Causes of coccyx pain and treatment options

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Pain in the coccyx (coccydynia) can develop after an injury to the coccyx (or coccyx ), which can result from degenerative changes in the joints, as well as as a result of an acute or repeated injury. Riding a horse and giving birth through the birth canal are some of the most common causes of coccydynia.

It is an unpleasant sensation that can range from a mild stabbing pain to a sharp, disabling and severe pain that radiates up and / or down. Pain and discomfort usually occur when sitting, standing for long periods of time, and get up from a sitting position. Pain during bowel movements and sexual intercourse is also common.

The coccyx is the point of attachment of various muscles, tendons, and ligaments. It consists of three, four, or five small bones called coccygeal vertebrae, found at the end of the spine, below the sacrum (a triangular-shaped bone located between the two hip bones).

Get Medical Information / Alexandra Gordon

Causes

There are several potential causes of coccyx pain, some of which are more common than others.

Common causes

The most common cause of coccyx pain is trauma. Because the coccyx is the site of attachment for many muscles and ligaments, this can include severe direct trauma or repeated trauma to the bones of the coccyx or the surrounding muscles or ligaments.

Acute injury: A fall on the back or any injury to the tailbone can cause inflammation or deformation of structures in the tailbone area.

Trauma can cause bruising or fracture of the tailbone. In rare cases, a dislocation of the sacrococcygeal joint can occur, which is located between the upper part of the sacrum and the base of the coccyx.

Repeated trauma : Activities such as horseback riding or cycling can increase the risk of coccyx pain from repeated pressure or friction against the coccyx for prolonged periods. Similarly, simply sitting on a hard surface during a long trip in a car or plane can cause tailbone pain.

Vaginal labor: A vaginal delivery, especially if labor is difficult and forceps are used, can cause coccyx pain due to pressure on the top of the tailbone of the baby's head. Usually, tailbone pain during childbirth occurs as a result of a bruised bone or sprains, although sometimes the tailbone can break.

Degenerative joint disease: Wear and tear from repetitive motions can cause osteoarthritis , a degenerative joint disease that can affect any joint in the body, including the tailbone.

Unique morphology of the coccyx: The number of coccygeal bones varies in humans. Also, some people have a spur or spicule (bony growth) located at the lower end of the tailbone.

This growth can irritate the coccyx area when a person is sitting. It can pinch the skin and fatty tissue between the spur and the stool. In addition to bone growth, some experts point to scoliotic deformity as a possible cause of coccydynia.

Nerve pain: A group of nerves called gangliosis is located in front of the upper part of the tailbone. Increased activity or irritation of these nerves can cause chronic coccyx pain.

Pelvic Floor Muscle Spasms – Because the tailbone serves as an attachment point for a deep layer of pelvic floor muscles (called the levator ani), muscle spasms and irritation can cause levator ani syndrome , a condition that causes a dull, aching ache that is often felt in the tailbone and higher in the rectum.

Rare causes

Although other causes of coccyx pain are less common, they can be especially dangerous and require urgent medical attention.

Cancer: In rare cases, the source of coccyx pain may be a malignant tumor that metastasizes to the coccyx (for example, cancer of the prostate, ovary, cervix, or colon). Also, in rare cases, chordoma, which is a primary tumor of the bone, can occur in the coccyx or in the coccygeal region.

Infection: a localized infection in the coccyx, such as A pilonidal cyst can cause swelling and pain in the coccyx area, as well as redness, warmth, and pus (thick, whitish fluid).

Osteomyelitis , an infection of the bones, can also rarely cause coccydynia. It can start as a deep ulcer of the sacrococcygeal ulcer and can cause signs of infection, such as fever, warmth, and redness near the coccyx.

When to contact a healthcare provider

If you have severe and debilitating tailbone pain, for example, unable to go to work, take care of children, or at home, be sure to see your doctor.

Other symptoms of tailbone pain that require medical attention include:

  • Persistent pain despite conservative treatment
  • A lump or formation on the tailbone
  • Fever or redness, warmth, swelling, or drainage near or on the tailbone.

Diagnostics

Your medical history may indicate an inflammatory factor, such as a direct fall or other injury to the tailbone. Or you may have a more gradual onset of tailbone pain. In this case, the physical exam plays a key role in diagnosing the "why" of coccyx pain.

Physical exam

During a physical exam, your doctor will first examine your tailbone for signs of bruising, swelling, a rash, or infection (warmth, redness, or discharge). A dimple in the skin can be a sign of a tailbone spur. Your healthcare provider will press on your tailbone to see if you have any local tenderness that could indicate a fracture.

