Coccygectomy

Coccygectomy is a surgery performed to remove a portion or whole of the coccyx bone. The coccyx, also known as the tailbone, is located at the end of the spinal column and consists of two or three bones joined one below the other. The sacral bone connects the coccyx to the lumbar spine (lower back). 

Coccygectomy is performed if you have pain in the tailbone region. The doctor will initially advise certain self-help measures to relieve this pain as follows:

• Avoid sitting in one place for a long time.
• Use special coccygeal cushion while sitting.
• Apply cold or hot packs to the pain region.
• Perform exercises, such as stretching, physiotherapy or massaging.
• Take medicines for pain, such as ibuprofen, as prescribed.

If there is no change in the severity of pain with the passage of time, corticosteroid injections or using the above self-help measures, the doctor may offer a coccygectomy. Based on your condition, the doctor will decide whether only a part or all the bones of the coccyx should be removed. For example, if one of the parts of the coccyx is loosely attached to the sacral bone due to a trauma to the area, only that particular part may be removed.

You will require this surgery if you have pain and tenderness in the coccyx bone (coccydynia). This pain is described as follows:

• Feels uncomfortable and increases suddenly at times
• Worsens on standing for a long time or when sitting down
• Interferes with daily activities 
• Worsens during sexual intercourse
• Causes sleep disturbance

The following conditions may cause coccydynia:

• Accident or injury 
• Poor posture 
• Obesity or rapid weight loss
• Childbirth, usually after a difficult delivery 
• Age-related wear and tear 
• Poor pelvic floor (the group of muscles that support the pelvic organs, such as bladder, intestine and uterus) function
• Recurrent or prolonged strain on the ligaments (a type of tissue that connects the bones) surrounding the coccyx
  
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This surgery may show better results in people who: 

• Had a history of an injury to the coccyx
• Have had some relief of pain from medicines, such as corticosteroid injections 
• Have abnormal movement of the coccyx

This surgery is avoided in people with the following conditions:

• Chronic (long-term) pain disorders 
• Perirectal abscess (infection near the anus)
• Concomitant (associated) severe spinal disorders

Before the surgery, you will need the following preparations:

• Medical examination: The doctor will conduct a physical examination and review your medical history. He/she will also conduct imaging scans, such as x-rays, to reach a diagnosis.
• Medications: 
  • Tell your doctor if you are using any the medicines, vitamins and supplements and if you have any allergies.
  • Your healthcare practitioner will inform you when you should stop using blood-thinning medicines, such as aspirin or ibuprofen, before the surgery. 
• Fasting: You will need to be fasting from midnight before the surgery until after the procedure when the doctor gives you permission to eat. 
• Smoking: You will be asked to quit smoking to prevent risks, such as infection, after the surgery. 
• Driving: Your doctor will suggest you to bring someone, a friend or family member, who can drive you home after the surgery. 
• Consent: You will have to sign some consent forms before the procedure, allowing the physician to perform the surgery. 

Before conducting the surgery, the surgeon and the medical team will perform the following steps:

• You will be provided with a hospital gown.
• An intravenous (IV) line will be placed in your hand or arm. This will be used to provide you fluids during the procedure
• You will be given general anaesthesia that will keep you asleep during the surgery.
• Your skin around the surgical site will be cleaned with an antiseptic solution.

After the surgical site is prepared, the surgeon will perform the following steps:

• He/she will make an incision at the top of the crease of your buttocks and remove the skin and the fat tissues aside to find your coccyx bone. 
• The coccyx bone will then be carefully removed, and the prominent end of the sacral bone will be made smooth with the help of a special instrument. 
• Finally, the surgeon will place stitches on the incision and cover the area with a dressing.

Directly after the surgery, you will be shifted to the recovery room. You will be given oxygen through a facemask and liquids through the IV line until you can drink properly. You will experience pain while sitting for a while after the surgery. The nurse may give you laxatives to soften your stools and to avoid strain while defecating.

You will be sent home when you are comfortable and able to move independently.

Once you are home, you will need to take care of the following: 

• Wound care:
  • You may have absorbable or removable stitches on the site of the surgery. Removable sutures will be removed at your follow-up appointment.
  • You can shower two days after the surgery, but avoid bathing in a bathtub for up to two weeks. 
  • Avoid wetting the dressing too much. If it gets wet, the dressing should be changed.
• Pain relief:
  • You will be given pain killer medicines to manage the pain after the procedure.
  • Once the swelling has been reduced, you can use heat packs for pain relief. 
• Posture: 
  • You may experience discomfort when sitting for several weeks after the surgery. To ease this pain, you should use a gel-filled cushion or try leaning ahead while supporting your weight on a flat surface, such as a table. 
  • Try sleeping on your side with or without a pillow between your knees to avoid the pain. 
• Swelling relief:
  • To reduce swelling, you may apply an ice pack on the area, for not more than 10 minutes. 
• Driving:
  • Avoid driving up to four weeks after your surgery or until your doctor allows you to. 
• Clothes:
  • Avoid wearing tight jeans or trousers until your wound has completely healed. 
• Activities:
  • Once you can sit comfortably, you can resume your job. 
  • You should walk regularly and gradually increase your distance for better recovery. 
  • The doctor may give you permission to resume other activities, including swimming or running after four weeks. 
  • You should not travel by air for six weeks or more.

When to See the Doctor?

You must contact your doctor if you are experiencing the following:

• Fever
• Wound leakage 
• Redness or pain around the surgical wound 
• Difficulty in breathing or difficulty swallowing 
• Pain in the chest while coughing or taking a deep breath
• Increased difficulty in walking 
• Increased headaches

The complications of coccygectomy are:

• Constant pain for more than several weeks
• Infection and wound healing issues 
• Anaesthesia problems, heart attack or stroke
• Bleeding 
• Injury to the rectum, nerves or skin
• Sagging of the pelvic floor muscles 
• Blood clots in the deep veins of the lungs (pulmonary embolism) or legs (deep vein thrombosis)

You may need to visit the clinic about 10-14 days after the surgery to get the stitches removed. A follow-up appointment with the doctor may be scheduled for six to eight weeks after the surgery.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.