Coccydynia: Tailbone Pain

Anatomy
The spinal column consists of the atlas and axis, 5 cervical (neck) vertebrae, 12 thoracic (midback) vertebrae, and 5 or 6 lumbar (low back) vertebrae. Below the last lumbar vertebra is the sacrum. The sacrum is made up of 5 bones fused into a triangular shape. At the bottom of the sacrum are 5 smaller bones, creating the coccyx.

The Cause of Coccydynia
There is no definitive cause for coccydynia. However, trauma from falling or being bumped, repetitive action (extensive bike riding or rowing), or childbirth can cause tailbone pain. Aside from an injury, coccydynia can appear to be spontaneous. Tailbone pain and lower back pain can mimic coccydynia in sciatica, infection, pilonidal cysts, and fractured bone. Your doctor will rule out these causes to make a coccydynia diagnosis.

Exams and Tests
The symptoms and examination findings of localized pain is typically all the doctor needs to diagnose coccydynia. If there is any question about the condition, the doctor can order a CT scan or MRI. Those tests are used to exclude bone or tissue disorders, such as a tumor.

Nonsurgical Treatment
Coccydynia usually is initially treated with noninvasive methods. A well-padded seat can provide relief. Patients typically are asked to avoid long periods of sitting, which can include lengthy concerts and airline flights. These treatments usually are sufficient to treat the tailbone pain. Rest also plays an important part to help avoid re-injuring the tailbone.

If pain is persistent, anti-inflammatory and pain medications can help reduce the lower back and coccyx pain. Should the medication be insufficient, the doctor can administer a local cortisone injection. Local nerve blocks also can be beneficial, especially when fluoroscopic guidance is used. For patients with recurrent, persistently troublesome tailbone pain, the injection can provide quick, thorough, and sometimes lasting relief; for some patients, the injection completely resolves the symptoms.

Surgical Treatment
In rare cases, the surgeon can perform a coccygectomy, or removal of the tailbone. The surgery can increase the risk of a perineal hernia (weakened pelvic muscles supporting the rectum) later in life, but otherwise is considered effective and relatively low risk.

Protect Your Tailbone
There is no definitive way to prevent coccydynia, but general caution while taking part in certain sports (e.g., skating [ice, inline, and roller], biking, and horseback riding) and careful footing in icy conditions can help minimize your risk for tailbone pain.