Coccyx pain or coccygodynia: where does it come from?
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Coccyx pain or coccygodynia: where does it come from?

The tailbone is a small bone located at the bottom of the spine, just below the sacrum. When it becomes painful, it is called coccygodynia. After a fall, without a fall, just after childbirth… A localized pain in the tailbone can have many causes. It is necessary to consult when the pain is intense or persists.

How to relieve tailbone pain? Can it be prevented? Let’s take stock of this symptom.

How to recognize coccyx pain?

Definition of coccygodynia

Coccyx pain, or coccygodynia, is pain felt in the coccyx area. This bone is located at the end of the spine, just below the sacrum, and at the buttocks.

The tailbone is formed by four, sometimes five, small vertebrae more or less fused together. They can be slightly mobile to each other, thanks to the presence of joints and ligaments.

How does pain manifest itself?

The pain felt in the tailbone can be:

  • Continuous;
  • aggravated when sitting and when performing the movement of standing up or sitting;
  • intensified by touch, whether by external or internal touch, that is, by digital rectal examination.

We generally distinguish:

  • acute coccygodynia that lasts less than 8 weeks;
  • chronic, persistent coccygodynia.

It should be noted that these pains are more common in women than in men.

Other pain in the lower back, related, for example, to the lumbar vertebrae or sacrum, can be wrongly attributed to the tailbone. It is therefore necessary to consult to ensure the source of the pain.

What causes coccygodynia?

Coccyx pain is, to summarize, due to:

  • abnormal movement
  • a displacement of the tailbone.

The tailbone, placed in the extension of the sacrum, can be more or less curved inwards, like the tip of a tail that “bends forward”. The more it is aligned with the sacrum, the more the tailbone is protected from trauma, for example.

Traumatic causes

The causes of coccyx pain are diverse. The number one cause of tailbone pain is trauma which can be caused by:

  • a fall on the buttocks;
  • childbirth, the tailbone being displaced by the passage of the baby;
  • repetitive strain injuries, for example, in motorcyclists or cyclists who experience shocks while sitting.

The causes of coccyx pain without falling

  • A dislocation of the joint between the sacrum and the coccyx, or of all or part of the movable portion of the tailbone itself. It represents 20 to 25% of cases of coccyx pain;
  • a “coccygeal spine”, which is a small bony outgrowth at the tip of the tailbone. It is present in 15% of cases of coccygodynia. The spine can be perceived on palpation: it puts pressure in a sitting position and causes local inflammation;
  • Hypermobility is defined as abnormal flexion of the tailbone while sitting, i.e. with an angle of more than 25 to 30°.

Often, no specific cause is found. This is called idiopathic coccygodynia.

More rarely, symptoms may be due to:

  • tumor or cancer
  • infection
  • inflammation of the sacrococcygeal joint.

What diagnosis is in case of a painful tailbone?

A painful tailbone is often the subject of medical imaging tests such as:

  • X-rays;
  • dynamic X-rays, i.e. images taken as the patient leans forward to stand up;
  • a coccygeal discography;
  • MRI;
  • a bone scan.

The fracture of the tailbone can be seen on an X-ray. It can also be determined during a clinical examination, after trauma. It can also be fractures of the sacrum, which lead to pain in the same area. These fractures heal within a few weeks, without treatment.

Risk factors

It should be noted that certain risk factors have been associated with coccyx pain:

  • overweight and obesity;
  • The anatomy of the coccyx itself: certain “forms” are more often associated with pain.

What are the complications and possible evolutions of a coccygodynia?

Depending on the cause, the pain may fade on its own or persist. Since the movement of sitting and standing up is particularly frequent and difficult to avoid, coccyx pain is very troublesome in everyday life. It becomes difficult to:

  • drive;
  • work in a sitting position;
  • move;

It is therefore imperative to consult a doctor for pain relief and appropriate management.

How to prevent and treat coccyx pain?

Management of coccygodynia depends on the diagnosis. It is usually multidisciplinary and begins with advice on sitting posture, such as:

  • modify the supports to avoid pain;
  • Use a hollowed-out cushion to relieve pressure, especially after a fall.

Treatment of a coccygeal spine

In case of acute pain, related, for example, to a coccygeal thorn:

  • Taking painkillers or anti-inflammatories may be helpful;
  • Applying heat or cold to the painful area can also be beneficial.

Treatment of a coccyx fracture

  • no orthosis or plaster may be used;
  • physiotherapy or physiotherapy sessions may be necessary to regain mobility;
  • The use of calcitonin intranasally has shown its effectiveness in several studies.

Other solutions to treat coccyx pain

Osteopathy

Osteopathy sessions or manipulations can sometimes be beneficial, especially to restore mobility or replace the vertebrae following childbirth. They are also effective if the problem is rather at the lumbar level.

Intradisc infiltrations of corticosteroids

Intradiscal infiltrations of corticosteroids such as prednisolone and local anesthetic are sometimes effective.

Removal of the tailbone by surgery

In very rare cases, removal of the coccyx by surgery, called a coccygectomy, may be considered, after the failure of other treatments.

Image Credit: Image by gpointstudio on Freepik

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