Bone pain and tailbone

Dr. Mahdi Saeedi

The tailbone The medical term for tailbone pain is coccydynia, referring to the tailbone or coccyx (pronounced coc-six) and refers to pain symptoms in the area of the tailbone. Even though this problem could affect individuals ages as well as gender, the typical age is forty years and the occurrence is 5 times higher with women compared to men.

Tailbone Injury Overview

A coccyx injury results in pain and discomfort in the tailbone area (the condition is called coccydynia). These injuries may result in a bruise, dislocation, or fracture (break) of the coccyx. Although they may be slow to heal, the majority of coccyx injuries can be managed with cautious treatment.

The coccyx is the triangular bony structure located at the bottom of the vertebral column. It is composed of three to five bony segments held in place by joints and ligaments.

The majority of coccyx injuries occur in women, because the female pelvis is broader and the coccyx is more exposed.

Tailbone Injury Causes

Most tailbone injuries are caused by trauma to the coccyx area.

  • A fall onto the tailbone in the seated position, usually against a hard surface, is the most common cause of coccyx injuries.
  • A direct blow to the tailbone, such as those that occur during contact sports, can injure the coccyx.
  • The coccyx can be injured or fractured during childbirth.
  • Repetitive straining or friction against the coccyx (as happens in bicycling or rowing) can injure the coccyx.
  • Sometimes, the cause of coccyx injuries is unknown.
  • Less common causes of coccyx injuries include bone spurs, compression of nerve roots, injuries to other parts of the spine, local infections, and tumors.

Tailbone Injury Symptoms

  • Severe localized pain and tenderness may be felt in the tailbone area.
  • If the injury is traumatic, a bruise may be visible in this area.
  • The pain is generally worse when sitting for prolonged periods of time, or with direct pressure to the tailbone area.
  • Bowel movements and straining are often painful.
  • Some women may experience pain during sexual intercourse.

When to Seek Medical Care

If you have the signs and symptoms of a coccyx injury or unexplained discomfort in the tailbone area, contact your doctor. It may be necessary for the doctor to decide if the injury is traumatic or if the pain is caused by other, more serious, problems.

Injuries to the region of the tailbone rarely require a visit to the emergency department. However, if you are concerned about your symptoms, it is wise to call a doctor or visit the nearest hospital's emergency department.

Exams and Tests

The cause of a coccyx injury is largely determined based on a medical history and a physical exam. Occasionally, X-rays are taken.

  • The entire vertebral column (spine) may be examined. A neurologic exam may be performed. A rectal exam may also be performed. For this exam, the doctor inserts a finger into your rectum to feel the area of the coccyx and determine if there is a dislocation or a fracture that can be felt and if direct pressure against the coccyx reproduces your pain.
  • Rarely, if the cause of discomfort is unknown, a local anesthetic may be injected into the tailbone area to determine whether the origin of the pain is from the coccyx or another part of the vertebral column.
  • X-rays may be taken to determine whether there is a fracture or dislocation. However, X-rays occasionally may not reveal these injuries. Some doctors recommend X-rays in both the standing and seated positions to better determine the presence of a fracture or dislocation.

Tailbone Injury Treatment

Nonsurgical

Non-surgical regarding tailbone pain includes medicines like non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen pain killers, minimal sitting, stool softeners, a tailbone cushion as well as additional postural changes intended for unloading, ice at first and then moist heat following a few days, ultrasound therapies and also manual treatment such as massage, stretches, and also joint mobilization. Coccygeal adjustment may shift the coccyx back to it’s correct placement and relieve pain. People who have normal tailbone movement respond better to these types of therapies. Using loose fitted clothing that won’t place pressure on the area around the tailbone is advised. Additionally, it may help by wearing flat, comfortable footwear. Many individuals having tailbone pain find it more comfortable to sleep on their side . You can even try to sleep using a body pillow or cushion in between the knees. It may take weeks or even months of conventional therapy before substantial tailbone pain relief is experienced. Depression as well as anxiety, if existing – particularly if the pain has been a problem for a long time – really should be treated. A mix of therapies in order to diminish pain as well as activity changes in order to keep pressure away from the tailbone is generally adequate in order to manage or relieve the pain.

Injections

Localized injections into tailbone region is a possible means of therapy when non-operative measures fail. For some with ongoing pain, injections along with manipulation of the coccyx while using general anesthesia can be used. Corticosteroid injections reduce inflammation and pain and may be combined with local anesthetic to make them even more effective. Corticosteroid injections relieve the symptoms of tailbone pain, although the effects may only last for several weeks at a time. Corticosteroid injections can’t cure the condition and too many corticosteroid injections can damage your tailbone and lower back, so you may only be able to have this type of injection once or twice a year. A ganglion nerve block for the cluster of nerves next to your tailbone may help nerves that many of the pain signals travel. A ganglion nerve block temporarily suppresses these nerves by injecting them with a local anesthetic to stop them transmitting pain signals. Unlike corticosteroid injections, it is usually safe to have repeated injections of local anesthetic.

Manual therapy

Manual therapy can be used as a conservative treatment for a coccyx injury by aiming to relax and extend the muscles in the area. Once musculofascial balance is restored to the pelvic bowl and lumbar spine, the therapist can use ligaments as levers to help move the coccyx back into a correct position. This can be done in a sitting, prone or side lying position. The therapist begins by palpating the coccyx and pulling the attached ligaments in a posterior direction. After holding for a period of 10-60 seconds the tissues surrounding the coccyx should begin to release. A contract-relax method can be used in conjunction with this technique. As the coccyx is pulled posterior, the client is asked to do a gentle contraction of the pelvic floor muscles for 3-5 seconds. Upon relaxation, the coccyx can be moved further posterior

Home Remedies

Tailbone injuries are often extremely painful, so home remedies aim to control pain and avoid further irritation to the area.

  • Avoid sitting down for long periods of time. When seated, avoid sitting on hard surfaces and alternate sitting on each side of the buttocks. Also, lean forward and direct your weightaway from the tailbone.
  • For traumatic injuries, apply ice to the tailbone area for 15-20 minutes, four times a day, for the first few days after the injury.
  • Take nonsteroidal anti-inflammatory drugs (NSAIDS) such as aspirinor ibuprofento reduce pain and improve your ability to move around. Do not take NSAIDS if you have kidney disease, a history of gastrointestinal bleeding, or are also taking a blood thinner -- such as Coumadin -- without first talking with your doctor. In that case, it is safer to take acetaminophen, which helps lessen pain but does not reduce inflammation.
  • You can purchase a "doughnut" cushion or pillow to sit on. This cushion has a hole in the middle to prevent the tailbone from contacting the flat surface.
  • Eat foods high in fiber to soften stools and avoid constipation.

Surgery

Surgery is only considered in rare instances, and only in very severe cases, however, it may be appropriate in certain patients who suffer tailbone pain that is disabling and have not responded to non-operative therapies. Generally, surgery consists of removal of a hypermobile segment or complete removal (coccygectomy). These options may be used in those individuals with advanced degeneration with coccyx instability (e.g., subluxation or hypermobility) and are successful between 60 – 91 percent.