Tailbone fracture

definition

The coccyx fracture is a fracture of the coccyx (= tailbone).
The coccyx is the lowest bone of the spine and consists of 3-5 parts of the vertebral body.
However, through a synostosis (synostosis = fusion of two bones), these vertebral bodies are evolutionarily fused with one another. The coccyx is the starting point for some muscles and ligaments in the pelvic region.

causes

The coccyx can be felt on the buttocks and is due to it location prone to breakage.
Through a Fall or one hard kick A tailbone fracture can therefore quickly occur against the buttocks.
Less often one suffers a tailbone fracture constant stress of the bone such as after a long bike ride. Most of the time, the tailbone fracture is associated with an existing one osteoporosis hand in hand. With osteoporosis, the clinical picture is reduced Bone density and strength, which increases the susceptibility to fracture of the skeletal bones.

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Symptoms

Affected people complain after a tailbone fracture very severe pain in the buttock region. This type of pain is also called Coccygodynia designated.
Characteristic for this are severe pain in the area of ​​the Os coccygis with broadcast in Anal, lumbar and hip regions, mostly triggered by one Tailbone fracture.
Anomalies of the coccyx, Bruises, heavy Constipation or injuries during the birth however, they can also trigger coccygodynia.
After a tailbone fracture, swelling and swelling often occur in addition to pain Hematomas (Bruise). During a rectal examination by a doctor, painful mobility of the coccyx can be determined.

Symptoms often follow the tailbone fracture bowel movement, at the Sexual intercourse and even in normal quiet Sit. As soon as there is any kind of tension in the surrounding pelvic muscles, pain can be provoked, for example when you sneeze got to.

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Pain

A fractured tailbone causes severe pain in the affected buttock area. The pain is often called dull and agonizing described.
The most severe pain is also covered by the technical term Coccygodynia summarized. Here, severe attacks of pain occur in the area of ​​the coccyx that extend up to Anal, lumbar and hip regions can radiate. The pains of coccygodynia are called stabbing, pulling and burning described. Despite the appearance, the fracture of the tailbone results in relatively well-defined local pain in the back and buttocks. Since the coccyx is the starting point for some muscles and ligaments in the pelvic region, tensile and compressive stresses can be transferred to the bone through it. This also causes severe pain.
General charges the affected region through a lot of exercise and long periods of sitting aggravate the pain intensity.

The pain before treatment of the tailbone fracture must be differentiated from the pain afterwards. As a rule, patients are symptom-free after successful therapy. Pain only occurs when conservative treatment is insufficient. Long-lasting pain is therefore always a pioneering factor in reconsidering and adapting the choice of therapy. Scars and general healing processes can cause pain after surgery. However, the pain intensity should not be comparable to that immediately after the fracture. The drug therapy of the pain is independent of the time of the disease process. Painkillers (analgesics) are particularly suitable, as they not only relieve pain but also have anti-inflammatory effects.

Diagnosis

X-ray to diagnose a fractured tailbone

If a tailbone fracture is suspected, a discussion about the cause of the injury takes place first. If the patient describes a hard fall on the tailbone with subsequent long-lasting, severe pain, the diagnosis of the tailbone fracture hardens.
Usually one takes place Palpation (= Examination by touch) des Os coccygis to test a pain trigger. This palpation can be from Outside or transrectal respectively. During the transrectal examination, the doctor inserts a finger into the anus and feels the tailbone at the end of the spine. If the tailbone is broken this is caused by slight movements des coccygis strong Pain.
However, this diagnostic measure alone is not sufficient to diagnose a tailbone fracture. Coccyx dislocations, Bruises or Tumors as well as injuries during childbirth can cause similar pain.
Hence it is important to have one in addition imaging procedure consult. The is particularly suitable here X-ray diagnostics. As a rule, 2 x-rays of the coccyx that are perpendicular to each other are taken in order to be able to assess the bone properly. Further diagnostic measures usually do not need to be taken in the case of a fractured tailbone.

therapy

The tailbone fracture is usually conservative (i.e. not surgically but preserving the tissue of the injured organ).
Can be used to relieve pain and reduce inflammation Analgesics (Painkillers) are being taken. Since the pain is provoked by pressure on the tailbone, is a Ring pillow helpful when sitting for relief.
In order to reduce the pressure, medication can also help to reduce the pressure bowel movement keep soft. In principle, the affected buttock region should spared and chilled become. If these measures are unsuccessful and there is no visible improvement in the symptoms, the coccyx fracture must be treated surgically.

surgery

If symptoms persist after a fractured tailbone, an operation may be necessary.

The fracture of the tailbone is a fracture that does not affect the stability of the pelvis. Therefore, the operation is not absolutely necessary and is only considered to be Last instance if conservative therapy does not help, which is rarely the case.
After a tailbone fracture, surgical removal occurs (Resection) of the affected bone. Since the Os coccygis around the lowest proportion of Spine The removal of this bone is largely unproblematic. An operation for a broken bone always goes with one scar hand in hand.
After a surgical resection of the coccyx, there are often symptoms of surgical scar in the form of Wound healing disorder. This is mainly due to the localization of the scar, as it is exposed to mechanical stress and friction that can hardly be completely avoided. Therefore the healing process can be delayed. The local proximity to the anus with potentially infectious stool sets special hygienic measures ahead in wound care.

forecast

The fracture of the tailbone presents itself as an uncomplicated fracture with no loss of stability, so that it can primarily be treated conservatively.
Treatment beyond this in the form of surgical resection is less common.
In principle, both therapeutic approaches are promising and can alleviate the symptoms, especially the pain. However, the therapy often develops into a lengthy process. If the diagnosis “tailbone fracture” is made, a decision must be made as to whether conservative therapy is already promising or whether an operation should be carried out immediately. If you decide in favor of conservative therapy Painkiller, Immobilization and Ring pillow sometimes, contrary to expectations, there is no improvement in the symptoms so that an operation is recommended afterwards.
Again, there is no guarantee that the operation will bring the desired recovery. Adverse effects can be caused by the pain Surgical scar be. The healing process and the response to therapy are very individual.

