Coccydynia is a rare orthopedic disorder that results in pain at the bottom of the spine. Get detailed information about the symptoms, causes, types and treatment options for the disorder.
The condition is manifested by an inflammation of the triangular bony structure, called tailbone or coccyx, located at the bottom of the vertebral column. It is an extremely bothersome problem associated with acute discomfort at the tip of the coccyx between the buttocks. It is generally a sign of an underlying condition. The disease affects females more than the males.
The condition is known by many other names like:
Picture 1 – Coccydynia
- Coccygeal pain
- Coccyx pain
- Tailbone pain
A number of activities, such as horseback riding and bicycling, can directly impact the tailbone. This puts tremendous pressure on the lowermost region of the spinal column, which aggravates the condition further. In some cases, a small bruise is observed in the tailbone area, owing to an injury to the rear bone. Some of the classical symptoms experienced by affected patients include:
- Intense localized pain and tenderness in the coccyx region
- Acute pain when constipation and straining occurs with bowel movements
- Pain during sex, particularly for women
- Severe or sharp pain when sitting or standing on soft surfaces for a prolonged duration of time
Traumatic injury is believed to be the predominant cause of coccyx pain. In most cases, however, the causes are unknown and the condition is often denoted as “Idiopathic coccydynia”. The pain could be a result of the following factors:
- Backward fall onto a hard surface, such as slipping on ice or rock
- Direct blow to the coccyx, resulting in injury, that commonly occurs in contact sports
- Overstretching of the muscles and ligaments around the coccyx during second and third trimesters of pregnancy
- High chance of a fracture or injury to the tailbone during childbirth
- Repetitive strain or friction against the coccyx from movements like cycling and rowing
In addition to coccyx injuries, there are some less common causes of this discomforting condition that include:
- Tumors, such as Sacrococcygeal teratoma, located at the base of the coccyx
- Infection of tailbone
- Injury to the other regions of the backbone
- Spinal nerve root compression, as observed in people with Sciatica
- Bony projections on the coccyx, called bone spurs
- Pilonidal cysts that arise at the base of the tailbone
- Partial dislocation of the coccyx
- Muscle strain
Pain in the tailbone area can be due to a variety of conditions. In the majority of cases, the coccyx as well as the muscles attached to it may not be involved. The medical history of a patient is important to the physicians in order to get a clue to any type of past injury to the tailbone. Women who had prolonged labor or childbirth injury in the past are also likely to develop Coccydynia. A detailed physical examination of the tailbone region is performed by using the following techniques:
Rectal and Pelvic tests
Rectal test involves an internal examination of the rectum for any kind of tumors or abnormal masses/abscesses. Pelvic exam is specifically carried out in females to thoroughly examine the pelvic organs like uterus, ovaries and fallopian tubes.
Palpation is also done as a part of the physical examination in which the inside of the rectum and pelvic region is felt by the healthcare practitioners. The goal of this technique is to determine the size, shape, firmness, or location of the internal organs. Local tenderness, which is a common symptom of this condition, can be detected by direct palpation of the coccyx in the affected individuals.
Health care providers can also opt for a few additional exams and tests for further confirmation of the condition before giving the final result of the diagnosis. Some of the commonly used diagnostic options include:
In this test, local anesthetic injection is used in the tailbone region. Patients suffering with the condition will get instant relief and the physicians can also rule out the possibility of other coccyx disorders.
Dynamic (sit/stand) x-ray
In this process, health specialists take both sitting and standing X-ray images of the backbone of the patients. If the coccyx undergoes abnormal movement while sitting, then there is a possibility of one of the following conditions:
In this form, there is a partial dislocation of the tailbone in the backward direction.
The coccyx, in this case, undergoes partial dislocation in the forward direction.
The condition is marked by excessive bending of the tailbone towards the forward and upward direction.
Presence of small, slender, sharp-pointed bone spurs on the coccyx.
Magnetic Resonance Imaging scan
The test can help in the diagnosis of a tailbone fracture or a dislocated coccyx. It may even detect any form of bruise on the lower region of the spine. MRI scans can also reveal other causes of coccyx pain, such as infection and cyst.
