What is Coccyx Pain (Tailbone Pain)?
Coccyx pain, also referred to as coccydynia, coccygodynia, or tailbone pain, has many possible causes. It could be from an injury like a bruise, fracture, or dislocation, or from an infection or a serious illness. Some people may experience this pain briefly and it goes away on its own. However, others can have lingering, severe pain that’s difficult to manage and can have a significant impact on their life. Getting diagnosed with coccyx pain can be challenging as some doctors might not take it seriously.
It’s important for medical professionals to know the different methods available for diagnosing and treating coccyx pain. If the cause of pain is not clear or the usual treatment doesn’t work, the patient might be referred to a specialist. Treatment may include avoiding actions that worsen the pain (like sitting), using cushions, taking medication, and getting pain-relief injections. Surgery to remove the coccyx (coccygectomy) is only necessary in a small number of cases.
The coccyx, or tailbone, is the last part of the spinal column. Even though “tailbone” sounds like one bone, it’s actually made up of 3 to 5 separate bones. The coccyx curves forward when you’re seated and is attached to a group of muscles and ligaments. Together with the two ischial tuberosities (at the bottom of each buttock), it forms a tripod that supports your weight when you’re sitting. The coccyx also has many nerves, including the terminal end of the sympathetic nervous system, also known as the ganglion impar.
What Causes Coccyx Pain (Tailbone Pain)?
Pain in the coccyx, or tailbone, can be caused by many things. Common causes include a direct hit to the tailbone, repetitive minor injuries, and childbirth. However, it’s also important to check for more serious issues like infections (including abscesses or bone infections) or cancer (especially chordoma, which is a cause for concern).
Additionally, tailbone pain can sometimes be linked to problems in the lower digestive tract or urinary system. In rare cases, it could be due to neurological issues like a slipped disc in the lower back.
A direct hit to the tailbone can result in anything from a bruise to a fracture or dislocation of the tailbone. Injury or damage to the ligaments in the tailbone can cause it to move too much (or not enough). This abnormal movement can also cause tailbone pain.
Some people have tailbones shaped in ways that make them more susceptible to tailbone pain. This can include abnormal tailbone shape or position. For example, a tailbone that curves too much to the side or is too bent or stretched out.
Sometimes, a small bony growth on the end of the tailbone can pinch the skin when sitting, causing pain.
In some cases, it’s not clear what’s causing the tailbone pain. When no other cause can be found, this is referred to as idiopathic coccydynia.
Risk Factors and Frequency for Coccyx Pain (Tailbone Pain)
Coccydynia, or tailbone pain, is more likely to develop in certain groups of people, with different factors contributing to the increased risk. These factors include being female, being overweight, or losing weight quickly. For overweight individuals, the increased body mass can add extra weight on the tailbone when sitting. Additionally, rapid weight loss could remove the natural padding provided by body fat in the buttocks, increasing the likelihood of tailbone pain. Conditions like osteoarthritis and osteomyelitis, as well as participation in contact sports, have also been identified as other risk factors.
- Coccydynia is more common in women, with five times as many cases as men.
- Obesity is a risk factor due to the added weight on the tailbone when sitting.
- Rapid weight loss can increase risk by removing the natural padding in the buttocks.
- Conditions such as osteoarthritis and osteomyelitis also increase the risk.
- Participation in contact sports is another identified risk factor.
Signs and Symptoms of Coccyx Pain (Tailbone Pain)
Coccydynia, or tailbone pain, often presents as soreness or discomfort specific to the tailbone area. In cases where the issue comes from an injury or trauma, the pain typically starts suddenly, right after the incident. However, in coccydynia cases without any apparent cause, the pain generally starts slowly and gets worse over time. For other causes of coccydynia, a detailed review of your medical history can give clues about the root cause.
People with coccydynia frequently experience worsening of the pain when sitting, especially in a backward-leaning position. Other activities that could increase the discomfort include prolonged sitting, cycling, standing too long, sexual intercourse, and bowel movements. Surprisingly, the simple act of standing up from a sitting position can cause a brief yet severe intensification of the tailbone pain.
Medical professionals diagnose coccydynia through a physical exam, which includes checking the skin around the tailbone for any signs of infection or unrelated issues like pilonidal sinus or hemorrhoids. One typical diagnostic method is the “Foye’s finger” test where the patient points to their worst site of pain. In coccydynia patients, they usually indicate a spot much lower than common areas of back pain and more centered than typical buttock pain.
