strain on the tailbone is if the spine is curved inward during birth, also known as lumbar lordosis. A substantially curved spine could position the baby in a way that during delivery, its head could strain the tailbone as the baby travels through the birth canal. (3)


Some women have unusually pointed tailbones. No need to panic, because there is a distinct birthing position to keep pressure off your tailbone during birth: The lateral position. (2)


Giving birth on your side relieves pressure from the baby (and the force of gravity!) off of your tailbone. Women with pointed tailbones have more to gain from this birthing position. Plus, tailbones of this shape also tend to be more flexible. They may not be as securely attached to the sacrococcygeal joint which can lead them to curve inward and be more vulnerable during birth. There are many alternative positions to discuss with your doctor, midwife or doula, and birthing on one’s side is a comfortable alternative! (2)


It is important to be mindful that excessive weight gain during pregnancy could put stress on the pelvis during birth. Rapid weight gain in the third trimester could fatigue the tailbone and cause a fracture even before birth. Intense sports activities during pregnancy have also shown to stress the pelvis, and have been associated with stress fractures from childbirth. (3)


There is some evidence that an intravaginal contraceptive ring could cause pain in the tailbone to women who are not pregnant. Heparin injections, used in childbirth to prevent blood clots, have also been associated with tailbone injuries. (5,3)


If you have osteoporosis and are pregnant, or have developed pregnancy associated osteoporosis, be particularly careful not to fall or hurt yourself. Osteoporosis causes your bones to become more fragile, thin, or porous. Women with this condition during pregnancy are more vulnerable to bone fractures while pregnant and up to 3 months after birth. The standard injuries of pregnant women with osteoporosis are fractured spine, legs, wrists and clavicle bones, so take care to avoid situations that could involve an accident or a fall. (3)


Although rare, arthritis of the sacrococcygeal joint has been known to cause tailbone pain. (5)


Conclusion

Seek treatment if you believe you are suffering from coccydynia. Women are more prone to coccydynia, and childbirth can cause fractures and dislocations of the tailbone. Be mindful of exercising, home-remedies and treatments for pain. Rest, but also be dedicated to your physical therapy exercises. Seek out professional help to diagnose and correct damage to your tailbone, especially if pain persists. The sooner your tailbone can start healing, the better—your tailbone, although small, has a big impact on your pelvic health!



References

  1. JY Maigne, F Rusakiewicz, M Diouf, 2012 Postpartum coccydynia: a case series study of 57 women European Journal of Physical and Rehabilitation Medicine, 48(3):387-92

  2. Editors: M. Fitzgerald Colleen, A. Segal Neil Musculoskeletal health in pregnancy and postpartum An Evidence-Based Guide for Clinicians

  3. L. Roller Rebecca, A. Walker Eric, W. Michelitch Scott, 2009 Postpartum sacral fracture in a 30-year-old female Radiol Case Report, 4(3): 264, doi: 10.2484/rcr.v4i3.264

  4. Editors: M. Fitzgerald Colleen, A. Segal Neil Musculoskeletal health in pregnancy and postpartum An Evidence-Based Guide for Clinicians

  5. D.Waldman Steven, 2019 Coccydynia Atlas of Common Pain Syndromes (Fourth Edition), Chapter-97 Pages 378-382

  6. Galhom Ayman, Al Shatouri Mohammad, Abo El Fadl Sameh, 2015 Evaluation and management of chronic coccygodynia: Fluoroscopic guided injection, local injection, conservative therapy and surgery in non-oncological pain The Egyptian Journal of Radiology and Nuclear Medicine, Volume 46, Issue 4, Pages 1049-1055

  7. Patel Ravi, Appannagari Anoop, G. Whang Peter, 2008 Coccydynia Current reviews in musculoskeletal medicine, 1(3-4): 223–226, doi: 10.1007/s12178-008-9028-1

  8. Smallwood Lirette Lesley, Chaiban Gassan, Tolba Reda, Eissa Hazem, 2014 Coccydynia: An Overview of the Anatomy, Etiology, and Treatment of Coccyx Pain The Ochsner Journal, 14(1): 84–87

  9. Cheng Shao wen, Chen Qing yu, Lin Zhong qin, Wang Wei, Zhang Wei, Kou Dong quan, Shen Yue, Ying Xiao zhou, Cheng Xiao-jie, Lu Chuan-zhu, Peng Lei, 2011 Coccygectomy for stubborn coccydynia Chinese Journal of Traumatology (English Edition), Volume 14, Issue 1, Pages 25-28

  10. Dayawansa Samantha, Garrett Jr. David, Wong Marcus, H.Huang Jason, 2019 Management of coccydynia in the absence of X-ray evidence: Case report International Journal of Surgery Case Reports, Volume 54, Pages 63-65

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