Coccydynia (Tailbone Pain)

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Jerry R. Balentine, DO, FACEP
    Jerry R. Balentine, DO, FACEP

    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

Coccydynia facts

  • Coccydynia is inflammation localized to the tailbone (coccyx).
  • There are many mimics of coccydynia.
  • Symptoms and signs of coccydynia include focal pain and tenderness at the tailbone. The pain is usually dull and achy.
  • An injury to the coccyx is a major risk factor for coccydynia.
  • Coccydynia is diagnosed based on the history and physical examination.
  • Conservative treatment measures usually resolve coccyx inflammation.

What is coccydynia?

Inflammation of the tailbone (coccyx or bony area located deep between the buttocks above the anus) is referred to as coccydynia. Coccydynia is associated with pain and tenderness at the tip of the tailbone between the buttocks. Sitting often worsens coccyx pain.

What causes coccydynia?

An injury or trauma may cause inflammation of the coccyx, but it may occur seemingly spontaneously. There are many causes of tailbone pain that can mimic coccydynia, including sciatica, infection (including shingles of the buttocks), pilonidal cysts, sacroiliitis, and fractured bone (broken tailbone or tailbone fracture).

What are risk factors for coccydynia?

The major risk factor for coccydynia is injury to the coccyx or pelvic bones.

What are coccydynia symptoms and signs?

Pain and local tenderness that occur at the coccyx are the major symptoms of coccydynia. Tailbone pain can lead to difficulty sitting or leaning against the buttocks. Along with the coccyx pain with sitting, there is typically exquisite pain at the tailbone area.

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Causes of Coccydynia

Coccydynia is associated with pain and tenderness at the tip of the tailbone between the buttocks. The pain is often worsened by sitting.

Coccydynia is often caused by an injury, but may occur seemingly spontaneously. There are many causes of tailbone pain which can mimic coccydynia, including sciatica, infection, pilonidal cysts, and fractured bone.

How do doctors diagnose coccydynia?

Doctors may diagnose coccyx inflammation based solely on the symptoms and the examination findings of local pain. Other conditions can be excluded by the examination (such as shingles, which typically would be associated with local rash) and other testing (to exclude bone or tissue disorders, such as with CAT scan or MRI scan).

What is the medical treatment for coccydynia?

Patients with coccydynia are advised to use a well-padded seat when sitting and avoid long periods of sitting when possible. If the condition becomes severe or persistently troublesome, then medical attention should be sought to accurately evaluate the cause of the pain, especially if there is associated bruising or rash.

Rest, avoiding reinjury to the affected area, anti-inflammatory medications, and pain medications can relieve symptoms. Sitting on a pillow, cushion, or buttock support can help. Treatment for patients with persistent coccydynia involves local cortisone injections. This corticosteroid shot is simply performed in the doctor's office and can potentially dramatically relieve chronic pain and even resolve the symptoms for many. Sometimes, the injection includes fluoroscopy or ultrasound. Physical therapy with exercises can be helpful with a patient's recovery. Rarely, when patients have unrelenting or severe coccyx pain, surgery can be performed on the coccyx to remove the irritated bony prominence.

What is the prognosis for coccydynia?

The majority of people with coccydynia have complete recovery in response to the conservative treatments described above.

Is it possible to prevent coccydynia?

Because coccydynia is associated with injury, avoiding trauma to the coccyx bone is the best method of preventing coccydynia.

REFERENCE:

Klippel, J.H., et al. Primer on the Rheumatic Diseases. New York: Springer, 2008.

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Reviewed on 6/27/2017
References
REFERENCE:

Klippel, J.H., et al. Primer on the Rheumatic Diseases. New York: Springer, 2008.

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