Coccygodynia is pain at the coccyx. It is also referred to as coccydynia or tailbone pain. Though this condition resolves with supportive care in majority of the patients, symptoms can persist for months and years in some. Intractable coccydynia is relatively uncommon, but when it occurs it can dramatically decrease patient’s quality of life.
Prevalence & Risk Factors :
It must commonly occurs in adolescents & adults, children being affected sometimes. It is five times more prevalent in women than in men. The higher prevalence is thought to be due to injuries that occur during childbirth as well as coccyx being located more posteriorly in women, thus being more susceptible to external trauma. Obesity is thought to be a risk factor as it may lead to coccydynia by changing the way people sit or by increasing the total weight bearing load.
Etiology :
External direct trauma : It is the commonest of Coccygodynia resulting in external trauma from a fall backward into a sitting position.
Repetitive minor trauma : It may occur in a setting of prolonged sitting from repetitive microtrauma. This occurs with poor posture, on a hard or ill fitting surface, or on a narrow surface.
Maternal injuries during child birth : Injury may occur due to pressure exerted on the coccyx during child birth & delivery.
Coccygeal instability : Both hyper & hypomobility of the sacro-coccygeal joint have been associated with Coccygodynia.
Others : Rare causes include somatization in the setting of known depression, infection, metastatic cancer, avascular necrosis, calcium crystal deposits etc.
Clinical Features :
In patients with coccydynia pain & tenderness are typically well localized to the coccyx. Patients complain of pain in the tailbone on sitting, especially when leaning back. Patients may also complain of pain during defecation, sexual intercourse & radiation of the pain to the floor of the pelvis from muscle spasms. On examination, focal external palpation of the coccyx reproduces pain symptoms but palpation of the surrounding area does not. In patients where diagnosis is on certain with external palpation, internal palpation of the coccyx via rectal examination can be helpful.
Diagnosis :
Diagnosis of coccydynia is done on history & clinical features. Imaging is obtained only if infection, malignancy or fracture is suspected.
Management :
Initial Management : for patients with infection & malignancy, they have to be treated accordingly. For other patients with acute history conservative management with acute history conservative management with protection, analgesics, heat or ice foamentation help in 90 % of the patients.
Persistent Symptoms : Chronic Coccygodynia is said to develop when symptoms persist for more than 2 months.
Imaging is obtained in patients with persistent symptoms. X-ray or MRI is preferred depending on the aetiology.
Interventional Techniques :
Local Injections : A series of injections of local anaesthetic with or without gluco-corticoids can be tried in patients with persistent symptoms. These injections are directed towards sacro-coccygeal junction, Coccygeal joint & pericoccygeal area.
Injection at Ganglion of Impar : Ganglion of Impar is the terminal ganglion of the sympathetic chain. It is located just anterior to sacro-coccygeal joint or first intercoccygeal joint. Injection at the ganglion impar with local anaesthetic gluco-corticoid has found positive results in a case series carried out in patients with persistent Coccygodynia. This injection is carried out under fluoroscopic guidance with the needle position confirmed is AP & lateral view & satisfactory dye spread along the ganglion of impar.
Radiofrequency Ablation of Ganglion of Impar : If the results of injection at ganglion of impar are good with local gluco-corticoid, radiofrequency ablation of the ganglion of impar can be done if the symptoms occur.
Other Treatments :
Pelvic floor physical therapy : This is most helpful in patients with significant pain within the muscles, tendons & ligaments of the pelvic floor. This can also be used as an adjuvant to interventional techniques.
Manipulation : This is useful in patients with pain from muscle spasms in proximity to sacro-coccygeal region. It is not recommended in patients with Coccygeal fractures, hypermobility & spurs. Manipulation via the rectum is done to massage the muscles attached to coccyx so as to relieve the spasm.
Ultrasound, shortwave diathermy & Trans-cutaneous nerve stimulation can also be tried in resistant cases.
Surgical excision : Surgical excision of the coccyx is the last resort reserved to patients intractable Coccygodynia who have undergone a full trail non-surgical treatments without significant relief.
Disclaimer: The information provided here should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. The information is provided solely for educational purpose and should not be considered a substitute for medical advice.
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