Tailbone Pain (Coccydynia) Treatment in Delhi, India

Coccydynia, commonly known as tailbone pain, refers to the discomfort or pain experienced in the coccyx, which is the small triangular bone at the bottom of the spine, also known as the tailbone. Coccydynia can vary in intensity, ranging from mild discomfort to severe, debilitating pain.

This condition can result from various factors, including trauma to the tailbone from falls, childbirth, or sports injuries, as well as prolonged sitting, obesity, or degenerative changes in the coccyx joints. The pain associated with coccydynia may worsen when sitting or with certain movements, such as rising from a seated position or leaning back while sitting.

Tailbone pain can have various causes, including:

Traumatic Causes

• Falls: Falling directly onto the buttocks can result in trauma to the tailbone, leading to pain and discomfort. This can occur due to slips, trips, or accidents.
• Childbirth: During vaginal childbirth, the pressure exerted on the tailbone as the baby moves through the birth canal can cause injury or trauma to the coccyx, resulting in pain post-delivery.
• Sports Injuries: Certain sports activities, particularly those involving high impact or frequent falls, can cause trauma to the tailbone. Activities such as horse riding, cycling, or ice skating may increase the risk of tailbone injuries.

Non-Traumatic Causes

• Prolonged Sitting: Sitting for extended periods, especially on hard surfaces or in poor posture, can exert pressure on the tailbone, leading to discomfort and pain over time. Individuals with sedentary lifestyles or occupations that require long hours of sitting may be particularly susceptible.
• Obesity: Excess weight can put additional pressure on the tailbone and surrounding structures, exacerbating any existing discomfort or predisposing individuals to develop tailbone pain. Obesity can also contribute to poor posture and increased strain on the lower back and pelvic region.
• Degenerative Joint Changes: Over time, the joints, and structures surrounding the tailbone may undergo degenerative changes, such as arthritis or degenerative disc disease. These changes can result in inflammation, stiffness, and pain in the tailbone region, particularly with movement or prolonged sitting.

Symptoms of tailbone pain, or coccydynia, can vary depending on the underlying cause and severity of the condition. Common symptoms include:

• Pain and Tenderness: The primary symptom is usually pain and tenderness in the tailbone region. This pain may be dull, achy, or sharp and can worsen with prolonged sitting, standing up from a seated position, or pressure on the affected area.

• Discomfort when sitting: Individuals with coccydynia often experience discomfort or pain when sitting for extended periods, especially on hard surfaces or when sitting in certain positions.

• Pain with Movement: Activities that involve bending or twisting and sliding the lower back, such as getting in and out of a car or lifting heavy objects, may exacerbate tailbone pain.

• Pain during Bowel Movements: Straining during bowel movements can increase pressure on the tailbone, leading to pain or discomfort in individuals with coccydynia.

• Pain during Sexual Intercourse: For some individuals, coccydynia can cause pain or discomfort during sexual intercourse, particularly in positions that put pressure on the tailbone.

• Localised Swelling: In cases of trauma or injury to the tailbone, there may be localised swelling or bruising in the area.

• Numbness or Tingling: In more severe cases, coccydynia may be associated with numbness or tingling sensations in the tailbone region or down the legs, indicating nerve involvement or nerve compression.

• Difficulty Walking or Standing: Severe tailbone pain may make it challenging to walk or stand for prolonged periods, affecting daily activities and quality of life.

If you are experiencing persistent tailbone pain or any concerning symptoms, do not hesitate to contact Max Hospitals, as proper diagnosis and treatment are essential for managing the condition effectively.

Here's how tailbone pain can be diagnosed using clinical evaluation and various imaging studies:

Clinical Evaluation

• Personal information: Age, sex, BMI (Body mass index), occupation, etc. 