Duration

The timing of a tailbone fracture is very variable.
Severe pain after a serious fall makes most of those affected more likely to see a doctor than if, subjectively, there was only a slight force. Therefore, only the time with which those affected torment themselves with the symptoms is different. Conservative therapy can bring about the desired improvement within a few weeks. The healing process can be prolonged due to a lack of consistency with regard to conservative measures.Regardless of this, there are always patients who have a fractured tailbone chronic complaints develop that they carry with them for a lifetime.

consequences

The consequences of a fractured tailbone are common to every patient very different. In general, it depends on how strong the tailbone (Os coccygis) was broken and whether the patient was properly treated after the break.

Has a patient herself under childbirth If the tailbone is broken, it is often only slightly damaged. In this case, subsequent bed rest and avoidance of sitting can reduce the tailbone grow together again completely. In this case, the consequences of the tailbone fracture are often only minimal. During the first few weeks, the patient suffers from pain when sitting or riding a bicycle, rarely pain when standing upright. Heavy pressing during bowel movements is extremely painful for the patient. Since this can also prevent the tailbone from growing together adequately from the pressure, patients should switch to light, high-fiber foods. This minimizes the chances of struggling with the consequences of a tailbone fracture for a long time.

It occurs commonly in most patients healing after a few weeks of the tailbone fracture. The patient then has no more pain and can sit again (initially only with the help of a seat ring). Unfortunately, however, there are also patients who always have to live with the consequences of a tailbone fracture. Especially if that Tailbone completely broken pain can occur for months. In rare cases, these can then be used in chronic pain pass over, which still exist after years. In order to avoid chronic pain as a result of a fractured tailbone, it is important to protect the fracture sufficiently. As a result, protracted consequences can often be avoided.

birth

Another cause can be the special circumstance in the birth represent, as the head of the child against the coccyx presses.
The surrounding muscles and ligaments, along with the tailbone, provide good resistance. However, this is not always sufficient if the compressive force is too strong, so that in some cases a tailbone fracture can occur.

When can you do sports again after a fractured tailbone?

When a patient is allowed to exercise again after a fractured tailbone depends very much on how young the patient is and how well the tailbone is healing. In general, the patient should not start exercising again until he or she painless is. It is important that the patient with Sports that protect the coccyxsuch as swimming begins. Bicycling or horseback riding puts enormous strain on the tailbone and should only be done again when the patient is absolutely pain-free.

However, when a patient can exercise again is very different and must be decided individually. Some patients are completely pain-free after 3 months and can then go back to exercise. However, other patients still have it after a year Tailbone pain and can therefore only practice sports such as aqua aerobics.

Since the tailbone fracture is very different from one individual to the next, there is no general indication of when sport is possible again after the tailbone fracture. Here the patient should take care of himself above all. It is important to note that a fractured tailbone must heal completely so that there are no consequential damages such as chronic pain. It is therefore strongly advised not to take up any sport too early if the fracture has not yet completely healed.

Figure pelvis from the front - tailbone pain and causes
  1. Tailbone - Os coccyxis
  2. Fifth lumbar vertebra -
    Vertebra lumbalis V
  3. Iliac crest - Iliac crest
  4. Sacrum-iliac joint
    (Sacroiliac joint, abbreviated ISG)
    Articulatio sacroiliaca
  5. Hip joint - Articulatio coxae
  6. Pubic bone - Pubis
  7. Ischium - Os ischii
  8. Intervertebral disc -
    Intervertebral disc
  9. Iliac bone - Os ilium
  10. Lumbar cruciate ligament kink -
    Promontory
  11. Sacrum - Sacrum
  12. Pubic symphysis -
    Pubic symphysis

    Coccyx pain - coccygodynia
    a - Nerve Pain - The region of the body
    becomes of plexus of nerves
    (Plexus coccygeus) supplied
    b - inflammation of the tendons,
    Muscles or bones -
    chronic loads or germs
    c - rectum and anus, chronic
    inflammatory bowel disease
    (Ulcerative colitis, crohn's disease)
    d - Coccyx fracture, coccyx contusion -
    Swelling, bruising (due to
    Fall, kick, etc.)
    e - pregnancy
    (hormonal changes) -
    usually in the 1st and 3rd trimester
    f - sport - tensioning the ligaments
    and muscles (e.g. cycling, rowing)
    g - Lying for a long time - (older and
    bedridden people)
    h - microtraumas - prolonged sitting
    on hard chairs
    i - coccyx inflammation - redness,
    Swelling, fistula (Pilonidal sinus)

You can find an overview of all Dr-Gumpert images at: medical illustrations