The coccyx bears the weight of the body in the sitting posture, especially when a person leans backwards. An injury to the coccyx impairs ones ability to sit comfortably, because of tenderness and pain in that region. Pressure on this area hampers the healing process and displaces the edges of the broken coccyx. Thus, a wide variety of cushions have been designed for people with a broken coccyx or longstanding coccyx pain to avoid pressure on the coccyx while sitting. These are called coccyx seat cushions or simply, coccyx cushions, which are used for treatment of broken coccyx.
Treatment with Coccyx Seat Cushions
As the broken edges do not displace much because of the muscle and ligament attachments a coccyx fracture can be treated conservatively with good results. Coccyx seat cushions are specially designed cushions with a cut in the region where the coccyx touches the seat (Picture 1, 2, 3).
Picture 1: Soft Coccyx Seat Cushion
Picture 2: Firm Coccyx Seat Cushion
In this manner, the coccyx remains in the air and bears no weight of the body. Earlier, the coccyx seat cushions were donut or ring shaped, but these do not actually relieve the coccyx from pressure and so have been replaced. A coccyx cushion need not be soft always, infact a hard cushion keeps it away from pressure much better than a soft one (Picture 3).
Picture 3: Hard Coccyx Seat Cushion
The cushions have to be used all the time and even while sleeping. This has to be done for 4-6 weeks for a broken coccyx and 2-3 weeks for a bruised coccyx. Pain-killers and local ointments can be effective to reduce the pain to a minimum.
Old coccyx fractures may require prolonged treatment with cushions. Local steroid injections may be used to lessen the longstanding inflammatory changes and promote healing. The injections may have to be repeated for 3 times for complete relief of symptoms. It is advisable to use the cushions even after complete relief of pain for a period of 6-8 months to prevent recurrence. Prolotherapy gives excellent results when ligament injury is the primary concern, especially in childbirth injuries.
Surgical Treatment of Broken Coccyx
Surgical treatment is a last resort option for an old broken coccyx. This is because of the high rate of complications caused by surgery. The coccyx is very near the anus, thus, infections are very common in the surgical wound. Moreover, it does not relieve the pain in all cases and may make the condition worse than before. Surgery also increases the chances of getting a hernia in the region of the coccyx. Hence, this option should only be taken after completely using all the other forms of treatment.
Coccygectomy is the surgery performed for longstanding coccyx pain, which does not respond to conservative therapy. It consists of removing the coccyx completely and attaching the muscles and ligaments to a different location, like the sacrum.
Sometimes the broken parts of the coccyx are highly displaced because of a high energy trauma from a road accident. In this situation, the pieces have to be correctly aligned with a surgery. This is called open reduction of coccyx fracture and is an emergency procedure.