Protruding Sacrum - this is my 'tail'

James, Australia -

Posted 2017-04-23

The end of my sacrum has stuck out for as long as I can remember. Even as a kid I remember feeling it through the skin, visibly poking out just at the top of the butt crack, sometimes sore, and calling it my 'my tail'. I had always assumed I had broken my tailbone from falling out of a tree or off a horse both of which I had done before the age of 5. I never really spoke to anyone about it until I was 20 years old. I saw a spinal doctor, got some x-rays and was promptly told that there was nothing they could do about it. That was in 1995.

protruding sacrum   protruding sacrum

Pre-Op: Roll on another 20 years, I came across this fantastic website (thanks Jon!) and realised two things (i) that I'm not the only one out there with this issue, and (ii) that it actually is possible to remove the coccyx! I decided to take out private health cover and book in to see a specialist. After seeing my local GP and armed with my x-rays I saw Mr Michael Johnson, an orthopaedic surgeon in Melbourne, Australia, listed on this site (see Doctors and specialists in the Australia, Victoria). He inspected the x-rays and told me that he suspected that my coccyx bone isn't actually the issue and it is in fact my sacrum. It's the final segment of my very straight and long sacrum which pokes out through my skin. The coccyx then comes off the base at a 90 degree angle to the sacrum and protrudes deep back in to the body. He also suggested that it possibly wasn't like this from an accident, but that I was probably just 'born that way'. He also said that cortisone injections would not help in my case and that if I really wanted to relieve the pain for good, then I would need it operated on. He explained that the success rate of having a pain-free area following the operation is likely to be 70%. Being a good candidate, as well and being fit and healthy, I decided I would probably go ahead.

Michael asked me to get a CT scan as well, just in case there was any cancer in there causing the positioning of the bones, so I organised these and re-booked with him. Meantime I also saw a 2nd orthopaedic surgeon for a 2nd opinion, also listed on this site, who took one look at my bony behind and recoiled in shock, telling me that operating on it would be dangerous, skin wouldn't heal over the top, I would probably need a skin-graft. He said that what I really need to do is work on my glutes by running up The Rialto Tower (the 2nd highest building in Melbourne)! Now I'm no expert, but clearly this was never going to be a long term fix sure I could build up these muscles now, but I had visions of myself: old and frail in bed with wasting muscles and a big pressure wound right over my 'tail'. To be honest his response was pretty disheartening and I felt like I had wasted my time and money with him.

protruding sacrum mri

Back at Michael Johnson's we reviewed the CT scans and he confirmed the area was cancer free. He also said that if I decided to go ahead and operate, he would not only remove the coccyx but also 'shave off' the end of the sacrum and smooth it over. I reflected on this after our session and booked in one final appointment with him. In this session I told him about the 2nd opinion I had and he asked who the doctor was (they all seem to know each other). He then told me that that particular doctor isn't comfortable in performing coccygectomies as some people still feel some pain after the operation and he is therefore very reluctant to carry them out.

I also asked Michael whether it was necessary to remove my coccyx when it was actually just the end of the sacrum which is the real issue. I thought that the less we take out, the smaller the wound and the quicker I would heal. He explained that we really would need to remove the lots as all those bits are connected. Finally, he mentioned that I would need 4 weeks off work.

I decided to go ahead, and booked the surgery. I thought about the best timing for this for some while. I work for a small business and it is very awkward to take much time off like this, so I booked the surgery for just before Easter in order to maximise public holidays with sick leave. I also went alcohol free for a month before the operation and hit the gym, getting my body in as best shape as possible to assist a rapid recovery.

