• Coccyx Fracture

    (Tailbone Fracture; Broken Tailbone)

    Definition

    A coccyx fracture is a broken tailbone. The coccyx is the lowest part of the backbone or spine. It is small and shaped like a triangle. The bone curves gently from the end of the spine into the pelvis.
    The Coccyx
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    Causes

    Causes of coccyx fracture include:
    • Falling on the buttocks—Skating and other activities that lead to falls in a seated position
    • During birth—Newborns can break their coccyx going through the birth canal

    Risk Factors

    Risk factors that increase your chance of a coccyx fracture include:
    • Sex: female—A woman's broader pelvis leaves the coccyx more exposed to injury
    • Increased age
    • Reduced muscle mass, which may lead to poor balance and increased risk of falls
    • Osteoporosis
    • Poor nutrition, especially low in calcium and vitamin D
    • Certain congenital bone conditions
    • Participating in certain activities, such as skating
    • Violence

    Symptoms

    Symptoms may include:
    • Pain that increases with sitting or getting up from a chair
    • Pain that increases during a bowel movement
    • Tenderness over the tailbone

    Diagnosis

    The doctor will ask about your symptoms and how the injury occurred. A physical exam will be done. The exam may include a rectal exam. During a rectal exam, the doctor places a lubricated, gloved finger into the rectum and feels for any abnormalities. If the coccyx is fractured, your doctor may feel abnormal movement of the coccyx. You will experience pain. X-rays may or may not be needed.

    Treatment

    The goal is to manage pain until the bone can heal. Strong muscles in the area can pull the coccyx back out of position. The location of the coccyx and the number of muscles attached to it makes it difficult to prevent it from moving while it is healing.
    The area may remain painful for a long period of time, even after the fracture has healed. You may be advised to stay in bed for a day or two, or move only as comfort allows. Steroid injections or surgery may be considered if severe pain persists. Surgery for a painful coccyx fracture is rare and not very successful. Usually, pain slowly disappears.

    Pain Relief

    You may be given medication to ease the pain. To reduce discomfort during bowel movements:
    • Drink plenty of fluids and eat a diet rich in fruits, vegetables, and whole grains.
    • Stool softeners may help decrease straining during bowel movements.
    • Sitz baths can help relieve muscle spasms. A sitz bath involves soaking the anal area in warm water for 10-20 minutes.
    Sitting can be uncomfortable after a coccyx fracture. Suggestions to make sitting less painful include:
    • Sit on an air cushion or doughnut pad.
    • Alternate between sitting on one side of the buttock or the other.
    • Avoid sitting on soft surfaces. Sinking into a soft chair sometimes increases the pressure on the coccyx.
    • Slouch to move your weight forward and off the coccyx. Note: This advice only helps until you are well enough to sit properly again.
    • Sit on a large book, with the area of the coccyx hanging off the posterior portion of the book.

    Surgery

    If pain continues and causes disability, a coccygectomy might be recommended. During this procedure, the doctor removes the coccyx. It is not a common procedure and the success rate is not high.
    If you are diagnosed with a coccyx fracture, follow your doctor's instructions.
    If you are diagnosed with a coccyx fracture, follow your doctor's instructions.

    Prevention

    To help prevent a coccyx fracture:
    • Eat a diet rich in calcium and vitamin D.
    • Do weight-bearing exercises to build strong bones.
    • Build strong muscles to prevent falls.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org

    American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org

    Canadian Orthopaedic Foundation http://www.canorth.org

    References

    Acute low back pain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 16, 2013. Accessed January 29, 2013.

    Low back pain. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00311. Updated May 2009. Accessed January 29, 2013.

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