Also, in some cases, your healthcare provider may perform a rectal exam. During this exam, your healthcare provider inserts a lubricated, gloved finger into your anus, holding the tailbone with the thumb and forefinger, to assess the sacrococcygeal joint and surrounding ligaments for joint tenderness and range of motion.

Display

X-rays do not always reveal an injury to the coccyx, but your healthcare provider may perform one while you are standing or sitting to assess the extent of the coccyx injury and observe any alignment problems, dislocations, or coccyx fractures. … Magnetic resonance imaging (MRI) can detect cancer or infection of the coccyx.

Differential diagnosis

Tailbone pain feels like it is coming from the tailbone when it is actually coming from another part of the body.

Medical conditions that may indicate coccyx pain include:

Lumbar Spine Disease: A degenerative disc disease in the lumbar spine can cause coccyx pain. The key to distinguishing lumbar spine disease from true coccyx disease is that with spinal disease there will be no pain in the coccyx.

Pelvic disease: Pelvic disease, such as pelvic inflammatory disease in women or prostatitis in men, can cause tailbone pain.

Proctalgia fleeting: Proctalgia fleeting refers to intense and fleeting episodes of rectal pain. It may be due to compression of the pudendal nerve. The pudendal nerve is the main nerve of the perineum, which is the area between the coccyx and the pubic symphysis.

Watch out

Most cases of coccyx pain can be treated with lifestyle changes.

Keep in mind that a bruised coccyx can take several days to several weeks to fully heal, and a broken coccyx can take four to six weeks. In general, you will be able to slowly return to your activities as you recover. A full return to sports may depend on the sport you are involved in, but you must be able to sit, bend, and walk without pain before you can resume high-performance activities.

Lifestyle treatment options

Here are some self-care strategies you can use at home to ease pain and prevent further injury as you recover.

Avoid sitting for a long time: While sitting, lean forward to relieve the strain on your tailbone. Some people sit on a "donut," a round pillow with a hole in the middle, to relieve pressure on the tailbone; This can actually isolate the tailbone and put more pressure on it. Instead, choose a modified wedge-shaped pillow (called a coccygeal pillow) to relieve pressure on the tailbone. They are available without a prescription.

Apply ice or heat: Ice can be applied to the coccyx area for 10-15 minutes several times a day for three days after the injury to reduce pain. Using a heating pad can also be helpful. Experts recommend trying both ice and heat to see which strategy works for you, as neither has been better than the other.

Avoid constipation: Eating high-fiber foods and drinking plenty of water can help soften your stool and make bowel movements easier.

Medicine

Your healthcare provider may also recommend topical or oral nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation.

If your pain persists despite conservative measures, your doctor may prescribe a stronger pain reliever or inject a steroid into the joint or ligaments surrounding the sacrum and coccyx to control chronic pain. An unpaired ganglion block can also provide relief if it is believed to be the source of your pain.

If an infection is causing pain in the tailbone, antibiotics and possibly a surgical incision of the abscess and drainage may be needed.

Physiotherapy

If spasms of the pelvic floor muscles are the cause of coccydynia, physical therapy is the preferred treatment. Therapeutic interventions often include posture retraining exercises, stretching, and reverse Kegel exercises.

Operation

Very rarely, an operation called a coccygectomy (in which the tailbone is surgically removed) is used to relieve pain .

Prophylaxis

While many coccyx injuries cannot be prevented, it is important to wear proper protective gear and sports equipment. Proper padding often reduces the risk of tailbone injury.

Get the word of drug information

Tailbone pain is a fairly common condition, so try not to be ashamed or embarrassed about it. I hope you can calm yourself down knowing that in the vast majority of cases, coccyx pain goes away with simple measures, such as avoiding aggravating factors (like sitting for a long time) and taking oral pain relievers.

Frequently asked questions

  • Doctors often recommend lying on your side to relieve pressure on the tailbone. Other strategies that may work include using a soft foam topper or special cut-out pillows so that you can lie on your stomach with your head down.

  • Certain circumstances during childbirth put pressure on the tailbone and can cause coccydynia or pain in the tailbone. Difficult deliveries increase the risk, and the use of forceps for these deliveries further increases the risk. Mothers with a BMI greater than 27 may also experience tailbone injuries.

  • Yes, but contact sports that can cause repeated injuries to the tailbone should be avoided, along with seated exercises like cycling or rowing that put pressure on the area. Stretching is recommended, and a physical therapist can suggest exercises to help you recover from a particular injury.

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