Coccydynia, also known as tailbone pain, refers to discomfort or pain in the coccyx, which is the lowest part or tip of the spine. This condition affects approximately 2% of the population, with women being more commonly affected than men. The pain is often linked to a fall on the buttocks or repetitive strain on the coccyx from prolonged sitting.

In this comprehensive guide, we explore the causes, symptoms, diagnostic methods, and treatment options for coccydynia, including both non-surgical and surgical approaches.

What is the Coccyx?

The coccyx, commonly called the tailbone, is a small triangular bone at the base of the spine. Though considered a vestigial structure, it plays a crucial role in supporting the body while sitting and is an attachment point for various ligaments, tendons, and muscles.

Common Causes of Coccydynia

Several conditions and mechanical factors can lead to tailbone pain:

1. Trauma or Injury: Direct trauma to the coccyx from a fall can cause fractures or bruising.
2. Abnormal Coccyx Anatomy: Excessive anterior angulation or hypermobility of the coccyx can lead to pain.
3. Childbirth: Vaginal deliveries may injure the coccyx due to pressure and displacement during labor.
4. Repetitive Strain: Activities like long hours of sitting, driving, cycling, or horse riding can lead to chronic irritation.
5. Coccygeal Pathologies: Rare conditions such as tumors or teratomas in the coccygeal region.
6. Rectal Disorders: Rectal conditions may refer pain to the coccyx.
7. Spine Conditions: Lumbar spine pathologies may sometimes mimic or contribute to coccygeal pain.

Symptoms of Coccydynia

The hallmark symptom of coccydynia is localized pain at the tailbone, especially when:

• Sitting for extended periods
• Rising from a seated position
• Bending backward
• Engaging in activities that put pressure on the coccyx (e.g., cycling, horse riding)

Other Notable Symptoms:

• Pain relief when standing or walking
• Discomfort during bowel movements (constipation often worsens pain)
• Tenderness in the lower back or coccyx area

How is Coccydynia Diagnosed?

Accurate diagnosis is key to effective treatment. Here are the steps typically involved:

1. History & Clinical Examination

Patients often describe a worsening of pain with sitting that improves with standing or lying down. On physical examination, there is localized tenderness in the coccygeal area.

2. Diagnostic Injection

A local anesthetic injection around the coccyx can help confirm the diagnosis. Immediate relief following injection suggests coccygeal origin of pain.

3. X-ray Imaging

X-rays can detect:

• Fractures of the coccyx
• Abnormal angulation or hypermobility
• Comparison of sitting and standing X-rays helps detect abnormal movement.

4. MRI Scan

MRI is essential when:

• Pain is chronic or non-responsive to initial treatment
• Differentiating bone edema from normal variants
• Ruling out tumors, infections, or spinal pathologies

5. CT Scan

Used sparingly, CT may help in identifying complex sacral fractures or suspicious bone lesions.

Non-Surgical Treatment Options for Coccydynia

Most cases of coccydynia improve with conservative (non-surgical) treatment.

1. Medications

• Painkillers and anti-inflammatory drugs reduce pain and swelling.
• Stool softeners help prevent straining during bowel movements.
• Nerve pain medications such as Gabapentin or Pregabalin for chronic pain.

2. Sitting Aids

• Donut-shaped pillows or cushions with a coccyx cut-out help offload pressure.
• Prefer firm surfaces over soft ones like sofas to avoid coccyx compression.

3. Sitz Baths

Warm water baths can soothe the inflamed area and improve blood flow.

4. Physiotherapy

• Pelvic floor exercises (Kegel exercises) can strengthen the muscles around the coccyx.
• Posture correction during sitting to avoid direct coccyx contact with hard surfaces.
• Avoid sitting on the floor or on excessively soft furniture.

5. Manual Therapy

Though not widely accepted by patients, manual coccygeal manipulation via rectal access has shown improvement in 63% of cases.

6. Steroid Injections

Injection of corticosteroids with local anesthetic is often effective in cases involving:

• Hypermobility
• Fractures
• Chronic inflammation

7. Nerve Blocks

In persistent or severe cases, temporary or permanent nerve blocks may help reduce pain.

Surgical Treatment (Coccygectomy)

When all conservative measures fail, surgical removal of the coccyx may be considered. This procedure is known as coccygectomy.

Indications for Surgery:

• Persistent pain despite months of non-surgical treatment
• Confirmed fracture or instability of coccyx
• Coccygeal tumors or teratomas

Things to Consider:

• Results can be unpredictable
• Surgery is a last resort
• Thorough counseling is necessary before opting for surgery
• Residual pain after surgery may still require medications or injections

When Should You See a Spine Specialist?

If you experience chronic tailbone pain that does not improve with rest, medication, or posture changes, it is important to consult a spine specialist. At Neo Spine Clinic, we offer a comprehensive evaluation and personalized treatment plan for patients suffering from coccydynia.

Conclusion: Tailbone Pain is Treatable

Coccydynia can significantly affect your quality of life, especially when it interferes with daily activities like sitting, driving, or working. Thankfully, most cases are treatable with proper diagnosis and conservative care.

 Dr. Amit Sharma provides expert care for coccygeal pain, from accurate diagnosis to advanced pain management techniques and minimally invasive procedures when needed.

Need Help with Tailbone Pain?

Book an appointment at Neo Spine Clinic, an experienced spine surgeon in Mumbai. Let us help you get back to a pain-free life.