Coccydynia is a medical term meaning pain in the coccyx or tailbone area, often brought on by a fall onto the coccyx or by persistent irritation usually from sitting.
Synonyms
Coccydynia is also known as coccygodynia, coccygeal pain, coccyx pain, or coccalgia. Other ways that coccydynia develops are partial dislocation of the sacrococcygeal synchondrosis that can possibly result in abnormal movement of the coccyx from excessive sitting, and repetitive trauma of the surrounding ligaments and muscles, resulting in inflammation of tissues and pain.
Diagnosis
A number of different conditions can cause pain in the general area of the coccyx, but not all involve the coccyx and the muscles attached to it. The first task of diagnosis is to determine whether the pain is related to the coccyx. Physical rectal examination, high-resolution X-rays and MRI scans can rule out various causes unrelated to the coccyx, such as Tarlov cysts and pain referred from higher up the spine. Note that, contrary to most anatomical textbooks, most coccyxes consist of several segments: 'fractured coccyx' is often diagnosed when the coccyx is in fact normal or just dislocated at an intercoccygeal joint.
A simple test to determine whether the coccyx is involved is injection of local anesthetic into the area. If the pain relates to the coccyx, this should produce immediate relief.
If the anesthetic test proves positive, then a dynamic (sit/stand) X-ray or MRI scan may show whether the coccyx dislocates when the patient sits.
Use of dynamic X-rays on 208 patients who gave positive results with the anesthetic test showed:
- 31% not possible to identify the cause of pain
- 27% hypermobility (excessive flexing of the coccyx forwards and upwards when sitting)
- 22% posterior luxation (partial dislocation of the coccyx backwards when sitting)
- 14% spicule (bony spur) on the coccyx
- 5% Anterior luxation (partial dislocation of the coccyx forwards when sitting)
This study found that the pattern of lesions was different depending on the obesity of the patients: obese patients were most likely to have posterior luxation of the coccyx, while thin patients were most likely to have coccygeal spicules.
Angle of incidence
Sagittal coccygeal movement is measured using the angle of incidence—or the angle at which the coccyx strikes the seat when an individual sits down. A smaller angle indicates the coccyx being more parallel to the seat, resulting in flexion (or "normal" movement) of the coccyx. Coccydynia due to these causes usually is not permanent, but it may become very persistent and chronic if not controlled. Coccydynia may also be caused by sitting improperly thereby straining the coccyx.
Rarely, coccydynia is due to the undiagnosed presence of a sacrococcygeal teratoma or other tumor in the vicinity of the coccyx. 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.
Orthopaedic surgeons commonly inject corticosteroids into the painful joint. Maigne and Tamalet applied this treatment to 86 patients under fluoroscopic guidance. Two months after the injection, 50% of the patients with luxation or hypermobility were improved or healed, but only 27% of the patients with no visible abnormality improved. Where an abnormality had been found, and injection relieved the pain, the abnormality remained but ceased to be painful.
Temporary or permanent nerve blocks are sometimes applied in cases of coccydynia. Foye et al. reported that repeated temporary nerve blocks by injection at the ganglion impar could give relief in a number of cases, and occasionally a single injection was sufficient.
Surgical treatment
If non-surgical treatments fail to relieve the pain, or in cases of cancer, surgery to remove the coccyx (coccygectomy) may be required. Coccygotomy (severing the tendons and ligaments attached to the coccyx) has also been historically used to treat coccydynia. Coccygeoplasty, which involves injections of polymethylmethacrylate (PMMA) cement into the sacrococcygeal segments, been used more recently.
In cases where pain persists after surgery, standard drugs for chronic pain, such as tricyclic antidepressants, may help alleviate the pain.
Prevention or to ease coccyx pain
Body positioning and alignment is significant for producing less stress in the coccyx region. Bad posture can influence coccyx pain. People may not realize that they are over-stressing their coccyx while doing daily activities. Pain in the coccyx can be caused from many incidents like falling, horseback riding, or even sitting on hard surfaces for a long period of time. The main focus is to prevent coccyx pain from occurring by correcting everyday activities that contribute to tailbone pain. Hot or cold water baths may help. Running a stream of hot or cold water down the back continuously may help if pain becomes unbearable. Cold water can be used if pain persists, with the procedure repeated in intervals of 5–6 minutes.
Proper equipment used to preventing coccyx pain
There is no definite way to fully prevent coccyx pain because an accident can occur at any given time. However, people who are obese are at a higher risk for developing coccyx pain. Carrying excessive weight contributes to more stress on the coccyx while sitting down causing increased chances of pain.
Prevention of carrying excessive weight gain can help reduce the tension and pressure on the coccyx. In other words, the coccyx for obese people may be more posteriorly outward when they are sitting down.