Coccydynia

Coccydynia refers to the inflammation of the coccyx, which is the tip of the tailbone. It causes pain and tenderness in the area between the buttocks, particularly aggravated by sitting.

Symptoms of Coccydynia
The coccyx is the bony structure located deep between the buttocks, just above the anus. The main symptom is tenderness and pain in this specific area, especially when sitting, even for short periods of time. Additional symptoms include:

• Localized pain confined to the tailbone area, without radiating to the pelvis or lower extremities
• The pain can range from mild to severe and is often described as an aching soreness
• Pain may fluctuate with different pressure or movements and can be constant or intermittent
• Discomfort typically increases while sitting or leaning back in a seated position

Causes of Coccydynia
While direct trauma leading to inflammation is the most common cause of coccydynia, there can be underlying factors contributing to the condition, such as:

• Limited mobility: Reduced movement of the coccyx can cause it to protrude when sitting, increasing pressure on the sacrococcygeal joint and bones. Limited mobility may also result in tension in the pelvic floor muscles, leading to increased pain.
• Hypermobility: Excessive movement of the coccyx can put extra stress on the joint between the coccyx and the sacrum, or directly on the coccyx itself. Hypermobility can also pull the pelvic floor muscles attached to the coccyx, resulting in tailbone pain.
• Dislocation: Although rare, dislocation can occur when part of the sacrococcygeal joint becomes displaced either at the back or front of the tailbone, causing severe pain.

Diagnosis and Treatment of Coccydynia
A diagnosis of coccydynia can typically be made based on a thorough medical history and physical examination by a doctor. In some cases, additional diagnostic tests such as injections or scans may be recommended. The diagnosis process may involve:

• Assessment of local tenderness: The doctor will manually examine the area to identify tenderness and swelling around the coccyx.
• Evaluation for potential coccygeal tumors, cysts, or spicules (bone spurs).

In nearly 90% of cases, coccydynia can be successfully treated without surgery. Noninvasive treatments and activity modifications are usually effective. Self-care measures are the initial approach and include:

• Taking non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil, Aleve, or Celebrex to reduce inflammation and pain in the coccyx.
• Applying cold packs or ice to the area several times a day to reduce inflammation.
• Using a heating pad at the base of the spine to relieve muscle tension.
• Modifying activities to reduce pressure on the tailbone, such as adjusting posture, using a cushion to relieve weight on the coccyx, or limiting sitting time.
• Using custom U or V-shaped pillows designed to relieve tailbone pain while sitting.
• Dietary changes, such as increasing fiber and water intake, to address constipation or bowel movement issues that can worsen tailbone pain.

Other non-surgical treatments that can help alleviate tailbone pain include injections, manual manipulation, massage, stretching exercises, and the use of a TENS unit (transcutaneous electrical nerve stimulator), which applies electrical stimulation to interfere with pain signals transmitted from the tailbone to the brain.