Coccygodynia

Coccygodynia, or, as it is sometimes called, coccydynia, is a painful

affection of the coccyx or bony end of the spinal column. It usually

results from trauma, as a fall on the buttocks on an icy pavement, or

particularly a fall in coming down stairs in which the main portion of

the impact is on the seat. Occasionally it follows horseback riding.

It is said to be on the increase among women who ride astride.

Occasional y it is reported after severe labor, particularly when the

head of the child was very large, or after first labor when the coccyx

has been beforehand bent inward somewhat abnormally and is pushed out

by the oncoming head. It seems to develop with special frequency in

nervous people who have to sit much, particularly if they sit on

unsuitable chairs. The chair seat with the ridge in the center which

has been introduced in recent years is sometimes blamed. Occasionally,

on the other hand, it is said to come from sitting on heavily

cushioned chairs, particularly leather chairs which do not allow of

much transpiration and cause a feeling of uncomfortable heat.



There are, indeed, so many different causes suggested, sometimes of

quite opposite or even contradictory effects, that it seems evident

that the main element in the disease is some predisposition to

sensitiveness in this region which is exaggerated and emphasized by

the cause that is blamed. It occurs particularly in women, though it

is occasionally seen in delicate or neurotic men. Sufferers from it

sometimes find it impossible to sit for any length of time. Even

lying down, especially if they lie on their backs, becomes a source of

pain. Various operations, such as the reposition in place of the bent

coccyx, or even the removal of the tip of the coccyx, have been

suggested. Some reported cures are to be found in the literature.

These are mainly surgical cures, however, that is to say, the patient

recovered from the operation, was seen for a month or two afterwards,

and was then on a fair way to complete recovery. Some of us who have

had to treat these cases afterwards for painful conditions apparently

due to the scar of the operation, or to a neurotic condition closely

corresponding to the old coccygodynia, are not so confident of the

value of an operation, though probably in purely traumatic cases

surgical intervention is of value.



In most cases the sufferers are women who have little to do, who have

much time on their hands to think about themselves, and who usually

receive abundant sympathy from friends and relatives. In one case

under my observation the death of a husband and the discovery that his

estate was much less than had been anticipated, so that his widow had

to take up a wage-earning occupation, did more in a short time than

all the treatment that had been employed before to relieve her

discomfort. She had been quite unable to move around at times,

especially in rainy weather, and was something of an invalid during

all the winter, but now she was able to go out to work every day and

had very little trouble. Her affection originally dated from a fall on

an icy sidewalk and her fear to go out in the winter seemed to be

dependent on the dread of another fall. She realizes now that

practically all her former trouble was due to over-attention to a

discomfort which is still present, but which she is now able to

forget, except at times when she is alone after there have been

worries and troubles that have reduced her power to control her

nerves. In young girls an injury to the coccyx by a fall on the

buttocks will often leave tenderness for months or even years, but if

attention is distracted from this and the patient is not allowed to

concentrate her mind on it and does not hear of the awful

possibilities of coccygodynia--a mouth-filling Greek name in which we

map out our ignorance, and which seems to carry with it such a weight

of pathology--she will probably recover completely.



Coccygodynia often resembles hysterical coxalgia or the hysterical

arthritises, and seems sometimes to be due to the fact that there is a

natural or traumatic abnormal mobility of the coccygeal vertebrae

which, owing to concentration of attention, has developed into a

neurosis analogous to the corresponding condition in a joint. There

are undoubtedly cases in which a real pathological lesion exists, but

these are comparatively few. In this, as in other joint and bone

affections with vague pains likely to be worse on rainy days, the word

rheumatism is often mentioned, but it has no proper place. Treatment

that will put the patients into good general condition--never local

unless there is objective indication--outdoor air and exercise with

reassurance of mind and distraction of the attention are the important

therapeutic agents. Patients with much time on their hands do not

readily get well, while those who are busily occupied seldom suffer

for long.