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Coccyx Pain

Coccydynia, or coccyx pain, (also known as coccygodynia) may be a gradual aching or a severe pain near the base of your spine. It may hurt when you get up, during sex, or go to the restroom. In a few weeks or months, it normally fades away on its own. Coccyx is a very critical part of the low back skeletal system as it acts as an insertion site for multiple muscles, ligaments, and tendons.

The origin is often unclear, but frequent causes include falls, infections after delivery, and sitting on a hard surface for too long. Cancer may cause tailbone discomfort, albeit this is an uncommon occurrence. It might be bone cancer or another sort of cancer that has spread to your bones, known as metastatic cancer.

The most frequent cause of coccydynia is direct damage to the tailbone, which generally results in inflammation around the coccyx, which causes pain and discomfort.

There have been several reports of discomfort that have no identified cause (called idiopathic coccydynia).

The following underlying anatomical abnormalities often induce coccydynia:

  • Coccyx hypermobility, or excessive movement, places additional strain on the sacrumcoccyx joint as well as the coccyx itself. Too much movement may cause tailbone and pelvic discomfort by pulling the pelvic floor muscles that link to the coccyx.
  • When sitting, the tailbone juts outward due to limited coccyx movement, putting additional strain on the bones and sacrococcygeal joint. In addition to causing pain, limited coccyx mobility may cause pelvic floor muscle strain.
  • A displaced section of the sacrococcygeal joint at the front or rear of the tailbone might cause coccyx discomfort in rare circumstances.
  • The preceding variables may occur as a consequence of a coccyx injury or from idiopathic coccydynia.

Coccyx pain: What Causes It?

Coccyx pain is generally diagnosed by identifying one of the following underlying causes of pain:

Trauma 

The most prevalent cause of coccydynia is a direct injury to the coccyx. A fall on the tailbone may inflame the ligaments and cause injury to the coccyx or the sacrum‘s coccygeal connection. Coccygeal trauma generally results in a bruised bone, but it may also lead to a fracture or dislocation of the coccyx, either in the front or rear.

Consistently high levels of stress

Coccyx discomfort may develop due to activities that place extended pressure on the tailbone, such as horseback riding and sitting on hard surfaces for lengthy periods. The pain from these reasons is typically not permanent. Still, if the inflammation and symptoms are not treated, the discomfort may become chronic and create long-term sacrococcygeal joint mobility issues. In some instances, constipation may also aggravate coccyx pain. Sciatica is another condition that needs to be treated in order to get rid of coccyx pain.

Childbirth and coccyx pain

The baby’s head passes over the top of the coccyx during delivery, and the pressure on the coccyx may cause harm to the coccygeal tissues (the disc, ligaments, and bones). The pressure may potentially produce a coccyx fracture, causing back pain which is a rare case.

Coccyx discomfort 

Pain originating elsewhere in the spine or pelvis, such as a lumbar herniated disc or degenerative lumbar disc, may be directed to the coccyx in rare situations.

Coccygeal discomfort is more likely to occur if certain variables are present. Obesity is a risk factor for coccydynia. Pelvic rotation, including coccyx movement, is frequently reduced in overweight people, putting more stress on the coccyx and raising the risk of discomfort. According to one research, women with a BMI (body mass index) of more than 27.4 and males with a BMI of more than 29.4 are more likely to develop coccydynia due to repeated stress or a one-time injury.

Other causes of coccyx pain can include infection etiologies such as pilonidal cyst.

Gender and coccyx pain

Due to a larger pelvic angle and stress to the coccyx after delivery, women have a higher risk of developing chronic coccydynia than males which often lasts for a long period of time.

It may not be required to determine the specific aetiology of coccydynia if the pain is modest or moderate. However, since coccyx pain may be severe or have a significant cause in certain circumstances, it’s crucial to have a broad understanding of why it’s formed so that it can be treated successfully.

Diagnosis

A doctor will do a detailed examination that includes a complete medical history to determine a diagnosis.

