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My wife is suffering from severe pain in the tail bone, what should be done?

Q: My wife had an ectopic ruptured pregnancy and the fallopian tube was removed a few months before. Now she is having problem with her tail bone. She can't sit properly or for a long time in one position. The pain is so severe that she can't even touch. Is it related to laparotomy done for ectopic?

A:Your wife's symptoms are typical of what is known as Coccygodynia. This is a condition which can start without any provocation. It can also start after an injury. Your wife's surgery is only incidental. It is unlikely to cause Coccygodynia. The important thing in coccygodynia is to confirm that there is no other underlying cause for the pain. In other words, is the pain due to an infection or a growth or even a fracture. In 98 to 99% of cases no cause can be found and we call it coccygodynia. The only treatment for this is to avoid pressure on the coccyx. A simple way of doing this is to sit between two cushions so that the coccyx does not touch the cushion. You may also choose to sit on one buttock. Some people prescribe a round air pillow with a hole in the middle (an inflated tube of a tyre will also do). You can use it at home but you cannot carry it around. The disease has a natural history and pain may last for 8 to 9 months and then subside on its own. In persistent pain, which is not getting relieved, some surgeons advise local steroid injection. However, this should be a last resort and must be done in an operation theatre with full aseptic precautions. A major risk factor is infection as it is in the perineal region. To decide about idiopathic coccygodynia you need to have a clinical examination including, at times, palpation of the inner surface of tail bone through the rectum. Some find this unpleasant and prefer to get CT or MRI of the coccyx. The choice between CT and MRI will depend on what the examining surgeon is suspecting. In suspected fracture cases a simple X-ray will suffice. Depending on the finding the patient may need surgical intervention or just continuation of pain killers. I suggest you get your wife's case reviewed by an orthopaedic surgeon.


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