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The Coccyx  
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Definition  

Coccydynia is pain in the area of the coccyx (tailbone). It is a small, curved, V-shaped bone at the bottom of the spine.

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Causes  

The tailbone can be found at the end of the spinal column. It supports the body in a sitting position and helps transfer body weight during changes in sitting positions. It is also an area where muscles, nerves, ligaments, and tendons from other locations in the body come together. Excess pressure can affect these structures.

In most cases, the specific cause of coccydynia is unknown. Other times, it may be caused by:

  • Trauma or injury from falls
  • Tailbone shift during childbirth
  • Other stress that affects that tailbone

Pain can come from bones, muscles, nerves, or supporting structures.

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Risk Factors  

Coccydynia is more common in females. Other factors that may increase your chance of coccydynia include:

  • Brittle bones, which can occur with osteoporosis
  • Joint inflammation or changes in bone structure, which can occur with arthritis
  • Participation in contact sports or certain activities, such as horseback riding
  • Dislocation from injury or obesity, which can cause bones to shift
  • Prolonged sitting on hard surfaces
  • Low back pain
  • Infections, such as osteomyelitis
  • Spinal cyst or tumor
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Symptoms  

Pain may occur when:

  • Sitting down
  • Changing position from sitting to standing
  • Having a bowel movement
  • Having sex

Coccydynia may cause:

  • Tenderness directly over tailbone
  • All-over backache
  • Pain or spasm of pelvic or rectal muscles
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Diagnosis  

Your doctor will ask about your symptoms and medical history. A physical exam will be done. This will include an evaluation of the tailbone to see if the area is swollen, red, or warm.

Imaging tests to look for fractures, dislocation, or other damage in the tailbone may include:

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Treatment  

In most cases, coccydynia will resolve on its own with conservative treatment. This includes using a special seating cushion to relieve pressure on the tailbone.

If the coccyx is misaligned, it may be manually manipulated into place. Other treatments include:

Medications  

Inflammation and/or pain may be relieved by:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Steroid injections
  • Nerve blocks
  • Antidepressants

Stool softeners can help reduce strain during bowel movements.

Physical Therapy  

Physical therapy may include:

  • Exercises to strengthen muscles and supporting structures (like ligaments)
  • Relief and stimulation with heat therapy and ultrasound therapy

Other Treatments  

Some people find relief with:

  • Massage
  • Transcutaneous electrical nerve stimulation (TENS)

Your doctor may also refer you to counseling.

Surgery  

Coccygectomy is the surgical removal of the tailbone. This surgery is not generally recommended and may be considered if all other treatments methods fail.

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Prevention  

To help reduce your chance of coccydynia:

  • Learn proper sitting posture
  • If you have to sit for long periods at work, get up and move around periodically
  • Use proper protection during sports or activities where you may be injured