Coccydynia


The spine is divided into four parts:  the cervical spine, thoracic spine, lumbar spine, and the coccyx.  The coccyx is the very bottom portion of the spine;  also known as a vestigial tail, it is made up 3-5 vertebrae and is the location where coccydynia develops. Coccydynia has a history of being poorly understood; in the early 1900s, coccydynia was incorrectly given as a diagnosis for many different kinds of lower back pain. Medical understanding of the coccyx has since developed a great deal, and most current coccydynia cases are associated with abnormal mobility of the coccyx, which may trigger a chronic inflammatory process. Coccydynia causes persistent pain and tenderness at the tip of the coccyx, between the buttocks.  The pain is often worsened by sitting, or activities that put pressure on the bottom of the spine.  This condition is found more commonly in women than in men.

Causes of Coccydynia

  • Injury to the area (falling, childbirth, etc.)
  • Fracture
  • Infection
  • Tumour
  • Unknown (idiopathic)

Symptoms of Coccydynia

  • Pain when pressure is applied to the coccyx
  • Immediate and severe pain when moving  from sitting to standing positions
  • Pain during bowel movements
  • Pain during intercourse
  • Deep ache in the region of the coccyx

Symptoms usually improve with relief of pressure when standing or walking.

How is Coccydynia Diagnosed?

Coccydynia is diagnosed by conducting a thorough medical history and physical exam.  During the physical exam, it is important to palpate and inspect this area to detect any abnormal masses or abscesses. It is important to rule out any other diseases, such as cancer, as the cause of the pain.  This can be checked via X-rays, CT scans, MRIs, or colonoscopies.

When diagnosing back pain, it is important to distinguish between low back pain and coccyx pain; other problems have similar symptoms, but different treatments. For low back pain, see our article on lumbago.

How is Coccydynia Treated?

  • Avoid sitting for long periods, if possible
  • Use a well-padded seat
  • Rest to avoid re-injury
  • Take medications to reduce the inflammation
  • Take medications to reduce the pain in the affected area
  • Nerve block injections of the ganglion impar (the nerve structure that provides nerve supply to the coccyx area)
  • Cortisone injection
  • Surgical resection of the coccyx is used in rare cases

We offer ultrasound guided ganglion impar nerve block injections, caudal epidural injections, medication, chiropractic, physiotherapy, acupuncture, active exercises, psychotherapy, biofeedback and assistive devices like a doughnut (donut) cushion for patients suffering from coccydynia.

Sources:

www.medicinenet.com/coccydynia/article.htm

my.clevelandclinic.org/…/coccydynia/hic_coccydynia_tailbone_pain.aspx

www.ncbi.nlm.nih.gov/pmc/articles/PMC2682410/

www.coccyx.org/

 

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