  • Prior pregnancies and birthing experiences, which the doctor may inquire about
  • Any stomach issues in the past
  • If you have any additional muscular or nerve issues       
  • Some tests can determine the cause of pain based on symptoms and medical history. 
  • A pelvic exam to measure pelvic floor strength 
  • A rectal exam to identify whether a problem with these muscles is causing discomfort 
  • Imaging studies of the tailbone and spinal cord, such as X-rays or magnetic resonance imaging (MRI) scans 
  • Blood tests to rule out infection or autoimmune diseases

Coccyx Pain Treatment Options

Prolotherapy

Many of the structures in and around the coccyx have a poor blood supply, which is why they can struggle to heal on their own. It is the oxygen and nutrients in our blood supply that help to heal these structures.

Prolotherapy involves the injection of oxygen and nutrients into these structures to provide a direct supply of what is required to heal and repair.

As the treatment is helping to treat the root cause of the problem, it is deemed to be a permanent fix.

Other less effective treatments for tailbone pain –

Medication

Nonsteroidal anti-inflammatory drugs (nsaids) and over-the-counter medications may assist with pain relief. Ibuprofen, paracetamol, and aspirin are examples of these drugs.

Voltaren gel, for example, is a topical ointment that may assist. Local anesthetics can also help offer pain relief in severe conditions.

Changes in your way of life

Stretching the coccyx muscles with gentle stretching and mild exercises like yoga and pilates may assist. This may help relieve discomfort from mild lower back injuries or sitting for lengthy periods.

Massages and posture modifications may also aid in the relief of muscle injury pain.

Other options for coccyx pain

People who must sit for lengthy periods may benefit from wedge-shaped or doughnut/donut-shaped cushions. These may assist in reducing the amount of pressure placed on the tailbone. In some instances, coccygectomy is also recommended.

Physical therapy for coccyx pain: 

A physical therapist may advise strengthening surrounding muscles, supporting the pelvic floor, or moving and sitting less probably to aggravate the tailbone.

Prescription pain medication: 

If over-the-counter pain relievers are ineffective, a doctor may prescribe prescription pain relievers.

Surgery for coccyx pain: 

A surgeon may address physical disorders such as pelvic floor prolapse or herniated discs. A section of the coccyx may need to be removed as part of the treatment.

Injectable steroids: 

Injectable steroids are often used to relieve pain but long-term aren’t good for you. While a person works with a physical therapist to treat the underlying source of the pain, this may help with muscular tightness.

Medical issues that need to be treated: 

Tailbone discomfort may be caused by muscle tension from other disorders such as haemorrhoids. The discomfort around the tailbone may be alleviated by treating the underlying reasons.

Coccyx discomfort might not always need therapy. During pregnancy, people who have tailbone pain may discover that it goes away within a few weeks after giving birth, although pain caused by an injury may improve without therapy.

A woman holding her coccyx pain

Summary

Physical damage to the coccyx and surrounding tissue is the most common cause of tailbone pain.

Tailbone discomfort is a common side effect of childbirth. The coccyx and associated muscles may be damaged by impact trauma or sitting on hard surfaces for long periods.

Most instances of tailbone discomfort may be alleviated with over-the-counter medications, mild exercise, and sitting assistance. If your tailbone pain doesn’t improve (chronic coccydynia), consult your healthcare provider for medical advice. He or she might do a rectum examination to rule out any other conditions.

To treat more severe tailbone pain, a doctor would usually recommend prescription pain medication, physical therapy, and potentially steroid injections or nerve block procedures. A person may need surgery to fix any bone or muscle damage causing discomfort in certain circumstances.

References:

  1. Foye PM. Coccydynia (coccyx pain) caused by chordoma. International orthopaedics. 2007;31(3):427–427. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2267587/
  2. Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner Journal. 2014;14(1):84–7. https://pubmed.ncbi.nlm.nih.gov/24688338/
  3. Foye PM, Shupper P, Wendel I. Coccyx fractures treated with intranasal calcitonin. Pain physician. 2014;17(2):233–229.
  4. Mabrouk A, Alloush A, Foye P. Coccyx Pain. StatPearls [Internet]. 2020;
  5. DUNCAN GA. Painful coccyx. Archives of Surgery. 1937;34(6):1088–104.
  6. Foye PM, Buttaci CJ, Stitik TP, Yonclas PP. Successful injection for coccyx pain. American journal of physical medicine & rehabilitation. 2006;85(9):783–4. https://journals.lww.com/

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