Ultimate Guide to Understanding and Managing Tailbone Pain: Expert Tips for Fast Relief

Coccydynia, commonly known as tailbone pain, refers to pain in the region of the coccyx, the triangular bone located at the bottom of the spine. While often caused by trauma, it can also stem from various other factors. This article will explore the causes, symptoms, diagnosis, and treatment options available for coccydynia.

What is Coccydynia?

Coccydynia describes pain in the tailbone. The coccyx is at the very bottom of your spine and consists of three to five fused vertebrae. The tailbone helps steady you and support your weight when you sit down. It is also where several tendons, ligaments, and muscles in your body connect. When your tailbone is in pain, it can interfere with daily routines and quality of life. Despite its small size, the coccyx has several important functions. Along with being the insertion site for multiple muscles, ligaments, and tendons, it also serves as one leg of the tripod-along with the ischial tuberosities-that provides weight-bearing support to a person in the seated position. Leaning back while in a seated position leads to increased pressure on the coccyx.

Causes of Coccydynia

There are many reasons why you might develop tailbone pain. The most common etiology of coccydynia is external or internal trauma. Understanding the potential causes is crucial for effective management.

Traumatic Injuries

Falls: A bad fall on your tailbone can cause a bruise, break, or dislocation. External trauma usually occurs due to a backwards fall, leading to a bruised, dislocated, or broken coccyx. Fortunately, most tailbone injuries are merely bruises rather than breaks.
Repetitive Strain Injuries: Sports that require you to lean back and forth, like rowing, can strain the tissues around the tailbone. Minor trauma can also occur from repetitive or prolonged sitting on hard, narrow, or uncomfortable surfaces. Anyone who has to sit on a hard, narrow surface for long periods of time is at risk of developing tailbone pain.

Pregnancy and Childbirth

During the third trimester, your body secretes hormones that soften the area between your tailbone and sacrum. This gives your tailbone more flexibility during childbirth. In some cases, it can stretch the muscles and ligaments too far, causing pain. The location of the coccyx makes it particularly susceptible to internal injury during childbirth, especially during a difficult or instrumented delivery. Women who have given birth vaginally or who required a forceps delivery may also experience persistent tailbone pain, as these deliveries can cause muscle spasms and arthritic changes around the base of the spine.

Weight Factors

Carrying Extra Weight: Extra weight places extra pressure on the tailbone, causing it to lean backwards. Obesity is associated with increased risk of developing coccydynia.
Not Enough Weight: Less fat means less cushioning, which may cause your tailbone to rub against muscles, ligaments, or tendons. Anecdotally, rapid weight loss can also be a risk factor because of the loss of mechanical cushioning.

Prolonged Sitting

Sitting for long periods of time can cause excess pressure on your tailbone.

Read also: Myofascial Pain Syndrome Relief

Other Medical Conditions

In some rare cases, tailbone pain can be a sign of cancer near your coccyx or metastatic cancer that has spread to the bones. Nontraumatic coccydynia can result from a number of causes, including degenerative joint or disc disease, hypermobility or hypomobility of the sacrococcygeal joint, infectious etiology, and variants of coccygeal morphology. Less commonly, neoplasms have been associated with coccydynia.

Symptoms of Coccydynia

Tailbone pain is common. The classic presentation of coccydynia is localized pain over the coccyx. Patients present complaining of “tailbone pain.” Recognizing the symptoms can help in seeking timely intervention. The most common symptoms of coccydynia include:

Dull or sharp tailbone pain.
Tailbone pain that worsens when you go from sitting to standing.
Pain when you poop.
Pain with sex.
The pain will usually be worse with prolonged sitting, leaning back while seated, prolonged standing, and rising from a seated position.

Diagnosis of Coccydynia

Your healthcare provider will perform a physical exam and review your medical history. They will ask about previous injuries or trauma to the tailbone area. Then, they will examine the area to check for fractures, lumps, or signs of infection. Rectal examination allows the coccyx to be grasped between the forefinger and thumb. Manipulation will elicit pain and may reveal hypermobility or hypomobility of the sacrococcygeal joint. Normal range of motion should be approximately 13 degrees. Other causes of coccyx pain, such as infection etiologies (eg, pilonidal cyst), masses, and pelvic floor muscle spasms, should be ruled out. They may need diagnostic scans, like X-ray or CT scans to make a diagnosis. Radiographic images can more closely evaluate for the presence of fractures, degenerative changes, or masses.

Treatment Options for Coccydynia

Multiple conservative treatment options are available for coccydynia. Tailbone pain usually goes away on its own in a few days with the help of home remedies and patience. Conservative treatment is successful in 90% of cases, and many cases resolve without medical treatment. A multidisciplinary approach employing physical therapy, ergonomic adaptations, medications, injections, and, possibly, psychotherapy leads to the greatest chance of success in patients with refractory coccyx pain.

