Coccydynia in postpartum women: A retrospective study of final results of extracorporeal shock wave treatment

Abstract

Introduction: Postpartum coccydynia is pain that appears as soon as a sitting position is adopted after delivery. Coccyx morphology, body mass index, vaginal delivery, instrumental delivery, multiparity, female sex, mature age and short perineum in women with difficult delivery are risk factors. Coccydynia is pain around the coccygeal region, which is caused by sudden impact over the coccyx area from falling from height or traumatic injuries, prolonged sitting for a long time in a narrow space, leaning back while in a seated position leads to increased pressure on the coccyx, vaginal birth delivery etc. which results in pain and inflammatory changes around the surrounding ligaments and muscles. Most patients prefer the conservative treatment with non-invasive methods for coccydynia. In recent years (ESWT) is suggestive for the non-invasive treatment of many musculoskeletal conditions, including plantar fasciitis, epicondylitis and shoulder calcification and coccydynia. Aim and objectives: The purpose of the study is to evaluate the effects of ESWT on the outcomes of Coccydynia in postpartum women. Materials and methods: This study had a retrospective design from january 2018 to december 2021.The clinical data of 22 patients treated with ESWT were analysed and followed up at regular intervals of 1month, 3months, 6months. All the patients were referred from department of obstetrics & gynaecology or an obstetrics & gynaecology consultant to Orthocare, Vijayawada and department of orthopaedics, NRI general hospital, chinnakakani. We have given three sessions per week, preferably on the alternative days. The number of sessions per patient varies from 6 -10. Visual analog scale (vas) scores were noted at the initial consultation, at each session, and during the initial and final follow-up (at 6 months) examinations after the treatment. The 36-item short-form (sf-36) quality of life scale survey was conducted at the beginning and end of the treatment. Results: The mean VAS score was 9.6 (9–10) before the treatment and 3.4 (0–2) after the treatment (p < 0.05). The VAS score decreased to ≤3 in 79.4% of patients. Compared with the preoperative SF-36 scores for physiological function, mental health, and social function, the postoperative scores were significantly improved. Conclusion: ESWT is a cost-effective treatment method with low rates of complications especially in breast feeding mothers where anti inflammatory analgesics are not a good choice to control the pain. In our study, ESWT provided effective pain control for chronic coccydynia. At least four sessions are needed to achieve a successful outcome.