What is coccyx (Tail bone) pain?
Coccydynia is a type of lower back pain felt around the last bone at the base of the spine (known as the coccyx or tailbone). Tenderness and pain is experienced at the tip of the tailbone, between the buttocks, which can range from mild to severe. The pain is worse when sitting down and some people are unable to sit in the same position for more than few minutes.
What are the causes of pain in the tailbone?
The pain and discomfort that arises in coccydynia is due to damage caused to the coccyx bone or its surrounding tissue. The tailbone can be damaged in many ways; the various causes of coccydynia are as follows:
- Injury – Hard impact to the base of the spine (like an accidental kick to the spine base while playing contact sports, falling from a height and landing on the coccyx) can injure the coccyx by bruising it or in severe cases, cause dislocation or fracture. Coccydynia can also occur due to repetitive strain injury as a result of sports like cycling or rowing that involve a continual position of leaning forward for a long period of time. This causes the muscles and ligaments around the coccyx to become stretched and strained, which makes it difficult to hold the coccyx in its regular position.
- Poor posture – Bad posture, while at work or driving, puts excess pressure on the coccyx, causing pain and discomfort.
- Childbirth – This is one of the most common causes of coccydynia. The lower spine and coccyx become flexible towards the end of the pregnancy period, allowing them to bend and give way for the birthing process. However, overstretching and permanent dislocation of muscles and ligaments around coccyx can occur.
- Weight issues – Being overweight (excess pressure on coccyx while sitting down) and underweight (not enough buttock fat to cushion coccyx) can cause coccydynia.
- Ageing – With age, the bones of the coccyx can fuse together or cartilage discs that hold the coccyx in place wear down, putting more stress on the coccyx.
- Cancer – Cancer in the bone or cancer from another part of the body that spreads into the bone can cause coccydynia.
What one needs to know about symptoms or signs?
Most common symptom of coccydynia is pain and discomfort at the base of the spine. It can make everyday activities like sitting, driving or bending very difficult. Other symptoms include:
- Painful buttocks and hips
- Pain while passing stools
- Pain during sex
- Increased pain during periods (for women)
What are the screening tests and investigations done to confirm or rule out the disorder?
Coccydynia can be diagnosed based on symptoms presented and a physical examination of the lower back and spine. The doctor may also recommend the following:
- X-rays – X-rays in sitting and standing positions allow the doctor to compare the images to determine any abnormal coccyx movement and detect and fracture in the bone.
- Magnetic resonance imaging (MRI) – MRI scan is recommended if a patient also displays additional symptoms like fever or unexplained weight loss. The scan can check for other conditions like bone infection or bone cancer.
What treatment modalities are available for management of the disorder?
Treatment options for coccydynia include:
- Medication – Pain relief medications and other drugs for treating tail bone pain are:
- Anti-inflammatory painkillers (NSAIDs) – NSAIDs relieve pain and also reduce inflammation around the coccyx.
- Strong painkillers – These are prescribed in cases of more severe or long-term (chronic) coccydynia.
- Stool softeners – These prevent constipation and painful stools.
- Injections – If the pain does not respond to painkillers, doctors may inject injections into the tail bone to relieve pain. Different injections may be used like corticosteroid injections, ganglion impar nerve block, and sacrococcygeal joint injections.
- Surgery – It is a rare form of treatment used only if all other treatments have failed. The coccyx may be completely removed (coccygectomy) or only a part of the coccyx may be removed (partial or limited coccygectomy). Performed under general anaesthesia, the surgeon makes a small cut in the skin over the coccyx. After removal, the coccyx muscles, ligaments and tendons are reattached to other parts of the pelvis to preserve their function.
What are the known complications in management of the disorder?
- Some people are allergic to NSAIDS or are at a higher risk of developing stomach ulcers.
- Too many corticosteroid injections can cause damage to coccyx and lower back. These injections should be restricted to one or two in a year.
- Coccyx surgery may lead to post-operative infection. This is a common complication as the coccyx is located next to the anus and rectum, increasing the possibility of spread of bacteria to the site of operation is easy.
What precautions or steps are necessary to stay healthy and happy during the treatment?
Recovery from tailbone surgery can take a long time, between few months to a year. Rest, avoiding a re-injury and physical therapy are helpful in recovery of tail bone pain. Patients must avoid sitting for long periods of time and should avoid sitting on hard surfaces when seated.
Alternate sitting on each side of buttocks, leaning forward and directing weight away from the tail bone are useful in dealing with the pain. Further, foods rich in fibre soften stool and prevent constipation and pain to coccyx while passing stools. Those suffering coccyx pain from injury should apply ice for 15 to 20 minutes, four times a day, in the initial days post injury.
How can the disorder be prevented from happening or recurring?
Injury to the tail bone can be prevented by wearing protective padding while playing contact sports.