The tail bone known as the coccyx can be a common source of pain postpartum it is known as Coccydynia. The coccyx is a small triangular shaped arrangement of bone at the end of the spine. It serves as a very important attachment point for the muscles of the pelvic floor.
Despite it being a small area it can be a very debilitating condition. It can be caused by the huge change in hormones experienced during and after pregnancy as the body softens ligaments and allows more movement around the joints to prepare for birth. Another common cause of coccydynia is trauma during childbirth, for example where the baby’s head passes over the tailbone and causes injury or in the case of an instrument assisted birth (especially with baby in a face up position) can result in a bruised or fractured tail bone.
- Pain located above the anus right at the end of the spine or the tailbone. It may come and go or be persistent
- Pain increases with sitting especially if sitting directly onto the tailbone or on a hard surface
- Pain increases when moving from sitting to standing
- Pain increases with sexual intercourse or having a bowel movement – this is due to the proximity of the tail bone to the genitals as well as the natural movement of the coccyx during defecation
Depending on the severity of pain or possible mechanism of injury your doctor could suggest some diagnostic tests such as x-rays or CT scans. However the most common method for diagnosis is a physical examination with thorough history taking. The examination includes an external palpation of the tailbone and if required an intra-rectal examination.
The good news is conservative treatment is effective in 90% of cases! Many of the treatments are simple and can be undertaken at home.
- Anti-inflammatories – there are some over the counter medications that can still be taken during breastfeeding. Have a chat to your doctor or pharmacist
- An ice pack over the area can help with temporary pain relief
- A hotpack over the lower part of the spine or over the gluteal region could help relax the muscle tension often accompanied by coccyx pain
- Off loading pillows which takes pressure off the coccyx when siting – we would not recommend ring shaped pillows for lengthy sitting after birth as it could cause fluids to pool in the vulva; but rather a wedge shaped pillow with coccyx cut out area for shorter periods
- If there is pain on defecation then ensuring to manage constipation is critical (see our post on constipation)
- Stretches such as the child’s pose, happy baby & puppy pose can help alleviate some muscle tension
- Appropriately administered pelvic floor muscle training in combination with manual release and coccyx mobilisations can help alleviate a lot of pain but you would need to see your pelvic floor physiotherapist to assess and administer this
- If conservative treatment fails then more invasive options can be sought such as injections and in very rare and extreme cases surgical options