Coccydynia is an uncommon painful condition that originates from the coccyx, the tailbone at the end of the spine. Trauma and falls are the most frequent causes of coccydynia. In the vast majority of cases, nonsurgical treatment, such as medications and physical therapy work well to ease symptoms.
The spine is composed of a series of bones called vertebrae. Joints that allow movement while providing stability connect the vertebrae. The end of the spine, the coccyx, has 3-5 small bones. The coccyx bones align in a curve like a small tail. Some of the coccyx bones may be fused together. However, fewer than 10% of people have a completely fused coccyx. Muscles, ligaments, and tendons attach to the coccyx. It plays a role in weight bearing when seated.
Coccydynia is caused by trauma to the coccyx, such as from a fall, injury during childbirth, or prolonged sitting. Trauma can cause ligament inflammation or injure the coccyx where it attaches to the spine. In some cases, the cause is unknown.
The primary symptom of coccydynia is pain. You may experience increased sensitivity to pressure, especially when sitting and leaning backwards. The area around your tailbone may ache. Coccydynia can cause pain that shoots down the legs. It can also contribute to pain during sexual intercourse or bowel movements.
A doctor can diagnose coccydynia by reviewing your medical history and examining you. You should tell your doctor if you have fallen or given birth recently. Imaging tests, such as X-ray or MRI, may be used to rule out other sources of pain. Electromyography (EMG) and nerve conduction studies may be used to assess nerve function.
Coccydynia is typically first treated with non-steroidal anti-inflammatory medications. Your doctor may recommend that you sit on a donut shaped pillow to help relieve tailbone pressure. It may take several weeks or months for the pain to decrease. For persistent or severe pain, your doctor may prescribe pain medications. Local medication injections are used to place numbing and anti-inflammatory medications near the source (joint or bursa) of the pain. Nerve blocks are used to interrupt a nerve’s ability to transmit pain signals. Your doctor may gently move (manipulate) the coccyx after you receive a pain relieving injection. You may be referred to physical therapy for gentle stretching. Ultrasound therapy may be used, which soothes pain with warmth. If treatments fail to relieve symptoms, surgery may be used to remove a portion of the coccyx (coccygectomy). The short outpatient surgery is successful for relieving symptoms for most people. However, surgery is very rarely used.