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The pudendal nerve is the main nerve of the perineum. It is a mixed nerve and also conveys sympathetic autonomic fibers. It carries sensation from the external genitalia of both sexes and the skin around the anus and perineum, as well as the motor supply to various pelvic muscles, including the male or female external urethral sphincter and the external anal sphincter.
The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis.
The coccyx, commonly referred to as the tailbone, is the final segment of the vertebral column in all apes, and analogous structures in certain other mammals such as horses. In tailless primates since Nacholapithecus, the coccyx is the remnant of a vestigial tail. In animals with bony tails, it is known as tailhead or dock, in bird anatomy as tailfan. It comprises three to five separate or fused coccygeal vertebrae below the sacrum, attached to the sacrum by a fibrocartilaginous joint, the sacrococcygeal symphysis, which permits limited movement between the sacrum and the coccyx.
The sacrum, in human anatomy, is a large, triangular bone at the base of the spine that forms by the fusing of the sacral vertebrae (S1–S5) between ages 18 and 30.
Coccydynia is a medical term meaning pain in the coccyx or tailbone area, often brought on by a fall onto the coccyx or by persistent irritation usually from sitting.
The stellate ganglion is a sympathetic ganglion formed by the fusion of the inferior cervical ganglion and the first thoracic ganglion, which is present in 80% of individuals. Sometimes, the second and the third thoracic ganglia are included in this fusion.
The coccygeus muscle or ischiococcygeus is a muscle of the pelvic floor, located posterior to levator ani and anterior to the sacrospinous ligament.
The anococcygeal nerve is a sensory nerve of the pelvis that arises from the coccygeal plexus. It pierces the coccygeus muscle and the sacrotuberous ligament to supply a small area of skin between the coccyx and anus, as well as the sacrococcygeal joint. The number of anococcygeal nerves varies between one and three.
The sympathetic trunks are a paired bundle of nerve fibers that run from the base of the skull to the coccyx. They are a major component of the sympathetic nervous system.
Pelvic pain is pain in the area of the pelvis. Acute pain is more common than chronic pain. If the pain lasts for more than six months, it is deemed to be chronic pelvic pain. It can affect both the male and female pelvis.
The sacrococcygeal symphysis is an amphiarthrodial joint, formed between the oval surface at the apex of the sacrum, and the base of the coccyx.
The anterior sacrococcygeal ligament or ventral sacrococcygeal ligament consists of a few irregular fibers, which descend from the anterior surface of the sacrum to the front of the coccyx, blending with the periosteum.
The posterior sacrococcygeal ligament or dorsal sacrococcygeal ligament is a ligament which stretches from the sacrum to the coccyx and thus dorsally across the sacrococcygeal symphysis shared by these two bones.
Pelvic splanchnic nerves or nervi erigentes are splanchnic nerves that arise from sacral spinal nerves S2, S3, S4 to provide parasympathetic innervation to the organs of the pelvic cavity.
The coccygeal plexus is a small nervous plexus upon the pelvic (anterior) surface of the coccygeus muscle.
The hypogastric nerves are the continuation of the superior hypogastric plexus that descend into the pelvis anterior the sacrum and become the inferior hypogastric plexuses on either side of pelvic organs. The hypogastric nerves serve as a pathway for autonomic fibers to communicate between the lower abdomen and pelvis.
The coccygeal glomus is a vestigial structure placed in front of, or immediately below, the tip of the coccyx.
Coccygectomy is a surgical procedure in which the coccyx or tailbone is removed. It is considered a required treatment for sacrococcygeal teratoma and other germ cell tumors arising from the coccyx. Coccygectomy is the treatment of last resort for coccydynia which has failed to respond to nonsurgical treatment. Non surgical treatments include use of seat cushions, external or internal manipulation and massage of the coccyx and the attached muscles, medications given by local injections under fluoroscopic guidance, and medications by mouth.
The lumbar ganglia are paravertebral ganglia located in the inferior portion of the sympathetic trunk. The lumbar portion of the sympathetic trunk typically has 4 lumbar ganglia. The lumbar splanchnic nerves arise from the ganglia here, and contribute sympathetic efferent fibers to the nearby plexuses. The first two lumbar ganglia have both white and gray rami communicates.
The sacral ganglia are paravertebral ganglia of the sympathetic trunk.:39 As the sympathetic trunk heads inferiorly down the sacrum, it turns medially. There are generally four or five sacral ganglia. In addition to gray rami communicantes, the ganglia send off sacral splanchnic nerves to join the inferior hypogastric plexus. Near the coccyx, the right and left sympathetic trunks join to form the ganglion impar.
References
This article incorporates text in the public domain from page 984 of the 20th edition of Gray's Anatomy (1918)
- ↑ Erasmus Wilson, William James (1838). Practical and surgical anatomy. p. 431.
ganglion impar - azygos.
- ↑ Foye P, Buttaci C, Stitik T, Yonclas P (2006). "Successful injection for coccyx pain". Am J Phys Med Rehabil. 85 (9): 783–4. doi: 10.1097/01.phm.0000233174.86070.63 . PMID 16924191.
- Munir MA, Zhang J, Ahmad M. (2004) "A modified needle-inside-needle technique for the ganglion impar block." Can J Anaesth. 2004 Nov;51(9):915-7.
