What is Coccydynia?
Tailbone pain, known in the medical community as coccydynia can be acute and a painful condition that leads to chronic pain. As with many conditions, the earlier the diagnosis, the earlier one can expect to be appropriately treated and the condition corrected. Musculoskeletal conditions such as sacroiliitis, deep gluteal muscle spasms of muscles such as the piriformis and anococcygeal muscles, and generators of low back pain must be ruled out according to clinical exam. Pelvic organ diseases can also be ruled out with history and clinical exam. Many times, coccydynia can exist on its own or with the above conditions and a thorough clinical history and exam is essential.
What is the Coccydyx?
The tailbone, known as the coccyx, is attached to the bottom of the sacrum through the sacrococcygeal ligament. Anatomically, the tailbone is the lowest part of the spine and it protects a portion of the pelvic floor including the posterior wall of the rectum. The coccyx contributes to the structural integrity of the pelvic floor through the anococcygeal muscles. The structure of the coccyx consists of multiple coccygeal vertebra that are most often fused, but may consist of synovial and fibrocartilaginous joints as well.
What causes Coccydnia?
Coccydynia can occur from traumatic injury where some type of external force causes the bones to move beyond their limited range of motion. This can be from something as simple as sitting too long on a hard surface or falling on your tailbone. Joint damage can also exist from general wear and tear from aging or repetitive motions. Additionally, women run the risk of developing tailbone pain from the natural process of childbirth as the ligaments around the coccyx loosen in pregnancy. These can all cause inflamation and pain.
How to treat tailbone pain?
Once the diagnosis is established, conservative treatment and anti-inflammatory medicine management is often initiated. Anti-inflammatories help to reduce the inflammation and relieve pain. One can also get cushions designed to reduce pressure on the tailbone, called coccyx pillows, to relieving coccyx pain when sitting. Physical therapy may be beneficial in helping to strengthen and realign the muscles of the pelvic floor and adjacent hip structures. Topical creams made with various pharmacological medications can be very effective for pain complaints and can be utilized under the prescription and direction of your physician.
Interventional procedures that treat tailbone pain?
Persistent coccyx pain can be treated with focal corticosteroid injections into the specific site of tenderness and/or pain. This procedure should be done under the skilled hands of a practitioner with sound knowledge and skills of fluoroscopic or ultrasound guidance as it is essential for the practitioner to place the medication at the site of pain or inflammation without inadvertently entering the pelvic cavity lying immediately in front of the coccyx.
Ganglion impar blocks may also be beneficial for chronic coccydynia and can be performed at the same time of performing the corticosteroid injection to the coccyx. Fluoroscopic or ultrasound guidance is essential as this injection is performed just anterior to the coccyx and just prior to pelvic wall, where the chain of nerves called the ganglion impar lie.
Coccyx manipulation can be performed for the coccygeal vertebrae that have dislocated from their respective joints, as can occur from direct trauma to the tailbone. This can be performed by the practitioner placing their index finger into the rectal vault and placing the coccyx between the index finger and the thumb and applying appropriate pressure to realign the coccyx. It is in the authors opinion that this is most easily and comfortably performed after directly blocking the respective joint with anesthetic and steroids and then manually manipulating the coccyx under fluoroscopic guidance.
For unresponsive pain that fail to respond to the above measures, sophisticated and state-of-the-art devices that incorporate spinal cord stimulation and peripheral nerve field stimulation may provide further opportunities for pain relief.