Tailbone Pain (Coccydynia)

Coccydynia is tailbone pain that occurs at the tip of the tailbone between the buttocks.

• 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 history and physical examination.
• Conservative treatment measures usually resolve coccyx inflammation.

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.

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 tailbone pain (coccydynia), including

• sciatica,
• infection (including shingles of the buttocks),
• pilonidal cysts,
• sacroiliitis, and
• fractured bone (broken tailbone or tailbone fracture).

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

Pain and local tenderness that occurs 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 in the tailbone area.

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 another testing (to exclude bone or tissue disorders, such as with CAT scan or MRI scan).

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 reincur 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.

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

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