What is Coccydynia?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

Coccydynia is considered more of a symptom than a diagnosis, and it is characterized by pain around the coccyx. Coccydynia is also called coccygeal neuralgia and other times Coccygodynia.

The coccyx is the lower part of the spine and is often referred to as the tailbone and is comprised of a three to five vertebrae part with an infusion. It forms the part of the body where tendons, muscles, and some ligaments are inserted. The coccyx plays many roles in the body like providing weight-bearing support to your body. Furthermore, the coccyx is designed to give the anus positional support. As you lean back while seated, your spine will apply pressure on your tailbone. If this pressure is in excess, it results to lower back pain.

This pain is induced while you are seated and may be severe when you stand erect. The pain one experiences with this condition may be excruciating and sometimes move from the coccyx, down the spine, into the buttocks and then to the thighs. This pain may be chronic and sometimes unbearable, thus reducing the quality of your life.

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More About Coccydynia

lumbar foraminotomy

Back pain is a multi-factor by nature, and this makes its treatment difficult. The pain is often debilitating and may affect how you lead your life.

Lumbar pain that comes from inflammation of the sacro-coccygeal joint and sometimes it may be due to an unstable coccyx. In some instances, the development of back pain has shown a significant relationship to the anatomy of the coccyx. Synovial joints and other coccygeal morphology may lead to predisposition that then develops into coccygeal neuralgia.

While the precise incidence of coccygeal neuralgia pain has not be well documented, research shows that women are 5 times more likely to develop the problem as compared to men. Women have a higher probability of getting coccygeal neuralgia because they have a wide pelvic bone that keeps the tailbone exposed. Moreover, it is more common in adolescents and adults rather than children.

The condition of a painful tailbone is also associated with obesity because it has to support too much weight.

Although the external traumas such as dislocation, bruising, or breaking of the coccyx could lead to coccydynia, internal factors are the major contributing factors. Since the coccyx is strategically located on the lower back, it is susceptible to internal injuries and is readily affected by childbirth. This often occurs if labor was difficult or the childbirth involved the use of instruments.

What are the symptoms?

The pain associated with coccygeal neuralgia is multifaceted and may be caused by psychological, physical, and physiological factors.

  • Excruciating pain at the tailbone area
  • You might even notice bruises around the region.
  • Severe pain when you sit on an uncomfortable surface for a long time that stops if you stand up or walk.
  • Painful bowel movements might also be painful
  • Women might also experience pain when having sexual intercourse.

How is Coccydynia Diagnosed?

When diagnosing coccygeal neuralgia, the physician will first review your medical history and conduct a few physical examinations. This will help him or her to determine the cause of the pain. During this process, you need to notify him/her if you had any injuries or were involved in activities that could make your coccyx ache.

An anesthetic test will be done in which the coccyx is injected to see whether the pain is relieved or not. If the result is positive, the doctor may then request an imaging or X-ray of your tailbone for further assessment. This will show whether the tailbone is fractured or dislocated.

In most instances, the physician will request an X-ray of your coccyx while you are seated and another one when you are in a standing position for accurate diagnosis.

If the doctor wants more clarity into the condition, he or she may ask for a CT scan, a bone scan, or an MRI. This, however, is only done if he or she detects the presence of an infection around the affected area. A tumor might also cause intense discomfort in the coccyx area and is only visible when using these imaging techniques.

The physician will then proceed to examine your spine for any swollen, red, bruised, or tender regions. A neurologic examination and a rectal examination may also be recommended. The latter is done by inserting a finger into the rectum to check for injuries. The physician will also try to exert pressure directly against the tailbone to determine whether the pain decreases.

Causes of Coccydynia Pain

low back pain

Various psychological and physiological factors could lead to the onset of coccygeal neuralgia, and it can be categorized as either traumatic or non-traumatic. Coccygeal neuralgia is caused by a variety of factors such as falling on your tailbone or having it hit. Giving birth is also a major cause of tailbone pain. Undertaking some outdoor activities like skateboarding and cycling could also cause coccygeal neuralgia.

It is more common in women due to the exposed nature of their tailbone. It is also common in obese people because their weight is too much for their tailbones to provide adequate and efficient support. Conversely, if you undergo a rapid weight loss process, you are also likely to develop coccygeal neuralgia due to the reduced mechanical cushioning on the tailbone.

If you sit on an uncomfortable surface for prolonged periods each day, you are also likely to experience tailbone pain that may develop to coccygeal neuralgia.

Somatization disorder, degenerative joint diseases, and other health conditions are also linked to non-traumatic coccygeal neuralgia.

How is Coccydynia treated?

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

How Much Does Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. IN the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

Calculate how much you've spent on back pain this year.
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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used in Diagnosis and Treatment of a Coccydynia

In the diagnosis stage of coccygeal neuralgia, a physician will highly rely on an X-ray machine or other imaging machines to take pictures of the tailbone area.

Treating coccydynia pain requires different techniques with most of them requiring no equipment. Equipment like surgical tools may only become necessary if you have to undergo a surgical procedure to remove the aching coccyx.

As a preventive measure, wearing proper sports equipment while undertaking activities such as basketball, hockey, football, cycling, skateboarding, etc. is highly recommended.

 

How Does Coccydynia Compares to Other Spine Conditions?

A wide variety of conditions are associated with an aching lumbar region. Although patients and medical experts confuse these conditions for coccygeal neuralgia in most incidences, it is not always the case. Coccygeal neuralgia is known as an inflammation of the coccyx, which is also referred to the tailbone.

On several occasions, some medical experts and patients use the term coccygeal neuralgia to refer to all inflammations of the tailbone. However, special knowledge is needed to correctly and properly diagnose and treat each condition. Since they are caused by various factors, the physician may seek to know your medical history and review previous cases of injuries.

It is often tricky even for the most experienced physicians to determine if you have coccygeal neuralgia or another back problem after an X-ray. Scans, however, have a unique accuracy that will increase the chances of making the right diagnosis.

Shingles is one of the lower back problems commonly mistaken for coccygeal neuralgia and vice versa. Both conditions can be extremely painful and make it hard for you to lead a high-quality life.

If you are experiencing an ailment in your lumbar region, it is imperative to find a specialized doctor who can treat all lower back problems. Getting help from any chiropractic professional is also a great idea because they are more likely to make the right diagnosis.

The treatment options for all these spinal conditions are almost identical. The aim is to relieve pain or completely heal the affected region. However, in most incidences, the former is the case. Physiotherapy and psychotherapy are most common due to their higher chances of success. Medication is also used, especially since the other treatment methods may be more costly and time consuming.

Analogy: Blow-Out vs Flat Tire

A bulging disc is like a flat tire, a slipped disc is like a blowout. When you have a flat tire, the wheel’s material loses its shape, but it stays more or less together. In a blowout, the inside of the wheel becomes exposed to the outside.

Both conditions can cause pain, and both should be professionally evaluated. And don’t forget: a bulging disc (flat tire) can progress to become a slipped disc (blowout).

Blow-Out

Blow-Out = Instant Rupture

Flat Tire

Flat Tire = Slow Leak

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