An Overview of Tailbone Pain

 

tailbone pain2Tailbone pain occurs in or around the bony structure (coccyx) that lies at the bottom of the spine. This discomfort can be brought on by a fall onto the buttocks, degenerative joint changes, a traumatic vaginal childbirth, or prolonged sitting on a hard surface. Tailbone pain is common among horseback riders, motorcycle enthusiasts, and anyone who sits for long periods of time.

Also called coccydynia, tailbone pain is more common in females, making menstruation and bowel movements uncomfortable. The pain is often described as dull and achy, but it becomes sharp during prolonged sitting, or with rising from a seated position to a standing position. The degenerative changes seen at the area of the sacrococcygeal junction (where the sacrum and coccyx join) seems to increase with age.

Causes of Tailbone Pain

Coccyx pain is often caused by trauma, fracture, growths, and dislocations. However, many patients have no known cause of their pain (idiopathic). One source of pain is abrupt trauma, such as giving birth, a fall onto the coccyx, or injury from a motor vehicle accident. Nonabrupt trauma includes prolonged sitting, and this is a source of tailbone pain. Risk factors for tailbone pain include:

  • Having a colonoscopy
  • Age
  • Female gender
  • Occupations that require prolonged sitting, such as secretaries and truck drivers

Diagnosing the Cause of Tailbone Pain

To determine the exact cause of tailbone pain, the doctor will take a medical history and conduct a physical examination. Sometimes, no cause is ever found, however. Depending on the individual case, the doctor may order tests, including:

  • X-ray of the coccyx – To assess for growths and fractures.
  • Magnetic resonance imaging (MRI) – To assess for structural damage, tumors, and degenerative changes.
  • Rectal examination – To assess for blood in the stool, prostate problems, and colon masses.

Treatment Options for Coccyx Pain

For tailbone pain, the doctor will first attempt to treat the underlying cause. Treatment options for prolonged and persistent coccydynia include:

  • Medications – Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, asganglion impar block well as acetaminophen.

 

  • Physical therapy – The therapist will teach pelvic floor relaxation techniques and deep breathing to do while you are using the bathroom.

 

  • Coccygectomy – The surgical removal of the coccyx, which is done when all other measures fail.

 

  • Ganglion impar block – The ganglion impar is a cluster of nerve cells located in the front of the sacrum-coccyx joint. 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 block is done using x-ray guidance (fluoroscopy). To permanently block the nerve, the doctor injects a destructive agent into the region of the ganglion impar to destroy the nerve, or at least a portion of it.

Homecare for Tailbone Pain

While some incidents of tailbone pain go away without treatment, the pain can persists for months. To lessen the pain at home:

  • Sit in an upright position with proper posture, keeping the back against the chair and feet flat on the floor.
  • Lean forward when sitting down
  • Use a doughnut cushion or a V-shaped wedge
  • Apply ice or heat to the painful tailbone

 

Resources

Nathan ST, Fisher BE, Roberts CS. Coccydynia: a review of pathoanatomy, aetiology, treatment and outcome. J Bone Joint Surg Br. Dec 2010;92(12):1622-7.

Foye PM. Coccydynia (coccyx pain) caused by chordoma. Int Orthop. Jun 2007;31(3):427.

Foye PM. Finding the causes of coccydynia (coccygeal pain). J Bone Joint Surg Br. Jan 18 2007.