Coccyx pain explained
Almost 10% of all coccyx pain is caused by childbirth. This is because the coccyx is in a very sensitive spot during the last stage of labour. The coccyx, or tailbone, needs to move and increase to make room for the baby to pass through the birth canal. The coccyx is where the pelvic floor muscles attach at the back of the pelvis. During the birth of an average-sized baby, the pelvic floor muscles have been shown to stretch up to three times their normal length, which can further change the coccyx position.
What Happens to the Coccyx During Childbirth?
Surprisingly, research has not looked at birth-related coccyx injuries, so little is known from evidence-based information. However, we can learn a lot from listening to women’s stories.
For example, birth positions that allow the tailbone to move, like being on hands and knees or lying on the side, seem to have less risk. These positions help the tailbone move backwards, making more room for the baby to come out.
Other factors that can increase the risk of coccyx injuries during childbirth include:
- Coccyx shape: There is a lot of variation in the shape and position of tailbones. Tailbones that are more bent or tucked under are thought to be more likely to get injured.
- Using instruments during delivery: Using tools like forceps or vacuum.
- Having multiple births: More pregnancies and deliveries.
- Short perineum: A shorter distance between the baby’s head and the tailbone.
Types of Injury to the Coccyx
There are two main types of injuries to the tailbone that can happen during childbirth:
1. The tailbone can get fractured due to the pressure on it.
2. The tailbone can get dislocated or partially dislocated.
There might also be a third type of injury involving the soft tissues or muscles that attach to the tailbone, like the iliococcygeus muscle.
The most common symptom of birth-related coccyx injury is local pain at the tailbone, which can make it hard to sit comfortably. Some women can hear a pop or feel immediate coccyx pain during birth, while others feel pain in the 24 hours after birth. Some women report not being able to sit at all and need cushions or need to side lie to breast or bottle feed. Sometimes, opening the bowels can be painful as it can place pressure on the coccyx.
It’s not common for birth-related coccyx injuries to be investigated with an X-ray or MRI , but these tests can be used to diagnose the injury or rule out other causes of tailbone pain.
Treatment usually includes pain-relief medication, ergonomic support for sitting, stool softeners, gentle pelvic floor exercises or pelvic/hip stretches, and a referral to a pelvic health physiotherapist.
More information on coccyx pain can be found at here.
Did you know?
In a study of 57 women with coccyx pain after childbirth, 50.8% of cases were caused by forceps delivery complications.
References
Ashton-Miller, J. A., & Delancey, J. O. (2009). On the biomechanics of vaginal birth and common sequelae. Annual review of biomedical engineering, 11, 163–176. https://doi.org/10.1146/annurev-bioeng-061008-124823
Maigne JY, Doursounian L, Chatellier G. Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine (Phila Pa 1976). 2000 Dec 1;25(23):3072-9. doi: 10.1097/00007632-200012010-00015. PMID: 11145819.
Maigne, J-Y., Rusakiewicz, F. & Diouf, M. (2012). Postpartum coccydynia: A case series study of 57 women. European Journal of Physical and Rehabilitation Medicine, 48, 387-92.
Márquez-Carrasco, Á. M., García-García, E., & Aragúndez-Marcos, M. P. (2019). Coccyx pain in women after childbirth. El dolor de cóccix en la mujer tras el parto. Enfermeria clinica, 29(4), 245–247. https://doi.org/10.1016/j.enfcli.2019.01.005
