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Tail Bone Pain

What is Coccydynia/Tail Bone Pain ?

Coccydynia , more commonly referred to as tail bone pain is persistent pain felt at the very bottom of the spine. The pain is typically aggravated on sitting or any activity that increases pressure on the lower part of the spine. Patients can typically localize the pain to the distal most part of the spine.

Anatomy of the Coccyx

Coccyx is the distal most part of the spine. It is triangular in shape and comprises of 3-5 fused segments. It serves as one leg of the tripod, also comprising of the two ischial tuberosities and this tripod forms the weight bearing surface in a seated position. It forms a central connecting point for various pelvic floor muscles which support the anus, vagina in females and also play a supporting role in defecation, walking and running. (Diagram to be added)

Prevalance & Etiology

Coccydynia has shown a preponderance towards women and overweight individuals. It shows a prominent gender bias with women affected five times more than men. Moreover, adolescents and adults are more commonly predisposed to developing Coccydynia as opposed to the prepubertal age group

Alternate terminology for Coccydynia used frequently

Symptoms
Diagnosis

Careful history can indicate an episode of inciting trauma or the pain might just be insidious in onset. Local palpation can elicit tenderness. Rectal examination may be performed to palpate the coccyx between the forefinger and the thumb. This can help in eliciting any increased or decreased mobility of the sacrococcygeal segment by manipulation. Infection, masses and spasms of the muscles supporting the pelvic floor are to be ruled out. Dynamic X-ray imaging and MRI are helpful in detecting laxity, fractures, anatomical variations and other concomitant conditions like degenerative disc disease.

Treatment

Conservative treatment modalities usually are adequate in controlling the symptoms in majority of the patients. Anti inflammatory medication may be initiated.

At Alleviate

We follow a combination procedure of Ganglion Impar Injection,
Local trigger injection followed by local manual massage.

Ganglion Impar Injection

The ganglion impair is a terminal midline sympathetic ganglion which is present over the first coccygeal vertebral body and the sacrococcygeal junction. It is a very useful treatment modality as this block provides relief of coccydynia and pain involving the lower part of the rectum, anus, urethra, and vagina.
 This procedure is performed with the patient in a prone position on the Operating table. Some practitioners like to prepare patients with laxatives the night before. With fluoroscopic guidance, a thin spinal needle is advanced through the sacrococcygeal hiatus. Needle placement is confirmed and dye spread is checked under fluoroscopy. Medication is delivered at the site of the Ganglion of Impar. This helps in blocking the sacrococcygeal plexus of nerves.

Lateral view

Intraop fluoroscopy image of ganglion impar injection

AP View

Intraop fluoroscopy image
of ganglion impar injection

Intraop fluoroscopy image of contrast dye injection for confirmation of placement of needle

Intraop fluoroscopy video
of contrast dye injection for confirmation of placement of needle

For chronic and resistant cases, the surgical approach is Coccygectomy. It is
generally reserved as a last resort owing to long and poor healing rates and high
chances of post-operative infection.

FAQs - Tail Bone Pain

What is Coccydynia or Tail Bone Pain?

Coccydynia (Tailbone Pain) is a persisting pain felt at the very bottom of the spinal column in the region on the coccyx. The pain can be dull but aggravates sitting or while doing any activity. Patients can feel the pain to the distal most of the spine.

Why does my tail bone hurt?

Tail bone pain called “coccydynia” is pain that occurs in and around the spine. The bone structure beneath the base of the spine (coccyx) – can cause pain due to falls, prolonged sitting position, or other factors like infection and tumors. Following are the causes of an event for tail bone hurt:
• External Trauma – A bruising, dislocation, or fracture of the coccyx.
• Internal Trauma – Trauma caused due to prolonged or obstructed labour, especially due to childbirth or from sitting on a narrow or hard surface for too long.
• Pregnancy/Childbirth
• Repetitive strain injury (RSI)
• Poor Sitting or Standing Posture
• Overweight or Underweight
• Cancer (rare case)
• Others – Degenerative disc disease, infections, abscesses, and tumors

Is tail bone pain lifelong?

No. Tail bone pain is rarely lifelong.

How long does the tailbone pain last?

Tail bone can last for days, weeks, months, or sometimes longer.

What are the symptoms of tailbone pain?

The symptoms of tailbone pain include:
• Pain due to dull, achy soreness, or piercing
• Pain aggravates due while sitting to standing up. Hard surfaces and unforgiving metal chairs can also annoy pain.
• Painful while getting up from sitting position or in some cases, a person can feel intense pain leaning for the support while standing or sitting.
• Pain during bowel movements
• Pain can occur during intercourse and defection

When should I see a doctor for tail bone pain?

You must immediately consult your doctor if you have pain in the tail bone and any other following symptoms:

  •  a sudden increase of pain or swelling
  • constipation lasts long
  • numbness, weakness, or tingling in one or both legs
  • unable to perform bowels or bladder
How is coccydynia (tail bone pain) is diagnosed?

Depending on your symptoms, your doctor will ask you to undergo a physical examination of the area. Rectal examination may also be performed.
Your doctor will ask to undergo tests – X-ray, Imaging, and MRI, which help in detecting laxity, fractures, anatomical variations, and other concomitant conditions like degenerative disc disease.

How is coccydynia (tail bone pain) treated?

Most of the tail bone pain is successfully treated using conservative treatment modalities. Based on the condition, anti-inflammatory medication is prescribed.

Can tail bone pain is treated with heat & cold application?

If there is an acute exacerbation of pain, ice or a cold pack is applied. Applying a local heat pack can help in relaxing the spasming muscles and relieves pain.

Can physical therapy helps (tail bone pain)?

Under the physical therapist, pelvic floor rehabilitation exercises help in the complete relaxation of the muscles supporting the pelvic floor. Manual massage manipulation is helpful for muscles supported to the tail bone might help in relieving pain.

What is the best medicine for tail bone pain?

Your doctor may prescribe over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) to ease pain or discomfort until the tail bone heals. Drugs recommended by doctors are ibuprofen or naproxen, and Acetaminophen (Tylenol), also used to relieved tail bone pain.

Does nutritional adjustment good for tail bone pain?

Yes. Intake of fibre rich foods with a marked increase in water is good got tail bone. Stool softeners might help those associated with constipation.

What are the recommended surgical options?

Surgical procedure for tail bone is extremely rare as many patients have successfully treated with non-surgical techniques. During the surgery process, partial coccygectomy or total coccygectomy is surgically removed.

When can I go back to routine activity?

Although tail bone pain is uncomfortable it should not obstruct your daily activities. If you find any discomfort or difficulty, you need to contact your doctor immediately.

Which doctor should I consult for the tail bone pain?

Most cases are cured by consulting with the pain management specialist doctor. However, booking an appointment with a highly experienced spine doctor helps in getting the best treatment.

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