Computerized Tomography scan
In this X-ray procedure, cross sectional views of the backbone as well as the anatomy of the intervetebral discs and spinal cord is generated using a scanner. The technique aids in detecting any form of abnormality in the coccyx.
A small amount of radionuclide, that emits gamma rays, is used in this procedure. The chemical is injected into a vein, which slowly gets accumulated in areas of a bone that are affected due to an injury, fracture, or cancer. A gamma camera detects the emitted gamma rays from the target bone and converts them into an electrical signal. The images are later viewed on a computer monitor.
Coccydynia Differential Diagnosis
The differential diagnosis for this disorder normally helps in distinguishing it from other conditions, which give rise to similar symptoms. Some of them include:
- Disc herniation
- Degenerative disc disease
- Mechanical Low Back Pain
The treatment of this orthopedic condition involves the following:
Picture 2 – Coccydynia Image
In mild to moderate cases, non-steroidal anti-inflammatory drugs like ibuprofen or naproxen are administered to affected individuals for alleviating the inflammation and discomfort. Anti-depressants are generally used to reduce persistent pain.
Nerve blocks are generally used for pain management and treatment. Some of these contain local anesthetic that specifically helps in controlling acute pain. In some cases, corticosteroids injections are used to treat continuing pain.
Stool softeners are used on a short-term basis to prevent constipation and avoid straining during bowel movements.
Surgical removal of the coccyx is normally performed in rare cases like cancer. Surgery is also recommended to patients who are unable to respond to the prescribed drugs. Coccygectomy is the surgical approach used to remove the entire affected coccyx or a small portion of it.
Coccydynia Home Remedies
Tailbone pain can be very annoying and may affect the normal life of a patient. In order to control the painful symptoms and avoid further disturbance to the coccyx, a few self-care techniques must be followed – as recommended by the health care providers. Some of these include:
- Avoiding sitting at one position for a prolonged duration. Affected patients must sit on hard surfaces and direct their weight away from the tailbone while leaning forward.
- Placing ice packs on the tailbone area for 15-20 minutes in case of traumatic injuries, four times a day.
- Using a doughnut cushion or pillow to sit. Such cushions have a small aperture in the middle to redistribute the body weight and prevent resting on an injured tailbone.
- Consuming high-fiber foods on a regular basis to soften the stools and avoid constipation.
Routine medical therapy may aid in relieving the symptoms. However, the body may gradually become weak and performing day-to-day activities could get difficult. Physiotherapy or physical therapy exercises, in which specialists manually stretch and massage the muscles around the coccyx, may prove beneficial to sufferers. There are a few pelvic and stretching exercises that can also be performed to control the constant lower back pain like:
Mula bandha exercise
The technique involves the contraction of the perineum-the portion of the pelvic floor between the anus and genitals. It basically helps in inhibiting the urge to urinate or have a bowel movement. The nerves in the sacral as well as coccyx region are stimulated along with toning and strengthening of the pelvic area.
The body is placed in a supine, table-top position with the hands directly under the shoulders and the knees under the hips. Then, affected patients have to inhale and simultaneously lift their back upward. The chest should be pressed forward and the belly must be allowed to sink towards the floor. Individuals must now lift the head and gaze towards the ceiling for a while. This exercise serves the following purposes:
- Stimulation of spinal nerves
- Stretching of the back and neck muscles
- Alignment of the vertebrae
- Increasing the blood flow
- Reducing back and neck pain
In this exercise, a patient lies down on the back and brings the left knee into the chest. The right leg is then extended on the floor. The left knee is lowered across the right one. The shoulders are kept in contact with the floor. This position should be held for around 1 minute.
In a supine, lying down position, the elbows are placed on the floor under the shoulders with the hands in the forward position. The chest is then stretched and lifted, followed by straightening of the arms. The hips must be kept in contact with the floor. The shoulder blades and buttock muscles must then be squeezed.
Coccydynia is very often a result of an intense activity, or a faulty posture. In most cases, people with injured coccyx are found to recover in a short span of time with the help of proper treatment. However, chronic cases require special attention and timely diagnosis. Affected patients must wear protective padding when participating in contact sports to avoid further injuries to the tailbone.