Coccydynia is coccyx pain. This is also referred to as tailbone pain or coccygodynia. For many patients, coccydynia resolves with only supportive care, but for some, the symptoms persist long-term. Intractable coccydynia is not that common, but when it occurs, it can cause a serious decrease in quality of life.
What is the coccyx?
The coccyx is a small fused bone at the very bottom of the spinal column. This bone curves into the pelvis and bears weight when a person is sitting. Many patients report increased pain with leaning backwards. The coccyx is 3-5 vertebral segments that are fused. These small joints are supported by muscles and ligaments.
How common is coccydynia?
The prevalence of coccydynia is not exactly known. However, it occurs in adults and adolescents mostly, but school aged children can be affected. Coccydynia also occurs in women five times as often as it does in men. The majority of patients with coccydynia have a subluxated (hypermobile) coccyx. Many people report a history of trauma.
What symptoms are associated with coccydynia?
Tailbone pain occurs when pressure is applied to the coccyx. Many patients report pain relief with standing or walking. Other symptoms are:
- Pain with bowel movements
- Pain during sex
- Deep aching pain in the tailbone region
- Immediate or sever pain when moving from sitting to standing
What is the cause of coccydynia?
Coccydynia is caused by:
- Trauma from falling onto the buttocks
- A direct blow to the tailbone
- Pilonidal cysts
How is coccydynia diagnosed?
The doctor will first ask questions about your symptoms, take a medical history, and perform a physical examination. The diagnosis of coccydynia is made when serious causes of tailbone pain are ruled out. The doctor often uses diagnostic tests to assess the coccyx, such as x-rays, computed tomography, and magnetic resonance imaging.
How is coccydynia treated?
Coccydynia is often difficult to treat. Options include:
- Support seating – A donut cushion is a seat pad with the center missing. Shaped like a donut, this device is used for prolonged sitting to relieve tailbone pressure and pain.
- Frequent breaks – The patient will need to avoid sitting for long amounts of time, and take frequent breaks from the workstation.
- Medications – These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen, ibuprofen, and Clinoril.
- Local nerve blocks/ganglion impar block – Using fluoroscopic technology, the doctor can inject an anesthetic, steroid, and/or neurolytic agent onto the nerves that supply the coccyx. In clinical studies, ganglion impar blocks were found to be around 74-100% effective for coccyx pain.
- Physical therapy – Mobilizations are used to realign the coccyx position. The therapist may perform massage to alleviate pain. Other modalities include ultrasound, electrical stimulation, and heat therapy. In a recent study, researchers found that massage produced a 30% success rate, and stretching had a 32% success rate. Overall, 43% of patients had good results with physical therapy.
- Manipulation – The doctor can perform coccyx manipulation by inserting the index finger into the rectum. This is performed only for one minute.
- Surgery – When other measures fail, the doctor may perform a coccygectomy (removal of the tailbone).
Buttaci CJ, Foye PM, Stitik TP, et al. (2005). Coccydynia successfully treated with ganglion impar blocks: a case series. Am J Phys Med Rehabil, 84(3):218.
Maigne J, Doursounian L, Chattelier G. Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine. 2000;25:3072–79. doi: 10.1097/00007632-200012010-00015.