Coccydynia

This condition is an inflammation of the tip of the tailbone, called the coccyx. It causes pain and tenderness between the buttocks. Sitting often makes the pain in this area worse.

Symptoms of Coccydynia

The coccyx is the bony area located deep between the buttocks above the anus. This is where all the tenderness will be felt (the tip of the tailbone) especially when sitting, even for a short amount of time. Also:

• Pain will be localized to just this area, it doesn’t radiate into the pelvis or lower extremities
• The pain can be mild to severe and is explained as an aching soreness
• Pain can come and go by applying different pressure or moving differently, or it can be constant discomfort
• Pain generally increases while sitting or when you lean back while in sitting position

Causes of Coccydynia

Although direct trauma causing inflammation is the most common cause of coccydynia, there can be underlying causes to the diagnosis such as:

• Limited mobility: this causes the tailbone to stick out while in a sitting position, which puts increased pressure on the sacrococcygeal joint and bones. Limited movement of the coccyx can also result in pelvic floor muscle tension, which can increase pain
• Hypermobility: The exact opposite of limited mobility; this is when there is too much movement of the coccyx which puts extra stress on the joint between the coccyx and the sacrum or directly onto the coccyx. Hypermobility can pull the pelvic floor muscles that are attached to the coccyx, which results in tailbone pain
• Dislocation: This occurs rarely, but part of the sacrococcygeal joint can become dislocated at either the back or front of the tailbone causing severe pain

Diagnosis and Treatment of Coccydynia

By your doctor gathering your past medical history as well as doing a physical exam, he/she will be able to correctly diagnose you. This is usually all it takes to be diagnosed, though in some cases your doctor may want to utilize diagnostic tests such as injections or scans. To be correctly diagnosed, your doctor will:

• Check for local tenderness: he/she will feel the area by hand to identify tenderness and swelling around the coccyx
• Feel around for potential coccygeal tumors, cysts, or spicules (bone spurs)
• Intrarectal manipulation/exam: In some cases, your doctor may choose to manually manipulate the coccyx through the rectum. By doing this, he/she will be able to assess excessive or limited mobility of the sacrococcygeal joint. An intrarectal exam may also be used by your doctor to check for muscle tension within the pelvis.

According to studies, nearly 90% of coccydynia cases are treated successfully without surgery. These treatments are usually noninvasive and consist of activity modification. Self-care is usually the first form of treatment consisting of:

• Taking non-steroidal anti-inflammatory drugs such as Advil, Aleve, or Celebrex, in order to reduce inflammation that causes pain in the coccyx
• Icing the area by applying a cold pack several times a day which reduces inflammation
• Heating pad: apply a heating pad to the bottom of the spine can relieve muscle tension. You can use long-lasting adhesive heating strips, a hot water bottle, or a hot bath
• Activity modification: minor adjustments to daily movement can help to take cumulative pressure off of the tailbone, which will alleviate pain. Certain modifications may include adjusting your posture, using a pillow to take weight off of the coccyx, or reducing the time you are sitting
• Custom U or V-shaped pillows that remove tension and ease the pain while sitting
• Dietary changes such as increasing fiber and water if bowel movements or constipation worsens tailbone pain

There are additional non-surgical treatments used in order to relieve tailbone pain such as injections, manual manipulation, massage, stretching, and TENS unit (transcutaneous electrical nerve stimulator) which applies electrical stimulation that interferes with the transmission of pain signals from the tailbone to the brain.