The coccyx (tailbone) is a triangular arrangement of bone that makes up the very bottom portion of the spine below the sacrum. It represents a vestigial tail, hence the common term “tailbone” – Coccydynia may also be referred to other various terms, such as:
- Coccygeal pain
- Coccyx pain
Depending on a person’s development, the coccyx may consist of three to five different bones connected by fused (or semi-fused) joints and / or disc-like ligaments. While it was originally thought that the coccyx is fused together, it is now known that the coccyx is not one solid bone; there is some limited movement between the bones permitted by fibrous joints and ligaments.
Coccydynia (tailbone pain) can be a dull ache or a sharp pain at the bottom of your spine. It might hurt when you stand up, have sex, or go to the bathroom. Oftentimes, the cause is unknown, but common causes include injury from falls, childbirth infections, or sitting too long on a hard surface. Whilst rare, tailbone pain may also be caused by cancer; it may be bone cancer or another type that spreads into your bone, which is called metastatic cancer.
Generally, Coccydynia ranges from a dull ache to a fierce stab. It can last for weeks, months, or sometimes even longer. There are three types of events that cause Coccydynia, such as:
- Internal trauma – Trauma caused by difficult childbirth or from sitting on a narrow or hard surface for too long.
- External trauma – A bruised, broken, or dislocated coccyx caused by a fall.
- Others – Infections, abscesses, and tumors.
Although Coccydynia can last for a vast amount of time, fortunately, it is rarely a lifelong condition.
Causes & Symptoms
Coccydynia can result from bruising, dislocation, or a broken bone caused by a trauma or injury. It may occur if you fall back or get hurt while playing sports like skating and gymnastics. It can also result from a repetitive strain that comes with activities like cycling or rowing. Doing these activities over and over puts an ongoing strain on your muscles, ligaments, and spine, which then leads to pain.
If you sit on a hard chair or hard surface for a long period of time, you may feel pain in your tailbone. It can also happen when you’re driving or if on a heavily cushioned surface if you are in an awkward position. In addition, if you have hemorrhoids, the tissue that cushions and protects your anal opening gets inflamed and muscles pull on your coccyx. That condition can cause Coccydynia. In most rare cases, part of the sacrococcygeal joint may become dislocated at the front or back of the tailbone, causing coccyx pain.
Coccydynia is typically accompanied by other, more specific symptoms that can sometimes indicate how pain is occurring. Coccydynia may be further characterized by one or a combination of the following symptoms:
- Localized pain and tenderness – Pain is generally confined to the tailbone and does not radiate through the pelvis or to the lower extremities. Pain is usually described as an aching soreness and can range from mild to severe. Tightness or a general discomfort around the tailbone may be constant, or pain may come and go with movement or pressure.
- Pain that may worsen with bowel movement or sexual intercourse – Some patients experience heightened pain during sexual intercourse or defecation, due to the proximity of the coccyx to the anus and genitals.
Symptoms may differ from patient to patient, depending on one’s unique anatomy and the underlying structures causing pain. Coccyx pain has the potential to become chronic, lasting longer than 3 months, if the bones’ structural instability persists and the surrounding muscles and ligaments continue to be strained, and / or if there is local inflammation.
Who gets Coccydynia?
There are several risk factors that are associated with Coccydynia, such as the following below:
- Pregnancy – During the third trimester of pregnancy, a woman’s body secretes hormones that soften the area between the sacrum and the coccyx. This enables the coccyx to move as necessary during childbirth. This is a natural process, however, such movement may stretch the muscles and ligaments around the coccyx too far, causing additional pain. Such a strain on those soft tissues keeps them from supporting the coccyx at the correct angle.
- Obesity – Extra weight applies additional pressure to the coccyx. This can cause the coccyx to lean backward. Your tailbone will also hurt if it is out of position.
- Underweight – If you do not have enough fat in your buttocks to prevent your coccyx from rubbing against the muscles, ligaments, and tendons, can cause Coccydynia. The rubbing may also inflame the soft tissues.
- Gender – Women are affected by Coccydynia 5 times more than men, which is likely due to injuries during childbirth. Also, the female coccyx is positioned farther back than its male counterpart, making it more vulnerable to trauma.
- Age – Elders are more likely to experience Coccydynia due to the wear and tear of the coccyx.
How Does it Affect You? How Serious is it?
In severe cases, Coccydynia can lead to various amount of complications, including cancerous and tumorous conditions. The following complications include:
- Chordoma – Coccydynia may stem from chordoma, a rare, cancerous tumor that develops in your spine, the base of your skull, or your tailbone. As the mass grows, it can cause chronic pain.
- Prostate cancer – Tailbone pain is sometimes related to prostate cancer, a common cancer for men. As prostate cancer grows, it can lead to bone pain.
- Vertebral tumor – A vertebral tumor is a tumor in your spine that affects your bones or vertebrae. As it grows, it may cause pain in your tailbone.
