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Your Health - Dr. Gita Mathai

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We humans have evolved biologically so much that we tend to forget that we were once animals and had a tail. That is, till we suddenly develop a pain deep down in the cleft between the buttocks, making it difficult to abruptly shift positions, from sitting to standing or getting up after lying down. This pain is called coccydynia.

That last bone in the vertebral column is called a coccyx. It actually is a vestigial tail, which has shrunk over generations. About 2.7 per cent of patients who see a doctor for "backache" actually had pain in the tailbone. It is more likely to occur in physically active youngsters and adults over the age of 40. Women, with their wide pelvis, are more prone to coccodynia.

The coccyx is prone to injury. Acute dislocations, sprains and fractures can occur. Usually there is a history of having fallen abruptly, on a staircase, the side of the swimming pool or some other hard surface. It can also occur while cycling or rowing. Chronic injury can occur if work or academics involves sitting for prolonged periods on hard surfaces like a wooden bench or a chair without cushions. In women, the coccyx can be injured during childbirth, especially if labour is prolonged. Overweight and obese men and women are more likely to develop problems with the coccyx.

Once coccydynia has been diagnosed, conservative treatment can make the pain disappear in 8-12 weeks. This involves sitting in a basin of hot water (sitz bath) for 10-15 minutes at least twice a day. A donut shaped cushion makes sitting during work easier. Inflatable rubber cushions are available which can be carried around. When seated on chairs or in the toilet, try to lean slightly forwards.

Stretches can be done for that area. The two common ones are the kneeling stretch, when you kneel on one leg keeping the other bent at a right angle. After 30 seconds switch sides. The other stretch involves lying down, bending the knees, crossing the legs at the ankle and then pulling the legs towards you with your arms.

NSAIDs (non-steroidal anti inflammatory drugs) like ibuprofen and pain modulators like amitriptyline can help reduce the discomfort. Even mild constipation can aggravate the pain because of straining. Stool softeners like ipsagol husk should be taken. Physiotherapists can manipulate the coccyx if it has been displaced. Orthopaedic surgeons can give an injection of a local anaesthetic in the coccyx. This numbs the pain, the effect lasts for many months and quite often the pain never returns. If all else fails then the coccyx can be surgically removed. Like the appendix, it is a vestigial structure. Removal has no structural consequences.

Every part of our body (even the coccyx) needs looking after.

• While cycling on a stationery bike or on the road, make sure the cycle seat is soft and comfortable. Special "cycling innerwear" is available with padding and should be used.
   
• Do not run on slippery surfaces like the edges of the swimming pool.
   
• Wear footwear that is rubber soled or has a "grip", not smooth leather.
   
• Maintain ideal body weight. This can be calculated as height in metre squared X 23.
   
• Walk and sit with the correct posture. If you feel you are slouching, stand with both shoulders touching the wall and balance a book on your head.
   
• Do not sit on hard surfaces for prolonged periods of time.
   
• Do the stretches described above.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her atyourhealthgm@yahoo.co.in