598 - Persistent Coccydynia in a Post-Partum Female: A Case Report

Case Diagnosis: Tailgut Cyst

Case Description: A 33-year-old G1P1 female with a medical history of constipation presented for evaluation of persistent coccydynia. The constant burning, cramping pain started at 38 weeks gestation and was impacting her ability to function- walking, sitting, and exercise exacerbated her symptoms. Her OB/GYN team was unable to induce her, so a C-section was performed. Her symptoms persisted post-operatively and work up for typical causes (including CT scan) was negative. She was referred to PM&R and was found to have hypertonicity of the pelvic floor musculature. An MRI was obtained and revealed a 6x4x4cm presacral mass. The mass was surgically removed and pathologically confirmed to be a Tailgut Cyst. Her constipation improved but the tone and pain persisted. She was enrolled in pelvic floor physical therapy (PFPT) which focused on pelvic floor muscle strengthening and controlled relaxation techniques. Pain and tone both significantly improved with PFPT.

Discussions: Tailgut Cysts are a rare, congenital condition typically presenting in female patients between 30-60 years old. Though it is often asymptomatic, it can cause compressive symptoms resulting in urological, neurological, and gastrointestinal issues. Since tailgut cysts are so rare, there is limited data evaluating the impact it has on patient symptoms and the outcomes of pelvic floor therapy.

Conclusions: There is a broad differential of pain generators and causes of high pelvic floor tone in pregnant women, but it is important to consider rare causes including congenital masses. Even when a suspected pain generator is identified and treated, it is crucial to acknowledge and evaluate the surrounding physical structures, in this case, the pelvic floor muscles, to adequately treat the pain associated with a mass such as a tailgut cyst.