Coccygodynia is a pathological condition characterized by paroxysmal or persistent pain in the coccyx, anus and rectum in the absence of organic pathology. Pain syndrome is more pronounced at rest and at night, is not associated with the act of defecation. The disease is debilitating, causes insomnia, depression, sexual disorder, often leads to disability. The disease is diagnosed on the basis of complaints and examination data after excluding other diseases. Treatment – physiotherapy, psychotherapy, if ineffective, surgery is indicated.
M53.3 Sacrococcygeal disorders not classified elsewhere
Coccygodynia is a disease, the main sign of which is persistent pain in the perineum, in the anal opening and coccyx. It is a polyethological pathology, which indicates a variety of possible factors of its occurrence. It combines such clinical manifestations as anism, proctalgia, anal neuralgia, anorectal pain, coccygodynia. Due to certain difficulties in identifying the cause and choosing etiological treatment measures, the cure of anococcal pain syndrome is a difficult, sometimes unsolvable task.
Causes of coccygodynia
As a rule, pain in coccygodynia is not associated with weather changes, diseases of the genitourinary system, osteochondrosis and spondylosis. Anococcal pain can be a consequence of:
- a bruise or fracture of the coccyx (both fresh and occurred in the past, sometimes quite a long time ago);
- disorders of the functioning of the neuromuscular system of the pelvic floor and retroanal zone;
- pathologies of the pelvic and lower spine bones, diseases of the spinal column with a pronounced neurological component;
- diseases of the rectum (hemorrhoids, anal fissure, proctitis and paraproctitis, sigmoiditis, etc.), including treated,
- severe childbirth, perineal prolapse;
- psychoemotional experiences (sometimes patients with coccygodynia need a psychotherapist’s consultation or psychiatric help);
- disorders of the stool (chronic constipation or diarrhea), a tendency to sit in the toilet for a long time.
According to the predominant localization of pain, coccygodynia is divided into coccygodynia itself (pain in the coccyx) and anorectal pain syndrome (pain is mainly located in the anus and rectum). Traumatic coccygodynia, which occurs as a result of injuries to the coccyx, prone to pathological mobility, is considered as a separate disease.
Symptoms of coccygodynia
Coccygodynia includes the following clinical symptoms: pain in the coccyx (coccygodynia), in the anus (anorectal pain), occurring for no apparent reason at any time of the day, may have different duration and also suddenly or gradually subside. The pain can be of a diverse nature: it can be dull or sharp, cutting, stabbing, constant and cramping, pulsating. There may be irradiation of pain in the gluteal region, sacrum, thigh. The pain is persistent, prolonged (sometimes it exists for several years), occurs unexpectedly and stops just as unexpectedly, can increase and weaken depending on the position of the body, increase when walking, straining and pressing on the coccyx.
Pain localized in the rectum (proctalgia), as a rule, appears unexpectedly, more often at night, lasts 15-30 minutes, after which it subsides. The intervals between proctalgia attacks can be quite long. The pain is sometimes accompanied by intestinal spasm. Pain in the perineum can contribute to the development of painful priapism in men. Sometimes an attack of anorectal pain can be triggered by sexual intercourse. Often, coccygodynia during the acute clinic is accompanied by general neurovegetative symptoms – pallor and sweating of the skin.
Coccygodynia is localized mainly in the coccyx area, increases when pressed on it, may increase after walking. Sometimes the pain is difficult to localize, patients complain of soreness in the rectum, in the coccyx area noting a feeling of heaviness, burning, discomfort.
Anorectal neuralgia is a diffuse soreness in the anus, sometimes with irradiation into the sacrum and buttocks, thigh and vagina. Anorectal neuralgia most often occur in post-menopausal women and often accompany various neurasthenic and neurological diseases (depression, neurosis, hypochondria).
Coccygodynia often has a neurogenic character. In many patients, prolonged pain is associated with a dangerous fatal disease, persistent carcinophobia often develops, patients require the attending physician to perform the most complete examination and prescribe surgical treatment.
Diagnostics of coccygodynia
The diagnosis of coccygodynia is established only after a thorough examination and exclusion of the organic nature of the soreness. To do this, it is necessary to take diagnostic measures to exclude pathologies of the rectum (hemorrhoids, anal fissure, paraproctitis, etc.), genitals (adnexitis, endometritis, prostatitis), neurological and rheumatological diseases (sciatica, spondylitis, sciatica). The exclusion (or detection and cure) of these pathologies with the subsequent preservation of painful manifestations makes it possible to diagnose coccygodynia that takes place.
