Bone & Joint Problems

COCCYDYNIA: A Pain in the Backside!

Everyone knows humans have a tailbone and where it’s located. Everyone knows when you fall backward and land on your tailbone it really hurts. And everyone knows if you sit on a hard surface too long its going to become sore. But not everyone has experienced tailbone pain.

Coccydynia, the medical term for pain in the tailbone, can be a very annoying problem. Sitting, which people are wont to do, becomes painful. And sometimes, nothing you do seems to relieve it. The small, segmented, flexible bone at the end of the spine is called the Coccyx. It extends downward from the sacrum, the large bone which connects to the lower lumbar spine and the pelvis. The coccyx is thought to be a remnant of the tail most mammals have. But the human tail never fully develops, and the coccyx is a vestige thereof. When the coccyx is bruised, it hurts because the tissues around it become inflamed. It‘s the inflammation of those surrounding tissues that results in patient discomfort.

The coccyx has very little fatty padding covering it so it is constantly exposed and very susceptible to injury. Prolonged sitting or falling directly on it will cause pain and tenderness that can potentially last for months.

Why is coccydynia such a problem? Why does it last so long? Why is it hard to get rid of? The answers to these questions are based on knowing the pathophysiology of the disorder. Coccydynia is usually traumatically-induced, but acute and chronic inflammation play a big part in the severity and prolongation of the pain. The coccyx has several segments that are slightly flexible. They bend when sitting, straighten when standing and walking, and must move out of the way during childbirth or bowel evacuation. It is a soft bone surrounded by tissue that easily becomes inflamed, and once it is inflamed stays inflamed until something is done to relieve it. Repeated prolonged sitting, sitting down too hard, or other aggravating activities re-inflame the already-sensitive tissues around the bone. Unless pressure on the coccyx and trauma to it are eliminated, the inflammation and pain will persist.

Coccydynia is easily diagnosed clinically by patient history and localized tenderness over the tailbone. Taking pressure off the tailbone is the basis of treatment. Avoiding prolonged sitting, lying one one’s side instead of sitting, and sitting on an inflated donut cushion or padded surface are all helpful. Taking anti inflammatory drugs (NSAID’s) and the application of ice or heat help to relieve the inflammation. A localized injection of a combination of local anesthetic and corticosteroid may also help. Physical therapy treatments are helpful for prolonged cases, and as a last resort, for severe or unrelenting pain, excision of the coccyx (coccygectomy) may be required. This measure is rather drastic but justified in some cases.

Dr. G’s Opinion: Some of the most uncomfortable patients I saw were those with Coccydynia. Most of us feel better when we sit down and relax, but Coccydynia sufferers have just the opposite effect; they are in pain when they sit. One lady was so uncomfortable I admitted her to the hospital (when you could do that) for pain control. Ice, heat, cushioning, padding, analgesics, and cortisone failed to give her relief, and hospitalization afforded her a chance to lie down, avoid stress, and relax. She finally got better, but it took quite a while.

The best treatment for coccydynia is to never get it in the first place. Avoiding prolonged sitting on hard, unpadded surfaces, long movies or sports events on bleachers, and protecting oneself from falling are important. At the first sign of tailbone pain begin NSAID’s, ice, and sit on a padded surface. Here, prevention is very important for avoiding major discomfort. A shot of cortisone in the tailbone area is quite painful so exhaust all conservative measures before doing that.

References: nhs.uk/Coccydynia

“Coccydynia (Tailbone Pain)” Shiel, RxList.com/diseases/coccydynia

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