Tail Bone Pain (Coccygodynia)

Tailbone pain or Coccygodynia, is a condition that can cause persistent pain at the very bottom of the spine (Coccyx). Coccygodynia is felt as a localized pain and is usually worse when sitting or with any pressure on the bottom area of the spine. The condition is more common in women, it is usually caused by local direct trauma, falling on your backside, or giving birth. On rare occasions, an infection or tumor can also cause pain in the coccyx.

The various terms are all used to describe a set of symptoms in the tailbone that can be caused by various injuries or conditions. Treatment may vary depending on the underlying cause of the symptoms and the severity and duration of the symptoms.

Coccygodynia symptoms may consist of one or all of the following:
– Pain that is markedly worse when sitting
– Local pain in the tailbone area that is worse when touched or when any pressure is placed on it
– Pain that is worse when moving from a sitting to standing position
– Pain that is worse with constipation and feels better after a bowel movement.

The coccyx is the very bottom portion of the spine and consists of three or more very small bones fused together. The coccyx is made up of between three and five separate or fused vertebrae. While it was originally thought that athe coccyx is always fused together (with no movement between the vertebrae), it is actually not one solid bone, and there is some movement between the bones permitted by the fibrous joints and ligaments. The coccyx is connected to the sacrum with ligaments, and there is limited movement between the coccyx and the sacrum as well.

Women are more susceptible to coccyx injury because the women’s coccyx is rotated, leaving it more exposed to injury, Women also have a broader pelvis so sitting places more pressure on their coccyx, and Childbirth is a common cause of coccyx pain.
It is difficult to determine the cause of coccyx pain. In many cases the exact cause of the pain is not known, pain can by caused in the coccyx if an injury or some type of excess pressure on the area causes the bones to move beyond their normal limited range of motion, resulting in inflammation and localized pain. An injury to either the ligaments or disc may cause pain. The bones of the coccyx can be fractured, and in rare cases a tumor or infection in the coccyx can be a primary cause of tailbone pain. Generally the cause of coccydynia will be one of the following.
– Local trauma. A fall on the tailbone. This is probably the most common cause of coccygodynia.
– Childbirth. During delivery, the baby’s head passes over the top of the coccyx, and the pressure created against the coccyx can sometimes result in injury to the coccyx structures (the disc, ligaments and bones). While uncommon, the pressure can also cause a fracture in the coccyx.
– Pressure. Certain 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 coccyx 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.
– Tumor or infection. Rarely, coccydynia is due to a tumor or infection in the coccyx area that puts pressure on the coccyx.

The diagnoses of coccygodynia is achieved through medical history and physical examination to check for a mass or tumor that could be a cause of the pain, and palpation to check for local tenderness which is the most common finding. If the coccyx is not tender to palpation, the pain is most likely referred from another structure such as the lumbar spine from ether disc herneation or degeneration. Diagnostic tests, such as x-ray or MRI, may also be performed in order to rule out other potential causes of the pain.

Initial treatment typically consists of: Applying ice or a cold pack to the area several times a day for the first few days after the pain starts, then applying heat or a hot pack to the area after the first few days. You should avoid sitting for prolonged periods, or placing any pressure on the area as much as apossible. You can use a custom donut or u-shaped pillow to help take pressure off the coccyx when sitting. If the tailbone pain is caused or increased with bowel movements or constipation, then increased fiber and water intake is recommended.

If the pain is persistent or severe, non-surgical treatment such as: Manipulation, gentle stretching, ultrasound, or electrical stimulation can be beneficial. After attaining sufficient pain relief so that movement is not too painful, daily low-impact aerobic activity is started, as the increased blood flow brings healing nutrients to the area and encourages the body’s natural healing abilities. The additional benefit of aerobic activity is the release of endorphins, the body’s inherent pain relieving process.

If conservative care fails to give adequate relief, surgical removal of the coccyx may be indicated.

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