To analyze pain sensations, the patient is examined in the knee-elbow position, and then on the gynecological chair. The proctologist performs a finger examination of the anus, determining the presence or absence of scarring, signs of inflammation, injuries to the coccyx and sacrococcygeal junction, muscle spasm of the anal canal or pelvic floor. Women are recommended to consult a gynecologist, a bimanual examination of the vagina and rectum is performed.
- Examination of the rectum. In order to exclude diseases of the end parts of the large intestine, a rectoromanoscopy is performed. Anoscopy (examination of the anal canal) and rectoromanoscopy give an idea of the state of the mucous membrane of the rectum, allow you to identify internal hemorrhoids, polyps of the rectum and inflamed anal papillae (papillitis).
- X-ray. X-ray examination of the rectum (irrigoscopy) allows you to detect tumors, narrowing of the lumen of the large intestine. Radiography is also used to visualize the condition of the coccyx and sacrum, pelvic bones, hip joints. On the X-ray you can find traces of a coccyx fracture, dislocations (subluxations), areas of osteoporosis and other bone pathologies.
- EP methods. In order to detect muscle spasm, an electrophysiological examination of the rectal locking apparatus and the muscular diaphragm of the pelvic floor is performed. In addition, such a study allows us to form an idea about the type of intestinal motility and the peculiarities of its terminal departments.
- Laboratory tests. They include a coprogram, bacteriological fecal culture, fecal examination for hidden blood, a general urine analysis, if necessary, swabs from the vagina in women and prostate secret in men are taken for analysis. Intrarectal intussusception occurring is detected by irrigoscopy.
In addition, pelvic organs are visualized using ultrasound. For the diagnosis of anococcal pain syndrome, a urologist, gynecologist and andrologist, a traumatologist are often involved for consultations and, in a mandatory manner, a neurological examination is carried out. To identify the psycho-emotional causes of pain, a psychotherapist’s consultation is prescribed.
Treatment of coccygodynia
A thorough examination and identification of the cause of the pain syndrome is one of the main factors for the success of treatment. Therapeutic measures include etiological treatment (elimination of the cause of the disease), pathogenetic therapy (blocking the mechanisms of pathology development) and symptomatic means (aimed at relieving the patient from pain).
Currently, medicine pays special attention to the treatment of pain itself. In developed countries, a system of medical institutions is being organized, which are primarily aimed at treating pain of any, including unknown, etiology. It is preferable to treat pain without the use of narcotic analgesics: apply blockade of nerve fibers with novocaine, local anesthetics, mud hot applications (peloidotherapy). Today, the use of cortisone blockades is limited because they have lower efficacy and are poorly tolerated by patients. In the complex treatment of coccygodynia, the use of physiotherapy techniques is quite common:
- low-intensity laser radiation;
- dynamic current exposure;
- mud treatment.
Topically, neuroblocks, candles and microclysms with anesthetic and anti-inflammatory agents are used. To relieve spasm from the muscles of the perineum and pelvic floor, they are massaged.
Sometimes (in the case of the psychogenic nature of pain) a good effect is achieved by using a placebo. In cases of increased anxiety, depression, and other neurotic conditions, treatment is prescribed with the help of psychotherapeutic influences and drugs of central action (sedatives, tranquilizers, neuroleptics, etc.). If necessary, treatment is prescribed with the participation of a psychiatrist.
Traumatic coccygodynia may be an indication for surgical treatment (extirpation of the coccyx). The resection of the tip of the coccyx or its fixation to the sacrum is performed in case of its complete or partial separation. If there is no such, surgical intervention is impractical and may lead to deterioration of the condition. It is possible to plan surgical measures only with the precise determination of the traumatic origin of coccygodynia and the exclusion of other possible causes of pain.
Coccygodynia is quite difficult to respond to therapeutic measures and has a very pronounced psycho-emotional component. However, with an integrated approach and a thorough examination, the correctly chosen treatment tactics helps to relieve patients from pain and restore the quality of life. Coccygodynia and anorectal soreness, not associated with serious pathologies of the bones of the spine, pelvic organs and perineum, does not lead to the development of somatic complications and does not cause death.