Tenderness in the tailbone area becomes apparent when the doctor applies slight pressure externally. Moreover, a rectal examination can not only provide more information about how movable the coccyx is but also typically triggers pain when the doctor manipulates the tailbone.
Even though attention gets focused on the coccyx when diagnosing coccydynia, it’s crucial to also check for other possible pain sources. Thus, a physical exam might also include assessing areas such as the sacroiliac joints, ischial bursae, and piriformis muscles.
Testing for Coccyx Pain (Tailbone Pain)
Standard X-rays can show if your tailbone, also known as the coccyx, is unusually curved or bent to one side. By taking pictures from the side, your doctor can identify different types of curves. For instance, it could be slightly curved forward, pointed straight forward, have a sharp forward bend, or show signs of dislocation at the joints connecting the coccyx to other bones.
The X-rays can also let your doctor measure the angle between the first and last segment of your coccyx. This can help them identify if the forward bends in the coccyx are contributing to tailbone pain, known as coccydynia.
In addition, your doctor may take X-rays while you’re sitting and standing. This can show how the position of your coccyx changes when you sit down, which is usually when people with coccydynia feel the most pain. By comparing these positions, the doctor can measure the changes in the angle of your coccyx. Based on these changes, they can classify patients into groups – those whose tailbones move less than normal (hypomobile), more than normal (hypermobile), or have normal movement.
The treatments that work best often depend on how your coccyx moves. For instance, people with a normal moving coccyx usually respond well to manual therapies. On the other hand, those with an immobile coccyx may not see good results with these therapies.
A CT scan can show how well the joints in your tailbone are fused together. It can often reveal whether women’s tailbones are shorter, straighter, and more tilted backward. But while these findings can be helpful, it’s important to pair this with a detailed medical history and a thorough examination to determine if they’re causing your pain.
An MRI can further assess the forward curvature of your tailbone, how well the joints are fused, and if there’s a bone spur at the end of your tailbone. These can either be causing your coccydynia, or be a result of it. Plus, an MRI can help rule out local tumors.
Another method is a coccygeal discogram, which involves injecting a contrast dye and local anesthetic into your tailbone area. This can help pinpoint the exact source of your pain and also double up as a treatment method.
Nuclear medicine bone scans are typically only used to look for serious conditions like cancer or infection in patients who have tailbone pain. Lastly, routine blood tests can sometimes be helpful when the cause of pain is thought to be linked with other conditions like infections, cancer, or problems with the digestive or urinary system.
Treatment Options for Coccyx Pain (Tailbone Pain)
Many people suffering from coccydynia, or tailbone pain, often see their symptoms improving within weeks or months, whether they receive medical treatment or not. It’s reported that non-surgical treatments are successful 90% of the time. This treatment can be offered in both fresh and long-standing cases:
For new cases of coccydynia:
- Oral or topical anti-inflammatory medications can be used initially to reduce pain and swelling.
- A cushion on the patient’s chair can make sitting more comfortable. Cushions with a cut-out section under the tailbone, U-shaped cushions and donut-shaped cushions are options. These take the pressure off the tailbone and can lead to less pain.
- Pelvic floor physiotherapy might be particularly useful for patients who have lots of muscle pain near the tailbone. You can also check and improve your sitting posture.
- Applying a cold or hot pack may offer some relief for some patients, but be careful not to injure the skin with too cold or hot temperatures. Steroid injections guided by fluoroscopy, or imaging technique, can be particularly helpful in patients who have had tailbone pain for less than six months.
For long-standing and hard-to-treat coccydynia:
- Manual manipulation under anesthesia, possibly coupled with an injection of a local anesthetic and corticosteroid, may help relieve pain linked with ligament or muscle spasms. Several manual treatments have been explored, including massage and stretch of levator ani (pelvic floor muscle), and joint mobilization. It’s reported that the levator ani massage and stretch may yield better outcomes.
- Ganglion impar nerve block with local anesthetics, even without corticosteroids, can offer full and long-lasting symptom relief for some patients. Some may need repeat injections, and adding corticosteroids might offer additional relief. There are various techniques to perform this injection. Pelvic floor physiotherapy can also be helpful, including in patients who continue to experience pain after tailbone removal surgery.
