In fact, because sitting — a staple activity for most of us, and one that directly impacts the coccyx — can be very uncomfortable when you have coccygodynia, this condition is notorious for interrupting quality of life.
Causes
While some of the time coccygodynia results from trauma to the tail bone, there are other causes, as well.
Problems with your coccyx bone that can result in coccygodynia may include injuries (including but not limited to falls, as discussed above), disc degeneration at your sacrococcygeal (defined above) and/or intercoccygeal joints (joints between the tiny bone pieces that together comprise the coccyx), bone spurs at the coccyx (called coccygeal spicule), infection in the bone (called osteomyelitis) or a tumor on the bone.
Childbirth is another possible cause of coccygodynia (in the mother).
Symtpoms that mimic occygodynia may be the result of referred pain, i.e. pain arising from organs in which disorders are present. Examples may include conditions or problems in the sigmoid colon, urogenital system, and/or the rectum.
Not only that, pain in the tail bone region can sometimes be traced to problems occurring at, on or in nearby structures. Examples include problems in the lumbosacral area of your spine, sacrum and sacroiliac joint issues, piriformis syndrome, diseases of the pelvic organs, hemorrhoids, and more.
Finally, your coccygodynia maybe be a case of “cause unknown.” A 2012 review of studies states that 30% of coccygodynia is idiopathic; in other words, the reason for the tail bone pain could not be found.
Hypermobile Tail Bone
With that said, hypermobility of the coccyx (hypermobility refers to the tendency of the bone to subluxate) is the most common medical finding associated with tail bone pain. Grgić asserts that 70% of patients with coccygodynia showed signs of excess motion of this bone when dynamic X-rays were taken.
Along with injury (as mentioned above), overloading the coccyx during movement as well as when stationary can cause a hypermobile (and painful) coccyx. Activities and states of being that might predispose you to overload your coccyx include being obese and/or sitting for long periods of time (static overloading), and bicycling, rowing or riding (dynamic overload).
In their 2014 study published in the Ochsner Journal, researchers assert that obesity and being female are two risk factors for tailbone pain.
Symptoms of Coccygodynia
Symptoms of coccygodynia include discomfort and pain at the base of your spine (this is where the coccyx bone is located, particularly when sitting. It can also include pain in your lower back and/or hips. You may find you get a shooting pain down your legs, too.
Coccygodynia intensity varies from person to person. In some cases, the severity of your coccygodynia pain may worsen over time, but in many cases may resolve on its own.
As I mentioned earlier, coccygodynia can be very disruptive to your lifestyle. It can ruin a good night’s sleep and interrupt your ability to carry out activities in which sitting and/or bending is necessary.
This means that things you normally do — and perhaps take for granted — such as working at your computer or driving may become too painful. The fact is that when you put weight on your coccyx bone, even if the surface underneath you is a soft pillow or chair, your pain may increase. You may also find that getting up from a sitting position is difficult.
Diagnosis
Healthcare providers typically diagnose coccygodynia by taking a medical history, doing a physical exam (which involves palpation of the area) and taking standard and dynamic x-rays. Most likely, your healthcare provider will ask you to sit and/or to do some cycling, to try to reproduce your pain and symptoms.
A coccygodynia diagnosis can sometimes be confirmed by means of an injection. In this case, a local anesthetic is injected into the specific place or places in the tail bone region from which, based on what you say about your symptoms and the results of your physical exam, as well as the x-rays and possibly an MRI (see below for more information), your healthcare provider suspects the pain originates.
Research on MRIs
Most of the time an MRI is not used in the diagnosis process. But in 2012, French researchers found that MRIs may provide details that can be used to determine the cause of a painful tail bone. Their study revealed that when the relative state of the mobility of the coccyx is known, an MRI may help further paint a picture of what’s going on. For example, in the study, out of 172 cases being tested, 105 showed a mobile coccyx. Of these, most showed abnormal discs; in the 67 patients with a rigid (immobile) coccyx, abnormal features were found at the bottom part of the bone, called the tip.
Treatment and Pain Relief
As with most spine problems, treatment is divided up into two main types: Conservative (non-invasive) and surgical (also called invasive). The surgery for tail bone pain is called a coccygectomy. It can be either partial or total removal of the tailbone; this surgery is usually reserved for times when everything else has been tried without success. Generally speaking, results tend to be moderate at best, and by having surgery, you run the risk of experiencing complications.
Conservative treatment for tail bone pain include rest, medication, such as NSAIDs (especially at first), sitting on a cushion with a hole cut out of the middle (often jokingly called a “whoopie cushion”), and physical therapy. Once you’re in the chronic phase of the injury, physical therapy treatment may include hands-on techniques to increase the flexibility of the pelvic floor - specifically the levator ani muscle, which in turn may release the coccyx bone if it is stuck.
The researchers mentioned above whose 2014 study was published in the Ochsner Journal say that a multidisciplinary approach to treatment tends to work best. They also say that non-surgical treatment works about 90% of the time.
Your healthcare provider may suggest getting a steroid injection, or an injection of a local anesthetic, to help with the pain. Sometimes a pain control procedure known as radiofrequency ablation is used for coccygodynia, but this is not generally recommended.