• Medical History: The tailbone specialist will begin by taking a detailed medical history, including asking about the onset, duration, and severity of symptoms, as well as any relevant medical conditions or previous injuries.
• Physical Examination: A thorough physical examination will be conducted to assess the tailbone region for tenderness, swelling, or abnormalities. The healthcare provider may also evaluate the range of motion of the lower back and pelvis.
• Provocative Tests: Specific manoeuvres or tests may be performed to reproduce or exacerbate the pain, helping to pinpoint the source of the discomfort. For example, the patient may be asked to sit or stand in certain positions to assess for pain exacerbation.

Imaging Studies

• Blood: Blood tests such as CBC (Complete Blood Count), ESR (Erythrocyte Sedimentation Rate), and CRP (C-Reactive Protein) are commonly used to assess overall health and diagnose conditions like anaemia, inflammation, and infections. An arthritic profile typically involves a combination of tests aimed at diagnosing and monitoring arthritis, including inflammatory markers like CRP and ESR, along with specific tests for autoimmune forms of arthritis. These tests collectively provide valuable insights into a person's health status, aiding in timely diagnosis and treatment of various conditions.
• X-rays: X-rays are often the initial imaging study performed to evaluate the bony structures of the tailbone and surrounding area. X-rays can help identify fractures, dislocations, or abnormalities in the coccyx or nearby bones.
• MRI (Magnetic Resonance Imaging): MRI may be ordered if further evaluation of soft tissues, such as muscles, ligaments, or nerves, is needed. MRI provides detailed images of soft tissue structures and can help identify inflammation, tumours, or other abnormalities that may be contributing to the tailbone pain.
• CT Scan (Computed Tomography): CT scans may be used to provide more detailed images of the bony structures of the tailbone and surrounding area, particularly in cases where X-rays are inconclusive or further evaluation of bony abnormalities is needed. CT scans can help identify fractures, bony spurs, or other structural abnormalities.

Treatment for tailbone pain can involve various approaches aimed at alleviating discomfort and promoting healing. 

Pain Medication

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and alleviate pain. Acetaminophen may be recommended for pain relief, especially if NSAIDs are not suitable for the individual. In some cases, prescription medications such as muscle relaxants or nerve pain medications may be prescribed for more severe pain, as may antidepressants and steroids (oral).

Physical Therapy

Physical therapy can help strengthen the muscles surrounding the tailbone, improve flexibility, and correct posture, which can alleviate pressure on the coccyx. Techniques such as gentle stretching exercises, massage therapy, and pelvic floor exercises may be utilised to reduce pain and improve mobility.

Tailbone Cushions

Donut-shaped or wedge-shaped cushions can provide relief by redistributing pressure away from the tailbone when sitting. These cushions can be used at home, in the car, or at work to minimise discomfort during prolonged sitting periods.

Steroid Injections

Corticosteroid injections directly into the area around the tailbone can reduce inflammation and provide temporary pain relief. These injections are typically performed under fluoroscopy or ultrasound guidance to ensure accuracy and safety.

Ganglion Impar Block

A ganglion impar block involves injecting medication, such as a local anaesthetic or steroid, into the ganglion impar nerve located near the coccyx. This procedure can provide significant pain relief for individuals with coccydynia (tailbone pain) by blocking pain signals from reaching the brain.

Coccygectomy

Coccygectomy is a surgical procedure where part or all of the coccyx is removed. It is usually considered as a last resort when conservative treatments have failed to provide relief and the pain is severe and significantly impacting the individual's quality of life. Recovery from coccygectomy may take several weeks to months, and physical therapy is often recommended post-surgery to aid in rehabilitation and prevent complications.

Tailbone pain can have various complications depending on its underlying cause and severity. Some potential complications associated with tailbone pain include:

Chronic pain

Tailbone pain can become chronic if it is not properly managed or treated. Chronic pain is defined as pain that persists for an extended period, usually more than 6 weeks, typically beyond the expected healing time. It can significantly impact a person's daily activities, mood, and overall quality of life. Managing chronic tailbone pain may require a combination of medical treatments, lifestyle modifications, and pain management techniques.