Non-Invasive Treatments

In 90% of cases, people with tailbone pain will find relief with noninvasive treatments, including:

Medications: Medications to help reduce pain and swelling. Nonsteroidal antiinflammatory drugs (NSAIDs) are the most common analgesic prescribed for coccyx pain; opioids generally are not recommended and are reserved for severe pain-usually from an acute injury-that is not responsive to other measures. Although to our knowledge no literature exists on the use of topical NSAIDs for coccydynia, studies have shown that these preparations are useful for other painful conditions such as osteoarthritis.
Sitting on a Pillow: Sitting on a pillow to take pressure off the tailbone. Modified wedge-shaped cushions (coccygeal cushions) can relieve the pressure on the coccyx while the patient is seated and are available over the counter. Circular cushions (donut cushions) have been suggested for the treatment of coccydynia but they can place pressure on the coccyx by isolating the coccyx and ischial tuberosities and are more useful for treating rectal pain.
Applying Hot or Cold Packs: Cold therapy reduces the swelling and inflammation that occurs after an injury. The ice pack can be applied to the area over a towel for 10-15 minutes at a time 3-4 times a day for the first 48 hours after the injury. The application of heat and cold over the site also may be beneficial. Patients should try both as one has not been shown to be superior to the other.
Rest: You may need to avoid activity and sitting on hard surfaces for a couple of weeks.
Postural changes: Training patients to adopt proper sitting posture can correct poor postures that can be contributing factors.
Dietary changes: Taking a stool softener, sitz bath, or over-the-counter treatments. Stool softeners can help if you have tailbone pain during bowel movements. If hemorrhoids are causing your pain, taking stool softeners, eating more fiber, soaking in a sitz bath, or applying topical over-the-counter medications for hemorrhoids can help.
Physical Therapy: Physical therapy can help you stretch your muscles and improve your posture. This may include a physical therapist showing you how to do pelvic floor relaxation techniques. Stretching exercises, including those that stretch the piriformis and iliopsoas, muscles in the buttocks and hips, may help relieve pain. But check with your doctor first to make sure the exercises will be helpful, not harmful, for your tailbone pain. Pelvic floor rehabilitation can be helpful for coccydynia that is associated with pelvic floor muscle spasms.

More Invasive Treatments

If home remedies don’t work, your provider may recommend treatments like:

Coccygeal Nerve Block: Numbing medication and steroids to relieve pain. Injections around the coccyx, usually at the sacrococcygeal junction or around the sacrococcygeal ligaments, of local anesthetic with steroid can be both diagnostic and therapeutic. These injections can also help identify patients who might benefit from a coccygectomy if all other conservative treatments fail. Caudal epidural steroid injections have been used to treat cases of coccyx pain resulting from Tarlov cysts and to treat lower sacral radicular pain. Another approach is to target the ganglion impar, also known as the ganglion of Walther. The ganglion impar is the pelvic portion of the sympathetic trunk located in the midline anterior to the sacrococcygeal junction. This block is useful in refractory cases and cases associated with pelvic pain, as well as for pain associated with malignant neoplasms.
Massage Therapy: Manual manipulation and massage can be both diagnostic and therapeutic. Intrarectal manipulation can identify and potentially correct a dislocated sacrococcygeal joint. Manual manipulation and massage can help relieve associated muscle spasms or ligament pain.
Acupuncture
TENS (transcutaneous electrical nerve stimulation). Transcutaneous electrical nerve stimulation can be beneficial, employing either an external technique with 2 cutaneous probes or an internal technique with 1 cutaneous probe and 1 intrapelvic probe.

Surgical Intervention

In extremely rare cases, your provider may recommend surgery to help with your tailbone pain. Surgical procedures for the treatment of coccydynia are used only as a last resort once all other treatment options have failed. There are two types of surgery:

Partial Coccygectomy: Partial removal of your coccyx.
Total Coccygectomy: Total removal of your coccyx. A coccygectomy is the surgical amputation of the coccyx just proximal to the sacrococcygeal junction. Limited data support this procedure, with most of the available literature being case reports and retrospective case series. The current literature suggests that a coccygectomy may provide relief in an appropriate subset of patients who have failed all other treatments. However, this procedure can be associated with a high complication rate and failure to relieve the pain. Consequently, based on current available information, this procedure generally is not recommended.

Prevention

There are several ways you can lessen your risk of tailbone pain and injury.

Sitting: Avoid long periods of sitting, especially on hard surfaces. Maintain good posture when you are sitting down. Sit upright. Keep your back against the chair. Keep your knees level with your hips. Keep your feet on the floor. Relax your shoulders.
Falling: Reduce your risk of falls. Use stair railings. Keep your floors and pathways clear. Try not to look at your phone while walking.
Physical Activity: Be careful during physical activity or sports. Use care while cycling or doing other activities that can put pressure on your tailbone.

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