Surgery Day (the day before Good Friday): I was first on their list for the day at The Epworth in Richmond, checking in at 6.30 am. After meetings, measurements and gowning up, I fortunately had time for a quick toilet stop - I was worried that I may potentially have a bowel movement on the operating table! In the freezing cold, pre-op waiting room, I suddenly needed another bowel movement, probably from nerves. Sure enough, it was diarrhoea. At least I was emptied out! Back on the bed I was pretty much taken through straight away. My anaesthetist explained the process and said they may possibly put in a catheter. I asked if this was really necessary and whether I could do away with that. Also whether I would get a chance to see Michael before the surgery given it was some months since I had seen him since last time. The anaesthetists found Michael from the tea-room who popped in and they agreed not to put in a catheter so glad I asked. The anaesthetist then put in the cannula and said he would inject a bit of sedating medicine to calm my nerves before they put me under. It must have worked very well as I have very little memory from that point - the oxygen mask getting placed over my head and that's about it.

The operation lasted 70 minutes it was completed before 9 am. I was woken gently by some nurses who were talking amongst themselves about how the kitchen staff had made some hot crossed buns and where to find them. I was on my back, drifting in and out. After some time I was taken up to my hospital room I remember the bed jolting a bit when getting wheeled over the slot coming out of the lift. This caused me to groan with pain. I have only learnt since that it may be possible to get this operation done with an epidural to block off pain to the area, though I'm not sure whether that would actually be better.

In my hospital room by 10.30 am and was connected up to a drip, oxygen, IV antibiotics and some inflatable pillow things that wrap around your lower legs and which are on a rotation, filling and deflating with air to assist circulation stop DVT. The initial machine was noisy and faulty and a second one was hooked up. This was also faulty and so they ditched it altogether, although the uninflated pillows were kept on for the next 24 hours. I also had a morphine button to self-administer when the pain got too out of hand. This got pressed 15 times over the next 24 hours before it was taken away. There was also a small plastic bucket, not quite as big as a cup, taped to the outside of my butt check with a tiny tube to the incision site. This was for seepage from the site and made sleeping quite difficult as it was taped on and stuck in to the skin. It had about a teaspoon of blood in it, but during the night I must have rolled over and the bucket snapped off from the pipe. We found it the next morning amongst the bed sheets.

The rest of the day was spent on the bed, getting tangled in all the cords, watching crappy day-time TV and half-hourly visits from the nursing staff to check on blood-pressure, pulse and temperature. Dinner arrived at 5.30 pm! I usually eat at 8.30 pm or later so when they came to collect the tray at 6.30, we were both surprised as I had even started it yet! Hospital life

The half hourly checks continued all night as my blood pressure dropped low (85). The nurses called the anaesthetist which made me a little worried. He said to increase the drip flow and they asked me to drink more fluids. Very little sleep but bits here and there. With the increased drip and all the extra water I was drinking I started needed to wee, but managed to master the plastic bottle while in still in bed.

Day 1 Post-Op (Good Friday) The nursing staff at Epworth were brilliant and friendly, even when I repeatedly kept accidently buzzing them while try to press the light on/off button. My surgeon (Michael) came by the ward at about 9.30 am and told me all went well and that he wasn't surprised that I wanted the surgery as it was a 'very protruding bone'. He didn't stick around for long, told me to get the bandage off and stitches out in one week and to make an appointment to visit him in 3 weeks time. At mid-morning the self-administered morphine was disconnected and replaced with osteo-panadols every 8 hours and 'endone' tablets when I needed them. I then had a visit from the hospital physio who helped me to sit up on the side of the bed. I then carefully stood up and took my first steps. I turned around and saw a lot of dried blood on the sheets. The nurse changed these while I went for my first walk around the ward. It felt painful but fine. In the afternoon one of the nurses removed the remaining seepage tube. She told me I could try having a shower later if I wished and that I could probably go home tomorrow - sooner than I thought! The rest of this day was filled with visitors and very slow walks from the bed to the private little bathroom, and around the ward. In the evening I was pretty tired and had probably over done it. I thought I should try a bowel movement (though didn't really feel like it), but was paranoid as the staff had told me how the opioid medication can clog you up. The pain in sitting down on the toilet seat was extreme but once down, it was okay. Getting up was extreme again. Later on, I managed to go and with some success.

