Coccydynia is a medical term meaning pain in the
coccyxThe coccyx , commonly referred to as the tailbone, is the final segment of the human vertebral column. Comprising three to five separate or fused vertebrae below the sacrum, it is attached to the sacrum by a fibrocartilaginous joint, the sacrococcygeal symphysis, which permits limited movement...
or tailbone area, usually brought on by sitting.
Coccydynia is also known as coccygodynia, coccygeal pain, coccyx pain, coccaglia or (in
layperson'sA "layman" is a person who is a non-expert in a given field of knowledge. The term originated from "laity", but over the centuries, shifted in definition....
terms) buttache. But the term is more specific than just "buttache", which could include pain from sore gluteal muscles, etc., whereas coccydynia refers to pain specifically at the coccyx (i.e., tailbone pain).
A number of different conditions can cause pain in the general area of the coccyx, but not all involve the coccyx and the muscles attached to it.
Coccydynia is a medical term meaning pain in the
coccyxThe coccyx , commonly referred to as the tailbone, is the final segment of the human vertebral column. Comprising three to five separate or fused vertebrae below the sacrum, it is attached to the sacrum by a fibrocartilaginous joint, the sacrococcygeal symphysis, which permits limited movement...
or tailbone area, usually brought on by sitting.
Synonyms
Coccydynia is also known as coccygodynia, coccygeal pain, coccyx pain, coccaglia or (in
layperson'sA "layman" is a person who is a non-expert in a given field of knowledge. The term originated from "laity", but over the centuries, shifted in definition....
terms) buttache. But the term is more specific than just "buttache", which could include pain from sore gluteal muscles, etc., whereas coccydynia refers to pain specifically at the coccyx (i.e., tailbone pain).
Diagnosis
A number of different conditions can cause pain in the general area of the coccyx, but not all involve the coccyx and the muscles attached to it. The first task of diagnosis is to determine whether the pain is related to the coccyx. Physical examination, high resolution x-rays and MRI scans can rule out various causes unrelated to the coccyx, such as Tarlov cysts and pain referred from higher up the spine. Note that, contrary to most anatomical textbooks, most coccyxes consist of several segments: 'fractured coccyx' is often diagnosed when the coccyx is in fact normal or just dislocated at an intercoccygeal joint .
A simple test to determine whether the coccyx is involved is injection of local anesthetic into the area. If the pain relates to the coccyx, this should produce immediate relief .
If the anesthetic test proves positive, then a dynamic (sit/stand) x-ray or MRI scan may show whether the coccyx dislocates when the patient sits .
Use of dynamic x-rays on 208 patients who gave positive results with the anesthetic test showed:
- 22% Posterior luxation (partial dislocation of the coccyx backwards when sitting)
- 5% Anterior luxation (partial dislocation of the coccyx forwards when sitting)
- 27% Hypermobility (excessive flexing of the coccyx forwards and upwards when sitting)
- 14% Spicule (bony spur) on the coccyx
- 31% Not possible to identify the cause of pain
This study found that the pattern of lesions was different depending on the obesity of the patients: obese patients were most likely to have posterior luxation of the coccyx, while thin patients were most likely to have coccygeal spicules.
Natural history
One way of classifying coccydynia is whether the onset was traumatic versus non-traumatic. In many cases the exact cause is not known (called idiopathic coccydynia).
Coccydynia is often reported following a fall or after
childbirthChildbirth is the culmination of a human pregnancy or gestation period with birth of one or more newborn infants from a woman's uterus...
. In some cases, persistent pressure from activities like bicycling may cause the onset of coccyx pain. Coccydynia due to these causes usually is not permanent, but it may become very persistent and chronic if not controlled.
Rarely, coccydynia is due to the undiagnosed presence of a
sacrococcygeal teratomaSacrococcygeal teratoma is a teratoma located at the base of the coccyx . It is thought to be a derivative of the primitive streak.-Natural history:...
or other
tumorA tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells . Tumor is not synonymous with cancer. A tumor can be benign, pre-malignant or malignant, whereas cancer is by definition malignant....
in the vicinity of the coccyx. In these cases, appropriate treatment usually involves surgery and/or
chemotherapyChemotherapy, in its most general sense, is the treatment of disease by chemicals especially by killing micro-organisms or cancerous cells. In popular usage, it refers to antineoplastic drugs used to treat cancer or the combination of these drugs into a cytotoxic standardized treatment regimen...
.
Clinical features
Activities that put pressure on the affected area are bicycling, horseback riding, and other activities such as increased sitting that put direct stress on the coccyx. The medical condition is often characterized by pain that worsens with constipation and may be relieved with bowel movement. Rarely, even sexual intercourse can aggravate symptoms.
Non-surgical treatment
Since sitting on the affected area may aggravate the condition, a cushion with a cutout at the back under the coccyx is recommended (the donut cushion traditionally recommended by doctors is generally useless for this condition). If there is tailbone pain with bowel movements, then stool softeners and increased fiber in the diet may help. For prolonged cases,
anti-inflammatoryAnti-inflammatory refers to the property of a substance or treatment that reduces inflammation. Anti-inflammatory drugs make up about half of analgesics, remedying pain by reducing inflammation as opposed to opioids which affect the brain.-Medications:...
or pain-relieving drugs may be prescribed. The use of anti-depressants such as Elavil (amiltriptyline) may help alleviate constant pain. Local nerve blocks are often beneficial. Tailbone pain doctors specializing in
Physical Medicine and RehabilitationPhysical medicine and rehabilitation , or physiatry , is a branch of medicine which aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician who has completed training in this field is referred to as a physiatrist...
at
New Jersey Medical School have published that sometimes even just a single local nerve block injection at the ganglion impar can give 100% relief of coccydynia when performed under fluoroscopic guidance.
Reference Foye 2006
Surgical treatment
In rare cases, surgery to remove the coccyx (
coccygectomyCoccygectomy is surgery to remove the coccyx, e.g. for patients with coccyx pain . Typically, surgery is reserved for patients with cancer or those whose tailbone pain has failed to respond to nonsurgical treatment .In humans,...
) may be required. Typically, surgery is reserved for patients with cancer (malignancy) or those whose tailbone pain has failed to respond to nonsurgical treatment (such as medications by mouth, use of seat cushions, and medications given by local injections done under fluoroscopic guidance, as noted above). .
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