Coccydynia: A Pain in the You-Know-What

Anyone who has experienced tailbone pain will be the first to tell you that it truly is a pain in the behind.

The tailbone (coccyx) is located at the very bottom of the spine. It connects with the sacrum (the triangular bone at the bottom of the spine) through the sacrococcygeal joint. Coccydynia is the medical term for tailbone pain. The pain is often caused by a hard fall or a blow to the area. It may also be caused by pregnancy and childbirth. Repetitive friction through activities such as cycling or rowing may also trigger the pain. In rare cases, the pain may be the result of an infection or tumor.

Symptoms

Tailbone pain usually becomes sharp during certain activities, such as sitting, rising from a seated to a standing position, or prolonged standing. This pain is often aggravated by sitting or by activities that put pressure on the bottom of the spine. In some cases, patients report that even moving their bowels or engaging in intercourse can trigger the pain. Some women report that tailbone pain can make their menstrual cycles uncomfortable as well.

The pain from Coccydynia is usually confined to the tailbone. It usually does not radiate to other parts of the body, although some patients have radiating pain to the pelvis and/or down the legs. This can be due to the coccyx being adjacent to a dense band of nerve tissue called the ganglion impar. If this nerve tissue is inflamed and irritated, patients may experience burning and tingling sensation in and around the tailbone and surrounding areas.

Who is at Risk of Developing Coccydynia?

Coccydynia is often the result of a hard fall or other injury to the tailbone. That is why athletes may be more likely to experience tailbone pain.

The condition tends to be quite common among women, especially pregnant women. Many expectant mothers describe lower back and hip pain that is actually pain that comes from the tailbone. The coccyx is located right behind the uterus. During pregnancy, hormones may cause the pelvic floor to relax and stretch. This can cause the tailbone to move and shift. As the pregnancy progresses, the growing baby can push against the tailbone. Constipation, which is a common complaint of mothers-to-be, can also aggravate the condition. In some cases, vaginal delivery can lead to tailbone pain or exacerbate an existing condition.

Diagnosis

Your doctor will diagnose Coccydynia by conducting a thorough physical exam to pinpoint the source of your pain. He or she may:

• Ask you to move from sitting to standing positions to gauge the degree of your discomfort.
• Palpate the area to test for tenderness around the coccyx and assess for potential fracture, dislocation, bone spurs, cysts or tumors.
• X-rays may be of benefit, since the coccyx can often be seen as out of place. A thorough exam will also rule out other conditions such as shingles. In some cases, your doctor may order other tests such as an MRI or CT scan to rule out other bone or tissue disorders.

Conservative Treatments for Tailbone Pain

Most injuries to the coccyx will heal on their own with proper care. In the interim, your doctor will likely recommend several conservative treatments to alleviate the pain and discomfort:

• Prescription medications are sometimes effective in relieving tailbone pain, including topical anti-inflammatories to reduce swelling and relieve discomfort.
• Ice and heat therapy during periods of acute pain, particularly immediately after a fall or other trauma.
• Lifestyle changes, including taking breaks from sitting on hard surfaces and avoiding any activities that could risk re-injury.
• The use of special pillows to elevate the coccyx from hard surfaces to reduce pressure on the area.
• Physical therapy, massage and stretching exercises can help reduce muscle tension and tightness that can strain the ligaments that attach to the coccyx. Relaxation techniques, such as breathing deeply and completely relaxing your pelvic floor, may help alleviate the pain.
• Many expectant moms find relief from gentle yoga. This helps strengthen the lower back and pelvis to take pressure off the tailbone. It is always wise to discuss yoga and stretching exercises with your doctor first.
• Manual manipulation can realign the coccyx into the correct location, thereby reducing stress and pain.
• Corticosteroid injections to the area surrounding the coccyx (the sacrococcygeal ligaments) can decrease inflammation for pain relief that can last for weeks or in some cases, years.
• Ganglion impar blocks and caudal epidural steroid injections can be used to reduce nerve pain surrounding the coccyx.
• Regenerative treatments, such as prolotherapy and platelet rich plasma, can strengthen the ligaments and muscles around the sacrum and coccyx and can offer a long-term solution for pain relief if pain returns after steroid injections.

Long-term Relief from Tailbone Pain

Many patients suffer from tail bone pain or coccydynia for months or years without relief. Often, patients have undergone numerous tests and have seen several types of physicians without even a proper diagnosis. pain physicians can appropriately identify and treat this condition, with many options to provide long term relief.