Coccydynia is defined as pain in the coccyx or tailbone. Coccydynia can be a result of Pelvic Floor Dysfunction when the pelvic floor muscles, specifically those that attach to the coccyx such as iliococcygeus and coccygeus, are in a state of spasm. In order to appropriately treat the spastic pelvic floor muscles causing coccyx pain, intrarectal treatment is performed by a pelvic floor physical therapist.
If the pelvic floor muscles are the reason for Coccydynia, then these patients will have only minimal improvement or even worsening symptoms after going through a course of orthopedic physical therapy. This is due to the orthopedic physical therapist treating the lumbar spine or sacroiliac joint (SIJ) or other related structures as the cause of Coccydynia instead of the focus being on the pelvic floor muscles.
Manipulation of the coccyx is not typically necessary when the pain is caused by pelvic floor muscles. Even if appropriate imaging reveals a ‘forward flexed’ coccyx, releasing the spasm of the muscles will allow for the coccyx to return to it’s normal position versus manipulating the bone itself.
SIGNS & SYMPTOMS
Signs and symptoms that the pelvic floor may be the source of Coccydynia include the following:
- Pain with sitting
- Pain with intercourse
- Pain or relief with bowel movements
- Failed course of orthopedic physical therapy
Coccydynia is a difficult condition to treat at times, however, often when the cause is strictly due to the pelvic floor muscles, there will be significant relief of pain after each session with the greatest improvement after the first internal rectal treatment.
I also do not recommend sitting on a ‘donut’. I recommend rolling up two kitchen towels and sitting on them. The towels should be placed from the SITS bone (ischial tuberosity) and run parallel with the femur. This will elevate the pelvis enough to take pressure off the coccyx but still allow you to sit in neutral which is also an important part of treatment (proper sitting mechanics).