American Journal of Obstetrics and Gynecology
1937 33: 531-535
Waters, E. G.
Coccygodynia is of three types:
1. Reflex coccygodynia, caused by a systemic disturbance at some site away from the coccyx. Treatment must deal with the causative condition.
2. Truamatic coccygodynia, caused by a blow, kick or fall, or breakage of an ankylosed coccyx during childbirth. Treatment is bed rest combined with applications of heat, externally and internally, and analgesics. The acute phase is over in 10 to 20 days, often with complete relief despite persisting coccygeal deformity. If the pain becomes chronic, conservative measures should be given a thorough trial before surgery is considered.
3. Neuralgia and neuritis of the coccygeal plexus, caused by transient injury with subsequent inflammatory reaction, edema and secondary fibrosis resulting in pinching, pressure or chronic irritation. Over 60% of the 53 patients in this series suffered from this type. This is best treated by injections of novocaine. The point of maximum tenderness must be located using the index finger in the rectum with the thumb on the outside. At first the whole area may appear tender, but a persistent search will reveal one spot of exquisite tenderness. The injection into this spot should be 3-6 cc of 2% novocaine, repeated every 5 to 7 days until complete relief is obtained. Four injections usually suffice.
Where the pain is localized to a spot in the perineal body, 0.5 cc of 2% novocaine is injected, followed by 1.5 cc of 80% alcohol. Where the pain is localized on the ventral surface of the coccyx, a long needle may be inserted through the perineal body into the coccygeal plexus.
No serious complications will occur if these instructions are followed. In this series, two very severe reactions occurred due to overdosage of alcohol. 41 of 53 patients were clinically cured, 6 reported marked improvement and 4 who did not complete the series were not traced.
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