FAQ’s on Coccydynia (Tailbone Pain) Treatment in Las Vegas

Coccydynia is type of very low back pain felt around the tailbone (coccyx). This bone is located at the very bottom of the spine, and formed of fused bones. Coccydynia pain is usually worse with prolonged sitting or moving from a seated position to a standing position.

How common is coccydynia?

Coccydynia affects women more often than men. According to statistics, 1 out of every 100 people have coccydynia at some time during their lives. Older persons are more prone to tailbone pain, but children and young adults can also experience coccydynia.

What symptoms are associated with coccydynia?

Coccydynia pain varies from patient-to-patient. It can be mild to severe, dull to sharp, or intermittent to constant. In addition, symptoms associated with coccydynia pain when sitting on a hard surface, painful passing of stool, and pain with sex.

What can cause coccydynia?

Most coccydynia is caused by trauma and/or fracture to the coccyx, such as a fall onto the buttocks. Stretching of the muscles or ligaments supporting the coccyx can cause coccydynia as well. This can occur when the coccyx is moved out of normal position from repeated activities (rowing or cycling) or from poor posture.

What are the risk factors for coccydynia?

Certain people are at risk for developing coccydynia. Risk factors associated with this condition include:

  • Being overweight – Excessive weight puts pressure on the coccyx, causing pain.
  • Having osteoporosis – Weak, brittle bones increases the risk for coccyx fracture.
  • Playing contact sports – This puts a person at risk for falling onto the tailbone.
  • Having osteomyelitis – This condition causes frequent bone fractures.
  • Prolonged sitting – This occurs from work, riding bicycles, horseback riding, and motorcycle riding.
  • Traumatic childbirth – Pressure on the coccyx, damaged to the muscles, and ligament stretching.
  • Having inflammatory bowel disease – Ulcerative colitis and Crohn’s disease can produce referred pain to the coccyx region.

How does the doctor diagnose coccydynia?

When a patient has tailbone pain, the doctor will ask questions about the associated symptoms, take a medical history, and perform a physical examination. X-rays of the coccyx are used to assess for tumors, fractures, and displaced bones. To check for support structure damage (ligaments and muscles), a magnetic resonance imaging (MRI) test can be done.

What is the treatment of coccydynia?

For chronic tailbone pain, the doctor often uses a combination of treatments. Options are:

  • Medications – Mild pain relievers are used first, such as nonsteroidal anti-inflammatory drugs (NSAIDs). These include ketoprofen, ibuprofen, and naproxen. For severe pain, the doctor may prescribe a narcotic agent short-term, such as hydrocodone or codeine.
  • Donut cushion – To take pressure off the coccyx, the doctor will order a special donut-shaped device. The outer portion is elevated to keep the buttocks from putting pressure on the coccyx.
  • Corticosteroid injection – The doctor can inject a long-acting corticosteroid into the area near and around the coccyx. This decreases inflammation, swelling, and pain.
  • Physical therapy – This involves exercises to strengthen supporting muscles and stretch ligaments near the coccyx. Pain relief measures include massage, ultrasound, electrical stimulation, and heat/cold therapies.
  • Ganglion impar block – The ganglion impar is a bundle of nerves located in front of the sacrum-coccyx joint. The doctor will insert a small needle near the nerves using x-ray guidance for placement verification. A long-acting anesthetic, with or without a neurolytic agent, is instilled onto the nerves. Based on clinical studies, this block has a 95% success rate.
  • Radiofrequency ablation (RFA) – The doctor can insert a small needle and probe near the coccyx nerves to deliver radiofrequency energy. This destroys a portion of the nerve root. A recent clinical study found that this procedure produced a 50% reduction in pain scores for participants, with pain relief lasting for up to six months.

Resources

Agarwal-Kozlowski K, Lorke DE, Habermann CR, et al. (2009). Computed guided blocks and neuroablation of the ganglion impar (Walther) in perineal pain: anatomy, technique, safety, and efficacy. Clin J Pain, 25(7):570-6.

Balain B, Eisenstein SM, Alo GO et-al. (2006). Coccygectomy for coccydynia: case series and review of literature. Spine, 31 (13): E414-20.doi:10.1097/01.brs.0000219867.07683.7a

Ferrante FM, et al. (2004). Radiofrequency sacroiliac joint denervation for sacroiliac syndrome. Pain Medicine, 5(1):26–32. doi: 10.1111/j.1526-4637.2004.04009.x

Lirette LS, Chaiban G, Tolba, R, & Eissa H (2014). Coccydynia: An overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner Journal, 14(1), 84-87.