FAQS on Coccydynia in Nashville TN (Tailbone Pain)

Coccydynia refers to pain of the tailbone (coccyx), which is a curved, small V-shaped bone at the bottom of the spinal column. Coccydynia is an aching or throbbing pain in and around the tailbone. The triangular coccyx is formed of 3-5 vertebrae that are fused together. Along with the seat bones (called ischial tuberosities), the coccyx is a weight-bearing structure for sitting. In addition, the coccyx is an attachment for pelvic floor muscles, buttock muscles, tendons, and ligaments.

How common is coccydynia?

Coccydynia is an uncommon condition, accounting for less than 1% of lower back conditions reported by doctors.

What are the symptoms of coccydynia?

The pain of coccydynia varies from patient to patient. It can be constant or intermittent, severe or mild, and dull or sharp. In addition, tailbone pain often limits activities that require sitting, such as bicycle riding or work-related tasks.

What causes coccydynia?

Around one-third of coccydynia cases have no identifiable cause. However, coccydynia is often the result of childbirth, the presence of a tumor, or a medical procedure, such as a colonoscopy. However, the most common cause of coccydynia is a traumatic injury to the coccyx, such as a fall onto the ground/floor or a hard object. This trauma can bruise or fracture the coccyx, resulting in ongoing pain.

Some experts report that many cases of coccydynia result from increased mobility or an altered position of the coccyx following an injury. In rare incidences, the disc between the fifth lumbar vertebra and the first sacral vertebra can cause referred pain to the tailbone. Calcium crystals that are deposited in the coccyx region can cause tailbone discomfort.

What are the risk factors for coccydynia?

Coccydynia occurs more in people with/of:

  • Female gender
  • Osteoporosis
  • Arthritis and joint inflammation
  • Obesity
  • Jobs that require prolonged sitting

How is coccydynia treated?

The treatment of coccydynia depends on the symptoms present, the degree of pain, and the past medical history. Options include:

  • Medications – Several medications are used for the treatment of coccyxdynia, such as acetaminophen, ibuprofen, naproxen, and aspirin. For severe cases, narcotic analgesics are used short-term under the close supervision of a doctor. To reduce straining during bowel movements, stool softeners are often prescribed.
  • Physical therapy – This involves teaching the patient exercises to strengthen the supporting muscles and ligaments. In addition, heat therapy, electrical stimulation, and ultrasound therapy are administered during physical therapy sessions.
  • Donut cushion – Some doctors recommend the use of a specially designed seating cushion with an open area, which will take the weight off the coccyx. This device relieves coccyx pressure and promotes healing.
  • Coccyx injection – To relieve the pain for several weeks, the doctor may inject a local anesthetic, with or without a corticosteroid, into the coccyx.
  • Ganglion impar block – The cluster of nerves at the front of the sacrum-coccyx joint is called the ganglion impar. With this block, a long-acting anesthetic and possibly a corticosteroid is injected onto the nerve mass, which is done under imaging guidance. For long-term effectiveness, a destructive agent (absolute alcohol or phenol) is used to destroy a portion of the nerves. In a recent clinical study, patients reported that pain scores improved by 95%, with participants reporting results lasting up to four months.
  • Radiofrequency ablation (RFA) – This procedure uses radiofrequency waves delivered by the tip of an injection probe, which destroy nerve tissue in the coccyx region. In one review of clinical studies, participants reported more than 50% reduction in pain scores at the six-month follow-up after RFA.

Resources

Agarwal-Kozlowski K, Lorke DE, Habermann CR, et al. (2009). CT-guided blocks and neuroablation of the ganglion impar (Walther) in perineal pain: anatomy, technique, safety, and efficacy. Clin J Pain, 25(7):570-6.

Ferrante FM, et al. (2004). Radiofrequency sacroiliac joint denervation for sacroiliac syndrome. Pain Medicine, 5(1):26–32. doi: 10.1111/j.1526-4637.2004.04009.x

Foye PM & Buttaci CJ (2009). Coccyx Pain. eMedicine. Medscape.

Lirette LS, Chaiban G, Tolba, R, & Eissa H (2014). Coccydynia: An overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner Journal, 14(1), 84-87. PMCID: PMC3963058

Mitra R, Cheung L, & Perry P (2007). Efficacy of fluoroscopically guided steroid injections in the management of coccydynia. Pain Physician, 10, 775-779.

Patel R, Appannagari A, & Whang PG (2008). Coccydynia. Current Review of Musculoskeletal Medicine, 1(3), 223-226.