Department of Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, Florida, USA.
Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, Florida, USA.
PM R. 2022 Nov;14(11):1351-1359. doi: 10.1002/pmrj.12706. Epub 2021 Oct 22.
Coccygodynia is a painful condition of the tailbone that occurs more commonly in females. The association of coccyx pain with pelvic floor symptoms and the prevalence of coccyx pain in women with pelvic pain has not previously been reported.
To identify the prevalence of coccygodynia in women with pelvic pain and to describe the association of coccygodynia with pelvic floor examination findings and symptoms.
Retrospective cohort analysis.
Tertiary medical institution.
One hundred twenty-seven women presenting for outpatient pelvic floor physical therapy treatment who underwent vaginal and rectal pelvic floor examination.
Prevalence of coccygodynia, pain scores, association of coccygodynia with other comorbidities and diagnoses, and association of coccygodynia with physical examination findings.
Sixty-three (49.6%) of 127 women with pelvic pain presented with coccygodynia and 64 (50.4%) did not. Women with coccygodynia had significantly higher rates of muscle spasm (50.8% vs. 31.2%, p = .025) higher visual analog scale pain scores (median 5 vs. 3, p = .014), higher rates of outlet dysfunction constipation (31.7% vs. 10.0%, p = .032), and higher rates of fibromyalgia (15.9% vs. 3.1%, p = .014). On pelvic examination, women with coccygodynia were significantly more likely to have sacrococcygeal joint hypomobility (65.1% vs. 14.1%, p < .001), coccygeus muscle spasm (77.8% vs. 17.2%, p < .001), anococcygeal ligament pain (63.5% vs. 9.4%, p < .001), external anal sphincter pain/spasm (33.3% vs. 13.1%, p < .001), and impaired pelvic floor muscle coordination (77.8% vs. 57.8%, p = .016).
Almost 50% of women seeking pelvic floor physical therapy for pelvic pain had coexisting coccygodynia. These women had higher pain scores, increased pelvic floor dysfunction, and significantly greater abnormal physical exam findings. This study demonstrates a strong link between coccygodynia, pelvic floor symptoms, and pelvic pain and highlights the importance of screening for and identifying coccyx pain when evaluating women with pelvic pain.
尾骨痛是一种常见于女性的尾骨疼痛病症。尾骨疼痛与盆底症状的关联以及患有盆底疼痛的女性中尾骨疼痛的患病率此前尚未有报道。
确定患有盆底疼痛的女性中尾骨痛的患病率，并描述尾骨痛与盆底检查结果和症状的关联。
回顾性队列分析。
三级医疗机构。
127 名因盆底功能障碍性疾病而接受门诊盆底物理治疗的女性，她们接受了阴道和直肠盆底检查。
尾骨痛的患病率、疼痛评分、尾骨痛与其他合并症和诊断的关系，以及尾骨痛与体格检查结果的关系。
63 名（49.6%）有盆底疼痛的女性出现了尾骨痛，64 名（50.4%）没有。有尾骨痛的女性肌肉痉挛发生率明显更高（50.8%比 31.2%，p=0.025），视觉模拟评分疼痛中位数更高（5 分比 3 分，p=0.014），出口功能障碍性便秘发生率更高（31.7%比 10.0%，p=0.032），纤维肌痛发生率更高（15.9%比 3.1%，p=0.014）。在盆底检查中，有尾骨痛的女性骶尾关节活动度明显降低（65.1%比 14.1%，p<0.001），尾骨肌痉挛（77.8%比 17.2%，p<0.001），肛尾韧带疼痛（63.5%比 9.4%，p<0.001），肛门外括约肌疼痛/痉挛（33.3%比 13.1%，p<0.001），以及盆底肌肉协调性受损（77.8%比 57.8%，p=0.016）。
近 50%因盆底疼痛寻求盆底物理治疗的女性同时患有尾骨痛。这些女性疼痛评分更高，盆底功能障碍更严重，且体格检查异常发现明显更多。本研究证明了尾骨痛、盆底症状和盆底疼痛之间存在很强的关联，并强调了在评估患有盆底疼痛的女性时，筛查和识别尾骨疼痛的重要性。
