This not an uncommon condition. In summary coccydynia is pain in the coccyx.
Coccyx is the last bony structure in the vertebral column. Some people have a long coccyx. Es specially in thin people this can be prominent.
I have hardly seen an obese patient coming to me with coccygeal pain. That is because the fat in buttocks acts as a cushion. Most of my patients who come to me with this problem are thin and healthy. Commonest conditions where the coccyx can damage are
1. Trauma (Fall)
2. Child Birth
3. Repetitive pressure on the tail bone like sitting, horse riding and motor bike riding
Diagnosis
Mainly by examining the coccyx
Rectal examination
X ray and MRI to exclude
other conditions
Coccyx on standing and seated position
Prevalence
A study of 2000 cases of back pain referred to hospital found that 2.7 percent were diagnosed as coccydynia (9).
This type of pain occurs five times more frequently in women than in men. It can occur at any age, the mean age of onset being around 40.
There are no ethnicity or race associations with coccydnia
Clinical Features
Activities that put pressure on the affected area are cycling, horseback riding, and other activities such as increased sitting that put direct stress on the coccyx.
The medical condition is often characterised by pain that worsens with constipation and may be relieved with bowel movement. Rarely, even sexual intercourse can aggravate symptoms.
Treatment
Since sitting on the affected area may aggravate the condition, a cushion with a cutout at the back under the coccyx is recommended.
If there is tailbone pain with bowel movements, then stool softeners and increased fiber in the diet may help.
Anti inflammatory drugs may help If the pain persists, other treatments may be applied.
Manual treatment is carried out by repeated massage of the muscles attached to the coccyx, via the anus.
Interventions
1. Pain consultants commonly inject corticosteroids into the Coccyx.
2. Coccygeal never block Sacro coccygeal membrane block
3. Ganglion Impar block - This is what I mostly do in England
4. Manipulation of the coccyx under anaesthesia Surgery
Coccygectomy - Removing the coccyx
Ganglion Impar Block
Dr Namal Senasinghe
MBBS, Dip in Pain Med, FFARCS, FFPMCA Consultant in Pain Medicine Sandwell & West Birmingham Hospitals NHS Trust - United Kingdom
[email protected]
& of London Pain Clinic
31 Horton Place
Colombo 7 - Sri Lanka