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Coccydynia

What does Coccydynia mean?

The word “coccydynia” means “pain in the tailbone”.

What is the Coccyx?

The “tailbone” is made up of the sacrum, which is the wedge-shaped larger upper bone, and a smaller coccyx, which is the end of the tailbone. The two bones are connected by ligaments, which are touch strands of fibers.

What is Coccydynia?

In the condition of coccydynia, it is the end of the tailbone, the area we sit on, that is inflamed and painful. The ligaments connecting the sacrum to the coccyx or the ones connecting the different bones of the coccyx, can become inflamed and painful, causing coccydynia.

Why does the Coccyx hurt?

The most common issues are a coccyx which is bent backwards, or one which is too mobile and moves back and forth when sitting and getting up from sitting. Either situation can be painful.

The coccyx generally does not break (fracture) when we experience trauma such as a fall on our buttocks. Rather, the coccyx moves as a whole or one of its parts. This will often cause pain.

What are the causes of Coccydynia?

Here are some common causes of coccydynia:

  • Trauma to the tailbone such as a fall on the buttocks, which is common
  • Childbirth, where the coccyx is pushed outward as the baby comes down the birth canal
  • Bicycling
  • Horseback riding
  • Improper sitting
  • Tumor, which is extremely rare

What are some symptoms of Coccydynia?

Here are some common symptoms of coccydynia:

  • Pain with sitting
  • Pain with constipation, relieved by a bowel movement

How is Coccydynia diagnosed?

Spine specialists use information from the patient’s history, physical examination and special tests to make this diagnosis:

  1. History

A history of a fall on the buttocks, and subsequent pain when sitting, which is relieved when standing, is common in coccydynia.

      2. Physical Examination

To examine the coccyx, the patient is usually lying on their belly (prone). The doctor then will push on the coccyx to see which part of it might be painful and inflamed. Sometimes, a rectal examination has to be done to move the coccyx.

      3. Imaging

a. X-Rays

A front (AP) and side (Lateral) X-Rays is usually taken to see the coccyx and the sacrum. Normally, there is a smooth curvature to the sacrum and coccyx. When the coccyx is not in the proper position, this curvature has an angle to it, either inward or outward. This can be seen on the X-Ray and can help in the diagnosis.

b. CT-Scans

A CT scan can show the bone anatomy of the coccyx in detail. If one of the coccyx bones is broken, the CT-scan can show it. However, the CT-scan does not show the ligaments of the coccyx.

c. MRI Scans

MRI scans are not generally used to diagnose coccydynia, since they are not very good for analyzing bone. However, they can show swelling around the bone or a tumor.

What is the treatment of Coccydynia?

  1. Non-Surgical Care

A. Cushion

A soft cushion to be placed under the buttocks when sitting. This can help significantly with the discomfort from Coccydynia.

B. Alternative Health Care

Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition.

C. Nutrition and Weight Loss

Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms (Spine and Obesity).

D. Chiropractic Care

Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

D. Spine Exercises

Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility.

E. Physical Therapy (PT)

PT has some modalities to offer for this condition. They can range from Manual Therapy to Ultrasound Treatments.

F. Self Help Tools

Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories. There are also specific cushions available which can help with pain from this condition.

G. Spine Medications

Here are some of the common groups of medications which are available for this condition:

  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
  • Pain Killers
  • Nerve Pain Medications
  • Muscle Relaxants

H.Injections

Here are some of the available injections for this condition:

  • Coccyx injection:

Sometimes an injection of the inflamed part of the coccyx typically done with a combination of a local anesthetic and a steroid can help.

  • Ganglion Impar Block:

This is a specialized injection done by Pain Management specialists with an X-Ray machine. The target is a bundle of nerves, called the “Ganglion Impar” which is located underneath the coccyx close to the rectum. The Ganglion Impar gives sensation to the coccyx. By blocking it, pain can be relieved in some patients. The pain relief can last longer than the actual effect of the medication.

 

      2. Surgical Care

Surgery for chronic severe coccydynia is called a “coccygectomy”, or removal of part, or all of the coccyx.