Pain in the area of the coccyx (tailbone) is called coccydynia. The coccyx is a bony structure located at the base of the spine or tailbone. The ligaments and tendons surrounding the coccyx can become tender and painful. Coccydynia can be anything from discomfort to acute pain, varying between people and varying with time in any individual. The name describes a pattern of symptoms (pain brought on or aggravated by sitting), so it is really a collection of conditions, which can have different causes and need different treatments.
Causes of coccygeal pain are numerous and include unstable coccyx, spur, misalignment, muscle spasm, pilonidal cyst, tarlov cyst, neuropathy, cancer, referred pain, neuropathic pain, previous medical procedures, or factitious/imaginary pain.
Coccydynia can occur after falls, childbirth, repetitive strain or surgery. In some cases the cause is unknown. The pain can disappear by itself or with treatment, or it can continue for years, and may get worse. It is five times more common in women than men, probably because the female pelvis leaves the coccyx more exposed. It appears that in most cases an unstable coccyx, which causes chronic inflammation, causes the pain.
Coccydynia can be cured eventually in the great majority of cases, given the right treatment. However, finding a doctor who can do a proper diagnosis of the condition and supply effective treatments is difficult, and many people suffer years of pain.
The symptoms described vary:
- Pain during or after sitting, the level of pain depends on how long you sit. This is the main problem caused by coccydynia. The increased pain and sensitivity caused by having to sit for a long period may continue for days afterwards.
- Acute pain while moving from sitting to standing. To avoid this pain, try leaning forward a bit and hollow your back.
- Pain caused by sitting on a soft, but not a hard surface.
- Deep ache around the coccyx
- Sensitivity to finger pressure on the tip or edges of the coccyx
- Shooting pains down the leg
- Pain during bowel movements, and sometimes before
- Pain during sexual intercourse, either in men or women.
If the pain was caused by trauma, then there may be other parts of the body damaged as well. If this damage includes the sacrum, hips or legs, it may be very difficult to sort out what is causing the most pain. An injection into the area of the coccyx may help to find out how much of the pain is caused by the coccyx.
One of the first aims of investigation is to rule out any diseases such as cancer as the cause of the pain. This is very unlikely, but it needs to be checked. X-rays, CAT scans, MRI scans and colonoscopy may be used for this purpose.
When deciding on treatments, it is important to distinguish coccyx pain from low back pain or other sources not related to the coccyx. These other problems may cause discomfort when sitting, but require different treatments from coccydynia.
But the tests above don’t identify the cause of the pain in most cases. It is necessary to do other tests to find the cause of the pain. Occasionally injection into the coccyx may be diagnostic.
The initial treatment of coccydynia is conservative. This includes bed rest, heat, ice, physical therapy and non-steroidal anti-inflammatory drugs. For those patients who still have pain, an injection into the site with a local anesthetic and a steroid might be helpful. In rare cases, surgical removal of the coccyx may be necessary.
1. How is the injection done?
First, you will have a consultation with the pain specialist. Once he determines that you are a candidate for the injection, he will schedule your procedure. If you are taking any medications, such as blood pressure medications or blood thinners, you will need to discuss this with the doctor to determine whether or not to continue with them prior to the procedure. If you are diabetic, the doctor will need to know that as this injection may cause a rise in blood sugar several days after the procedure. You must have someone with you after the procedure to drive you home. The injection is usually quick, only several minutes for each side. The skin is numbed with a small amount of local anesthetic (lidocaine). Once the numbing medication is given, there is little or no pain during the injection. Although sedation is usually not necessary, a small amount of sedation can be given for an anxious patient. The needle is placed in the joint under X-ray and the medication is then given. You will have a brief recovery and will then be discharged home with your driver.
2. What should I expect after the procedure?
Immediately after the procedure, you may feel that your pain is less. This is due to the local anesthetic. After the local anesthetic has worn off in several hours, the pain will return. You may have some slight soreness at the injection site for several days due to the irritation from the needle. The medication itself may take several days to work. The duration of pain relief is different for each patient. For some patients, the pain relief may last from several days to as long as several months.
3. How many injections do I need?
You may get significant pain relief from the first injection and a second injection may not be necessary. If the first injection does not completely relieve your pain, a second may then be given. Usually no more than three injections are given within 6 months. If the injections do not relieve your pain, then the source of the discomfort may not be the sacroiliac Joint. There are several problems that cause similar symptoms including bulging or herniated discs, spinal stenosis and disease in the facet joints of the spine.
4. What are the risks of the injection?
Generally speaking, this is a simple and safe procedure. The most common side effect is pain at the site where the needle was inserted. This should resolve within several days. Bleeding and infection are a risk of any injection at any site. There are some side effects that can occur from the medication that is injected. This includes a rise in blood sugar, weight gain and water retention. These effects are minimized by using low doses of the medication and limiting the number of injections to three within 6 months.
5. Should I get the injection?
That decision can only be made after you see the pain specialist. He will discuss all of your options for treatment including injections. After the evaluation, he will determine if a problem in the Sacroiliac joint is the likely source of your problem and if you are a candidate for the procedure.