The tailbone, or coccyx, is the tip at the bottom of the spine.
Pain in the tailbone is called coccydynia.
The two most common causes of coccydynia are: An injury to the tailbone after a fall or
a woman after she gives birth to a child.
Today, I’ll answer these questions: What can you do to alleviate coccydynia?
When do you need to see a doctor?
How to manage chronic coccydynia?
So.
Let’s talk about coccydynia today.
The tailbone is this tiny structure at the bottom of the lumbar spine.
It is connected to the sacrum.
Although it seems small and unimportant, it has a critical function in holding many muscles
and ligaments in the pelvic floor.
The pelvic floor supports the pelvic structures, including the bladder, uterus and rectum.
During childbirth, the coccyx is pushed backward to make space for the baby to pass through
this space.
Women are five times more likely to develop coccydynia than men.
Another very important function of the coccyx is that it is one of the 3 tips that support
the body when the person is seated.
So, a person who spends too much time sitting on a hard surface, like concrete, or a hard
chair, will have more propensity to have tailbone pain.
Here, it seems there is some advantage to having some fat around the coccyx.
Some people start having tailbone pain when they have rapid weight loss; that is because
they are losing the cushioning that protects the coccyx.
The most common cause of coccydynia is a trauma, usually from a backward fall.
The person may, or may not have a coccyx fracture.
Hypermobility or hypomobility of the coccyx can also lead to coccydynia.
And there rare causes of pain in this region are referred pain from another nerve root
or an internal pelvic organ, an infection or tumour of the coccyx.
Before I continue, let me remind you that this video is intended for educational purposes
only.
It is not medical advice.
If you have a condition that is causing you pain, please talk to your doctor.
In case of emergency, go to the nearest emergency department or call an ambulance.
So, when do you need to see a doctor for coccydynia?
Most cases of coccydynia improve spontaneously without any medical intervention.
It may take 2 to 3 months for the pain to get better.
You don’t need any x-ray or investigation if the pain is improving and you don’t have
any other symptoms such as incontinence of your bowels or bladder, fever or numbness
in the perineal area.
When should you see a doctor?
Here are some reasons: If the pain starts interfering with your daily
activities, like sitting for a prolonged period, defecation or sexual intercourse.
The physician will need to examine the coccyx to find out if that is the cause of the pain.
And the way to examine the coccyx is by a rectal examination.
We must grasp the coccyx between our thumb and index finger and move it back and forth.
If this movement causes pain, then we know the source of the pain comes from the coccyx.
When we examine the coccyx, we may also check if the coccyx is mobile or not.
It is normal to have some movement.
Too much indicates hypermobility.
Too little indicates hypomobility of the sacrococcygeal joint.
The usual range of motion is between 10 and 15 degrees.
If the rectal exam shows pain when we manipulate the bone, then we may need to order an X-ray
to see the tailbone.
We need to order dynamic x-rays with the person standing and sitting.
This will allow us to see how the coccyx moves if there are subluxations or abnormal movements.
There are situations that the coccyx is dislocated or broken, and the patient will need to have
a coccygectomy, which is the surgical removal of the coccyx.
However, this procedure should be the last resort and avoided as much as possible as
there are high rates of complication and most commonly does not alleviate the pain it could
make the pain become worse and more chronic.
How do we treat coccydynia?
The good news is that in more than 90% of cases, coccydynia resolves without any medical
intervention.
With home-based interventions, the pain resolves, and there are no severe consequences.
Here are my suggestions for treatments you can do at home:
1 Heat and cold.
The person should try both and alternate a hot water bag with an ice pack.
The ice helps to reduce inflammation, and the heat helps to relax the muscles.
See my other video about heat and cold for pain.
2 Over-the-counter analgesics and anti-inflammatories for a few days.
Check my other video about NSAIDs to see if you don’t have any contraindications to
these medications.
3 Topical creams are rarely indicated, and there are no studies demonstrating their benefits
for coccydynia.
But if the person cannot tolerate oral anti-inflammatories, they can try topical creams for a few days.
4 Proper sitting posture, using the ischial tuberosities to support the body weight instead
of the coccyx may alleviate the symptoms.
5 Changing the chair or using a balance ball may be helpful.
Sometimes getting a special cushion may be necessary.
I will leave a link in the description of this video if you want to order any of these
cushions or balance balls.
There are cushions, called coccygeal cushions, that are wedge-shaped and they do not put
pressure on the coccyx.
The circular cushions or the donut cushions do not alleviate the pressure on the coccyx;
they are indicated for pain in the rectum. 6 Transcutaneous electrical nerve stimulation,
or TENS, may produce analgesia, especially if the person cannot take analgesics or anti-inflammatories.
I have another video in that I explain what is TENS and how to apply the electrical pads.
I also have a link in the description of this video if you are interested in purchasing
this equipment.
7 In cases more resistant to treatment, they may need to see a pelvic floor rehabilitation
physiotherapist.
In this case, when there are spasms of the pelvic floor muscles, manual manipulation
and massage can be helpful both in making the diagnosis and treating the problem that
is causing the pain.
8 Other interventional procedures involve injections, nerve blocks, radiofrequency ablations,
or sympathetic ganglion blocks.
There are also reports of people who used caudal epidural steroids for pain caused by
Tarlov cysts.
These procedures should be indicated when the cause of coccydynia involves a severe
disease such as cancer., which is very rare.
If you know someone with tailbone pain, known as coccydynia, send this video to them.
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Thank you for watching.
Goodbye