MD REVIEW

Coccydynia is a Pain in the Butt

When it hurts to sit, particularly on hard surfaces, sufferers may rotate their hips to shift weight onto their hip and relieve pressure. This can result in vertebral misalignment.

Sore Tailbone

The medical condition coccydynia has several names: coccalgia, coccygalgia, coccygial, coccygodynia are a few. The most obvious symptom is piercing pain in the coccyx (tailbone)—the very end of backache. The pain becomes severe when sitting for a long period, during sex, and changing from sitting to standing up. The challenge for an osteopath is to distinguish whether radiculopathy (referred nerve pain) or muscle spasms are primary or secondary symptoms.

Coccydynia Diagnosis

Thorough medical history and physical examination by an expert are sufficient for the coccydynia diagnosis. A doctor can ask about level of pain, injuries, childbirth experience, and exercise routine. A physical exam includes localized palpation to identify tenderness, swelling, tumors, or cysts in the coccyx region. This may be followed by an intrarectal examination. The physician may slightly manipulate the coccyx through the rectum to determine whether it is stationary or mobile.

Diagnostic tests include x-ray, coccygeal discogram, and less often, CT or MRI scans. It is important to visualize the weight-bearing coccyx when leaning forward and backward in addition to standing so facilities with dynamic MRI are diagnostically helpful.

Most common causes of coccyx pain include trauma, childbirth, repetitive strain injury, fractures, dislocations, and primary or metastatic malignancies. It is important to distinguish between a bruised tailbone and a fracture. A bruised tailbone can take up to four weeks to heal, while a healing time for a fracture can be up to 12 weeks. Coccydynia can last much longer.

Rare causes may be nerve damage, cysts such as Tarlov (sacral nerve) cysts, obesity, and a bursitis-like condition that can arise in patients with minimal gluteal fat padding. Obesity is three times more common in coccydynia patients than in the typical population.

Obesity is three times more common in coccydynia patients than the typical population.

There are four different orientations for the coccyx, as described by Postacchini and Massobrio:

TypeCoccyx Position
Type ICurved anteriorly with its apex facing downward and caudallyType 1
Type IIMore dramatic forward curvature with forward facing apexType 2
Type IIIAngles forward sharplyType 3
Type IVSubluxated at the sacrococcygeal jointType 4

Coccydynia Treatments

Why Your Coccydynia is a Pain in the Butt

Multiple anterior and posterior sacrococcygeal ligaments attach the sacrum to the coccyx. Depending on position, it can also bear one third of your weight when sitting, sharing weight with bilateral ischium. After coccyx pain becomes chronic (+ 3–6 months), it is less likely to resolve by natural recovery alone. Chronic pain is more likely to continue indefinitely, and maybe resistant to conservative treatment.

In most cases, pain is treated with pain relievers, physical therapy, special padded seating, and/or behavioral modification. Modified exercise routine might include a change from biking to swimming or walking.

Depending on pain severity, a coccygectomy (coccyx removal) may be performed for chronic coccydynia (malformation, coccyx dislocation, unstable coccyx, coccyx spur, or hooked coccyx). Because of the number of anatomical structures supported by the coccyx, its removal in whole or part is considered a last-resort treatment. There is a favorable success rate among ideal candidates when surgery is performed by an experienced coccydynia surgeon. Visit the Orthopedics category for anatomical studies of the lower back.

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