Question
I think my life is over. I cant sit, sleep, walk for long, pick up my son, go up stairs. The worst part? This car accident happened more than 1 year ago. I fractured the coccyx and nothing has been the same. Its too late for me? It already healed incorrectly, the coccyx bone protrudes to the rear. Spinal surgeon said I need surgery but does not suggest since its a sensitive area where the rectum can get damaged or it can get very easily infected. Is my life over for sure since I got an MRI and CT Scan all show it already has healed that way? I got a cortisone shot and lasted for 2 months and now I am fatter (5'2 female @ 178 pds) this does not help.

Answer
Dear Sandy,

Sorry it has taken me a few days to get back to you on this, but I wanted to get another opinion from a friend of mine who is a General Surgeon, as part of your question is really out of my expertise area.  He said that if the rectum is damaged, the repair is easy. However, you have to factor in three issues.  First, that some of the tissue may need to be removed to repair any issues, which may create problems, as you need the length of the rectum to properly allow for bowel compaction and storage...otherwise you will may have chronic bowel difficulties. Second, if one of the sphincters (circular muscle) that controls release, or being able to "hold it" is damaged, then you will may not be able to control bowel movements, which will lead to recurrent accidents and the need for adult diaper use.  Lastly, if the rectum is damaged badly (remote possibility) that may require The use of a lifetime colostomy bag.

Now, my first thought when reading your initial comments was that you should pursue some local pain management injections to reduce the inflammation ...then I read further and saw that the cortisone only gave you limited benefit.  Not to mention that you can only really get 2-3 of these safely anyway.  However, you may be able to utilize a local nerve block depending on the exact location of pain.  These have some inherent risks, but are generally pretty safe.  A physician certified in pain management would be the professional to consult.

On the other hand, acupuncture is also a very effective pain control technique.  I do not have any training in acupuncture, but I have co-treated patients with a local acupuncturist as well as referred patients to her.  She has a high success rate of reducing pain, and  this is an option I would suggest you explore.

The bottom line here is that if you cannot find any meaningful treatment to reduce your pain, then you need to weigh the risks versus the benefits of the surgery.  Ultimately the poor structure of the improperly healed coccyx is the most likely cause of the pain, and this may need to be corrected surgically.  I agree with the spinal surgeon that it is a very sensitive area to work around, but if your quality of life is so bad with pain that you cannot function or enjoy your children, then you may want to get the surgery anyway.  You need to have two meaningful conversations, one with a pain management physician, and the second with another surgeon for a second opinion.  Ultimately you will have to make a choice, and it needs to be made with all the facts you can gather.

Good Luck Sandy.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net