Coccydinia: Painful Coccyx (Tail Bone)

Coccydynia describes a painful coccyx or tail bone as it is more commonly referred to.  The Coccyx is the lowest part of the spinal column – triangular in shape, made up of three to five fused segments of vertebrae allowing limited movement. The word coccyx comes from the Greek work Kokkyx, meaning Cuckoo’s beak. In most cases coccyx pain will resolve itself without any treatment within a few weeks – however, in some cases it may become chronic and require professional treatment.

Functions of the Coccyx

Despite its smaller size in relation to the other regions of the spinal column, the coccyx still has important functions. It serves as one leg of a weight bearing tripod in the seated position – weight is distributed between the two bottom portions of the Ischium (two hip bones) and the coccyx. It is also the connecting point for many of the pelvic floor muscles, providing positional support for the anus and contributing to voluntary bowel movements.

Coccydinia Painful Coccyx

Symptoms of Coccydynia

Classic symptoms include localised pain and tightness in the coccyx region itself which may be worsened by any of the following:

  • Sitting down
  • The transition between sitting and standing
  • Bending over
  • Passing stools
  • Sexual intercourse
  • Standing for long periods

The pain may be anything from mild to severe and is commonly described as a dull ache with occasional episodes of stabbing pain.

Possible Causes

Trauma

The most common cause is direct trauma to the coccyx such as a fracture for example, this may be the result of an injury such as a backward fall, or another type of accident such as car crash.

Childbirth

One of the most common causes of Coccydynia – long and difficult labour can cause the coccyx to over stretch.

Repetitive Strain injury

Repeated motions during sports such as rowing or cycling, may strain the base of the spine, as may sitting for prolonged periods in positions which exert pressure onto the coccyx.

Gender

Coccydynia is more common in females than in males, this may be due not only to childbirth, but also to the fact that women have a broader pelvic structure and a wider pelvic angle therefore bearing more weight on the coccyx. This can result in inflammation to the ligaments between the bones –  whereas men predominantly bear the weight on the lower parts of the hip when seated.

Degenerative diseases

Conditions such as osteoporosis, arthritis, bone spurs caused by osteoarthritis, the general wear and tear of the ageing process may cause pain in the coccyx region.

Poor posture

Over long periods of time an awkward position whilst sitting or driving may strain your coccyx.

Cancer and Infection

Although rare, cancer, a tumour or infection may cause coccydynia.

Diagnosis

This is made from the history of pain with sitting and in addition, a physical examination will reveal tenderness and discomfort when any form of pressure is applied to the coccyx bone.

An X-ray may useful in determining any fractures and a CT or MRI scan may be helpful in identifying any degenerative changes or masses.

Treatment

There are a few conservative treatments which may be helpful in managing the pain caused by coccydynia.

Medication

NSAIDs can be effective in helping relieve the painful symptoms and reducing inflammation. Other stronger pain killers may be prescribed by your physician.

Physiotherapy

Manipulation, stretches and certain exercises can be very helpful. A physiotherapist can also provide useful advice on correct posture and devise an exercise program.

Injections and Nerve Blocks

Local steroid injections can reduce pain and inflammation.

Nerve block injections consist of an anaesthetic injection into the nerves to reduce the pain signals coming off them. 

An effective treatment of coccydynia is the Ganglion Impar Block – a nerve block injected into the ganglion impar, a bundle of nerves forming part of the sympathetic nervous system on the front of the coccyx.

Ganglion Impar Block Xray

This applied with pulsed radiofrequency denervation is often very successful in the long term.

Surgery

Surgical excision is regarded as a last resort if all other options have been exhausted. A coccygectomy may be considered in some extreme cases – it involves surgically removing part or all the coccyx bone. It carries with it the associated risks of surgery as well as complications, one of which may include difficulties arising in the healing process.

The greatest chance of successful treatment is via a multidisciplinary approach of medication, physiotherapy and injections.

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