Coccydynia is the medical term for persistent pain in and around your coccyx (tailbone). The coccyx is the small, triangular bone at the very bottom of your spine. This pain is often worse when sitting, especially on hard surfaces, and when moving from sitting to standing.
Coccydynia is a localised form of chronic pelvic pain which is more common in women than men, often due to differences in pelvic anatomy, childbirth, and hormonal influences on ligaments. Pain can be acute (following a specific injury) or become a chronic condition lasting more than 3 months.
Common Symptoms
The primary symptom is localized pain, but it can radiate and affect daily functions.
- Localised Pain: Achy or sharp pain directly over the tailbone, between the buttocks.
- Pain Triggered by Pressure: Significant worsening of pain when sitting, particularly when leaning back. Relief is often found when sitting on one buttock or using a special cushion.
- Pain with Movement: Pain when standing up from a seated position, or during activities that pressure the area (like cycling).
- Pain with Bowel Movements or sexual intercourse.
- Referred Pain: Discomfort that can radiate to the lower back, hips, or down the legs.
- Tenderness: The area is extremely tender to the touch.
Causes & Risk Factors
Pain arises from injury or inflammation of the coccyx and its surrounding ligaments and joints.
Common Causes
- Direct Trauma: A fall backwards onto the buttocks is the most common cause (e.g., slipping on ice, missing a chair).
- Repetitive Strain: Activities that involve prolonged sitting on hard or narrow surfaces (rowing, cycling).
- Childbirth: Vaginal delivery, especially of a large baby or with a prolonged pushing stage, can strain or even fracture the coccyx. This is a major cause in women.
- Poor Posture: Sitting with poor support for prolonged periods.
- Idiopathic: In many cases, no specific cause is identified.
Risk Factors:
- Gender: Women are 5 times more likely to develop coccydynia.
- Obesity: Increases pressure on the coccyx when sitting (though rapid weight loss can also reduce cushioning).
- Joint Hyperlaxity: Conditions like Ehlers-Danlos Syndrome can lead to instability.
Diagnosis
Diagnosis is primarily clinical, based on your history and a physical exam.
- Medical History: Your doctor will ask about any trauma, childbirth history, and the nature of your pain.
- External & Internal Examination:
- External: Palpating the area to find the exact point of tenderness.
- Internal (Rectal or Vaginal): This allows the doctor to grasp the coccyx between a finger inside and a thumb outside to assess its mobility and reproduce your pain. This is a key diagnostic step.
- Imaging (to rule out other causes):
- X-Ray: Taken while sitting and standing to assess the coccyx position and rule out a fracture or dislocation.
- MRI Scan: To rule out other causes like a tumour, infection, or severe inflammation.
Management & Treatment Options
Treatment follows a stepwise approach, starting with the most conservative options.
Conservative Management (First-Line for 90% of Cases)
- Adaptations & Cushions: Use a coccygeal cushion (“doughnut” or “U-shaped” pillow) to take pressure off the tailbone when sitting.
- Posture Correction: Learn to sit with your weight on your ischial tuberosities (the “sit bones”) rather than your tailbone.
- Physiotherapy: A pelvic health physiotherapist is crucial. Treatment may include:
- Internal and external manual therapy to mobilise the coccyx.
- Biofeedback to relax pelvic floor muscles.
- Stretching and strengthening exercises for surrounding muscles.
- Heat/Ice: Applying ice packs or warm baths can reduce acute pain and muscle spasms.
- Pain Relief: Over-the-counter NSAIDs (e.g., ibuprofen) or prescribed pain medication.
Interventional Procedures
- Coccygeal Steroid & Local Anaesthetic Injections: An injection directly into the painful joint or surrounding ligaments to reduce inflammation and break the pain cycle. This can provide significant, sometimes long-lasting relief.
- Ganglion Impar Block: A nerve block targeting a specific nerve bundle near the coccyx.
- Prolotherapy: Injections designed to stimulate healing of weakened ligaments.
Surgical Treatment (Last Resort)
- Coccygectomy: Surgical removal of the coccyx. Considered only after at least 6-12 months of failed conservative and interventional treatment. It has variable success rates and risks of infection and wound healing problems.
Frequently Asked Questions (FAQs)
Q: Why is it so painful to sit, but not to walk?
A: Sitting places direct pressure on the inflamed coccyx and its joints. Walking and standing transfer your weight to your legs and pelvis, taking the pressure off.
Q: Is the pain from my recent childbirth permanent?
A: In most cases, no. Coccydynia after childbirth is usually due to ligament strain or a minor fracture and often resolves within several months with proper care (physio, cushions). Persistent pain beyond 6-12 months is less common.
Q: Will an X-ray or MRI show the problem?
A: Not always. The injury is often to ligaments and soft tissues, not the bone itself. Imaging is more useful to rule out other serious conditions. The diagnosis is mainly based on your symptoms and the physical exam.
Q: Should I get the surgery?
A: Coccygectomy is a final option after all else fails. The recovery is lengthy and not guaranteed. A thorough trial of expert physiotherapy and injections should always be attempted first.
Q: Can my gynaecologist treat this, or do I need another specialist?
A: A gynaecologist, especially one with an interest in pelvic pain, can make the diagnosis and initiate first-line treatment (cushions, medication, physio referral). For injections or surgical referral, they will likely collaborate with a Pain Management Specialist or Orthopaedic/Spinal Surgeon.
eGynaecologist Advice
- You should seek a consultation if you experience persistent tailbone pain that interferes with sitting, work, or daily activities, and seek gynaecological advice especially if this pain is reported after a childbirth.
You must be referred to a specialist pelvic health physiotherapist. This is the cornerstone of effective treatment for coccydynia and should be one of the first steps.
