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Coccydinia

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Introduction


Coccydynia, also sometimes known as coccygodynia, is the medical term for pain around the coccyx. The coccyx is the last bone at the base of the spine.

The pain of coccydynia can range from mild to severe, and it is often worse when sitting down.

The coccyx

The coccyx is sometimes referred to as the 'tail bone' because it is the last remaining part of the full tail that belonged to our ape-like ancestors. The coccyx is located just above the cleft in the buttocks, and it curves forwards so that it points towards the front of the body.

The coccyx is made up of three small bones. The bones of the coccyx are loosely fused together. They become more flexible in pregnant women so that they are able to give birth more easily.

The coccyx has two main functions:

  • it serves as a weight-bearing structure when somebody is sitting down
  • it is an important attachment site for various muscles, tendons and ligaments

How common is coccydynia?

Coccydynia is an uncommon cause of back pain. It accounts for less than 1 out of every 100 cases of lower back pain.

Women are five times more likely to develop coccydynia than men. It is thought that the reason for this is that giving birth can sometimes damage the coccyx, leading to coccydynia. The coccyx is also more exposed in women, which makes it more vulnerable to damage and injury.

Other causes of coccydynia can include:

  • trauma to the coccyx, resulting from a fall or other type of accident
  • pulling the coccyx out of its normal position, either through poor posture or repeated activity or motion, such as cycling or rowing

In around a third of cases of coccydynia, no obvious cause can be found.

Outlook

The outlook for coccydynia is usually good. In some people, the pain will resolve within a few weeks.

In others, the pain can persist for several months (chronic coccydynia). Chronic coccydynia can usually be treated using painkillers and physiotherapy.

However, a small number of people with chronic coccydynia do not respond to treatment and may require surgery to remove some or all of their coccyx. See Coccydynia - treatment for more information.

Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Spine
The spine supports the skeleton, and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.
Physiotherapy
Physiotherapy is a treatment that uses physical movements, massage and exercise to relieve illness or injury.

Symptoms of coccydinia


Pain and discomfort

The main symptom of coccydynia is pain and discomfort at the base of your spine, where the coccyx is located. The severity of the pain varies from person to person, and it can get worse as time passes.

The pain in and around your coccyx can sometimes make it very difficult to carry out everyday activities, such as driving, bending over or sitting down. The pain may be particularly intense when you move from a sitting to a standing position.

You may find that the pain of coccydynia gets worse when you are in a sitting position, particularly if you are leaning backwards. The pain may be slightly better when leaning forwards. Some people find that they can only tolerate sitting in the same position for a few minutes before having to change their position to relieve the pain.

It may seem odd, but sitting on a soft surface may be more painful than sitting on something hard. This is because sitting on a soft surface places most of your weight on your coccyx rather than on the hard bones below your pelvis.

Other symptoms

As well as pain in your coccyx, other symptoms of coccydynia may include:

  • backache
  • shooting pains down your legs
  • pain before or when you pass stools (faeces)
  • pain during sex
  • painful buttocks and hips
  • increased pain during your period (in women)

If you have coccydynia, the pain in your coccyx can also make it difficult to sleep comfortably at night. You may need to keep changing positions while lying in bed.

Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Spine
The spine supports the skeleton, and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.

Causes of coccydinia


Coccydynia occurs when your coccyx, or the surrounding tissue, becomes damaged. This causes pain and discomfort at the base of your spine, particularly when you are sitting down.

The coccyx can be damaged in a number of different ways, although in a third of coccydynia cases it is not possible to identify a cause.

The various possible causes of coccydynia are outlined below.

Childbirth

Giving birth is thought to be the most common cause of coccydynia.

If you are pregnant, your coccyx will become more flexible towards the end of your third trimester (from week 27 to the birth). This is due to a release of hormones in your body which allow your coccyx, and the part of your spine above it, to bend and give way when you give birth.

