COCCYGODYNIA.
The pain is characterized as dull and dragging, often very severe like that of toothache (Scanzoni). It increases in intensity on protracted pressure on the coccyx in the sitting posture, and grows less or disappears entirely on the assumption of the lateral decubitus. The pain is greatest on sitting down and in rising. Many patients are also unable to walk.
Examination of and motion imparted to the coccyx by the finger, evokes the same pain, especially any motion imparted to the bones. It is apparent, hence, why constipation and cohabitation may cause intense eoccygeal pain. Scanzoni found it necessary to prohibit sexual inter course for a protracted period. The menstrual periods aggravate the pain, and Scanzoni had a patient who only suffered from the affection at these times.
Coccygodynia affects in particular married women, but only because they are more exposed to certain of the causes than the unmarried. There are cases recorded where nullipane and even children of four to five years suffered from the affection (llorschelmann). Although men may be affected, it appears most frequently in women, and usually as the result of child-bearing. We will first sketch the etiology of the affection and then treat of this special point more in detail.
Generally coccygodynia follows on protracted or instrumental labor, falls, riding (Scanzoni), the influence of cold (Blit). It is often seen as an accompaniment of uterine and ovarian diseases, and the ance of the affection on the cure of such diseases would seem to prove a causal connection. West believes the pain in case of uterine or ovarian disease to be sympathetic. The question arises as to whether we are here really dealing with coccygodynia. We have defined the affection as a disease characterized by pain on motion of or interference with the coccyx.
Now the pain accompanying uterine disease may or may not be localized over the coccyx, and this pain is hence not due to coccygodynia. Labor is by all odds the most common cause, as a result of the great pressure on the coccyx. Scanzoni's observations on this subject are noteworthy, and he has given us the best description of this affection. He met with the disease only in women who had borne children. Nine of the women stated that the pain had first appeared during the puerperium. Of the
nine, six had borne but one child, and in five of, these delivery had been accomplished by the forceps. In these instances, then, there has either occurred dislocation of the coccyx, or else such strain of the ligaments as to render passive motion of the bone acutely painful. Coccygodynia also results from inflammation of the bone. Nott, who extirpated the coccyx, found it carious. In many cases the coccyx is dislocated, and the pain disappears in case of ankylosis. Likely enough in instances of coccygo dynia, which do not yield to treatment, there exists caries. From Hyrtl's observations it results that of one hundred carefully examined pelves, there existed luxation of the coccyx in thirty-two with consecutive ossi fication.
In case of marked pressure of the coccyx backwards, the sacro-coccy goal and lateral coccygeal ligaments are naturally strained, and there occurs also a separation of the bones one from another, and even luxation from the fifth sacral vertebra. As a result of the traction and dislocation, the coccygeal nerves are irritated, and this would explain the excessive ten derness. In two of Scanzoni's patients the skin over the coccyx was very red, and the bone was very movable posteriorly. Often while under ob servation, great anterior ankylosis resulted. In two of the same gentle man's cases, the disease had followed on riding. The one patient began to ride at fourteen, was married at twenty-one, and was delivered normally at twenty-three. Three mouths afterward she again mounted a horse, but in a few minutes she suffered from such excessive cocegyeal pain, that she had to desist from riding. The second patient had been deliv ered twice, and complained of frequently recurring metrorrhagia. Four teen days after delivery she noticed for the first time pain in the region of the coccyx. One half year later she went out horseback riding, and on her return complained of such great pain in the coccygeal region that she fainted. From this time forth until two years after, when Scanzoni saw her, she suffered from coccygodynia. We might expect the affection to develop from the way women sit in their saddle, yet since Scanzoni's case no others have been recorded.