Brief Overview: Coccydynia is pain localized to the tailbone (coccyx) at the base of the spine. It often results from trauma like a fall or childbirth, or from prolonged sitting on hard surfaces. The pain typically worsens when sitting or rising, and may be tender to touch or feel like a stab or ache in the tailbone area. Coccydynia is considered chronic when symptoms persist for >2 months.
Prevalence: The exact prevalence is unknown.
Etiology:
- Traumatic causes: falls onto tailbone, direct compression, childbirth trauma
- Mechanical strain: prolonged pressure, poor sitting posture, or cycling
- Coccygeal instability: hyper- or hypomobility of the joint, influenced by obesity or coccyx shape
- Idiopathic: diagnosed when no clear cause is found, possibly involving pelvic floor muscle spasm or bursitis.
- Bone spicule/spur
- Osteoarthritis
- According to UpToDate, “Somatization, particularly in the setting of known depression”
Risk Factors:
- Female
- Obesity
- Childbirth
- Falls or repetitive impacts to the coccyx
Commonly Associated Conditions:
- Degenerative joint issues at sacrococcygeal junction
- Pelvic floor or ischial bursitis
- Lumbar or sacral musculoskeletal pain (may co-occur)
Common Medications:
- NSAIDs, Tylenol
- Opioids or tramadol for severe pain
- Coccygeal injection series – local anesthetic with or without glucocorticoid
Common Labs, Imaging, and Tests:
- Labs, imaging, or tests may not be needed
- X-ray or MRI may be indicated in some cases
Common Symptoms:
- Coccyx (tailbone) pain – can be dull or sharp
- Tailbone pain typically worsens when moving from sitting to standing
- Pain may be worse when having a bowel movement, during intercourse, sitting (particularly when leaning back), bending forward
Common Treatments:
- Wedge, or donut, cushions
- Heat/ice therapy – avoid direct contact with skin
- Pelvic floor physical therapy
- Manipulation therapy
- Extracorporeal shockwave therapy (ESWT)
- Surgery may be indicated for some, but generally is reserved as a last resort option when no other treatment options have been effective
Physical Findings:
- Pain/tenderness with palpation of the coccyx
- Rectal exam may be needed for internal palpation of the coccyx
Potential Complications and Contraindications:
- Chronic pain interfering with sitting and daily activities
- Surgical risks: infection, poor wound healing, persistent pain
- Rare underlying causes: infection or malignancy — imaging necessary when suspected
General Health and Lifestyle Guidance:
- Use well-padded or cut-out cushions when sitting if needed
- Maintain healthy weight to reduce tailbone pressure
- Avoid prolonged sitting—frequent position changes help
- Gradual activity and pelvic floor stretching may provide relief. Ask your healthcare provider for specific recommendations.
Suggested Questions to Ask Patients:
- When does your tailbone pain begin and what makes it worse?
- Does sitting or standing change how you feel?
- Have you tried posture changes or a special cushion?
- Any history of injury or childbirth related to your pain?
Suggested Talking Points:
- Ask your healthcare provider if you should take a stool softener to help with pain during bowel movements
- Avoid prolonged sitting or leaning back, change positions often if unable to ambulate
- Report any new, worsening, or persistent symptoms to your healthcare provider
- You may be managed by a Pain Management clinic for persistent pain
Sources:
- UpToDate: https://www.uptodate.com/contents/coccydynia-coccygodynia?search=coccydynia&source=search_result&selectedTitle=1~13&usage_type=default&display_rank=1
- https://www.nhs.uk/conditions/tailbone-coccyx-pain/
- https://my.clevelandclinic.org/health/diseases/10436-coccydynia-tailbone-pain
This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.