Coccydynia is the medical term for coccyx pain. The coccyx is the end of the vertebral column, which is also called the tailbone. Most cases of coccydynia respond to conservative, supportive care. In addition, intractable coccydynia can lead to significant decrease in quality of life.
What is the coccyx?
The coccyx is a small, fused bone that is at the very base of the spinal column. It is formed by 3-5 vertebral segments fused together to form small joints supported by ligaments and muscles. This bone curves into the pelvis, bears the weight of the torso when a person is sitting, and is slightly flexible.
How common is coccydynia?
In a study involving 2,000 people with back pain, 2.7% were diagnosed with coccydynia. This condition affects women 5 times more frequently than men. The mean age of onset is 40 years, and there is no race association with coccydynia. The higher incidence among women is thought to be related to childbirth trauma.
What causes coccydynia?
For many people with coccydynia, the cause is unknown, which is referred to as idiopathic coccydynia. Other causes include:
- Abnormal, excessive coccyx mobility
What symptoms are associated with coccydynia?
The main symptom of coccydynia is pain related to pressure applied to the coccyx, as with sitting on a hard surface. The pain usually improves when standing or walking, with relief of pressure. Other symptoms include:
- Pain with bowel movements
- Pain during sex
- Severe pain when moving from a sitting to standing position
- Deep aching in the tailbone area
How does the doctor diagnose coccydynia?
To make the diagnosis, the doctor first conducts a thorough medical history and physical examination. The doctor will inquire about injury, in the remote past or recent. The doctor will also assess for abnormal masses and abscesses around the coccyx. To detect a coccyx fracture, an x-ray is taken. For detailed analysis of the supportive structures, the doctor may order a magnetic resonance imaging (MRI) test, computed tomography (CT) scan, or bone scan.
How is coccydynia treated?
Treatment options include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) – Ibuprofen and naproxen are used to reduce inflammation and pain. Stronger pain medicines are prescribed for severe pain.
- Donut cushion – This therapeutic sitting device takes pressure off the tailbone with sitting. This cushion provides an open area that shifts the weight to the outside of the buttocks to promote healing of the coccyx.
- Physical therapy – The therapists use modalities to relieve pain, such as massage, heat therapy, and ultrasound. In addition, the therapist uses exercises to stretch the ligaments that attach bone to bone in the coccyx joints. Researchers conducted a study involving physical therapy for coccydynia and found that overall, 43% of patients reported good results.
- Coccygectomy – This is a surgical procedure used to remove the coccyx. It is only done in rare instances where extensive conservative management does not control pain and symptoms. In a study involving coccygectomy, 82% of patients reported improvement with the procedure.
- Ganglion impar block – The ganglion impar is located near the coccyx. This bundle of nerves supplies the coccyx. With the block, the doctor uses fluoroscopic technology to inject the nerves with a steroid, anesthetic, and/or neurolytic agent. According to clinical studies, this procedure has a 75-100% efficacy rate.
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