Coccydynia

What is Coccydynia?

Coccydynia is pain in or around the area of the coccyx, more commonly known as the tailbone. The coccyx is the last bone at the base of the spine. Injury or strain to the surrounding ligaments and muscles may cause this pain and discomfort, which is most often felt while sitting. Coccydynia may require medical treatment if the pain is severe or impeding the ability to perform everyday activities.

Causes and Risk Factors

The coccyx and surrounding tissue can be damaged in various ways. The exact cause is often unknown (idiopathic), but known causes can include:

  • Trauma
    • Childbirth is one of the most common causes. Childbirth can cause muscles and ligaments around the coccyx to overstretch.
    • A hard impact to the base of the spine, such as might happen during contact sports.
    • Falling backwards onto the coccyx, such as a fall during ice skating. This may result in bruising, but can be more severe, resulting in dislocation or a fracture.
    • Repetitive strain injury that causes the muscles and ligaments to stretch and become strained, such as due to repetitive sports.
  • Abnormal, excessive mobility of the tailbone.
  • Poor posture, especially from sitting too long in a position that puts pressure on the coccyx.
  • Being overweight, which can put excess pressure on the coccyx.
  • Being underweight, which can cause the coccyx to rub against and irritate the tissue around it due to lack of fat in the buttocks.
  • Age-related tissue breakdown

Very rare causes include:

  • Infection, such as an abscess in the cleft of the buttocks (pilonidal abscess)
  • Cancer, such as bone cancer or metastatic cancer that spreads to the coccyx

Symptoms

The classic symptom of coccydynia is pain and tenderness just above the buttocks, usually due to pressure being placed on the coccyx when sitting. Symptoms improve when the pressure is relieved, usually by standing. The pain may be dull or achy or have occasional sharp pains. Some patients also experience back pain and sciatica.

Other symptoms may include:

  • Pain during sex
  • Pain with bowel movements
  • Severe pain switching from sitting to standing
  • Depression and anxiety if the pain is persistent and long-term

Diagnosis

Coccydynia is diagnosed through a medical history and physical exam, palpation of the area to look for any masses or abscesses, and imaging tests, such as X-rays to look for a fracture, CT scan, MRI or a bone scan.

Treatment

Treatment of coccydynia most often consists of nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain, as well as a customized sitting cushion designed to take pressure off the tailbone. The pain usually improves after a few weeks to months; however, it may last much longer. Other potential treatments include:

  • Physical therapy
  • Heat therapy
  • Massage
  • Ultrasound
  • Coccygeal manipulation (to move the coccyx into proper position, relieving pain)

Very rarely, surgery to remove the coccyx (a coccygectomy) is considered when extensive conservative management is unsuccessful. If depression and anxiety have presented, they should also be treated by a professional. In some cases, a multidisciplinary chronic pain rehabilitation program might be utilized.

If you are experiencing pain around the tailbone or buttocks and suspect you have coccydynia, contact us today to speak with one of our specialists.