FAQ’s on Coccydynia

What is coccydynia?

Coccydynia refers to pain in the coccyx (tailbone). This vestigial structure is made up of three to five vertebrae that are fused together. The coccyx has a beak-like appearance, and gets its name from the Greek word for “cuckoo”. It is attached to the sacrum, and serves as the attachment to the gluteus maximus, coccygeal muscle, and other muscles and ligaments.

Coccydynia presents as pain and tenderness that can be felt between the buttocks, usually triggered by sitting or leaning against the buttocks. This pain can be mimicked by other condition, such as nerve injury, infection, tumors and fractures so it is important for you to consult a physician to get a proper diagnosis.

What causes coccydynia?

The most common cause of coccydynia is injury, typically following childbirth in women or sudden impact due to a fall. The dislocation of the sacrococcygeal bone can result from excessive sitting, chronic trauma of the supporting tissues and muscles, inflammation from wear and tear, etc.

How is coccydynia diagnosed?

The diagnosis of coccydynia is made after a complete medical workup and physical examination, which would rule out pain in the area from other causes. Your physician may request for additional imaging studies, such as X-rays, Computerized Tomography (CT) scans and Magnetic Resonance Imaging (MRI) scans to rule out other bone or soft tissue disorders that can cause pain.

How is coccydynia treated?

Coccydynia is typically treated with conservative non-surgical management. It is unlikely that you will require surgery, although it may be indicated, depending on the findings of your physician. The actual treatment used will vary, depending on the underlying condition and the severity of the pain that it causes.

Physical therapy can provide better outcomes than surgery. This typically involves relaxation techniques for the pelvic floor, which strengthen the supporting muscles and tissues of the tailbone. Manual manipulation of the coccyx has also been shown to improve pain symptoms, as well as increase range of motion.

You can also opt to undergo physiotherapy, osteopathy, chiropractic techniques, acupuncture and other forms of complementary and alternative medicine.

Medications such as non-steroidal anti-inflammatory drugs (NSAIDs) can be prescribed to alleviate the symptoms of coccydynia. Local nerve block injections with anesthetics have also been shown to relieve pain symptoms. The injection of steroids into the tailbone area has also been shown to be beneficial. There are other novel treatments of coccydynia, like extracorporeal shock wave therapy, which have shown promising results in the resolution of pain symptoms.

Surgery is relatively uncommon in cases of coccydynia and only considered as the treatment of last resort. There are always risks that result with surgery such as infection, intraoperative damage to the surrounding nerves, muscles and blood vessels, and blood loss.

The entire coccyx may be removed in a procedure known as coccygectomy. If only a part of the coccyx is removed, it is referred to as a partial or limited coccygectomy. These procedures are carried under general anesthesia and will entail some postoperative recovery time. Operations are at relatively increased risk for infection, due to the location beside the anus.

References:

Emerson SS, Speece AJ. (2012). Manipulation of the coccyx with anesthesia for the management of coccydynia. The Journal of the American Osteopathic Association. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/23212432

Maigne JY, Rusakiewicz F, Diouf M. (2012). Postpartum coccydynia: a case series study of 57 women. European Journal of Physical and Rehabilitation Medicine. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/22820826

Moon SG, Kim NR, Choi JW, Yi JG. (2012). Acute coccydynia related to precoccygeal calcific tendinitis. Skeletal Radiology. doi: 10.1007/s00256-011-1326-9

Salar O, Mushtaq F, Ahmed M. (2012). Defecation pain and coccydynia due to an anteverted coccyx: a case report. Journal of Medical Case Reports. doi: 10.1186/1752-1947-6-175