FAQ’s on Coccydynia (Tailbone Pain) Treatment in Philadelphia

A type of very low back pain that is felt around the tailbone is called coccydynia. The tailbone is called the coccyx, and it is located at the base of the spine. Most patients with coccydynia report pain with sitting down or moving from a sitting to standing position.

What does coccydynia feel like?

Tailbone pain is described as dull to sharp, mild to severe, and intermittent to constant. Other symptoms associated with tailbone pain are problems sitting on a hard surface, pain with everyday activities, pain with sex, and pain with passing stools.

What causes coccydynia?

Coccydynia occurs due to:

  • Trauma to the coccyx (accident or fall onto the tailbone)
  • Problems with or stretching of the ligaments or muscles supporting the coccyx
  • Moving the coccyx from normal position, by poor posture or repeated activities (cycling or rowing)

How is coccydynia diagnosed?

If you experience tailbone pain, the doctor will ask numerous questions about your symptoms. In addition, the doctor will take a detailed medical history and perform a physical examination. X-rays of the coccyx are done to assess for fracture or tumors, and a MRI scan can be done to evaluate the associated coccyx structures.

Who is at risk for coccydynia?

Certain people are more at risk for coccydynia than others. Risk factors include:

  • Having osteoporosis – Weakens the bones.
  • Playing contact sports – Puts you at risk for falls onto the tailbone.
  • Having osteomyelitis – This is a condition that leads to frequent bone fractures.
  • Being overweight – Excessive weight tends to put pressure on the tailbone.
  • Having inflammatory bowel disease – This causes referred pain to the coccygeal region.
  • Traumatic childbirth – This causes pressure on the coccyx, as well as damaged to the associated structures (ligaments and muscles).
  • Riding bicycle, horse, or motorcycle – These activities require prolonged sitting.

How is coccydynia treated?

Treatment of coccydynia may involve a combination of efforts. Options include:

  • Drug therapy – The first step in treatment involves use of mild painkillers, such as ibuprofen and naproxen. Other pain relievers include narcotic analgesics, such as hydrocodone and codeine.
  • Corticosteroid injections – When medications do not work, the doctor may choose to offer a corticosteroid injection.
  • Donut cushion – Specially designed cushions are used to keep the tailbone from a hard surface. This device elevated the inner portion of the buttocks to relieve pressure on the tailbone.
  • Physical therapy – The therapist works with the patient teaching special exercises to strengthen supporting muscles and stretch the ligaments. Pain measures include heat therapy, ultrasound, and massage.
  • Ganglion impar block – The ganglion impar is a cluster of nerves positioned at the front of the sacrum-coccyx joint. With this procedure, the doctor inserts a special needle in the lower back and injects an anesthetic onto the nerves. If the patient has relief of pain, the doctor may use a neurolytic agent (phenol) to destroy a portion of the nerve root. This block has a 95% success rate, according to clinical studies.
  • Radiofrequency denervation – This procedure involves insertion of a special needle and probe near the coccyx nerves. Radiofrequency energy is emitted from the probe to destroy the nerves. In a recent study, participants reported more than 50% pain score reduction after the procedure. This pain relief lasted for up to six months.

Who suffers from coccydynia?

Coccydynia affects 1 out of every 100 persons with low back pain. Women are more often affected than men. In addition, older persons have more problems with coccydynia, but it does also affect young adults and children.

Resources

Agarwal-Kozlowski K, Lorke DE, Habermann CR, et al. (2009). Computed guided blocks and neuroablation of the ganglion impar (Walther) in perineal pain: anatomy, technique, safety, and efficacy. Clin J Pain, 25(7):570-6.

Balain B, Eisenstein SM, Alo GO et-al. (2006). Coccygectomy for coccydynia: case series and review of literature. Spine, 31 (13): E414-20.doi:10.1097/01.brs.0000219867.07683.7a

Ferrante FM, et al. (2004). Radiofrequency sacroiliac joint denervation for sacroiliac syndrome. Pain Medicine, 5(1):26–32. doi: 10.1111/j.1526-4637.2004.04009.x

Lirette LS, Chaiban G, Tolba, R, & Eissa H (2014). Coccydynia: An Overview of the Anatomy, Etiology, and Treatment of Coccyx Pain. Ochsner Journal, 14(1), 84-87.