coccyx removal

[Jo Denslow]

I have had back/ankle trouble for 20 yrs. I have just had a sub talar fusion on one ankle which is healing nicely and other one done later. My coccyx has always been quite painful and dislodged several times, however, since last year my oesteopath has put it back for me twice internally, and it hasnt even lasted a day. He says i need to have it removed. I have done all the pain killers and injections, they have not worked. I am perfectly fine walking and standing, the pain is only there when sitting and lying down. Could you please tell me if you think this is the right thing to do? And what department do i go to, Neurology (which a nurse has told me) or Orthapedics? Also how long after the operation does the pain go and you can sit comfortably? Thankyou for your time.

[gingermoggy]

I read your comments with great interest having lived with pain for more than 20 years.  Original problem linked to fall in teens.  Cortisone etc injections and physio in early 20s then it settled down and I endured for next 15 years.  Birth of second daugther 5 years ago has excacerbated and I am now recieving treatment through pain management centre (cortisone and nerve blocks -pulsed radiotherapy).  Relief lasts approx one month and I am considering surgery.  Consultant not keen and has stressed risks to pelvic floor etc.  I know I need someone experienced but don't really know where to turn.
Advice greatfully recieved

[HarleyDudeClassic]

I have the same issue; I have been in active treatment for seven years for chronic coccydynia, sciatica and damage to ganglion impar nerve. The coccyx is the anchor point of your spine and is very important. Check out this link although it is for roids it gives detailed drawings and explanations. http://www.hemorrhoid.net/anatomy.php

I was told by many Docs not to remove the coccyx it could cause bowl incontinence at the very minimum. I know you stated you tried injections have you tried injections to ganglion impar this has helped a lot of people and has a high success rate. http://www.coccyx.org/treatmen/foye.htm

I was told to make sure 30 gr of fiber a day and to drink at least 8 glasses of water per day as bowel movements can irratate an injured coccyx.

If you are having constipation on a regular basis watch out for diverticulitis.

[Quixotic1]

HarleyDude makes a good point, but overstates the danger of fecal incontinence.  Because an important nerve bundle (which innervates the rectal muscle) danger of damaging it by an unskilled surgeon.  However, in studies looking at complications, it is not a common one.  By far the most common complication is infection and that risk is fairly high - about 50%, though some were minor infections.  

All the studies emphasize that all conservative measures should be tried first.  The surgery is most successful when there has been truama to the coccyx and when there is instability (as opposed to pain from something like arthritis).  In cases where the patients were carefully chosen and the surgeon had experience in performing the surgery, the success in relieving pain was as high as 90%.

It appears to me that no one should consider the surgery lightly, but that the risks should be weighed against the quality of life when the patient has unrelenting pain limiting activities.

Here is a fairly long article on the subject.  I offer it because of the extensive list of more conservative things to try before resorting to surgery.  

http://www.emedicine.com/pmr/topic242.htm

Good luck, again, Quix

[Quixotic1]

It sounds like you've been through the ringer and tried the proper conservative maneuvers.  It's not my field of expertise, but I do not believe the coccyx is a vital bone for good living.  I know some coccygeal injuries require eventual removal.  I don't know anything about the surgery or recovery time.  I suspect (but do not promise) the relief would be almost immediate.  Whe you are in pain from the coccyx, every motion of your lower body from sitting to walking to pooping makes it hurt.

The coccyx is a part of the spain, but does not carry any large nerves through it.

As for surgery, I would seek and opion from a lower back specialist, orthopedist.  Then make your decision.

Good luck with your decision.  Quix