Tailbone Pain: When sitting hurts….

What is tailbone pain?

Tailbone pain or coccydynia is pain at the lower most aspect of the backbone called the coccyx. Coccyx is positioned at the very bottom of your spine, near the buttocks and is formed of 3 to 5 of fused bony segments. Its structure including length, angle of the curve and degree of mobility varies significantly between individuals. It was once believed to be remnant of the lost tail with no relevant function. Now we understand that it provides support for sitting and a place for attachment for various muscles, tendons, and ligaments.

What causes tailbone pain?

Trauma and falls are the most frequent cause of coccydynia. Trauma can lead to break, dislocation, subluxation or bruising of the coccyx and the surrounding area. Minor repeated trauma such as during prolonged periods of sitting on hard surfaces might often go unrecognized. Spasm of the pelvic floor muscles can pull on the coccyx and lead to pain. Rare causes of coccydynia include cancers and infection. Sometimes coccyx pain is referred from the spine.

Coccydynia is four or five times more common in women. Anatomical changes in the shape of pelvis, coccyx and childbirth may account for this. Some studies have found that it is more common in obese individuals.

Signs and symptoms of tail bone damage:

Most patients present with a dull ache, which changes to a sharp or throbbing pain with activities such as getting up from a sitting position or prolonged sitting. With time the severity and duration of pain can increase. Activities such as sexual intercourse and opening of bowels may become painful. The pain can radiate towards spine, legs and affect day-to-day activities.

When should I see doctor?

Tailbone pain is can be self-limiting and resolve on its own within few weeks to months. Those with moderate to severe pain interfering with daily activities and adversely affecting the quality of life should seek medical advice sooner. Other common reasons for medical consultation include – persisting pain despite conservative management, uncertain diagnosis, associated symptoms such as signs of infection or swelling etc.

The pain physician will take a complete history, and do an examination to narrow the possibilities. You may be asked to undergo investigations such as X-ray, CT or MRI scan to confirm diagnosis and rule out other conditions with similar presentation.

How is this condition managed?

There is variety of treatment options ranging from lifestyle modifications/ conservative management to injections. Simple measures that can help include

• Find an experienced pain physician/ doctor who can help you to confirm the diagnosis and treat the condition
• Avoid prolonged sitting especially on hard surfaces and bumpy rides as while travelling on in a car/ bus
• Modify your sitting posture to reduce pressure on coccyx such as leaning towards one side or leaning forwards while sitting. One should be careful with this as it can often place extra pressure on other areas leading to new pain symptoms.
• Using a doughnut-shaped or wedge (V-shaped) cushion while sitting
• When getting up from the sitting position do so slowly
• Avoiding aggravating factors such as constipation
• Appling heat or ice to the affected area
• Simple over-the-counter pain relievers
• Physical therapy. Aimed at pelvic floor relaxation techniques, postural retraining and stretching exercises

For severe or persisting pain the pain specialist may consider

• Medication. Stronger pain relief medications
• Injections. These are used to break the pain cycle and involve placement of local anaesthetic and steroids near the pain generator. Commonly performed injections include
• Injection of joint or ligaments surrounding the sacrum and coccyx such as the sacrococcygeal joint
• Ganglion Impar nerve block. Nerve blocks help to interrupt a nerve’s ability to transmit pain signals
• Manipulation. This can be used in combination with injection therapy or separately. Massaging the muscles attached to the tailbone might help in reducing pain
• Surgery. Surgical removal of coccyx is known as a coccygectomy. Because of the associated risks (infection, wound healing problems) and poor outcomes, this procedure is not commonly recommended/ used