Tailbone Pain/coccydynia

Tailbone pain is a pain that occurs in or around the bony structure at the bottom of the spine (coccyx) and can be caused by trauma to the coccyx during a fall, prolonged sitting on a hard or narrow surface, degenerative joint changes, or vaginal childbirth. The pain may radiate to the hips, thighs, or even to the rectum. It can make sitting difficult, exercise painful, and may even disrupt sleep.

The technical term for tailbone pain is coccydynia. In most people, the pain is a dull, throbbing ache that feels like a muscle spasm. Some people with tailbone pain also experience sharp, stabbing pain. This pain may occur when physically active or when sitting for extended periods of time. The pain may also radiate down the legs or up the back. It can feel like it is in the tailbone itself, or in the surrounding muscles and structures. The right treatment, as well as some home management strategies, can help.

Tailbone pain is usually accompanied by other, more specific symptoms that can sometimes indicate how pain is occurring. Coccydynia may be further characterized by one or a combination of the following symptoms:

• Localized pain and tenderness. Pain is generally confined to the tailbone and does not radiate through the pelvis or to the lower extremities. Pain is usually described as an aching soreness and can range from mild to severe. 
• Increased pain with sitting. Coccydynia is generally more intense when weight is placed on the tailbone, as in when a person leans backward in a sitting position. Likewise, sitting on hard surfaces without a cushion (such as a wooden bench or a metal folding chair) or leaning back against a wall puts added pressure on the tailbone, causing pain to worsen.
• Pain that is worse when moving from sitting to standing. When moving from a seated position to standing or vice versa, the rotation of the pelvic bones (and muscle movements that assist this rotation) may be painful. It may be difficult to stand or sit, requiring one to lean against something to provide better stability.
• Pain that may increase with a bowel movement or sexual intercourse. Some patients experience heightened pain during sexual intercourse or defecation, due to the proximity of the coccyx to the anus and genitals.

     Other related symptoms that may occur with coccydynia include:

• Depression.
• Anxiety.
• Poor sleep.
• Painful buttocks.
• Back pain.

A wide range of health issues, ranging from minor to serious, can cause tailbone pain. The pain often goes away on its own, particularly with home management. So, if the pain is minor and there is no known cause, it is safe to wait a few weeks before seeking medical care. The most common sources of tailbone pain include:

• A blow: This could be to the tailbone or the surrounding muscles. For example, falling from a bicycle may injure the tailbone, while running into the wall might cause pain radiating from other muscles to the tailbone.
• Sitting down: Especially for extended periods of time, or in awkward positions.
• Trauma during childbirth: The tailbone can be injured or even broken while delivering a baby.
• Degeneration: To nerves or joints.
• Compression: This can happen to nerves when pressure occurs during pregnancy.
• Pelvic floor dysfunction: Often due to childbirth.
• Levator syndrome: This is a condition that causes spasms in the muscles of the anus. The pain may radiate to the tailbone, hips, or other nearby areas.
• Straining: This could be due to constipation or hemorrhoids.
• Problems with the spine: For example spinal surgery or degenerative lumbar disc disease.
• Infections, tumors, bone spurs, and growths: Rarely, these may be the cause of coccyx pain.

To make a diagnosis, a doctor will undertake a comprehensive assessment that includes a complete medical history. The doctor may ask about:

• Previous pregnancies and childbirth experiences
• A history of gastrointestinal problems
• Any other muscle problems

Depending on symptoms and medical history, some tests can evaluate the source of the pain. These include:

• A pelvic exam to assess the pelvic floor
• A rectal exam to determine whether a problem with these muscles is the culprit
• Imaging tests, such as routine X-rays, magnetic resonance imaging (MRI) scans of the tailbone and spinal cord
• Blood tests to rule out other causes, such as an infection or autoimmune condition

Many studies find that non-surgical treatments are successful in approximately 90% of coccydynia cases. Treatments for coccydynia are usually non-invasive and include activity modification. The first line of treatment typically includes self-care that can be done without the assistance of a medical professional, such as some of the following:

• Non-steroidal anti-inflammatory drugs (NSAIDs). Common NSAIDs, such as ibuprofen (Advil), naproxen (Aleve), or COX-2 inhibitors (Celebrex), help reduce the inflammation around the coccyx that is usually a cause of the pain.
• Ice or cold pack. Applying ice or a cold pack to the area several times a day for the first few days after pain starts can help reduce inflammation, which typically occurs after injury and adds to the pain.
• Heat or heating pad. Applying heat to the bottom of the spine after the first few days of pain may help relieve muscle tension, which may accompany or exacerbate coccyx pain. 
• Supportive pillows. A custom pillow that takes the pressure off the coccyx when sitting may be used. Pillows for alleviating coccydynia may include U- or V-shaped pillows, or wedge-shaped pillows with a cut-out or hole where the tailbone is
• Dietary changes. If tailbone pain is caused by or worsened with bowel movements or constipation, increased fiber and water intake, as well as stool softeners, is recommended.

Additional Non-Surgical Treatments for Coccydynia

If tailbone pain is persistent or severe, additional non-surgical treatment options for coccydynia may include:

• Manual manipulation. Some patients find pain relief through manual manipulation of the coccyx. Through manual manipulation, the joint between the sacrum and the coccyx can be adjusted, potentially reducing pain caused by inadequate coccyx mobility.