Hello friends! Today we are going to talk about a condition called coccydynia. This is a fancy word for pain in or around the coccyx—AKA your tailbone. (Smallwood, 2014; Maigne, 2012)
As with most cases that involve pain in the pelvic region, coccydynia often deals with many factors including physiological (typically issues with muscles and tendons) and psychological (stress, depression, etc). (Smallwood, 2014)
We don’t know exactly why some people get coccydynia, but it is more common in females and individuals who are obese. (Smallwood, 2014)
The most common cause is trauma to the tailbone. (Smallwood, 2014) This can be a fall backwards, injury during childbirth (especially with the use of instruments like forceps), or simply sitting on a hard, narrow, or uncomfortable surface for long periods of time. (Smallwood, 2014)
With coccydynia you may experience pain with sitting or standing for long periods of time, standing up from sitting, sexual intercourse, or pooping. (Smallwood, 2014)
The good news is most cases of coccydynia improve within weeks to months. Some resolve on their own with no treatment while others need conservative management. However, there are some cases that become chronic and debilitating. (Smallwood, 2014; Maigne, 2012)
Before we go any further, let’s talk briefly about the anatomy of and around your tailbone.
Your tailbone is the end of your spine and serves as an attachment point for many of your pelvic floor muscles and ligaments. Most of your muscles attach to the pubic bone in the front and the tailbone in the back. These pelvic floor muscles sit like a hammock and support all of your abdominal organs.
Your tailbone sits directly behind your rectum (where poop comes out). That’s why having issues with your tailbone can cause difficulty with pooping.
This area can also be painful. When you sit, your tailbone along with your ischial tuberosities (or sit bones) act as a tripod to support you. If you lean back can put more pressure on the tailbone, typically causing more pain.
Some of this pain with sitting can be alleviated with a coccygeal cushion, like this one. Donut cushions are readily available in many stores and online, but be mindful that these cushions can often put more pressure on the tailbone and are better suited for patients with rectal pain. (Smallwood, 2014)
If you visit your healthcare provider with coccydynia-like symptoms, they may refer you for imaging, like an x-ray or MRI, to make sure there is no fracture in your tailbone or other diseases that could be causing pain.
When other conditions are ruled out, they will likely suggest conservative treatment. The great news is that conservative treatment is successful in 90% of cases. (Smallwood, 2014)
What exactly does conservative treatment entail?
Modalities like hot and cold can help to alleviate symptoms and calm to nervous system to help with pain relief. Be sure to never apply hot or cold for more than 15 minutes at a time to avoid burns.
Your doctor may recommend you start taking NSAIDs like aspirin, Motrin, or Aleeve. Make sure you discuss any medications with your doctor or pharmacist before you take them.
Pelvic floor PT!
Your pelvic physical therapist may want to perform a coccyx mobilization or massage to your pelvic floor muscles. This helps to improve alignment and optimize the functioning of your movement in order to decrease pain.
Physical therapists are "movement specialists" and can provide postural interventions—this include retraining your body to use proper posture when sitting, standing, or performing other tasks. Proper alignment can help to take stress off of the tailbone and improve pain.
Your pelvic floor physical therapist will also examine other parts of your body like your hips and back to check for any limitations. Limitations in other areas of the body can influence the tailbone. Fixing these limitations may improve tailbone pain and vice versa.
Your therapist may use transcutaneous electrical nerve stimulation--also known as TENS. (Smallwood, 2014) This can be helpful in two ways: it helps to calm the nervous system and it can relax tight muscles.
Along with physical therapy, your doctor may recommend injections which often include a local anesthetic with steroid. (Smallwood, 2014)
If all conservative treatments have not worked for you, your provider may recommend surgery. However, this is a last resort when no other treatments have been successful. (Smallwood, 2014) Remember, in most cases symptoms will go away! You don't have to "just live with it."
So, you have tailbone pain? What’s next?
Ask your healthcare provider for a referral to a physical therapist.
Find a physical therapist on your own at myPFM.com. We have links to 4 free searchable databases under Find a PT.
Providers, take our Coccydynia course with Michelle Nesin, PT, FAAOMPT, OCS, FCFMT for an in-depth discussion on coccydynia and treatment options for your patients/clients.
Check out our YouTube channel to learn more about your pelvic floor.
Sign up for our email newsletter and visit our website!
Visit our Instagram page for more on pelvic health.
Check out our Amazon store for pain relief and pelvic health products.
What experiences do you have with coccydynia? Please join the conversation in the comments section below.
By Emily Reul, PT, DPT
References
1. Smallwood Lirette L, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Oschner J. 14(1):84-87, 2014.
2. Maigne JY, Rusakiewicz F, Diouf M. Postpartum coccydynia: a case series study of 57 women. Eur J Phys Rehabil Med. 2012;48(3):387-392.