Coccydynia – Tailbone Pain

 

tailbone pain2Coccydynia is the medical term for pain in, at, or around the coccyx (tailbone). The cause of coccydnia is unknown in most cases, but it can occur from trauma during childbirth or from a fall onto the buttocks. Rare causes include a fracture, infection, and a tumor. While the exact incidence of coccydynia is not known, several factors are associated with the condition, such as obesity and female gender. Women are five times more likely to suffer with coccydynia than men.

Coccydynia Symptoms

The main symptom of coccydynia is pain when pressure is applied to the tailbone, as with sitting on a hard chair. This pain often improves when the patient stands up or with walking. Other symptoms include pain during bowel movements or sex, immediate pain when moving from a sitting position to standing, and a deep persistent ache in the tailbone region.

Diagnosis of Coccydynia

To diagnose coccydynia, the doctor will take a detailed medical history and conduct a thorough physical examination. Inspection and palpation of the coccyx is done to assess for abscesses, masses, and deformities. Certain diagnostic tests include:

  • Lateral x-ray of the coccyx
  • Computed tomography (CT)tailbone
  • Magnetic resonance imaging (MRI)

Coccydynia Treatment Options

  • Donut cushion – A specially designed seating cushion with an open area takes weight off the tailbone and promotes coccyx healing.
  • Medications – The doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen.
  • Physical therapy – With this therapy, the physical therapist teaches the patient certain exercises to stretch the ligaments and strengthen supporting muscles around or near the coccyx. Other measures used include massage, heat, and ultrasound.
  • Radiofrequency ablation (RFA) – To destroy the nerve tissue of the coccyx region, the doctor uses radiofrequency waves that are delivered by the tip of an injection probe. After the nerves are destroyed, they can grow back, but this is a slow process.

Ganglion Impar Block

The ganglion impar is a cluster of nerve cells located in the front of the sacrum-coccyx joint. This cluster is part of the sympathetic nervous system. Chronic coccyx pain occurs due to over-activity of these nerve cells. A ganglion impar block involves the injection of a local anesthetic (lidocaine) into this region. Sometimes, a steroid is added in the injection to provide long-lasting pain relief.

The ganglion impar block is done using x-ray guidance (fluoroscopy). Most patients report 100% relief of coccyx pain just minutes after the ganglion impar block procedure. Sometimes, the doctor uses this procedure to diagnose the cause of the coccyx pain and rule out referred pain from uterine fibroids or other conditions. When the anesthetic wears off, the pain usually returns, but many patients report that it is not as severe as it was before the procedure.

To permanently block the nerve, the doctor injects a destructive agent into the region of the ganglion impar. Agents used include absolute alcohol or phenol, which are toxic to the nerves. Injection of a destructive agent onto the nerve destroys that nerve, or at least a portion of it. When this is done, the patient has permanent pain relief.

 

Resources

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. PMCID: PMC3963058