Monday, August 15, 2011
Tailbone Pain.... Ouch!
What causes coccydynia?
Most often, the cause of coccydynia is unknown ("idiopathic"). Other causes include trauma (for example, from falls and childbirth); abnormal, excessive mobility of the tailbone; and – very rarely – infection, tumor, or fracture.
What are the symptoms of coccydynia?
The classic symptom is pain when pressure is applied to the tailbone, such as when sitting on a hard chair. Symptoms usually improve with relief of pressure when standing or walking.
Other symptoms include:
* Immediate and severe pain when moving from sitting to standing
* Pain during bowel movements
* Pain during sex
* Deep ache in the region of the tailbone
How is coccydynia diagnosed?
A thorough medical history and physical exam are essential. It is important to note any particular injury, whether recent or in the remote past. A history of prolonged labor or childbirth injury should be noted. A thorough inspection/palpation of this area is needed to detect any abnormal masses or abscesses (infections).
A lateral X-ray of the coccyx is taken to help detect any significant coccygeal pathology, such as a fracture.
Your health care provider might order more sophisticated tests such as CT scan, magnetic resonance imaging (MRI), or a bone scan of this area if this is clinically indicated.
How is coccydynia treated?
Treatment most often is conservative and consists of non-steroidal anti-inflammatory drugs (NSAIDs) -- such as ibuprofen and naproxen -- to reduce inflammation, and the use of a therapeutic sitting cushion to take the pressure off of the tailbone when sitting. It might take many weeks or months of conservative treatment before significant pain relief is felt.
Cleveland Clinic’s Spine Institute might refer you to a biomedical engineer for measurement and construction of a customized seating cushion. This specially designed seating cushion provides an "open area" in the seating surface that shifts the weight off of the tailbone to promote healing.
Your health care provider might consider physical therapy to treat coccydynia. This might include exercise to stretch the ligaments -- the tissue that connects bone to bone in a joint -- and strengthen the supporting muscles. Modalities such as heat, massage, and ultrasound might also be used.
Coccygeal manipulation is used to move the coccyx back into its proper position and alleviate pain.
Coccygectomy or surgery to remove the coccyx is only considered in rare instances, and only in very severe cases, when extensive conservative management does not control the pain of coccydynia. The main risks associated with surgery are infection and wound healing problems. There is a significant risk that the surgery will not result in pain relief.
Depression and anxiety, which might be present -- especially if the pain has been there for a long period of time -- should be aggressively treated.
A multidisciplinary chronic pain rehabilitation program might be offered in some instances.
Source: The Cleveland Clinic Foundation