Tailbone Pain (Coccydynia)

Dr. Nadheer K M (AIIMS)MBBS

January 27, 2020

March 06, 2020

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Tailbone Pain
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The human back and neck are supported by a complex structure of nerves, bones, joints, ligaments, and muscles which are woven together to form a spinal column. The bony arrangement (medically called the vertebral arrangement) in the spinal column makes it exceptionally strong and also provides flexibility in the lower back and neck. 

There are 33 vertebral bones which are stacked together to form the spine. The human spine is divided into five regions: cervical, thoracic, lumbar, sacral and coccyx.

The bottom triangular part of the spine below the sacrum is called the coccyx. It is a vestigial part of the body and looks like a tail, thus commonly called the tailbone.

The coccyx is formed by four fused bones that provide attachment for ligaments and muscles of the pelvic floor.

Pain in the tailbone region is medically called coccydynia. Reason of pain in the tailbone can be due to poor posture, a fall, weight gain or any tumours. The cause of pain can be diagnosed with the help of dynamic motion x-rays and MRI.

Coccydynia sometimes relieves on its own within weeks. If it stays for more than two weeks, medical help should be taken. Treatment of the disease can either be non-surgical or surgical. With the help of physiotherapy, painkillers and improving posture, coccydynia can be treated efficiently. Surgical treatment involves partial or complete removal of the coccyx, but it is only performed when non-surgical methods do not succeed.

Symptoms of coccydynia

Apart from constant pain, the other signs of coccydynia are:

  • Pain on sitting down, defecation and even during sexual intercourse.
  • Range of movement is reduced and it gets almost impossible to bend down (without bending the knees).
  • Swelling and inflammation in the lower back.
  • Feeling stiffness in the lower back.
  • Due to the constant pain, there is general weakness in the body.

Causes of coccydynia

Mostly, the cause of pain in the coccyx is unknown. Other possible reasons for coccydynia could be:

  • Falls: Any direct fall onto the back can lead to coccydynia.
  • Obesity: Obese or overweight people put a lot of pressure on their tailbone while sitting, which can lead to coccydynia.
  • Being underweight: Severely underweight people who do not have enough fat on their buttocks may end up being afflicted by coccydynia as their tailbone will rub against surrounding tissues.
  • Ageing: As people age, the flexible cartilages that hold the coccyx in place degenerate, making the tailbone stiff. This not only puts pressure on the tailbone, but also leads to coccydynia.
  • Childbirth: Coccyx becomes flexible towards the end of pregnancy, thus helping in delivering the baby normally. Sometimes during childbirth, the ligaments around the coccyx are strained from pushing, leading to coccydynia.
  • Repetitive strain: Continuously leaning forward and stretching the back in sports like cycling and rowing can lead to coccydynia.
  • Hypermobility of the tailbone: Excessive mobility of the tailbone makes it curve or flex abnormally, exceeding 25 degrees, which causes continuous pain in the lower back.
  • Incorrect posture: Sitting in the same position for a long period of time, like in workspaces or while driving can put too much pressure on your coccyx, leading to pain and discomfort.     
  • Injury to the coccyx: Sometimes the disks of the tailbone get damaged when you jerk your spine while sitting down. Injuries that lead to subluxation (partial dislocation) of the coccyx or dislocation of the coccyx can lead to severe pain in the tailbone region.
  • Malformation of the coccyx: Scoliosis (abnormal sideways curving of the spine) of the coccyx or an increase in the angle between the first and last segment of the coccyx can lead to severe pain in the tailbone region.
  • Tumours: Some malignant (the one that spreads) tumours of bones and cartilages like chordomas and chondrosarcomas are responsible for constant pain in the coccyx region.
  • Inflammation or infection of the coccyx: Though it is rare, an infection like a pilonidal abscess (collection of pus in the cleft of the buttocks) at the base of the spine or the soft tissue around it, can cause coccydynia.

Prevention from coccydynia

You can follow these measures in order to prevent coccydynia:

  • Those who are obese must make efforts to bring down their body weight to reduce pressure on the tailbone.
  • Underweight people can use a specially designed coccyx cushion that helps reduce pressure on the tailbone while sitting down.
  • Avoid sitting for prolonged hours. Whenever possible, stand up and walk around regularly.
  • Avoid wearing tightly fitted clothes like tight jeans or trousers that may put pressure on your tailbone. Wear loose-fitting clothes, especially while travelling. 
  • Sit in a proper posture. You may lean a little bit forward while sitting in a chair.

Diagnosis of coccydynia

The measures to diagnose coccydynia are: 

  • Clinical examination: Doctors will perform a proper clinical exam like palpation of the region to check for swellings or any mass. 
  • Dynamic motion x-rays: These are advanced x-ray techniques that allow medical professionals to take x-rays while the person is in motion. This helps in better visualisation, extent, location and nature of the injury, unlike conventional x-rays.
  • Magnetic Resonance Imaging (MRI): Advanced imaging techniques like MRI scans can be recommended by the doctor to get a correct diagnosis.
  • Additional tests: In the case of abnormal mass in the tailbone region, the doctor may recommend a biopsy to check for tumours and abscesses.

Treatment for coccydynia

The ultimate goal of coccydynia treatment is to reduce pain by reducing the pressure off the tailbone and relieving the inflammation or muscle tension around the bone. Treatment can be done both non-surgically and surgically. In most cases, coccydynia is managed non-surgically.

Non-surgical treatment

About 90% of the cases of coccydynia are successfully managed with the help of physical therapy, medication and a change in posture.

  • Physiotherapy: Physiotherapy can help in relieving the tense muscles and ligaments around the bone. The therapist can also teach you some pelvic floor relaxation techniques.
  • Medications: Over-the-counter drugs like ibuprofen can help in relieving pain in the tailbone. It also helps in relieving the inflammation around the bone. Certain antidepressants can also relieve tailbone pain.
  • Massage: Pain can also be minimised by massaging the muscles attached to the tailbone.
  • Steroid injections: Doctors may inject corticosteroids into the area around the tailbone to reduce inflammation and pain. 
  • Anaesthetic injections: The doctors can inject a local anaesthetic into the nerves that supply the coccyx so that they are unable to receive pain signals. The injection can help relieve pain for a few weeks.

Surgical treatment

Surgical treatment is an option only when non-surgical methods have been exhausted unsuccessfully. A surgery called coccygectomy is performed to remove all or part of the coccyx to relieve the pain, and regain movement.



References

  1. National Health Service [Internet]. UK; Treatment -Coccydynia (tailbone pain)
  2. Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: An Overview of the Anatomy, Etiology, and Treatment of Coccyx Pain. Ochsner J. 2014 Spring;14(1):84-7. PMID: 24688338; PMCID: PMC3963058.
  3. Cleveland Clinic. [Internet]. Cleveland, Ohio. Coccydynia (Tailbone Pain): Management and Treatment
  4. Patel R, Appannagari A, Whang PG. Coccydynia. Curr Rev Musculoskelet Med. 2008 Dec;1(3-4):223-6. doi: 10.1007/s12178-008-9028-1. PMID: 19468909; PMCID: PMC2682410.
  5. Winchester Hospital [Internet]. Boston. US; Coccydynia

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