FAQs on Tailbone Pain

Tailbone pain is any discomfort felt in the tailbone region. Coccydynia is inflammation localized to the tailbone, and symptoms of this condition include tenderness at the tailbone. The pain is often described as dull and achy. The main risk factor for long-term (chronic) tailbone pain is injury. Tailbone pain is often worsened with sitting on a hard surface or for a prolonged period of time.

What causes tailbone pain?

Coccydynia is caused by an injury in most incidences, but it may occur spontaneously. Many things cause tailbone pain, such as sciatica, infection, shingles, pilonidal cysts, fractured bone, and sacroiliitis.

What are the symptoms associated with tailbone pain?

Other than pain in the area of the tailbone, local tenderness is common with pain of the tailbone. The diagnosis is usually based on the subjective complaint of pain along with the examination findings of local tenderness.

How does the doctor diagnose the cause of tailbone pain?

While many cases of tailbone pain have no known cause, treating the pain depends on diagnosing the underlying cause. The doctor will ask many questions, taking a detailed medical history.

Also, a physical examination is necessary, which may involve a rectal examination, pap/pelvic exam (for women), and prostate exam (for men). A lateral x-ray of the coccyx is done to detect any fractures or bony growths. However, the doctor may order a bone scan, MRI, or CT scan to assess the soft tissues and other body structures of the tailbone region.

How is tailbone pain treated?

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

  • Medications – The doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, acetaminophen (Tylenol), or other pain relievers.
  • Physical therapy – The therapist will teach pelvic floor relaxation techniques and deep breathing to do while you are using the bathroom.
  • Coccygeal injections – Patients with chronic tailbone pain that has lasted less than 6 months received more than 50% relief of pain from fluoroscopically guided coccygeal injection of triamcinolone acetate and lidocaine.
  • Ganglion impar block – The cluster of nerve cells located in the front of the sacrum-coccyx joint is called the ganglion impar. A ganglion impar block involves the injection of a local anesthetic agent near this this region. Sometimes, a corticosteroid is added to the injection for long-lasting pain relief. To permanently block the nerve, the doctor injects a neurolytic agent near the ganglion impar to destroy the nerve root. In a recent clinical study, all participants reported a reduction of pain scores.
  • Radiofrequency ablation (RFA) – With this procedure, radiofrequency waves are delivered by an injection probe, which destroys the nerve tissue of the tailbone area. In clinical research trials, many patients reported both short-term and long-term pain relief following RFA. In one study, almost half of the participants had more than 50% pain reduction of pain scores on the 6-month follow-up evaluation.

Resources

Ferrante FM, et al. (2004). Radiofrequency sacroiliac joint denervation for sacroiliac syndrome. Pain Medicine, 5(1):26–32. doi: 10.1111/j.1526-4637.2004.04009.x.

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

Mitra, R, Cheung, L, & Perry P (2007). Efficacy of fluoroscopically guided steroid injections in the management of coccydynia. Pain Physician 10(6), 775-778.

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

Toshniwal GR, Dureja GP, & Prashanth SM (2007). Transsacrococcygeal approach to ganglion impar block for management of chronic perineal pain: a prospective observational study. Pain Physician, 10(5):661-6.