Jenny L. F Andrus, MD
The tailbone or coccyx is located at the end of the spinal column at the cleft of the buttocks. This small triangular boney structure is actually fused vertebrae that has muscles, tendons and ligaments connected to it, and along with your sacrum and pelvis, helps bear your weight when you sit down. Tailbone pain can be mild or severe, depending on many factors. In this article, I will discuss the symptoms, causes and treatments for coccydynia.
Tailbone pain strikes women about five times more frequently than it does men, and typically happens to adults or adolescents. It can be described as a dull aching pain or a sharp stabbing pain. It is usually worse sitting and improves upon standing and walking. Tailbone pain can also worsen during bowel movements, while having sex and during menstruation. It may last for days, weeks, or months and may even become chronic.
The cause of tailbone pain falls into many categories:
- Traumatic – The tailbone can easily be injured from a fall, as severely as a fracture or a dislocation to a mild bruise.
- Obesity – Excess weight puts additional strain on the muscles, ligaments and tendons attached to the tailbone, causing them to stretch and the tailbone to lean backward, causing pain.
- Pregnancy – Hormones secreted during the last trimester allow for the musculature holding the tailbone in place to stretch for childbirth. These tendons, ligaments and muscles can stretch too far and become painful.
- Sitting too much and/or on a hard surface.
- Rowing or Bicycling – Competing in these sports or doing them repetitively can cause tailbone pain due to the forward bend of the body stretching the soft tissues around the coccyx.
- Being underweight – losing too much fat in your buttocks can cause the tailbone to rub against the soft tissues causing inflammation.
- Cancer – although very rare, cancer can cause tailbone pain.
- Idiopathic – up to 30% of tailbone pain may stem from an unidentifiable cause.
When a patient comes to see me for chronic coccydynia, they have usually been treated by other physicians using conservative methods, such as NSAIDs, ice/heat, Physical Therapy, oral corticosteroids, stool softeners, using pillows while sitting, etc. When I do a consult, I do a thorough physical exam as well as ask the patient many questions about their condition, how it started, what helps, what doesn’t, when it is better or worse, etc.
I typically start treatment with Physical Therapy specifically designed to help patients work on strengthening their pelvic floor, which tends to help coccyx pain. I may recommend ligament injections to reduce any inflammation and to stabilize and reduce laxity near the coccyx. There are a variety of injections, either nerve blocks or epidurals that I can perform, where I inject a steroid and a numbing medication into or around the nerve(s) that will also reduce inflammation and allow for healing of the irritated nerve(s) in the area of the tailbone. These injections also provide more pain relief which allows the patient to perform their exercises more effectively during Physical Therapy, allowing them to make more progress.
If, after trying the specialized Physical Therapy and a combination of injections and the patient does not experience significant pain relief, I can offer them a Spinal Cord Stimulation trial for a week to see if their pain is reduced. During the Spinal Cord Stimulation (SCS) trial, I will place a lead into the patient’s epidural space during a short outpatient procedure. This lead is connected to a battery, through which mild electrical impulses are sent to interrupt pain signals on their way to the brain. The impulses (which may feel like champagne bubbles, a tingling, buzzing or no sensation) can be adjusted by the patient through a remote, according to their pain severity and activity level.
During this trial week, the patient does their normal activities of daily living and ascertains how they are able to manage their pain level with SCS. At the end of the trial, I remove the electrical lead from the patient’s back in my office, without them needing sutures or any further care at the lead site. If at the end of the trial, the patient’s pain level has been reduced by 50% or more, the patient can decide whether or not they would like to proceed with permanent implantation of the Spinal Cord Stimulator. If not, I will work with the patient to develop a plan to manage their tailbone pain through a continued regimen of medications, injections and Physical Therapy.
Make an appointment with Dr. Andrus or another OSC provider by clicking the “Request Appointment” button below or by calling (757) 596-1900.