The medical term for tailbone pain is coccydynia, referring to the tailbone or coccyx (pronounced coc-six) and refers to pain symptoms in the area of the tailbone. Even though this problem could affect individuals ages as well as gender, the typical age is forty years and the occurrence is 5 times higher with women compared to men. The term is actually taken from the Greek term for cuckoo because of it’s similarity to the beak of this bird. The tailbone is the last part of the spinal column and is a small bone that is just below the sacrum bone. It is made up of 3 – 5 small bones that, except for the first one, are usually fused together. The front part of the tailbone is slightly concave and the back part is slightly convex. The 5th nerve can exit through the tailbone, that also functions to attach the gluteus maximus and coccygeal muscles, as well as the anococcygeal ligament. Activities that put prolonged pressure on the tailbone, such as horseback riding and sitting on hard surface for long periods of time may cause the onset of pain.
Tailbone pain due to these causes usually is not permanent, but if the inflammation and symptoms are not managed, the pain may become chronic. People with tailbone pain most often complain of pain in and around the coccyx without significant low back pain, pain radiation or referral of pain to other areas. However, low back pain is known to be higher in individuals with tailbone pain compared to the general population, particularly those with a coccyx that is curved forward with the end pointed straightforward. Classically, this pain is associated with sitting and is worse when getting up from a seated position and can be relieved with standing or walking. Pain may be worse with constipation and feels better after a bowel movement. Pain may also be present with intercourse. Others may report relief of their pain when they sit on their legs or on one buttock. A fall on the tailbone which can inflame the ligaments or injure the coccyx or the attachment to the sacrum is probably the most common cause of tailbone pain.
Most instances of tailbone pain arise with a subluxated (not dislocated) or hypermobile (excessive motion) coccyx, which results in lack of stability that could produce persistent swelling. Most claim a medical history of injury or trauma, which is associated with tailbone or coccyx instability, especially a subluxation such as happens with a fall on the buttocks or even prolonged labor and giving birth, in which the child’s head goes over the coccyx, where the force can sometimes damage the coccyx components ( disc, ligaments as well as bones). While not common, the force may result in a fracture of the coccyx. Obesity is seen 3 times more with individuals having tailbone pain than the average population. Obese people mostly have posterior subluxation, while individuals having normal weight suffer mostly hypermobility and thin individuals usually have forward or anterior subluxations. The tailbone of a thinner individual rotates when sitting positioning the coccyx optimally to absorb forces.
As bodyweight increases, rotation of the pelvis during sitting is less, angle is greater and the tailbone is more susceptible to pressure that occurs from falling and with repeated sitting. This pressure is responsible for increasing risks of having a posterior subluxation, which is more common in falls. Below and normal weight individuals are more prone to developing tailbone pain besides a posterior subluxation as the coccyx rotates more optimally to reduces the force from falling and sitting. Tailbone pain may be seen in x-rays with normal a normal coccyx. Rarely, pain can happen from bursitis, arthritis, infection or a tumor. The pain may also result from spasm or other problems with the pelvic floor muscles. During an examination by a doctor, area over the tailbone is checked for a pilonidal cyst, which is a sometimes painful ingrowth of hair follicle(s). This area can have local swelling and tenderness. Additionally, a mass may a tumor or bone. For most instances of tailbone pain, direct manipulation rectally of the coccyx produces pain.
Coccydynia is a clinical diagnosis for tailbone pain and imaging studies are valuable in evaluation and assessment. Radiographs may be taken to look for fracture or obvious displacement or subluxation. Radiographs in sitting as well as standing positions can be more beneficial than regular radiographs since they permit measurements of pelvic rotation and angle of the coccyx. Comparing standing with sitting x-rays can revealc abnormal findings for up to 70 percent of tailbone pain sufferers. Five to twenty five degrees of rotation is normal, so hypermobility is greater than twenty five degrees. Magnetic resonance imaging (MRI) can show inflammation and CT or bone scanning may rule out pathologies like chordomas. Obtaining pain relief using injections of local anesthetics can aid in the diagnosis. Non-surgical regarding tailbone pain includes medicines like non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen pain killers, minimal sitting, stool softeners, a tailbone cushion as well as additional postural changes intended for unloading, ice at first and then moist heat following a few days, ultrasound therapies and also manual treatment such as massage, stretches, and also joint mobilization.
Coccygeal adjustment may shift the coccyx back to it’s correct placement and relieve pain. People who have normal tailbone movement respond better to these types of therapies. Using loose fitted clothing that won’t place pressure on the area around the tailbone is advised. Additionally, it may help by wearing flat, comfortable footwear. Many individuals having tailbone pain find it more comfortable to sleep on their side . You can even try to sleep using a body pillow or cushion in between the knees. It may take weeks or even months of conventional therapy before substantial tailbone pain relief is experienced. Depression as well as anxiety, if existing – particularly if the pain has been a problem for a long time – really should be treated. A mix of therapies in order to diminish pain as well as activity changes in order to keep pressure away from the tailbone is generally adequate in order to manage or relieve the pain. Localized injections into tailbone region is a possible means of therapy when non-operative measures fail.
For some with ongoing pain, injections along with manipulation of the coccyx while using general anesthesia can be used. Corticosteroid injections reduce inflammation and pain and may be combined with local anesthetic to make them even more effective. Corticosteroid injections relieve the symptoms of tailbone pain, although the effects may only last for several weeks at a time. Corticosteroid injections can’t cure the condition and too many corticosteroid injections can damage your tailbone and lower back, so you may only be able to have this type of injection once or twice a year. A ganglion nerve block for the cluster of nerves next to your tailbone may help nerves that many of the pain signals travel. A ganglion nerve block temporarily suppresses these nerves by injecting them with a local anesthetic to stop them transmitting pain signals. Unlike corticosteroid injections, it is usually safe to have repeated injections of local anesthetic. Surgery is only considered in rare instances, and only in very severe cases, however, it may be appropriate in certain patients who suffer tailbone pain that is disabling and have not responded to non-operative therapies.