Tailbone Pain (coccydynia)

Coccydynia is the term given to tailbone pain. The tailbone (coccyx) is a set of bones at the very base of the spine. Because of the position of the tailbone, the pain may be worse when sitting down.

Symptoms

The primary symptom is tailbone pain – that is pain at the base of the spine. The pain is very variable between people suffering from the condition but is often made worse by sitting, lifting objects and standing up. There are many other symptoms that you may have which occur with variable frequency.

  • Tailbone pain
  • Back pain
  • Pain on passing stools
  • Pain during sex
  • Pain during periods
  • Pain in buttocks/hips

Causes

Coccydynia is a fairly rare cause of back pain and can be provoked by a variety of factors including:

Direct trauma: This is very common and may cause the tailbone to be bruised or even broken. The most common causes are falls onto the tailbone or buttocks, or a direct kick or other impact to this area of the back.

  • Child birth: Tailbone pain is more common in women partly due to childbirth and partly due to the tailbone being more exposed in women. The tailbone is more flexible towards the end of the your pregnancy and if the soft tissues around the pelvis stretches too much then then tailbone pain is often the result.
  • Poor posture or repetitive strain injury: Tailbone pain is particularly associated with certain sports such as cycling. These sports involve a lot of bending of the spine under pressure and may stretch the soft tissues around the tailbone and cause pain. Many people will also have experienced tailbone pain after a prolonged period of sitting or driving. This is generally relieved by getting up or changing position.
  • Infections: Very rarely, a collection of infection at the base of the spine or pelvis can cause pain in this area. For this reason it is especially important you see a doctor quickly if you have other symptoms besides the tailbone pain – such as feeling unwell or having fevers. X-rays or a scan may be required for diagnosis.

Tailbone pain is more common and often worse if you are overweight or obese. This is because the coccyx has a function in carrying the weight of the body and therefore when it is injured it may be more painful for this reason. Paradoxically, being too slim can also be a problem due to the lack of fat padding around the coccyx leaving it vulnerable to injury or irritation. Often, however, tailbone pain can develop and no cause can be found for it.

Treatment

  • Painkillers: In most case the treatment is to manage the symptoms of the tailbone pain because generally this will improve on its own. Painkillers are generally required and your doctor may prescribe some strong painkillers when the pain is at its most severe.
  • Special Cushions: Most people with tailbone pain will find it difficult to sit down and the best way to improve this is a with a doughnut cushion or coccyx cushion – these redistribute your weight away from the tailbone when you are sitting down. You may also find sitting on a hard surface is better than a soft one as on a hard surface your weight tends to go on your pelvis more than the tailbone.
  • Manipulation: Some people benefit from some degree on back manipulation either by a physiotherapist or a chiropractor. These is little evidence of the effectiveness of this approach for tailbone pain – in comparison to lower back pain where there is a growing body of good evidence. This fact may, however, be due to the comparative rarity of the condition.
  • Injections: Steroid and anaesthetic injections may be tried if your pain is severe and lasting longer than expected. These can be very effective but may only have an effect for a few weeks. Nerve blocks are another option – this is another type of injection that aims to block the nerves transmitting the painful signals from your tailbone.
  • Surgery: Back surgery is rarely required and is always a last resort. Part of the coccyx may be removed in a surgical procedure aimed at relieving the pain. After the operation, infections of the area are a common complication although up to ninety in every one hundred people operated on have a significant resolution of their symptoms.

Prognosis

Most people with coccyx pain will improve within a matter of weeks. A fracture of coccyx can take 6-8 weeks to heal but pain will normally reduce gradually throughout this time. Regular painkillers perhaps combined with the some physiotherapy or stretches is generally all that is required. A very small proportion of people can develop chronic tailbone pain and some will require back surgery to remove some of the coccyx.

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