Have you ever fallen on your tailbone? Were you an ice skater, gymnast or football player and experienced multiple falls? Even one fall could play a role in your IC/BPS symptoms today. Now that we know to ask about tail bone injuries, we’ve found that they are remarkably common in the IC patient population. In his groundbreaking book Breaking Through Chronic Pelvic Pain, Dr. Weiss wrote “Tailbone injuries, be they fairly recent or lurking in the distant past, are notorious for causing muscle and nerve dysfunction and pain, as well as associated psychological distress.”

The coccyx is our vestigial (no longer necessary) tail, aka our tailbone. Some infants are born with longer, visible tails that are inevitably surgical reduced. Most of us, however, have just a small structure that gently curves inward. The coccyx is not one piece of solid bone. Rather, it consists of three to five smaller bones that are connected by fused joints or ligaments. Just as we see in our cats and dogs, the human tailbone can move though not as much.

The coccyx does have an important role to play. It helps to support the pelvis when seated. It is the connecting point for some pelvic floor muscles and helps to support the rectum, vagina and in the movement of our legs. Women are more likely to have tailbone injuries than men due, perhaps, to wider hips which then leave the coccyx more exposed to injury. Childbirth can also cause damage.

After a fall occurs, pelvic floor muscles often develop painful trigger points. And, of course, patients with tailbone pain will likely sit abnormally to avoid putting pressure on the tender spot. This, however, creates yet more muscle tension specifically on the illiococcygeus and coccygeus muscles which can then also develop painful trigger points.

Patient Success Stories

Scott

Scott struggled with penile, perineal, rectal, scrotal and urinary symptoms for about eleven months. Just 24 years old, Scott’s history revealed numerous injuries and falls with low back pain beginning at the tender age of 13. He also struggled with hip problems that required chiropratic adjustments. Upon examination, Dr. Weiss found that he had very tender trigger points in the muscles around the urinary sphincter, urogenital diaphragm, obturator, piriformis and puborectalis muscles. His pudendal nerve showed sensitivity. Pelvic floor physical therapy relaxed the pelvic floor muscles and calmed the trigger points. Clearly, muscle injury was the root of his problems.

Scott’s symptoms were preceded by a period of intense stress which Dr. Weiss believed activated latent, asymptomatic trigger points. Tension in the anterior and posterior perineal triangles resulted in his rectal burning, especially when having a bowel movement. Stress in the muscles of the perineum caused burning in the perineum, scrotum and penis. Stress in the urinary sphincter and urogenital diaphragm caused a slow urinary stream.

“Severe stress worked like an orchestra conductor, increasing the tempo to a painful crescendo” Dr. Weiss continued. More nerves and muscles became involved, resulting in out of control pain. “I treated Scott using internal myofascial release of compression and stretching to eradicate trigger points and lengthen contracted muscles…. After three treatments, all symptoms and abnormal findings had disappeared.”

Bruce

Bruce struggled with severe pain when having a bowel movement. Dr. Weiss’s examination found trigger points throughout the pelvic floor as well as sensitivity in his left pudendal nerve. Physical therapy helped though Bruce flared after having a colonoscopy. Dr. Weiss found that this had reactivated trigger points in his pelvis. One single treatment of physical therapy relieved his pain completely.

Bruce’s journey began years earlier when he fell down a flight of stairs and injured his tailbone. For months afterwards, his pain was so severe that walking was difficult. Dr. Weiss explained that tailbone injuries can overstretch attached muscles, including the puborectalis which surrounds the anus and rectum. During normal bowel movements, the puborectalis is supposed to relax thus allowing stool to pass easily. Sometimes, though, this muscle contracts which makes bowel movements much more difficult, triggering straining.

Dr. Weiss offered “What’s important to remember here is that trigger points seldom go away unless they are eradicated with appropriate treatment! Though they may no longer be causing pain, another nudge is all it takes to reactivate them and cause a symptom flare anywhere along the muscles route” such as straining.

For Bruce, activated trigger points were the clear source of his anal pain. His muscles had frozen in place to reduce pain (aka the guarding reflex) and bowel movements stretched these muscles, triggering more pain. This tension spread to other muscles resulting in a slow urine stream. The numbness and tingling in his penis could have been the result of tight muscles compressing the pudendal nerve. To most men and many doctors, the symptoms resemble chronic prostatitis when, in fact, it’s being driven by muscles and nerves.

Lorraine

Lorraine arrived in Dr. Weiss’s clinic with a 22 year history of tailbone pain, as well as a history of sciatica in her left leg and foot. She had been diagnosed with IC and underwent DMSO therapy which exacerbated her symptoms more. At the age of 12, Lorraine suffered a traumatic tailbone injury and experienced pain for several months. At the age of 24, her symptoms recurred.

Lorraine shared that she had been under extreme stress and was struggling with constipation when her tailbone and pubic pain began again. Dr. Weiss’s examination found trigger points through her urinary sphincter and pubourethralis muscles. The sciatica symptoms were triggered by trigger points in the adductor muscles of her inner thigh, the rectus adominus muscles and her left piriformis muscle.

Dr. Weiss said “Lorraine spent nearly half of her 46 years seeking relief from pain, initiated by a tailbone injury at the age of 12.”  Pelvic floor physical therapy and trigger point injections finally gave her relief.

Rachel

At the age of 77, Rachel struggled with tailbone, urinary and vulva symptoms that began at the age of 61. She struggled with a burning sensation in the vulva and despite aggressive treatment, her symptoms continued with one doctor suggesting that her pain was all in her head. Rachel struggled with a dull vulvar ache, urinary frequency and persistent tailbone pain while sitting. Dr. Weiss’s examination revealed painful trigger points throughout her pelvic floor, including her urinary sphincter, obturator internus, puborectalis, iliococcygeus and coccygeus muscles. While physical therapy eased her vulvodynia symptoms, her tailbone was still consistently uncomfortable. Dr. Weiss found yet more trigger points which he believed was the result of her sitting on her tailbone to reduce vulvar pain. When treated with trigger point injections, her pain resolved completely.

Anna

Perhaps the most instructive patient story comes from Anna*, a member of the ICN Forum. Her symptoms and pain were, as she said, bad. It felt like her whole pelvis was on fire. Her urologist diagnosed her with IC and did several bladder instillations which provided no relief. A hydrodistention found that she had a perfectly healthy and normal bladder lining.

After attending an ICN support group meeting, she learned about pudendal neuralgia. The symptoms matched and a new specialist ordered a pelvic MRI that showed that her sacrum (and tailbone) was pushing outward and in terrible alignment, undoubtedly stretching the nerves.

She embarked on a year long series of chiropractic adjustments to restore the proper position of her sacrum. Thankfully, her symptoms have improved substantially. She lives a normal life and was able to have a child. She still continues to have her sacrum evaluated and, if necessary, treated. She wrote “The moral of my long story is to investigate more and get tested for everything possible. Don’t let a doctor give you a diagnosis based off nothing There are so many other conditions other than IC that can cause a painful bladder.”

Conclusion

The patient stories above show that chronic pelvic pain is complex, the foundation of which can be laid in early injuries to the pelvic floor and tailbone. The challenge lay in the relationship between bones, muscles and nerves. It’s no wonder that patients struggle with a variety of symptoms. But here’s what we do know. This pain is not all in our heads. It is real and requires experienced, seasoned medical care providers to both diagnose and treat it.

Dr. Weiss compared his treatment approach with opening a combination lock. “We first dial to what we have determined to be the underlying cause and treat it. Then we dial back to the most obvious contributing factor and refine our treatment. Patiently we continue redialing and retooling our approach until we have addressed all of the pathological components and the door to symptom-free wellbeing has been opened.”

As you consider your symptoms, go back into your history. Did you ever fall on your tailbone? Can you remember any injuries? Does your parent remember any injuries? If so, this is vital information to share with your physicians and physical therapists. Dr. Weiss has clearly shown that there is hope with the proper muscle and nerve interventions.

*Name changed to protect privacy