Coccydynia, commonly called
tailbone pain or
coccyx pain, is a
fairly rare and relatively poorly understood condition that
can cause persistent pain at the very bottom of the spine.
This part of the spine is the coccyx, or tailbone. Coccydynia is felt as a localized pain and will generally
feel worse when sitting or with any activity that puts
pressure on the bottom area of the spine.
The condition is much
more common in women than men. It
is usually caused by
local trauma (e.g. a fall) or giving
birth. On rare occasions, an infection or
tumor can also
cause pain in the coccyx.
Coccydynia may be referred to in various terms, such as:
- Coccygeal pain
- Coccyx pain
- Tailbone pain
The various terms are all used to describe a set of
symptoms in the tailbone that can be caused by various
injuries or conditions. Treatment may vary depending on the
underlying cause of the symptoms and the severity and
duration of the symptoms.
Coccydynia Symptoms and Treatments
Coccydynia symptoms may consist of one or all of the
- Pain that is markedly worse when sitting
- Local pain in the tailbone area that is worse when
touched or when any pressure is placed on it
- Pain that is worse when moving from a sitting to
- Pain that is worse with
constipation and feels
better after a bowel movement.
A combination of treatments to reduce the pain and
activity modification to keep pressure off the tailbone
usually suffices to control or alleviate the pain. In very
rare cases, surgery to remove the coccyx may be recommended,
but the surgery (a coccygectomy) will typically only be
considered if the pain is severe and at least several months
of non-surgical treatment and activity modification has not
been effective in relieving the pain.
History of Coccyx Pain
Coccydynia has a long history of being poorly understood.
In the early 1900s, coccydynia was a popular diagnosis for
all types of
lower back pain. A fairly extreme treatment,
the surgical removal of the coccyx (coccygectomy), was
commonly undertaken to
treat low back pain. At best, this
operation had variable results.
Then the pendulum swung the other way, and the general
opinion was that since the condition was
mostly in women
was in some way related to "neurosis". The corollary was
that if the operation did not work, it was because the pain
was in the individualís head; therefore the operation fell
into disrepute and was no longer commonly performed.
Subsequently, little research on the subject has been done.
Both extremes of opinion have long since fallen by the
wayside, and it is now known that coccydynia does exist as a
medical condition. However, it is fairly uncommon.
Why Do More Coccyx Injuries Occur in
Women Than Men?
The majority of coccyx injuries occur in women because:
- The womenís coccyx is rotated, leaving it more
exposed to injury
- Women have a broader pelvis, which means that
sitting places pressure on their coccyx (male anatomy
causes them to sit without much pressure on the coccyx)
- Childbirth is a common cause of the condition
It is not clearly understood which portions of the
anatomy can cause coccyx pain. In many cases the exact cause
of the pain is not known (called idiopathic coccydynia), and
in these cases the symptoms are managed.
Possible Underlying Causes of
In general, pain can by caused in the coccyx if an injury
or some type of excess pressure on the area causes the bones
to move beyond their normal very limited range of motion,
resulting in inflammation and localized pain. An injury to
either the ligaments or the vestigial disc may be a cause of
pain. Rarely, the bones of the
coccyx can fracture and cause
pain. Also, in rare cases a
tumor or infection in the coccyx
can be a primary cause of tailbone pain.
- Local trauma. A
fall on the
tailbone can inflame the ligaments or injure the coccyx
or the coccygeal attachment to the sacrum. This is
probably the most common cause of coccydynia.
- Childbirth. During delivery, the
baby's head passes over the top of the coccyx, and the
pressure created against the coccyx can sometimes result
in injury to the coccyx structures (the disc, ligaments
and bones). While uncommon, the pressure can also cause
fracture in the coccyx.
- Pressure. Certain activities that
put prolonged pressure on the tailbone, such as
horseback riding and sitting on hard surface for long
periods of time, may cause the onset of coccyx pain.
Tailbone pain due to these causes usually is not
permanent, but if the inflammation and symptoms are not
managed, the pain may become chronic.
- Tumor or infection. Rarely,
coccydynia is due to a
tumor or infection in the coccyx
area that puts pressure on the coccyx.
Diagnosis Of Coccydynia
A health professional diagnoses
by taking a thorough medical history from the patient and
completing a physical examination. Diagnostic tests, such as
MRI, are also commonly performed in order to rule
out other potential causes of the pain.
A thorough physical examination for coccyx pain should
- Pelvic and rectal exam to check for a mass or tumor
that could be a cause of the pain
- Palpation to check for local tenderness.
The most striking finding on examination is usually the
local tenderness upon palpation of the coccyx. If the coccyx
is not tender to palpation, then the pain in the region is
referred from another structure, such as a
degenerative disc disease.
Preferable Diagnostic Tests for
Diagnostic studies that should be done include:
- X-rays of the sacrum and coccyx to rule out the
unlikely event that either an obvious fracture or a
large tumor is the cause of the discomfort
MRI scan to rule out infection or
tumor as a
cause of pain.
Bone scans and CT scans add very little information and
are generally not done. Typically, all imaging studies will
Treatments for Coccydynia
Treatments for coccydynia are usually noninvasive and local.
The first line of treatment typically includes:
- Non-steroidal anti-inflammatory drugs (NSAIDs).
Common NSAIDs, such as ibuprofen, naproxen and COX-2
inhibitors, help reduce the inflammation around the
coccyx that is usually a cause of the pain.
- Applying ice or a cold pack to the area several
times a day for the first few days after the pain
- Applying heat or a hot pack to the area after the
first few days.
- Avoiding sitting for prolonged periods, or placing
any pressure on the area, as much as possible.
- A custom pillow to help take pressure off the coccyx
when sitting. Some find a donut-shaped pillow works
well, and for others it is not the right shape and still
puts pressure on the coccyx. Many prefer a foam pillow
that is more of a U-shape or V-shape (with the back open
so nothing touches the coccyx). Any type of pillow or
sitting arrangement that keeps pressure off the coccyx
- If the tailbone pain is caused or increased with
bowel movements or
constipation, then stool softeners
increased fiber and water intake is recommended.
Additional Non-Surgical Treatments
- Injection. A local injection of a
numbing agent (lidocaine) and steroid (to decrease
inflammation in the area) can provide some relief.
Fluoroscopic guidance is recommended. Relief can last
from 1 week up to several years. No more than 3
injections per year are recommended.
- Manipulation. Some patients find
pain relief through manual manipulation (e.g.
- Stretching. Gently stretching the
ligaments attached to the coccyx can be helpful. A
physical therapist, chiropractor, physiatrist or other
appropriately trained healthcare practitioner can
provide instruction on the appropriate stretches.
- Ultrasound. Physical therapy with
ultrasound can also be helpful for pain relief.
Provided that infection and tumor has been ruled out as a
cause of pain (through exam, x-ray and
MRI scan), then
prolonged non-surgical treatment for pain relief and
activity modification is a reasonable option.
After attaining sufficient pain relief so that movement
is not too painful, daily low-impact aerobic activity is
beneficial, as the increased blood flow brings healing
nutrients to the area and encourages the bodyís natural
healing abilities. The additional benefit of aerobic
activity is the release of endorphins, the bodyís inherent
pain relieving process.
Coccygectomy Surgery for Pain
For people who have
persistent pain that is not alleviated
or well-controlled with non-surgical treatment and activity
modification, surgical removal of all or a portion of the
coccyx (coccygectomy) is an option.
This surgery is rarely performed, and the procedure is not
even included in most spine surgery textbooks. While the
surgery itself is a relatively straight-forward operation,
recovery from the surgery is a long and uncomfortable
process for the patient.