But in some cases, childbirth can cause the muscles and ligaments (stretchy tissue that connects bones) around your coccyx to overstretch. This means that these muscles and ligaments become permanently altered and can no longer hold your coccyx in the right position. This leads to coccydynia.

Injuring your coccyx

You can injure your coccyx if you suffer a hard impact to the base of your spine. For example, injury can sometimes occur during contact sports as a result of an accidental kick to the base of your spine.

Other ways that you can injure your coccyx include:

  • falling over while skiing or ice skating
  • falling from high up, such as from a horse, and landing on your coccyx
  • accidentally landing on one of the bars at the side of a trampoline

Although uncommon, injury to the coccyx has also been known to happen during sexual intercourse, particularly anal sex.

In most cases where the coccyx is injured, it will only be badly bruised. However, if your coccyx is severely injured, it may be partly dislocated (moved out of joint) or fractured (broken). If this happens, the bones that make up your coccyx may move around and cause pain, particularly when you are sitting.

Repetitive strain injury (RSI)

You may get coccydynia if you regularly take part in sports such as cycling or rowing. This is due to the motion of continually leaning forward and stretching the base of your spine.

If this motion is repeated many times, or if you hold a leaning forward position for a long period of time, the muscles and ligaments (stretchy tissue that connect bones) around your coccyx can become strained and stretched.

Straining your muscles and ligaments can permanently damage them. If this happens, your muscles will no longer be able to hold your coccyx in the correct position, and this will cause you pain and discomfort.

Poor posture

Sitting in an awkward position for a long period of time, such as at work or while driving, can put too much pressure on your coccyx. This causes pain and discomfort that will get worse the longer you stay in this position.

Being overweight or underweight

Being overweight or obese can place excess pressure on your coccyx when you are sitting down. This can cause coccydynia or make an existing case of coccydynia worse.

However, you may also develop coccydynia if you are very slim. If this is the case, you may not have enough buttock fat to prevent your coccyx from rubbing against the tissues that surround it.

You can use the Body mass index (BMI) calculator to find out whether you are a healthy weight for your height.

Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Spine
The spine supports the skeleton, and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.
Ligaments
Ligaments are made of fibrous tissue. They connect bone to bone, providing support while allowing flexibility and movement.
Joint
Joints are the connection point between two bones that allow movement.

Diagnosing coccydinia


See your GP if you think that you may have coccydynia. In most cases, they can diagnose coccydynia based on your symptoms and a physical examination of your lower back and spine.

If your GP thinks that you may have broken bones, they may recommend that you have an X-ray of your coccyx. X-rays use high-energy radiation to create images of the dense structures inside your body, such as bones.

You may have two X-rays - one when you are sitting, and one when you are standing. Comparing the two images will help determine whether your coccyx is moving more than normal when you sit or stand.

If you have any additional symptoms that are not usually associated with coccydynia, such as a high temperature (fever) of 38ºC (100.4ºF) or above, or unexplained weight loss, your GP may recommend that you have a magnetic resonance imaging (MRI) scan.

A MRI scan creates an image of the inside of your body using strong magnetic and radio waves. It is a useful method of checking that other conditions, such as bone cancer or a bone infection, are not causing your symptoms.

See the Health A-Z topic about MRI scan for more information.

Spine
The spine supports the skeleton, and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.
X-Ray
An X-ray is a painless way of producing pictures of inside the body using radiation.
MRI
MRI stands for magnetic resonance imaging. It is the use of magnets and radio waves to take detailed pictures of inside the body.

Treating coccydinia


The treatment for coccydynia will vary depending on what is causing your condition and how painful it is. The various treatment options for coccydynia are described below.

Anti-inflammatory painkillers (NSAIDs)

If your pain and discomfort is mild to moderate, treatment with painkillers may be enough to relieve your symptoms.

Your GP may recommend or prescribe a type of painkiller known as a non-steroidal anti-inflammatory drug (NSAID). As well as easing pain, NSAIDs will also help to reduce inflammation (swelling) around your coccyx. They are most effective when taken regularly, rather than when your symptoms are at their most painful.

