Tailbone Pain (Coccydynia)

What Is Coccyx?

The pelvis comprises two bones, namely the coccyx and ischial tuberosity. The term coccyx was given because it resembles the beak of a cuckoo. The bone is located below the sacrum at the base of the spine. It is made up of fused vertebrae, three to five in number. These bones are responsible for bearing the weight. In general, the coccyx bone should be pointed straight; however, it can be curved in some cases. The coccyx is termed abnormal when it is too curved and causes pain.

What Is Coccydynia or Tailbone Pain?

Any irritation (inflammation) of the bony area (tailbone) situated between the folds of the buttocks is referred to as coccydynia. Coccydynia comes from two words, 'coccyx' and 'dynia.' 'Coccyx' is a Greek word for the cuckoo and 'dynia' means pain. Pain in the tailbone can frustrate, irritate, and embarrass many individuals while getting the treatment. This condition can be cured and is preventable if proper care is taken.

How Common and How Long Does Coccydynia Last?

Tailbone pain or coccydynia is a quite commonly occurring phenomenon. It is much more common in people who are obese and have drastically lost their weight. Adults are most commonly affected, and it is comparatively rare in young children. Also, women have around five times more chances of getting coccydynia than men.

What Causes Coccydynia?

It is usually caused by injury, pregnancy, or chronic pressure on the tailbone due to sitting long hours, for example, in the case of cab drivers. Sometimes, tailbone pain occurs in patients with chronic constipation as well. In one-third of the cases, the cause is not known.

The following are the causes of coccydynia:

• Trauma From External Forces:

  • Falling on the back can cause the coccyx to bruise, fracture, or dislocate.

  • Repeated activities like rowing a boat or bicycling can strain the surrounding tissues of the coccyx.

• Trauma From Internal Forces:

  • Labor - One of the changes in a pregnant woman's body is softening of the area between the coccyx and sacrum. This is caused by the hormonal changes occurring in the third trimester of pregnancy. It leads to tissue stretching and produces strain, thereby resulting in pain.

  • Prolonged sitting on hard, narrow surfaces.

  • When individuals are obese, the coccyx naturally tends to lean backward, which might bring about pain in the tailbone.

  • Being very lean also does not help because soft tissue inflammation can occur when there is not enough fat to protect the rubbing of the coccyx against the ligaments, tendons, and muscles.

• Infection - Infection near the tailbone area.

• Tumors - Coccydynia can also be a sign of underlying cancer, but it is infrequent.

• Abscesses - Any pus-filled sacs in the tailbone region.

• Menstruation - It increases the intensity of tailbone pain and makes it too bad.

What Are the Symptoms of Coccydynia?

The usual complaint is pain at the bottom region of the back when sitting.

In addition, the following are the symptoms of coccydynia:

• Piercing pain in the tailbone.

• Sitting for a long time makes the pain worse.

• Even standing up after sitting for quite some time produces intense pain.

• Bowel movements cause pain.

• Pain during intercourse.

• Disturbance in sleep.

• Anxiety.

• Pain in the buttocks.

• Backache.

• Depression.

How Is Coccydynia Diagnosed?

Coccydynia is usually diagnosed based on typical complaints and sometimes by an X-ray. The doctor asks for the patient's medical history to know about any recent trauma, fall, or labor. A clinician can diagnose the condition by examining and eliciting local region tenderness. It is necessary to visualize the tailbone region directly to rule out other causes and any infection. Sometimes, infection of the hair follicles in the tailbone region can mimic coccydynia.

The following tests are done to look for fractures in the coccyx:

• X-ray.

• Computed tomography (CT) scan.

• Magnetic resonance imaging (MRI) and bone scan help diagnose inflammation in the coccyx and a rare tumor of the spine called chordoma.

How Is Coccydynia Treated?

This condition usually frustrates patients and impairs their quality of life. Sometimes, patients feel embarrassed to get the treatment done. Treatment is generally by activity modification, anti-inflammatory medications, and local injections. Surgery is rarely indicated in non-responsive cases.

The following are the available treatment modalities:

1. Physical Therapy: Pelvic floor relaxation techniques can be helpful. A physiotherapist will help individuals in doing these exercises. During this exercise, they will be asked to keep the pelvic floor muscles as relaxed as possible as they would do while peeing or defecating.

2. Massaging: Pain can also be relieved by rubbing the muscles attached to the tailbone or coccyx.

3. Medications: Certain medications like antiepileptics and antidepressants can help relieve the pain associated with the tailbone. Also, a local anesthetic is administered to the tailbone in some cases. It helps relieve pain for a few weeks. Oral anti-inflammatory medications and the local application of pain gels may alleviate the symptoms. Local trigger injections with low-dose steroid preparations will aid in complete relief in most cases. The doctor can give these local injections in the outpatient department.

4. Surgery: When all other treatment modalities fail, surgery is indicated. Surgical treatment for coccydynia involves removing the coccyx or tailbone, and this procedure is called a coccygectomy. It can be either partial or complete. In partial coccygectomy, part of the coccyx is removed, and in incomplete coccygectomy, the entire coccyx is removed.

5. Chiropractic: Treatment with a chiropractor can also help relieve the pain associated with coccydynia when it occurs due to forward or backward leaning of the coccyx.

How Can Coccydynia Be Managed?

• Since long hours of sitting may aggravate the condition, a modified padded cushion with a cut-out at the back (doughnut cushion) could relieve the pressure on the coccyx.

• Pelvic floor exercises could help to get relief from pain.

• While sitting, make sure one leans in a forward position.

• The use of stool softeners and laxatives in constipated patients could help relieve pain.

• Use hot water bags or ice packs in the area to relieve pain.

• It is normal to have tailbone pain during pregnancy. At those times, try sleeping on the side and use a cushion for the back to lessen the pain.

Conclusion:

Tailbone pain produces a lot of discomfort and frustration. But following the management strategies can help lessen the pain and prevent the condition from becoming severe. When one experiences any pain in the tailbone area, do not blindly take pain medications that are available over the counter. Instead, reach out to a healthcare provider and get the best possible treatment.