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Hip Pain
Published in Benjamin Apichai, Chinese Medicine for Lower Body Pain, 2021
Coccydynia is pain and tenderness at the coccyx; usually it is associated with inflammation. Injuries such as falls and childbirth can cause contusion of the sacrococcyx and inflammation of the adjacent ligaments or even dislocation and fracture of the coccyx. The risks of developing coccydynia include obesity and female sex. Coccydynia is five times more prevalent in women than men.65
The Governor Vessel (GV)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Clinical Relevance: Coccydynia has several causes; one may stem from neuropathic pain mediated by the coccygeal plexus. Trigger point pathology in the ischiococcygeus muscle may compress the coccygeal plexus and exacerbate coccydynia. Coccydynia frequently worsens with sitting, standing, and even walking. Etiologies include instability of the sacrococcygeal or intercoccygeal joints and/or entrapment neuropathy or traumatic irritation of the coccygeal plexus. While coccygectomy may prove curative, treatment with acupuncture and related techniques as conservative measures should ideally be tried before surgery.
Chronic Pelvic Pain
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Andrea J. Rapkin, Candace Howe
A bimanual examination should be performed beginning with a single digit exam noting introital spasm or vaginismus suggestive symptoms. Then the examiner can gently enter the vagina, palpating the levator ani muscles (including the puborectalis, pubococcygeus, and iliococcygeus), and inspecting the pelvic girdle for spasms and tenderness in addition to ruling out abnormal findings such as nodules or masses. The examiner should assess the course of the pudendal nerve for evidence of pudendal neuropathy. It is helpful to have a physical therapist who specializes in chronic pelvic pain to evaluate the patient as part of the multidisciplinary approach. If a muscular etiology is found, these individuals are trained in rehabilitation and are excellent at teaching patients relaxation techniques. The caudal anterior vaginal surface should be examined for tenderness representing a bladder or urethral origin of pain. In addition, any discharge or thickening should be noted and may mean that chronic urethritis, urethral syndrome, urethral diverticulum, a vaginal wall cyst, trigonitis, or interstitial pathology may exist (Howard, 2003b). Deeper vaginal palpation and examination of the uterus is then necessary. Pressing the uterus against the sacrum or between the examiner’s abdominal and vaginal hand may illicit tenderness. Posterior uterine pressure that causes tenderness is suggestive of pelvic congestion, adenomyosis, pelvic congestion syndrome, or pelvic infection (Howard, 2003b). Rectovaginal exam should always be performed, not only to adequately evaluate ovaries, but also to check for posterior cul-de-sac pathology (severe endometriosis can result in dense adhesions, a retroflexed uterus, and nodules on the uterosacral ligaments and rectovaginal septum) and stool for occult blood. On rectovaginal exam coccydynia may be diagnosed if an attempt to move the coccyx about 30° results in pain.
Influence of psychiatric disorders and chronic pain on the surgical outcome in the patient with chronic coccydynia: a single institution’s experience
Published in Neurological Research, 2020
Kristopher A. Lyon, Jason H. Huang, David Garrett
Overactivity of the nerves in this region are linked to certain psychiatric disorders associated with fear, stress, depression, or trauma in this region and have caused an increased resting tension in the pelvic floor muscles [13]. Additionally, patients with purely idiopathic coccydynia occurring in the absence of psychiatric disorders or trauma are believed to derive pain from the spasticity of their pelvic floor musculature [21]. Manifestations of increased pelvic floor muscle tension contribute to common associated symptoms of coccydynia including dyspareunia and dyschezia [20].