- Colorectal cancer – A tumor or cancer in your colon or rectum can cause Coccydynia. Your colon is your large intestine. Your rectum is the last 6 inches of your colon. Cancer in these areas is called colorectal cancer.
- Pilonidal cyst – Most pilonidal cysts, or abnormal pockets of hair and tissue debris in your skin, develop near your tailbone. When a cyst gets infected, it causes swelling and pain.
Recommended Treatment & Rehabilitation
Coccydynia is usually diagnosed by gathering a thorough medical history and completing a physical examination. These two standard diagnostic practices are normally sufficient in obtaining a diagnosis and evaluating treatment options, but in some cases, diagnostic tests such as scans or injections may be used.
A complete medical history collected will likely include information on current symptoms, as well as when and how symptoms developed. A doctor may also look for environmental or lifestyle factors for the patient’s pain, such as recent injury, exercise habits, or obesity. After a medical history is collected, a doctor will begin a physical exam. These exams for coccyx pain may include:
- Intrarectal exam and manipulation – In some cases, a doctor may choose to manipulate the coccyx manually through the rectum, in order to assess limited or excessive mobility of the sacrococcygeal joint.
- Palpation to check for local tenderness – A doctor will feel by hand to identify swelling and tenderness around the coccyx. Palpation may also be used to identify potential coccygeal spicules, cysts, or tumors.
In some cases of severe Coccydynia, a diagnostic test may be used to determine how pain is being caused and how it can best be alleviated. Some of these tests include the following:
- Dynamic X-ray – A dynamic X-ray produces two images, which is one of the patient sitting and another of the patient standing. A doctor will compare the images and measure the angle of pelvic rotation as well as the coccyx’s change in position from sitting to standing. If these measurements are outside of the normal range, too much or too little coccygeal movement can be identified as the cause of pain.
- CT or MRI scans – A static image of the coccyx taken by magnetic resonance imaging (MRI) or computed tomography (CT) scan may be used if the suspected cause of pain is a fracture, tumor, or abnormal mobility of the sacrococcygeal joint.
- Coccygeal discogram – Similar to the same procedure done on the lumbar spine, a coccygeal discogram consists of an injection of local anesthesia in the sacrococcygeal region.
Based on findings, a physiotherapist will design a treatment program to meet your specific needs and goals of recovering from Coccydynia. He or she may show you how to do pelvic floor relaxation techniques, such as breathing deeply and completely relaxing your pelvic floor as you would while urinating or defecating. Other treatments may also include the following:
Coccydynia can be reduced or alleviated by massaging tense pelvic floor muscles that attach to the coccyx. Tense muscles in this region can place added strain on the ligaments and sacrococcygeal joint, limiting its mobility or pulling on the coccyx.
Gently stretching the ligaments attached to the coccyx can be helpful in reducing muscle tension in the coccygeal area. Your physiotherapist can provide instructions on appropriate stretches for relieving coccyx pain.
Transcutaneous Electrical Nerve Stimulator (TENS) units apply electric stimulation that interferes with the transmission of pain signals from the coccyx to the brain. These devices can be a good option for patients who wish to keep their intake of medications to a minimum.
Additionally, some forms of tailbone relief may be helpful to manage pain – here are a few stretches you can try at home:
This helps to tone the muscles of the pelvis, stimulate blood flow to the pelvic organs, and stretch the back. This allows the nervous system to be rest and the body to rejuvenate properly. When you are performing it with your knees close together, this position helps to facilitate digestion and help to massage your internal organs.
A bow pose is a gentle stretch exercise that helps to strengthen your back, tailbone muscles, and tendons simultaneously. The Bow pose position is suitable for beginners as it poses a lesser risk of collapsing into your lumbar spine.
Side angle pose
The side angle pose strengthens your legs while at the same time lengthening the side of your body. This exercise helps to activate the entire spine, stretching the tailbone and spine simultaneously.
Triangle pose improves the strength of your legs and as a result, stabilizes the spine and tailbone while opening your hips. It also strengthens your hamstrings.
Alternative & Homeopathic Treatment
Many homeopathic treatments for Coccydynia help to reduce its inflammation, swelling, and other further symptoms associated with this condition. Some of these treatments are:
- Non-steroidal anti-inflammatory drugs (NSAIDs) – Common NSAIDs, such as ibuprofen or naproxen, help reduce the inflammation around the coccyx that is usually a cause of the pain.
- Ice application – Applying ice or a cold pack to the area several times a day for the first few days after pain starts can help reduce inflammation, which typically occurs after injury and adds to the pain.
- Heat application – Applying heat to the bottom of the spine after the first few days of pain may help relieve muscle tension, which may accompany or exacerbate coccyx pain.
- Supportive pillows – A custom pillow that takes the pressure off the coccyx when sitting may be used. Pillows for alleviating Coccydynia may include U- or V-shaped pillows, or wedge-shaped pillows with a cutout or hole where the tailbone is.