Coccydynia

Alternative Names

Tailbone pain, coccydynia , coccygodynia

What is Coccydynia

Coccydynia is a pain in the area of the coccyx (tailbone). It is also called coccygodynia. Coccydynia can be anything from discomfort to acute pain, varying between people and varying with time in any person. The name describes a pattern of symptoms (pain brought on or aggravated by sitting), so it is a collection of conditions which can have different causes and need different treatments.

Signs and symptoms

Coccydynia symptoms may consist the following:

• Pain that is markedly worse when sitting
• Local pain in the tailbone area that is worse when touched or when any pressure is placed on it
• Pain that is worse when moving from a sitting to standing position
• Pain that is worse with constipation and feels better after a bowel movement.

A combination of treatments to reduce the pain and activity modification to keep pressure off the tailbone usually suffices to control or alleviate the pain. In very rare cases, surgery to remove the coccyx may be recommended, but the surgery (a coccygectomy) will typically only be considered if the pain is severe and at least several months of non-surgical treatment and activity modification has not been effective in relieving the pain.

This article provides an in-depth review of the causes of coccydynia, diagnosis, and both nonsurgical and surgical treatment options.

Possible complications

Symptoms realted to Coccydynia usually do not bring any complications. However, surgical treatment for coccydynia (coccygectomy) has a high rate of postoperative infection and can result in injury to the rectal musculature that may progress to fecal incontinence. Surgical damage to the levator ani muscle group attached to the coccyx can result in sagging of the pelvic floor.

What causes

Injury may be the common cause of Coccydynia, but sometimes it may occur seemingly suddenly. There are many causes of tailbone pain which can mimic coccydynia, including sciatica, infection, pilonidal cysts, and fractured bone.

Prevention

To help decrease your chance of getting coccydynia, take the following steps:

• Learn proper sitting posture.
• If you have to sit for long periods at work, ask for an ergonomics consultation.

Treatment

The basic treatment involves taking a nonsteroidal anti-inflammatory drug (NSAID), using a "doughnut" or coccyx pillow, sitting in a few inches of warm water (sitz bath), modifying chair height, and cushioning and tilting the seat. Individuals should be instructed in proper posture and body mechanics to minimize pain, including the importance of avoiding prolonged sitting. Individuals may be encouraged to weight shift from one buttock to the other during prolonged sitting to reduce direct weight bearing on the coccyx, and to lean forward, because the coccyx bears more weight when leaning back in a chair.

Patients with persistent coccydynia may be treated with physical therapy including modalities such as ultrasound and heat. Osteopathic manipulation and mobilization techniques are sometimes performed if the physician determines that mobility of the sacrococcygeal segments is decreased. Three sessions of coccygeal manipulation via the rectum have been found to be twice as effective in reducing pain as external physical therapy for those with traumatic onset of pain and a stable coccyx (Maigne). Active exercises and a home exercise program to improve pelvic strength may be incorporated in the treatment regimen. Individuals may be advised to increase fiber intake or to take stool softeners to prevent painful constipation.