FAQS on Coccydynia (Tailbone Pain)

The medical term coccydynia refers to symptoms of pain in the region of the coccyx (tailbone). This condition can affect people of all ages and of both genders, but the mean age of onset is 40 years, with the prevalence five times greater in women than in men.

Made up of 3-5 bones fused together, the coccyx is the terminal portion of the vertebral column, which is the bones (vertebrae) that surround and protect the spinal cord. Unlike the rest of the spine, the tailbone and lower half of the sacrum do not assist with weight-bearing associated with standing. However, weight is transferred to the coccyx with sitting.

What is coccydynia?

Coccydynia is a term that refers to pain of the coccyx, which is often associated with inflammation of the coccyx or near-by parts. Many cases of coccydynia have an unknown cause, and they are referred to as idiopathic coccydynia.

What causes coccydynia?

Most cases of coccydynia are idopathic, arising spontaneously. The coccyx is protected by the subcutaneous and fat tissue of the buttocks, so injury to this structure is rare. However, for some individuals, an injury does occur that affects the coccyx as well as the joint that joins it to the sacrum.

Injuries occur due to a fall onto the buttocks, a kick or blunt hit to the coccyx region, or a sporting injury that results in a direct blow. A fractured coccyx can cause severe pain.

Who is at risk for coccydynia?

  • Long-distance cyclists – Prolonged sitting on the tailbone increases the risk of chronic pain.
  • Childbirth – The joint has increased flexibility during pregnancy, which makes it prone to dislocation and increased tension of the tendons and ligaments that attach to the coccyx.
  • Obesity – This causes pressure on the coccyx with sitting.
  • Underweight – This is the result of little fat padding on the buttocks.

What are the signs and symptoms of coccydynia?

The pain associated with coccydynia is usually worse with sitting, particularly on a flat and hard surface or when remaining seated for a long time. The pain often eases with standing, walking, or lying flat. Depending on the underlying cause of coccydynia, the pain often extends up the lower back or down the thighs. Possible triggers of pain include bowel movements, intercourse, and riding a stationary or regular bicycle.

How is coccydynia diagnosed?

If you experience tailbone pain, the doctor will take a thorough medical history and question your current symptoms and condition. In addition, the physical examination will include an evaluation of the rectal area, prostate gland (men), and possibly a pap smear/pelvic exam (women).

In some cases, a coccyx x-ray is all that is required in terms of diagnostic tests, but further investigation may require a bone scan, computed tomography (CT) scan, or magnetic resonance imaging (MRI) test.

What are the treatment options for coccydynia?

Depending on the underlying cause of coccydynia, there are several treatment options available. These include:

  • Donut cushion –This is a specially designed seating cushion with an open area, which takes weight off the coccyx to relieve pressure and promote healing.
  • Medications – The doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and naproxen.
  • Physical therapy – With this therapy, the patient learns certain exercises to stretch the ligaments and strengthen supporting muscles around or near the coccyx. Other pain relief measures the therapist uses include massage, ultrasound, and heat.
  • Ganglion impar block – The ganglion impar is a cluster of nerves at the front of the sacrum-coccyx joint. The procedure involves an injection of a long-acting anesthetic, with or without a corticosteroid, near the nerve cluster using x-ray guidance. For a long-lasting effect, the doctor may inject a destructive agent (phenol or absolute alcohol) to destroy a portion of the nerves. In a 2009 study evaluating the efficacy of this block found that patients’ pain scores reduced 95%, and the participants remained pain-free for 4 months post-procedure.
  • Radiofrequency ablation (RFA) – Using radiofrequency waves delivered by the tip of an injection probe, the procedures involves destruction of nerve tissue in the coccyx region. Once the nerves are destroyed, they can slowly regenerate, so the pain could recur. In a review of clinical studies, patients had more than 50% reduction in pain scores at 6 months following the procedure.