What causes coccydynia?
Coccydynia is most often caused by trauma such as falling on your lower back, or it may arise as a result of pressure on the lower back during childbirth. In many cases, a precise cause or trigger cannot be determined. These cases are referred to as idiopathic. Research has shown many cases of idiopathic coccydynia occur in people who have a hypermobile coccyx – that is, a coccyx that flexes beyond the normal range of motion. Women tend to experience coccydynia more often than men, and some studies have shown obese people may be three times as likely to experience coccydynia, perhaps because of extra strain placed on the coccyx when sitting.
What are the symptoms of coccydynia?
The telltale symptom of coccydynia is pain in the tailbone, especially when sitting or when the area is pressed. Symptoms typically resolve when standing or walking. Other symptoms may include pain in the coccyx area:
- When having a bowel movement
- While having sex
- When moving from a sitting to a standing position
- When changing positions while seated
Mild to profound aching in the tailbone area is also common.
How is coccydynia diagnosed?
The first step in diagnosis is to take a complete medical history and to discuss symptoms, as well as discussing any falls or other event that might have triggered an injury. Women who have a history of prolonged labor may be more prone to coccydynia; if that describes you, be sure to mention that to the doctor. A physical exam of the area can also help identify swelling, infected abscesses or masses that could indicate growths.
The doctor may also order an x-ray, computed tomography (CT) scan or magnetic resonance imaging (MRI) to look for fractures, tumors or other potential causes.
How is coccydynia treated?
In most cases, coccydynia will improve with conservative treatment such as:
- Seat cushions
- Decreased sitting time
- Stretching exercises
- Improved posture
- Pain and anti-inflammatory medications
- Local injections of steroids
When obesity is present, patients may also benefit from a diet and exercise program to help remove the excess weight and reduce the pressures on the coccyx.
Conservative treatment can take weeks or months to achieve full resolution of symptoms. In some cases, a customized therapeutic seat cushion used especially when seated in hard chairs or desk chairs may help speed healing. These cushions frequently feature an open area that removes pressure from the coccyx so inflammation can resolve more quickly.
In very rare instances, surgery may be performed to remove the coccyx entirely. A procedure, called a coccygectomy, is only performed when prolonged conservative treatments fail to provide relief and the patient’s quality of life is significantly diminished as a result.