Tailbone- Coccyx Pain

Tailbone- Coccyx pain, also termed coccydynia or coccygodynia, is discomfort located at the tailbone, which is the bone located at the base of the spine. This type of pain can be characterized as a constant dull ache or a sharp pain accompanying various actions. Long periods of standing or sitting, the motion of getting up from a chair, sex and defecation may exacerbate the sensation of pain. Possible causes of tailbone- coccyx pain include:

  • Injury to the coccyx secondary to a fall
  • Long periods spent seated on a hard surface
  • Vaginal childbirth
  • Degenerative joint conditions

Coccydynia usually resolves after a few weeks or months without treatment. Chronic, unrelenting tailbone- coccyx pain may be a sign of an underlying condition, and should be evaluated by a physician.

Tailbone- Coccyx Pain Pathology

The coccyx is found at the base of the spine, just below the sacrum. This group of 3-5 individual coccygeal vertebrae is curved and terminates in a narrow tip. Its shape is true to the imagery of a bird’s beak denoted by the name coccyx, the Greek word for cuckoo. In humans, the coccyx is referred to as the tailbone because it is believed to be a vestigial remnant of a tail. The coccyx does have two main functions:

  • Serving as an attachment point for muscles, ligaments and tendons
  • Bearing the weight of the body in conjunction with the ischial tuberosities (sitting bones at the base of the pelvis)

Acute injury to the bony structure of the coccyx may be the result of internal or external forces. Falling on the tailbone can result in fracture, dislocation of bone junctions or bruising. During vaginal childbirth, a woman may experience internal injury to the tailbone as the baby moves through the birth canal.

Tailbone- Coccyx pain may also be chronic, caused by degeneration of the bones at the base of the spine, or by poor posture and long periods spent sitting on a hard surface. Patients diagnosed with malignancy related to the bones or organs near to the coccyx may suffer from chronic neuropathic pain of the coccyx that is difficult to treat.

Tailbone- Coccyx Pain Diagnosis

Patients who present with tailbone- coccyx pain undergo a detailed medical history and physical exam. The physician questions the patient regarding the onset, location and severity of pain, as well as what makes the pain worse and how the pain affects physical activity. Though most tailbone- coccyx pain is benign and heals on its own, the medical team will look to rule out other causes related to conditions of the gastrointestinal system, urinary tract, nervous system and history of childbirth. Depending on the patient’s symptoms, colonoscopy or imaging studies may be performed to rule out cancer.

During the physical examination, the physician may perform sacrococcygeal palpation (pressing on the sacrococcygeal junction and coccyx) to determine the patient’s level of discomfort in the specific area. The physician may elect to take an internal/external approach by placing a glove on one hand and inserting one or two fingers into the rectum, applying pressure to the coccyx externally at the base of the spine.

This action tests the mobility of the sacrococcygeal junction and may give the doctor more information regarding injury and tenderness of the coccyx. Other nearby anatomical regions is also palpated, such as the joints, connective tissues and muscles found in the pelvic area. Range of motion, neurological response, and the appearance of skin around the coccyx are also examined.

Imaging studies, such as magnetic resonance imaging (MRI), may be ordered to look at the bones and tissues surrounding the coccyx. An MRI may show degeneration of the bone, fractures, or rarely, a tumor.

Tailbone- Coccyx Pain Treatment

Initially, tailbone- coccyx pain is treated with comfort measures in the hopes that it will resolve on its own. For example the patient may be instructed to:

  • Use heating pads or ice packs to reduce pain and inflammation.
  • Try over-the-counter pain medications such as acetaminophen or ibuprofen.
  • Sit on a cushioning surface, such as a doughnut-shaped pillow, to reduce pressure on the coccyx.
  • Lean forward while seated (rather than reclining backward) so the ischial tuberosities bear the majority of body weight.
  • Maintain proper posture while sitting by pressing the back against the chair, keeping knees level with the hips with relaxed shoulders and feet flat on the ground.

If the pain is chronic and the patient finds no relief from the methods listed above, other treatments such as physical therapy, manipulation, medications or surgery may be explored. Physical therapy helps the patient strengthen the muscles of the abdomen and pelvis. Often times, tight, stiff muscles exacerbate pelvic pain.

Relaxation techniques that involve deep breathing and focusing on relaxing the pelvic muscles may also be effective in preventing or relieving tailbone- coccyx pain. Another treatment that focuses on the muscles is manipulation, a massage technique performed through the rectum to ease tailbone- coccyx pain.

Pain that has been present for more than six months becomes especially resistant to treatment and requires a multi-therapy medical treatment plan. Medications may be prescribed to relieve pain, such as:

  • Acetaminophen relieves pain but not inflammation.
  • NSAIDs (non steroidal anti-inflammatory drugs), such as ibuprofen, reduce pain and inflammation.
  • Opioids, such as fentanyl and oxycodone, are given for pain relief and sedation.
  • Gabapentin, an anticonvulsant, is given to relieve neuropathic pain.
  • Antidepressants may relieve tailbone- coccyx pain.

Medication may also be injected locally to the tailbone for pain relief and to decrease inflammation. Local anesthetic injection has shown to provide weeks of pain relief. Steroids injected to the area help reduce inflammation and pain. For patients suffering from Complex Regional Pain Syndrome, a ganglion impar block is an effective treatment for chronic, neuropathic pain. This procedure is an outpatient nerve block performed with the visual guidance of ultrasound or fluoroscopy. If the nerve block is successful, patients report profound pain relief.

Surgery is a last resort of treatment. A coccygectomy involves surgical removal of the coccyx or partial removal of the coccyx. This is not ideal because the coccyx serves as an attachment point for several muscles, tendons and ligaments. The procedure also carries risks that the rectum or ganglion impar (a bundle of nerves) may be injured. Also, patients who’ve undergone coccygectomy show high rates of infection after the procedure, as well as problems with wound healing. Researches recommend all other treatment options be exhausted (comfort measures, physical therapy, medications, injections) before surgical treatment is considered.

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