Coccydynia

Pain in the Tailbone

Coccydynia is a condition commonly known as tailbone pain. It results from trauma or irritation of the coccyx (tailbone), a boney structure found at the bottom of the spine. Tailbone pain may start after a backward fall, prolonged sitting on hard surfaces, joint degeneration, pregnancy, and vaginal childbirth.

While tailbone pain usually improves on its own, sometimes it may go undiagnosed and persist for several months or longer. A pain specialist can diagnose tailbone pain and provide treatments that bring you much needed relief.

What is the Tailbone?

The coccyx (tailbone) is the ending of the spinal column. It contains several bone segments that are fused and it attaches, through a joint, to the large sacral bone above. Because it corresponds to the location of an animal’s tail, the coccyx is called the “tailbone."

• The coccyx is an important attachment site for tendons, ligaments, and muscles in the pelvis. It bears the body’s weight and acts as a shock absorber when a person sits.

• Its position under the skin, leveled with the cleft of the buttocks, makes the tailbone likely to get bruised or fractured.

• Some people have a coccyx that curves too far instead of pointing straight down, predisposing them to injuries and pain.

What Causes Tailbone Pain?

In most cases, tailbone pain starts after a trauma and is not a sign of a threatening condition.

Tailbone pain is caused by:

• Falls. Tailbone pain may start with a fall where a person lands on the buttocks, bruising, breaking, or dislocating (shifting out of place) the tailbone.

• Repetitive Strain. Sports like bicycling and rowing require back and forth movements that stretch the ligaments and tendons attached to the tailbone.

• Pregnancy and childbirth. Pregnancy hormones soften the pelvic tissues, causing the tailbone to shift. Constipation, the weight of the growing baby, and vaginal birth can push against the tailbone, causing pain.

• Obesity or excessive weight loss. Excess weight puts pressure on the coccyx, changing its position. Conversely, an underweight person, does not have enough fat in their buttocks to prevent the tailbone from rubbing against surrounding tissues. This creates inflammation and pain.

• Sitting too much. Sitting on a hard and narrow surface puts pressure on the tailbone.

• Cancer. In rare cases, the tailbone may develop cancer.

Symptoms in people with tailbone problems

Most people have tailbone pain only in the buttocks. Other people may feel that their pain radiates (moves) to the pelvis and legs. Radiating pain can start if the tail bone presses on a nearby nerve grouping, called the Ganglion Impar.

Most people with tailbone pain have:

• An achy or stabbing pain in the buttocks

• Pain when standing up from a seated position

• Increased pain when sitting for long periods

• Pain during bowel movements

• Pain during sexual intercourse

Finding a diagnosis for tailbone pain

Your pain specialist will start by asking about your medical history and conducting a thorough physical exam that checks for tenderness around the tailbone area.

The following tests are useful:

• X-rays

• MRI or CT scan

• Bone scan

Treatments for tailbone pain

Tailbone injuries heal slowly and may cause long-term pain if a person does not receive adequate care.

Initial tailbone pain treatments include:

• Over-the-counter pain relievers

• Ice/heat therapy

• Special pillows to cushion the tailbone

• Stretching and improved posture

• Physical therapy and massage to reduce muscle tension and ligament strain

• Manual manipulation to realign the coccyx into the correct position

• Corticosteroid injections to decrease inflammation around the tailbone

For additional pain relief, a pain specialist provides the following treatments: