COCCYDYNIA

Coccydynia is a pain felt at the lowest part of the spine - coccyx (tailbone) or between the buttocks. It can be due to injury or strain of coccyx, surrounding muscles, and ligaments. Mostly, the pain improves over a few days to weeks, but occasionally it can last much longer and severely affect sitting or ability to carry out daily activities.

SYMPTOMS OF COCCYDYNIA:

The main symptom is pain and tenderness in the area just between & above the buttocks.

The pain is usually dull- aching type mostly, with occasional sharp- shooting pain.

PRECIPITATING OR EXACERBATING FACTORS:

• Pain is worst on sitting down on a hard surface/chair.

• Moving from sitting to a standing position or standing for long periods.

• During having sex.

• During passing motions.

• Difficulty to sleep in a supine position.

• Difficulty in daily activities, such as driving or bending forwards.

CAUSES OF COCCYDYNIA

Common causes include :-

• Fall on the floor on buttocks (Most common cause): May result in subluxation or dislocation of the coccyx.

• Poor sitting posture: Prolonged sitting on bed/chair during long office hours/ long study hours.

• During Childbirth in pregnant females Over-Stretching of ligaments around the coccyx

• Accidental kick to the lower spine during contact sports e.g. football, hockey, rugby, wrestling

• Repeated strain injury in sports like rowing, cycling, etc. where sportsperson has to lean forwards and over-stretch sacrococcygeal ligaments.

• Overweight (excessive weight on coccyx) or underweight/slim (less soft-tissue padding over sacrum-coccyx)

Less common causes can include infection, tumor, a bony growth on the coccyx, too flexible or too rigid coccyx, arthritis, age-related wear & tear of sacrococcygeal joint.

WHEN TO GET MEDICAL ADVICE:

Coccydynia will often improve on its own after a few weeks with postural modifications and hot packs. But see Pain medicine Specialist if:

• The pain does not improve even after doing maximum conservative management for 2-3 weeks.

• Pain is severe and difficulty in sitting in office/studying.

• Associated symptoms like bleeding per rectum, high temperature or pain over the spine/inguinal region.

TREATMENT FOR COCCYDYNIA:

Conservative management at Home:-

• Postural modification or Self-care measures, such as Avoiding prolonged sitting: try to stand up and walk around regularly; leaning forward while seated may also help.

• Using a specially-designed coccyx cushion (doughnut cushions): they help reduce the pressure on your tailbone while you're sitting down.

• Wear loose-fitting clothes – avoid clothing such as tight jeans or trousers that may put pressure on your tailbone

• Apply warm and cold packs to your tailbone – warm packs include hot water bottles and microwaveable heating pads; cold packs are available as freezable gel-filled pads.

• Try laxatives (medicines to treat loosen stools & prevent constipation) if the pain is worse while passing motions or constipation.

• Non-steroidal anti-inflammatory (NSAID) painkillers e.g. paracetamol (Crocin), ibuprofen

Persistent symptoms lasting longer than 2-3 weeks and not responding to above home treatment may benefit from:

• Physiotherapy: exercises, massage, and stretching of gluteal/hamstring muscles.

• Per Rectum Coccyx: manipulation is done in some cases of rigid/arthritic sacrococcygeal joint.

• Peri-coccygeal injections: of anti-inflammatory medicine, combined with local anesthetic around the coccyx or surrounding ligaments can be given to reduce inflammation and pain. These are very successful in relieving pain, but the patient needs to follow posture modifications and re-injury to prevent the re-occurrence of pain. Not more than 2-3 injections can be given in a year.

• Ganglion Impar Block: can be given in resistant cases, where severe pain not responding to conservative management and occasionally associated with burning pain in the anal region/inguinal region. This is the technical pain procedure done under fluoroscopic guidance. This leads to a near-complete resolution of pain and other symptoms.

In very rare cases, coccygectomy (surgical removal of the coccyx) is done, but the success rate for pain relief in low.

To summarize, Postural modifications with adequate treatment procedures can lead to the complete resolution of coccydynia pain.