- Transcutaneous electrical nerve stimulation, using external or internal probes, can be used. Spinal cord stimulation is also an option for some patients.
- Surgical intervention involves removal of the tailbone. This treatment is typically reserved for a small number of patients who don’t find relief from non-surgical treatments. Partial or total tailbone removal has been found to be beneficial in cases after all other treatments have failed. However, post-surgery complications can include local infection, sagging pelvic floor, leftover tailbone fragments, and persisting pain despite the surgery.
- Psychotherapy can be helpful if a non-physical cause is suspected. However, it’s important to understand that people with coccydynia have a similar psychological profile to other patient groups, so there should not be an assumption that tailbone pain is due to psychological reasons.
What else can Coccyx Pain (Tailbone Pain) be?
If you’re experiencing pain in the tailbone area, it might not necessarily be coccydynia (tailbone pain). Here’s a list of other conditions that could be causing similar symptoms:
- Pain or inflammation in the sacroiliac joints (which connect the lower spine and pelvis)
- A pilonidal cyst (a type of skin infection with an abscess or sinus near the tailbone)
- Sciatica (pain originating from the sciatic nerve running from the lower back down to the legs)
- Hemorrhoids (swollen veins in the rectum or anus)
- Shingles or other infections on the buttocks
- Piriformis syndrome (muscle spasms that put pressure on the sciatic nerve)
- Certain types of cancer like chordoma or chondrosarcoma
- Pain in the muscles of the pelvic floor.
It’s important for your healthcare provider to correctly identify what’s causing your pain to provide the best treatment.
What to expect with Coccyx Pain (Tailbone Pain)
The outlook for patients with coccydynia, or tailbone pain, varies. While many people see their symptoms get better or even completely disappear with non-surgical treatment, others may suffer from intense, sometimes even lifelong, tailbone pain. This pain can be so severe that it becomes disabling, especially as it can limit the ability to sit.
Coccygectomy, a surgical procedure to remove the tailbone, carries a relatively high risk of infection after surgery. Moreover, even after this procedure, a lot of patients may continue to experience a certain level of persistent pain.
Possible Complications When Diagnosed with Coccyx Pain (Tailbone Pain)
Coccydynia, or tailbone pain, can potentially turn into a chronic pain syndrome, meaning the pain could persist for a long time. It’s crucial to seek medical attention promptly and fully if you suspect you have this condition. Quick diagnosis and treatment may lower the risk of the pain becoming constant and leading to disability.
Recovery from Coccyx Pain (Tailbone Pain)
Most people with tailbone pain, or coccydynia, don’t need surgery to remove the coccyx (also known as coccygectomy). However, for the few who do undergo this procedure, it’s very important to keep a close eye on the surgical site for any signs of infection. This is because the site of the operation is near the anus, where infections are common. In fact, one study by Dr. Wood from Harvard University found that about 39% of people who had this surgery had problems with the wound afterwards. Out of these, 22% got an infection on the surgical site. In some cases, a second operation may be necessary to clean out the infected tissue.
If the pain remains even after the surgery, doctors need to look at the area with updated scans, like X-ray and/or MRI. These can help detect if any parts of the tailbone or its fragments were accidentally left behind during the surgery. Dr. Foye at the Coccyx Pain Center at Rutgers New Jersey Medical School suggests using an X-ray during the operation itself. This can help confirm that all the planned parts of the coccyx have been removed (i.e., complete removal instead of partial). These scans can also identify if the surgery has resulted in any sharp edges at the site where the bone was cut. These pointed areas could then be smoothed down before ending the surgery to help prevent any post-surgery pain.
Preventing Coccyx Pain (Tailbone Pain)
If you’re experiencing severe tailbone pain, or if the pain continuously lasts for more than a month, it’s important that you see a healthcare professional experienced in diagnosing and treating this specific condition. If the first doctor you consult about your tailbone pain is unfamiliar with this condition or doesn’t treat your symptoms seriously, don’t hesitate to seek medical help elsewhere.
It might be challenging to find a center specialized in performing X-rays for the tailbone in both seated and standing positions, since this method is typically done to see the tailbone at its most painful state, which is usually when sitting. However, don’t give up on finding such a center. The seated X-rays can often detect an issue that would not be visible in standing X-rays. This detailed imaging can significantly aid in diagnosis.