FAQs on Coccydynia – Tailbone Pain

The coccyx (tailbone) is the very bottom portion of the vertebral column. The spinal cord is surrounded by vertebrae, but does not extend into the coccyx. The coccyx does not have a weight-bearing role when standing, but supports the weight when sitting. The weight is transferred to the tailbone when sitting backwards, and it decreases when sitting forward.

How does the pain of coccydynia feel like?

The pain of coccydynia can arise from a joint, tendons, ligaments, or the coccygeal vertebrae. It can also be of unknown origin (idiopathic). However, many cases of coccydynia occur related to injury to the coccyx or the joint where the tailbone connects to the sacrum. The pain of coccydynia is usually felt between the buttocks. The severity and duration of pain differs from case to case, but is worsened by prolonged sitting, especially on a hard surface.

What causes tailbone pain?

An injury to the coccyx is the most common cause of coccydynia. This can occur from a direct fall onto the buttocks, a kick, or a direct blow to the posterior region. Injury can lead to fracture, dislocation, or bruising of the tailbone.

Who is at risk for coccydynia?

Cyclists are more prone to coccydynia than the general population, particularly long distance cyclists. Childbirth puts a person at risk for tailbone pain as well, as increased flexibility makes the coccyx more prone to dislocation. In addition, the tendons and ligaments are easi

What are some conditions that lead to tailbone pain?

Tailbone pain can occur due to:

Meningeal cyst – Also called a Tarlov cyst, this arises within the spinal column.

Neuritis – Also called neuropathy or nerve inflammation, this occurs in the sciatic and/or pudendal nerve.

How is coccydynia diagnosed?

If you are experiencing tailbone pain, the doctor will conduct a medical history and do a physical examination. To rule out a fractured coccyx, the doctor may order an x-ray. computed tomography (CT) scan, and/or bone scan.

What is involved in the treatment of coccydynia?

To treat tailbone pain, the underlying cause should be identified. Treatment options include:

 

Medications – Depending on the severity and duration of pain, medications used include ibuprofen, ketoprofen, naproxen, and for severe cases, opioid analgesics.

 

Donut cushion – This specially designed seating unit takes the pressure off the tailbone. Shaped like a donut, the cushion supports the outer portion of the buttocks, and the hole allows for no pressure on the coccyx.

 

Radiofrequency ablation (RFA) – This procedure involves insertion of a needle with a special probe near the coccyxgeal nerves. The probe delivers radiofrequency energy onto the nerves to destroy a portion of the nerve root. A recent clinical study showed that patients enjoyed a 50% reduction of pain following this procedure.

 

Physical therapy – The pain specialist may prescribe a course of physical therapy for pain relief. The therapist teaches the patient exercises to strengthen the supporting muscles and stretch the ligaments. In addition, ultrasound, massage, and heat therapy for pain relief.

 

Ganglion impar block – This procedure targets the ganglion impar, which is a nerve cluster positioned in front of the sacral-coccyx joint. The doctor will insert a small needle near the joint and inject a long-acting anesthetic or a neurolytic agent (phenol or absolute alcohol). A 2010 research study found that this block has a 100% efficacy rate.