Mobility issues

Severe tailbone pain can limit mobility and make it difficult to perform activities that involve sitting, standing, or walking for extended periods. This limitation can affect one's ability to work, participate in social activities, or engage in exercise. Physical therapy and ergonomic adjustments may help improve mobility and reduce discomfort.

Psychological effects

Living with chronic pain can take a toll on a person's mental health. Tailbone pain may lead to emotional distress, anxiety, depression, and feelings of helplessness or frustration. It's essential for individuals experiencing tailbone pain to seek support from healthcare professionals, counsellors, or support groups to address the psychological impact of their condition.

Sleep disturbances

Persistent tailbone pain can interfere with sleep, making it challenging to fall asleep or stay asleep throughout the night. Sleep disturbances can worsen pain perception and exacerbate other physical and emotional symptoms. Establishing good sleep hygiene practices and exploring relaxation techniques may help improve sleep quality despite the presence of tailbone pain.

Impact on work and daily activities

Tailbone pain can hinder one's ability to perform tasks that require sitting, bending, or lifting. This limitation may affect productivity at work, household chores, and leisure activities. Occupational therapy or workplace accommodations may be necessary to accommodate individuals with tailbone pain and enable them to continue working or engaging in daily activities comfortably.

Pelvic floor dysfunction

Chronic tailbone pain may be associated with dysfunction of the pelvic floor muscles, which can lead to urinary or bowel problems. Symptoms may include urinary incontinence, faecal incontinence, urinary urgency or frequency, constipation, or difficulty emptying the bladder or bowels. Pelvic floor physical therapy or specialised treatments may be recommended to address pelvic floor dysfunction and alleviate associated symptoms.

Sexual dysfunction

Severe tailbone pain can interfere with sexual activities and intimacy, leading to sexual dysfunction and relationship issues. Pain during sexual intercourse or discomfort in certain positions may impact sexual desire and satisfaction. Open communication with a healthcare provider and exploring alternative sexual techniques or positions may help individuals with tailbone pain maintain intimacy and sexual health.

Increased risk of falls

Pain and discomfort from tailbone injuries may affect balance and stability, increasing the risk of falls, especially in older adults. Fear of falling may further limit mobility and independence. Fall prevention strategies, such as exercise programs to improve strength and balance, home modifications, and assistive devices, can help reduce the risk of falls and minimise the impact of tailbone pain on mobility.

Nerve damage

Severe trauma to the tailbone can potentially cause damage to nearby nerves, leading to symptoms such as radiation, numbness, tingling, or weakness in the lower back or legs. Nerve damage may result from fractures or dislocations of the coccyx or compression of nerves in the surrounding area. Prompt medical evaluation and imaging studies may be necessary to assess for nerve involvement and determine appropriate treatment options to prevent further complications.

Each of these complications highlights the importance of seeking medical attention and implementing comprehensive management strategies to address tailbone pain effectively and minimise its impact on physical, emotional, and social well-being.

Preventing tailbone pain or coccydynia involves taking measures to reduce the risk of injury or strain to the coccyx and surrounding structures. Here are some preventive measures:

• Proper sitting posture: Maintain good posture while sitting to alleviate pressure on the tailbone. Sit with your weight evenly distributed on both hips, and use a cushion or pillow to support your lower back and tailbone if needed, especially when sitting for extended periods.

• Use cushioning: Use a cushion or donut-shaped pillow when sitting for prolonged periods, especially on hard surfaces. This helps distribute your weight more evenly and reduces pressure on the tailbone.

• Avoid prolonged sitting: Take frequent breaks from sitting, especially if you have a desk job or engage in activities that require sitting for long periods. Stand up, stretch, and walk around periodically to relieve pressure on the tailbone.

• Exercise regularly: Strengthening the muscles surrounding the pelvis, lower back, and core can help support the spine and reduce the risk of tailbone injuries. Incorporate exercises that target these muscle groups into your regular workout routine.

