Coccygodynia

Coccygodynia (tailbone pain) is quite common, and is felt more keenly when that patient sits or tries from a sitting position. Although most cases resolve by themselves within weeks or months, it can become a chronic condition for some. These individuals may have pain in the pelvis and perineum when defecating, urinating or engaging in sexual activities.

Who is at risk for having pain over the tailbone? 

• Females are 5 times as likely to have tailbone pain, probably because of stress in the pelvis from pregnancy and delivery
• Patients who are overweight 
• Patients who have rapid weight loss, due to the loss of cushioning around the tailbone. Their tailbone is also more likely to move forward, which increases pressure and pain.

Causes of tailbone pain include

• Fall with direct impact on tailbone
• Prolonged sitting on hard surfaces like cycling
• Difficult labour
• Assisted delivery
• Abnormal disc in the spine
• Anatomical variant (type 2/3/4 coccyx)
• Tailbone that moves too much or too little
• Abnormal muscle tone of the pelvic floor muscles

Symptoms of cocccygodynia / tailbone pain

• Sensation of ‘cutting’ or ‘pulling’
• Need to sit on one buttock and lift the other off to take weight off the tailbone
• Worse on prolonged sitting or when standing up from sitting position
• Better when sitting on legs in a kneeling positing
• Pain worse when defecating, coughing or when having a period
• Pain during sexual intercourse

How do you treat coccygodynia?

• Physiotherapy, massage and medications
• Pain procedures:
  • caudal epidural
  • Steroid injections
  • ganglion impar injection/radiofrequency
  • spinal cord stimulation
• Open surgery