Tailbone Pain/Coccydynia

What is Tailbone Pain/Coccydynia

Tailbone pain, medically known as coccydynia, involves discomfort in the coccyx, the bony structure located at the lower end of the spine. This condition is characterised by pain and tenderness at the tailbone’s tip, particularly noticeable between the buttocks.

The coccyx supports body weight when sitting and provides attachment points for tendons, ligaments, and muscles. When affected by coccydynia, these functions can become impaired, leading to discomfort and potential interference with daily activities​​.

Symptoms

Coccydynia manifests through a variety of symptoms, primarily centred around discomfort in the coccyx area.

• Achy or Piercing Pain: Individuals often report either a dull, achy sensation or a sharp, piercing pain in the tailbone.
• Pain When Changing Positions: The transition from sitting to standing often exacerbates tailbone pain. This increase in pain upon movement is indicative of the strain placed on the coccyx during such transitions​​​​.
• Discomfort During Prolonged Sitting: Extended periods of sitting tend to worsen the pain associated with coccydynia, as prolonged pressure is applied to the tailbone​​.
• Pain During Bowel Movements and Sexual Activity: Coccydynia can cause pain during bowel movements and sexual activity, indicating the condition’s impact on various aspects of personal health​​​​.

Causes and Risk Factors

Coccydynia can be attributed to various causes and is influenced by several risk factors.

• Physical Trauma
  Injury to the coccyx or pelvic bones is a primary cause of coccydynia. Falls, for instance, can lead to bruising, fractures, or dislocation of the tailbone​​​​.
• Repetitive Strain Injury
  Activities like cycling and rowing, which involve repetitive leaning and stretching of the spine, can strain the tissues around the coccyx and lead to coccydynia​​​​.
• Changes During Pregnancy and Childbirth
  In the later stages of pregnancy, hormonal changes soften the area between the sacrum and coccyx to facilitate childbirth. This natural process may excessively stretch the muscles and ligaments around the coccyx, causing pain​​​​.
• Complications From Being Overweight or Underweight
  Both obesity and being underweight present risks. Excess weight can cause the coccyx to lean backwards and create pain, while insufficient buttock fat may lead to the coccyx rubbing against surrounding tissues​​​​.
• Prolonged Sitting
  Extended periods of sitting, especially on hard surfaces, increase pressure on the coccyx and can exacerbate coccydynia​​​​.
• Cancer
  In very rare cases, coccydynia might be a symptom of cancer near the coccyx or metastatic cancer that has spread to the bones​​.

Non-Surgical Treatment Options

Coccydynia is usually treated through non-surgical means, which aim to relieve symptoms and facilitate healing.

• Anti-Inflammatory Medication
  These medications are used to reduce inflammation around the coccyx, which may be a source of pain. Topical anti-inflammatory rubs or gels may also be considered as an alternative to oral medication​​.
• Ice and Heat Therapy
  Applying ice multiple times a day for the first few days after the onset of pain can help reduce inflammation. This should be followed by alternating with heat therapy for optimal relief, using ice for 5-10 minutes and then heat for up to 20 minutes​​​​.
• Alleviating Pressure
  Avoiding prolonged sitting in one position and using customised pillows (doughnut-shaped, U-shaped, or V-shaped) can help alleviate pressure on the coccyx and reduce pain​​.
• Stool Softeners and Dietary Changes
  For individuals experiencing pain during bowel movements, stool softeners, increased water intake, and a fibre-rich diet can help alleviate pressure on the coccyx​​.
• Physical Manipulation
  In certain cases, manual adjustment of the coccyx may help alleviate pain. This technique is often performed under anaesthesia and is only suitable for certain patients, such as those with a coccyx that is displaced forward.
• Coccygeal Nerve Blocks
  These may include injections of numbing medications and steroids. They are usually used in more persistent cases where home remedies are insufficient​​.

Surgical Treatment Options

Surgical intervention is only considered for severe cases of coccydynia.

Coccygectomy

This surgical procedure involves the removal of the coccyx. There are two types of coccygectomy: partial (removal of part of the coccyx) and total (removal of the entire coccyx). Coccygectomy is typically recommended only when other treatments fail to provide relief​​​​.

Prevention Strategies

While it is not always possible to completely prevent coccydynia, certain measures can be taken to reduce the risk.

• Mindful Sitting to Reduce Strain on the Coccyx: Avoid sitting for extended periods, especially on hard surfaces. Regularly changing positions can also help minimise pressure on the coccyx​​​​.
• Using Supportive Cushions When Sitting: Utilising specialised cushions, such as doughnut or wedge-shaped gel cushions, can relieve pressure on the tailbone during prolonged sitting.
• Using Proper Techniques and Equipment During Physical Activities: Activities that could potentially cause tailbone pain, such as cycling, should be approached with caution. Ensure proper technique and use appropriate equipment to reduce the risk of injury​​.
• Fall Prevention Measures: To reduce the risk of falls that can injure the tailbone, keep floors clear of hazards, ensure stairways are well-lit, and install railings where feasible. Avoiding distractions, such as using a phone while walking, can also help prevent accidental falls​​.