Examples of NSAIDs that are available over the counter (OTC) without a prescription include ibuprofen and aspirin. However, if these painkillers do not help to control your pain, your GP may prescribe a stronger NSAID, such as naproxen.

Some people cannot take NSAIDs because they are allergic to them, or they have an increased risk of developing stomach ulcers or a history of stomach ulcers. NSAIDs are known to increase the risk of stomach ulcers in certain people. If this is the case, you can use the over-the-counter painkiller paracetamol.

See the Health A-Z topic about NSAIDs for more information.

Other painkillers

In cases of moderate to severe chronic coccydynia, painkillers stronger than NSAIDs or paracetamol may be required.

Tramadol is a more powerful type of painkiller that may cause the following side effects:

  • constipation
  • feeling sick (nausea)
  • being sick (vomiting)
  • difficulty passing urine
  • stomach pain
  • indigestion
  • headaches
  • nervousness
  • irritability
  • dizziness, drowsiness or light-headedness

Avoid driving if you become dizzy, drowsy or light-headed while taking Tramadol.

Tramadol can be addictive if taken on a long-term basis, so your GP may only prescribe a short-term course to help control episodes of particularly severe pain before switching to an alternative painkiller.

If a long-term course of tramadol is felt to be the most effective treatment option to relieve severe pain, it is likely that you will have withdrawal symptoms if you suddenly stop taking the medication. For example, you may experience:

  • restlessness
  • anxiety
  • stomach pain
  • nervousness

In order to prevent these withdrawal symptoms when you no longer need to take tramadol, it is likely that your dose will be reduced gradually before being stopped.

Cushions and pillows

As well as treatment with painkillers, your GP may suggest that you use a special doughnut shaped pillow or a gel cushion when you are sitting down.

The pillow can help to take pressure off your coccyx, and can be taken with you whenever you are going to sit down for long periods of time.

Injections

If the coccydynia does not respond to the treatments above, or you are unable or unwilling to take painkilling medication, an alternative treatment option is to directly inject medication into your lower back to help relieve pain.

A number of different types of injections can be used, and they are described below.

Corticosteroid injections

Corticosteroids are medicines that help to reduce inflammation (swelling) and pain. Sometimes, corticosteroids are combined with local anaesthetic to make them even more effective. The local anaesthetic helps to numb the tissues around your coccyx so that they are no longer painful.

Corticosteroid injections work well to relieve the symptoms of coccydynia, although the effects may only last for several weeks at a time.

Corticosteroid injections cannot cure your condition and your symptoms may gradually return. Too many corticosteroid injections can damage your coccyx and your lower back, so you may only be able to have this type of treatment once or twice.

See the Health A-Z topic about Corticosteroids for more information.

Ganglion impar nerve block

The ganglion impar are a cluster of nerves next to your coccyx. It is through these nerves that many of the pain signals travel.

A ganglion impar nerve block involves temporarily suppressing (blocking) these nerves by injecting them with a local anaesthetic in order to stop them transmitting pain signals.

In some people, a ganglion impar nerve block provides a permanent relief in symptoms. In others, the pain will return after a few weeks or months, but the pain levels are usually lower.

Unlike corticosteroid injections, it is usually safe to have repeated injections of local anaesthetic, if required.

Sacrococcygeal joint injections

The two main joints that hold the coccyx and the rest of the spine in place are known as the sacrococcygeal joints.

In cases where it is thought that inflammation or other damage to the sacrococcygeal joints are causing the symptoms of coccydynia, the joints may be directly injected with a combination of corticosteroids and local anaesthetic.

Spinal manipulation

The idea behind spinal manipulation is to ease painful symptoms by stretching and manipulating the muscles around your coccyx. This may help to relieve pain and discomfort, particularly if your coccyx has been displaced from its normal position.

There is some limited evidence that spinal manipulation may be effective in providing short-term pain relief in some people with coccydynia.

