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What is coccydynia (Tail-bone pain)?
Coccydynia, commonly known as tailbone pain, is an intriguing yet often misunderstood medical condition centred around discomfort in the coccyx area. This tiny, triangular bone at the bottom of your spine is a relic from our evolutionary past, reminiscent of a tail in other species.
Despite its small size and the fact that it might seem unimportant at a glance, the coccyx plays a vital role in our anatomy. The coccyx serves as an anchor point for various muscles, tendons, and ligaments in the pelvic region, contributing significantly to our ability to sit comfortably, especially when leaning back. Coccydynia or tailbone pain can range from mild to severe and may be acute or chronic.
What causes coccydynia?
Coccydynia can stem from a variety of sources, both direct and indirect, affecting the tailbone:
- Direct trauma: a fall onto the tailbone in the seated position, often on a hard surface, is a common cause of coccydynia.
- Childbirth: during delivery, the coccyx can be injured as the baby’s head passes over it, potentially leading to fractures or dislocation.
- Repetitive strain: prolonged sitting on hard surfaces or repetitive activities that strain or place pressure on the tailbone, such as cycling or horseback riding, can irritate the surrounding tissues and contribute to coccyx pain.
- Degenerative changes: arthritis, osteoarthritis, or degenerative disc disease affecting the coccyx or surrounding structures can result in chronic coccydynia.
- Tumours or infection: though rare, a tumour, cyst, or infection near the coccyx can lead to coccydynia.
What are the symptoms of coccydynia?
Symptoms primarily revolve around pain and discomfort in the tailbone area. Common symptoms of coccydynia include:
- Pain or tenderness in the tailbone area when sitting, especially on hard or narrow surfaces, or when transiting from sitting to standing
- Pain when engaging in activities that apply pressure to the coccyx, like bowel movements, driving, or cycling
- Stiffness or limited range of motion in the pelvic region or lower back
The pain from coccydynia can range from mild annoyance to severe discomfort, significantly impacting an individual’s ability to engage in everyday activities and overall quality of life.
Who is at risk of coccydynia in Singapore?
Some individuals are more susceptible to coccydynia than others. Common risk factors for developing coccydynia or tailbone pain include:
- History of trauma or injury to the tailbone or surrounding structures: individuals with a history of injury to the tailbone or surrounding area are at an increased risk of developing coccydynia.
- Gender: women are five times more likely to be affected by coccydynia, partly due to pelvic anatomy differences and the potential for childbirth-related injuries.
- Prolonged sitting: individuals who sit for long periods, particularly on unsupportive surfaces.
- Weight issues: excess weight places additional stress on the coccyx, which may lead to tailbone pain. On the contrary, individuals with insufficient fat to cushion the tailbone may experience coccydynia, as their tailbone is more likely to rub against nearby soft tissues such as ligaments, tendons, and muscles, causing inflammation.
How is coccydynia diagnosed?
Coccydynia is typically diagnosed using a combination of the following:
- Medical history and physical examination: your pain specialist will discuss your medical history and the onset of symptoms.
- Palpation: the area is gently palpated to assess for tenderness, swelling, or deformities.
- Imaging studies: X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans may be ordered to evaluate the structure of the coccyx and surrounding tissues, identify any fractures or abnormalities, and rule out other underlying conditions.
- Bone scan: a bone scan may be conducted to identify other causes of coccydynia, such as inflammation or cancer.
What are the treatment options for coccydynia in Singapore?
Treatment strategies aim to alleviate pain and address any underlying causes:
- Lifestyle modifications: adjusting sitting positions and avoiding prolonged sitting on hard surfaces. Sitting on a donut pillow or a wedge can help to reduce pressure and strain on the coccyx, relieving pain.
- Physical therapy: physical therapy can help strengthen the pelvic floor muscles and improve posture.
- Medications: medications for pain management, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may be prescribed to reduce inflammation and relieve pain.
- Injections: injection therapy, such as coccygeal nerve blocks or steroid injections, may be recommended to provide temporary pain relief and reduce inflammation.
- Radiofrequency: RF treatment of the ganglion impar may be a useful alternative, especially if conservative strategies have not resulted in sufficient pain relief.
Frequently asked questions
Yes, coccydynia can be treated through various methods, including home remedies, nonsurgical treatments, and, in rare cases, surgery. Most people find relief from home remedies like NSAIDs, sitting on a donut pillow, hot baths, and applying hot or cold packs. Additional treatments such as nerve blocks, massage therapy, physical therapy, and TENS (transcutaneous electrical nerve stimulation) may be recommended.
The primary symptom of coccydynia is a dull, achy pain at the base of the spine, between the buttocks, that worsens when sitting or leaning against your backside. The condition is characterised by tenderness in the tailbone area.
While coccydynia is not considered serious, it is important to consult a doctor if you experience persistent tailbone pain to rule out other, more serious conditions. Immediate medical attention is recommended if you have tailbone pain along with symptoms like sudden swelling, constipation, numbness, weakness, tingling in the legs, or loss of bowel or bladder control.
Coccydynia is diagnosed based on symptoms, a physical examination of the area, and possibly imaging tests like X-rays or MRI scans to rule out fractures, tumours, or other conditions. If you experience pain in the tailbone area that worsens when sitting or pressing on the tailbone, you may have coccydynia.
The duration of coccydynia varies. Many individuals experience relief from symptoms with proper treatment within a few weeks or months. However, in some cases, symptoms can persist for more extended periods, and a small percentage of people may experience chronic coccydynia, where the condition becomes long-lasting and more difficult to treat.
Total Pain Specialist