Medical Edge Newspaper Column

Tailbone Pain Likely Caused By Chronic
Pelvic Muscle Tension

March 27, 2006
DEAR MAYO CLINIC:
I developed severe pain in my tailbone after the birth of my first child. One doctor said I broke my tailbone and another said I didn't. A year later, I still have pain and can't sit for very long. Is this common? What can I do to relieve my pain?

ANSWER:
Breaking the tailbone (coccyx) happens occasionally during childbirth. Statistics on exactly how often a coccyx fracture occurs during delivery are difficult to find. At Mayo Clinic, where we have more than 2,000 deliveries annually, it happens a few times a year.

A broken coccyx may be difficult to diagnose. If broken, it usually will heal without treatment within several weeks.

Since you've had pain for more than a year, I believe you are dealing with something else, possibly pelvic floor tension myalgia. This condition involves chronic tension in the muscles that make up the pelvic floor, leading to pain.

This condition can occur after childbirth, an injury or spontaneously. For most people, symptoms are worse when sitting or standing for long periods.

Symptoms can include:

• Low back pain
• Heavy feeling in the pelvis
• Pain with bowel movements
• Coccyx pain
• Pain during intercourse

Seek out a specialist who is familiar with pelvic floor myalgia to determine if it's causing your pain. Options to consider include an obstetrician/gynecologist, a physical medicine and rehabilitation specialist, and a pain specialist. In addition to taking a complete history, the provider will perform a physical exam of the pelvis.

While there is no specific cure, patients improve with treatment. There are several treatment options:

• Biofeedback: Using auditory or visual feedback from electrical sensors, a biofeedback therapist can help you learn to relax pelvic muscles.

• Physical therapy: A physical therapist can teach you specific exercises to relax the pelvis.

• Adequate sleep: Many people with pelvic floor myalgia report poor sleep. Regular exercise can improve sleep. Also, make time for adequate sleep -- which can be difficult with young children in the house. Over-the-counter sleep medications may help establish better sleep patterns. You could also talk to your care provider about prescription sleep medications.

• Other medications: Over-the-counter pain medications can help manage the pain, as long as you don't have health concerns that make taking them a problem. In addition, your care provider might suggest prescription muscle relaxant medications.

• Self-care: Avoid activities that make the pain worse. Warm baths and heat to the perineum may be helpful.

-- Mary Marnach, M.D., Co-director, Mayo Clinic Women's Health Clinic, Rochester, Minn.