Types of spinal manipulation include:

  • physiotherapy - a treatment that uses physical methods, such as massage and manipulation, to promote healing and wellbeing
  • osteopathy - a manipulation technique that some people claim can detect and treat problems with the muscles, nerves and joints
  • chiropractic - a manipulation technique that is based on the theory that many health problems are related to misalignments of the spine

Osteopathy and chiropractic are what are known as complementary and alternative medicines (CAMS), as they differ in important ways from more conventional treatments. Unlike conventional treatments, the use and principles of CAMS are not always based on scientific evidence.

Physiotherapy is not a CAM because it is based on conventional medical theory and practice.

Some people may find that these therapies help, although they can often be expensive and time-consuming.

If you decide to use a form of CAM to treat coccydynia, always ensure that your therapist is fully qualified and an accredited member of the appropriate organisation, such as the General Chiropractic Council or the General Osteopathic Council.

Surgery

Surgery for coccydynia is uncommon and is usually only recommended as a 'treatment of last resort' when all other treatment options have failed to relieve the pain.

If you need to have surgery for coccydinia, you may have your coccyx completely removed. This operation is called a coccygectomy. Alternatively, you may only have part of your coccyx removed in a procedure that is known as a partial or limited coccygectomy.

A coccygectomy is carried out under general anaesthetic, which means that you will be asleep during the operation. Your surgeon will make a small incision (cut) in the skin over your coccyx, so that it can be removed.

The muscles, tendons and ligaments that are attached to the coccyx will be reattached to other parts of your pelvis in order to preserve their function.

The most common complication of a coccygectomy is a post-operative infection, which occurs in around 20-30% of cases. It is thought that infections are so common because the coccyx is located next to the rectum and anus, making it easy for bacteria from these areas to spread to the site of the operation.

Minor to moderate infections can be treated with antibiotics. However, more serious infections may need additional surgery to remove or repair diseased tissue.

Following surgery, around 80-90% of people will experience a moderate to marked improvement in their symptoms. The remaining 10-20% will continue to have symptoms of pain.

It is important to be aware that a coccygectomy has a long recovery time. Post-operative pain can range from a few months to a year, in some cases.

Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Anti-inflammatory
Anti-inflammatory medicines reduce swelling and inflammation.
Corticosteroid
Corticosteroid is a naturally occurring hormone produced by the adrenal gland, or a synthetic hormone having similar properties. It is used to reduce inflammation, so reducing swelling and pain.
Incision
An incision is a cut made in the body with a surgical instrument during an operation.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Spine
The spine supports the skeleton, and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.

Self care


Coccydynia can make it difficult for you to carry on with your normal, daily routine because you may be in constant pain, particularly when sitting. The self-care advice outlined below may help you with your everyday activities.

Sitting

If you have coccydynia, it may not be possible to reduce the pain of sitting down altogether. However, it may help to lean forward in your seat and rest your arms in front of you on a flat surface, such as a table.

This can help to take some of the pressure off your coccyx. However, make sure that the surface in front of you is not too high, too low or too far away to be comfortable, otherwise you may strain your back.

Clothing

Some clothing, such as tight jeans or trousers, may make your coccydynia worse. Therefore, wear loose fitting clothes that will not squeeze the tissues around your coccyx. It can also help to wear flat, comfortable shoes.

Sleeping

Many people with coccydynia find sleeping on their sides to be most comfortable. However, if you have severe pain, you may find it better to sleep on your front. You could also try sleeping with a pillow or cushion between your knees.

Warm and cold packs

Applying either a warm or cold pack to the base of your spine may help to ease your pain.

Warm packs include hot water bottles and microwavable heating pads. Cold packs are available as freezable gel-filled pads.

You could try using both hot and cold packs to help ease your pain. However, when using hot and cold packs, always follow the manufacturer's instructions because inappropriate use could injure your skin.

Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Spine
The spine supports the skeleton, and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.

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