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Tailbone Woes

In this report, doctors at Baylor College of Medicine look at a condition called coccygodynia. Coccygodynia is defined as pain in the coccyx (the tailbone). The pain is often sharp. It's usually made worse by sitting.

Women are affected five times more often than men. Women often have past trauma such as a difficult vaginal birth. Obesity and trauma are the most common risk factors. There are other causes such as tumors, spastic muscles, and arthritis.

The authors describe the normal anatomy in the coccyx. They discuss causes of coccygodynia in detail. Patient symptoms, findings on exam, and the results of imaging studies are also presented. Dynamic X-rays offer the best understanding of the problem and what's causing it. These images are taken while sitting and standing.

Nonsurgical treatments may include anti-inflammatory medicine, hot packs, ultrasound, and instructions to sit on a pillow or cushion. Patients may also benefit with hands-on treatments, such as massage, joint mobilization, or manipulation. If symptoms continue despite these measures, steroid injections into the problem area may be recommended.

If patients still have pain and problems, surgery may then be recommended. The main procedure described in this review is called coccygectomy, which is the surgical removal of the coccyx. Possible problems after surgery include wound infection and delayed healing. In some cases pain is not relieved, and the bones of the sacrum (just above the coccyx) may stick out. Treatment is most successful when there's normal motion of the coccygeal spinal segments.

References: Guy R. Fogel, MD, et al. Coccygodynia: Evaluation and Management. In Journal of the American Academy of Orthopaedic Surgeons. January/February 2004. Vol. 12. No. 1. Pp. 49-54.

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