My appetite has been excellent (including a few hot crossed buns and Easter eggs). That night the sleep was much better as the legs had been disconnected from the pillow-machine and I took off my oxygen tube so I could move around a bit more. Plus the little bucket had come off my side so I could lay on that side too. The worst pain was when rolling over from one side to the other or getting on/off the bed. And laying on the back was out of the question. The cannula was also still a pain as it got caught up on things, and started to get quite bloody.

Leaving Hospital - Day 2 (Easter Saturday): Up at 7.30 for breakfast. Had a slow but fantastic shower in my own little bathroom. After a final injection of IV antibiotics the nurse removed the cannula yay! (that thing is an alien). The staff asked me to get ready for leaving as much as I could on my own and then they would help with the rest. I managed to get on my undies and jeans (a dancing act but possible!), plus my top half clothes. Shoes and socks were out of the question - definitely cant bend down that low. Got help with those and chatted with the nurses about medicines, recovery, check ups etc. My partner came in with a proper coffee from the shops, and to collect me and the medicine from the pharmacy downstairs. Then, out of the hospital at 10.30 am. I carefully laid myself down on the back seat of our SUV. The drive home is fortunately just 20 minutes and was actually fine/low to moderate pain. Very nice to be home, but also a little surprised at how quickly the hospital got me out. In hindsight it felt a bit rushed and like 'tough-love', but I do think it's a good thing to get out as soon as you're ready so you get on with coping on your own and the next chapter. From my short hospital stay I could see how, the longer you stay, the more nervous you may get about leaving. However, without the home support I have, I'm not sure how you could actually do it?!

The rest of day 2 was spent just around the house, walking a small amount the kitchen and toilet, lots of sleep and rest and of course the TV. Then an excellent nights sleep, woken up only once by the pain, but took some tablets and back to sleep fairly quickly.

Day 3 & 4 (Easter Sunday and Monday): lots of little walks here and there, and a shower and bowel movements both days. The walks were slow and look funny, like my hips are pushed out in front. I cant help it. This puts some pressure on the lower back so have been laying down on my front on my mum's massage table which I borrowed. From here I can watch the ipad through the face hole, which was a great tip from another blogger here. This takes some pressure off my back. My partner has been incredibly supportive cooking all the meals, doing the dishes, picking things up when I drop them, helping me get my shoes and socks on. I couldn't do this without him. At one point while he was down the shops, the cat brought in a dead mouse and dropped it at my feet. There was literally nothing I could do about it so it just stayed there till help arrived.

I managed to sit out the back in the sun on a wooden chair for a few mins, perched on the front edge to stay away from the wound site.

Regarding the pain, I usually can tell when the 8 hours has worn off and I'm ready for the next round of Panadol tablets. Generally the pain is low (3-4/10), but peaks to 8/10 when I sneeze, laugh or cough, so am super glad I'm healthy and don't have a cold or other sickness at the same time. It's still very sore laying down and getting up again as well as lowering and lifting to the toilet. Men definitely have the advantage in this department!

I managed to go for two short walks to the shops as well. It felt good to be out and socialising and I probably walked 1.5km in total. Very slow and a bit odd looking, but it made me feel normal. Finally, I started helping out around the house a bit: dishes, putting out the rubbish, but no lifting anything too heavy 5kg the physio said.

Day 5 : managed to put on my own shoes and socks!

Will write again after my stitches are removed in 2 days time.

Update, 2017-04-30 2 weeks Post-Op

As instructed by my surgeon, I visited my local GP one week after my operation to get the stitches removed. She took off the dressing (same shower-proof one that was applied at the end of the operation) and told me straight away that it's not ready and to come back in a few days time. She cleaned and re-dressed the wound and I re-booked.

My new appointment was made for 11 days post-op. The new dressing was removed along with the 8 stitches (see pic). This wasn't very comfortable, but was over with pretty quickly. The doctor said that there was no need to re-dress the site and I could shower without worrying. This is great as I was having to use a hair-dryer to dry the 2nd dressing each morning after showering and before getting dressed.