• Practise proper lifting techniques: When lifting heavy objects, bend your knees and keep your back straight to avoid straining the lower back and coccyx. Use your legs to lift rather than putting excessive pressure on your back.

• Maintain a healthy weight: Excess weight can put added pressure on the tailbone and lower back, increasing the risk of injury and pain. Maintain a healthy weight through a balanced diet and regular exercise to reduce strain on the coccyx and spine.

• Avoid high-impact activities: Activities such as horseback riding, cycling on rough terrain, or participating in contact sports can increase the risk of tailbone injuries. If you engage in these activities, take precautions such as wearing protective gear or using appropriate padding to reduce the risk of injury.

• Use caution when sitting on hard surfaces: Be mindful when sitting on hard or uneven surfaces, such as wooden benches or concrete floors. Place a cushion or pad on the surface to provide additional padding and cushioning for the tailbone.

• Seek prompt treatment for injuries: If you experience a fall or trauma to the tailbone, seek medical attention promptly. Early intervention can help prevent complications and promote faster healing

By incorporating these preventive measures into your lifestyle, you can reduce the risk of developing tailbone pain and maintain overall spinal health.

What is nerve pain in the tailbone?

Nerve pain in the tailbone, also known as coccydynia, is discomfort or shooting pain that originates from the coccyx, the small triangular bone at the base of the spine. This pain can be caused by injury, pressure, or irritation of the nerves in the area.

Why does my tailbone stick out and hurt?

Tailbone pain often occurs due to trauma, such as a fall or childbirth, which can lead to injury or inflammation of the coccyx. In some cases, the tailbone may stick out more than usual (known as hypermobility), causing discomfort and pain, especially when sitting or moving.

How do you massage a sore tailbone?

When massaging a sore tailbone, it's essential to be gentle and use techniques that relieve tension and promote circulation. You can try applying gentle pressure with your fingers in circular motions around the tailbone area, or use a foam roller or massage ball to gently roll over the muscles surrounding the coccyx.

How do I know if my tailbone pain is serious?

If your tailbone pain is severe, persistent, or accompanied by other symptoms such as numbness, tingling, or difficulty controlling bowel or bladder function, it's essential to seek medical attention promptly. These symptoms may indicate underlying issues such as a fracture, infection, or nerve damage.

Is walking good for tailbone pain?

In many cases, walking can help alleviate tailbone pain by promoting blood flow, reducing stiffness, and strengthening the muscles around the coccyx. However, it's crucial to listen to your body and avoid activities that exacerbate pain. If walking worsens your tailbone pain, consider consulting with a tailbone doctor for guidance.

How can I make sitting more comfortable if I have tailbone pain?

To make sitting more comfortable with tailbone pain, you can try using a donut-shaped cushion or a coccyx cushion, which helps relieve pressure on the tailbone while sitting. Additionally, sitting on a firm surface with good lumbar support can also help reduce discomfort.

Are there specific ergonomic chairs or cushions recommended for tailbone pain?

Yes, there are ergonomic chairs and cushions specifically designed to alleviate tailbone pain. Look for chairs with adjustable seat angles, lumbar support, and cushioning that provides adequate support and reduces pressure on the coccyx.

Can driving exacerbate tailbone pain, and are there any tips to make driving more comfortable?

Yes, prolonged sitting, such as during driving, can exacerbate tailbone pain. To make driving more comfortable, consider using a coccyx cushion or a seat cushion with appropriate lumbar support. Additionally, taking frequent breaks to stretch and change positions can help reduce discomfort during long drives.

Who treats tailbone pain?

Tailbone pain can be treated by various healthcare professionals, including primary care physicians, orthopaedic surgeons, spine surgeons, physical therapists, and chiropractors. Depending on the underlying cause and severity of the pain, treatment may involve a combination of conservative measures, such as pain management techniques, physical therapy, or, in some cases, surgical intervention.

Reviewed By Dr. Abhishek Srivastava, Senior Consultant – Spine Surgery on 17 May 2024.