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Coccyx Pain (Coccydynia): Causes and Treatment

Coccyx pain (coccydynia) refers to pain at the very base of the spine. It is often caused by falls, prolonged sitting, or childbirth, and is usually treatable without surgery.

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Things worth knowing about "Coccyx pain"

Coccyx pain (coccydynia) refers to pain at the very base of the spine. It is often caused by falls, prolonged sitting, or childbirth, and is usually treatable without surgery.

What is Coccyx Pain?

Coccyx pain, medically known as coccydynia, is pain located at the coccyx (tailbone) – the lowest segment of the spine. The coccyx consists of three to five fused vertebral bones and forms the tip of the spinal column. The pain can be dull, sharp, or burning, and often worsens when sitting, moving from sitting to standing, or during bowel movements.

Causes

Coccyx pain can result from a variety of causes:

Trauma: A fall onto the buttocks or a direct impact to the coccyx, for example during sports or an accident.
Childbirth: During delivery, the coccyx can be strained, dislocated, or fractured due to pressure from the baby.
Prolonged sitting: Sitting on hard or poorly shaped surfaces can put excessive pressure on the coccyx.
Degenerative changes: Age-related wear and tear of the joints and discs in the coccygeal region.
Pilonidal cysts: Inflamed cysts near the tailbone can cause localized pain.
Tumors or metastases: In rare cases, malignant conditions may affect the coccygeal region.
Idiopathic: In some cases, no clear cause can be identified.

Symptoms

Common symptoms of coccyx pain include:

Localized pain directly over or around the tailbone
Pain that worsens when sitting, especially on hard surfaces
Pain when transitioning from sitting to standing
Pain during bowel movements or menstruation
Radiating pain into the buttocks or lower back
Tenderness when the coccyx is touched directly

Diagnosis

Diagnosis typically involves a combination of:

Medical history: A thorough discussion of symptoms, previous injuries, and potential triggers.
Physical examination: Palpation of the coccyx and surrounding structures.
Imaging: X-rays of the coccyx, sometimes in weight-bearing positions; MRI (magnetic resonance imaging) if soft tissue involvement or a tumor is suspected.
Rectal examination: May be performed to assess coccygeal mobility.

Treatment

Conservative Measures

The majority of coccyx pain cases can be managed conservatively:

Pressure relief: Specially shaped cushions (donut or wedge cushions) help reduce pressure on the tailbone while sitting.
Pain medication: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac can relieve pain and reduce inflammation.
Physiotherapy: Targeted exercises to strengthen the pelvic floor muscles and improve posture.
Heat and cold therapy: Application of warmth or cold packs can help ease discomfort.
Local injections: Corticosteroid or local anesthetic injections directly at the coccyx may be considered for persistent pain.

Surgical Treatment

If conservative treatment does not provide sufficient relief after approximately six months, a coccygectomy (surgical removal of the coccyx) may be considered. This procedure is reserved for carefully selected cases.

When to See a Doctor?

Consult a doctor if:

Pain follows a fall or accident
Symptoms persist for more than a few weeks
Additional symptoms occur, such as fever, bloating, blood in the stool, or unexplained weight loss
The pain is severe or debilitating

References

Lirette, L. S. et al. (2014): Coccydynia: An Overview of the Anatomy, Etiology, and Treatment of Coccyx Pain. In: The Ochsner Journal, 14(1), pp. 84–87. PubMed PMID: 24688338.
Patel, R. et al. (2016): Coccydynia. In: StatPearls [Internet]. StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK431062/
Maigne, J. Y. & Doursounian, L. (1997): Entrapment neuropathy of the medial superior cluneal nerve. Nineteen cases surgically treated, with a minimum follow up of two years. In: Spine, 22(10), pp. 1156–1159.

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