The doc also said that the wound has healed well and believes the surgeon did a good job with stitching. He explained that as wounds heal they tend to flatten or even sink inwards creating a little crevice, so surgeons tend to overcompensate by stitching the cut with the two edges protruding outwards a little, knowing that as it will eventually heal flat rather than sink inwards.

I bought some scar-healing ointment from the chemist containing Vitamin E, aloe Vera and silicon to help it heal as quick as possible. This was the first chance I had got to look at the site. There was no visible bruising, and the cut appears to be about 8 cm.

In terms of pain, this really started to subside around the 10-12 day mark. I'm now only on Panadol tablets in the evening, and would like to drop them altogether, as am conscious taxing my liver. Hopefully in a week or so. Also, I don't mind a beer or two, so probably best not to over do it.

My partner has been so kind and understanding, helping with everything around the house. He even set up another bed in the spare room and has been sleeping on this for the past couple of weeks to avoid accidentally knocking the site in bed at night. This has meant good, healing sleep for me.

I went for a 15 min drive to some shops as a passenger seat at day 9 post-op, but it was too painful and I decided to lay down on the back seat for the journey back home. I tested this again today (day 14 post-op), and it is still pretty painful and I cant imagine Ill be driving for a few weeks yet. Walking is completely fine though, and I'm just about back to my normal fast pace. I'm getting shoes and socks on fine now too - by slipping the foot in to the shoe and then propping the foot over a chair arm to tie the laces. Bending down to get things off the ground is still not very comfortable but is achievable. I'm conscious of not over-doing it as I would hate to re-open the site and set myself back.

I did a test-run in to the office on day 8 post-op, by catching public transport, standing all the way. Fortunately this is only a 40 min journey and was fine. I picked up some files to work on from home and have been working quite a bit, standing up at the computer.

I plan to start back at work next week and will take in the raiseable desk table I bought on Ebay (Varidesk). I might also take in a roll-out mattress to take a lay down on at lunchtime, considering it will otherwise be a full day standing, including to and from work, which will be pretty tiring. I've been fortunate that they've been accommodating at work, and the boss has told me to take as long off as I need. I may possibly start with some shorter days if need be.

day after dressing off

My (hopefully final) appointment for this saga will be with my surgeon again mid-next week, which will be 3 weeks after the operation. I suspect this will be just to see how the site has healed and to assess the pain and improvement, and I look forward to it.

Overall, I'm glad the surgery is behind me, am pleased I went ahead with it and that there were not any hiccups (touch wood!). I look forward to the pain from the operation subsiding and starting a new chapter.

Update, 2018-05-13

It has now been just over a year (13 months) since my coccygectomy and the shaving down of my sacrum. Just a quick note this time, to reiterate that I still have no regrets at all and wish that this was something that I had done 25 years earlier. I have absolutely no pain in the area now as I don't have a bony nub sticking out in to a chair, bed or on a hard floor. There is still a slight bump, probably the end of my sacrum, but this is so minor compared to what was there previously. The scar has pretty much disappeared now. You would see it if you're looking closely, but that doesn't happen too frequently! It just blends in to the butt crack.

sacrum after one year   sacrum after 1 year 2

I had a recent trip over to Japan (from Melbourne) - the flight is 9 hours overnight. It was totally fine! I didn't even think about it once, where on previous long distance flights I would be squirming in my seat the whole time. Also, while in Japan, I slept on lots of hard futons. Sleeping on my back on hard mattress or lying on the floor (even with a yoga mat) used to be impossible. Now I don't even think about it. Top be honest it was the rest of my poor old body that felt the hard floor beneath me!

There have also be no other side-related issues - I recall that I was concerned that the surgeon would cut through important nerves in removing the coccyx which is quite deep inside - but I needn't have worried.

I know that a lot of people on this web page have quite different experiences to me and it's a shame that more people haven't had success. I also think that my anatomical aliment wasn't that common (judging from how few other post talk discuss it), and so if there is anyone else out there with a protruding sacrum, then I'd highly recommend getting it shaved down and the coccyx removed. Get it touch if you wish.

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