What Is Coccydynia?
Coccydynia refers to pain that is localized in the coccyx; a triangular structure that is also called the tailbone. It may also cause symptoms such as muscle spasms. The coccyx is made up of three to five vertebrae that are fused together and it is located directly below the region of the spine called the sacrum. Due to the fusion of the vertebrae, this structure is not very mobile. However, it provides weight-bearing support, especially when an individual is seated, and it is also the region where numerous ligaments, tendons, and muscles are imbedded. More specifically, it is the area where muscles in the buttocks and ligaments in the pelvis are located. The ligaments and muscles in this region help support the pelvis and the regulation of bowel control.
The first cases of coccydynia date back to the early 1600s, but this condition is still hard to treat despite its common occurrence. Coccydynia resolves on its own after a few weeks with or without treatment for most individuals, although some people may suffer from persistent pain that becomes debilitating.
Causes Of Coccydynia
An individual may be born with an abnormally shaped coccyx and this may lead to coccydynia. However, a traumatic injury is the most common cause of coccydynia. Falling backward is particularly problematic as it can lead to a broken, dislocated, or bruised tailbone. Adults and adolescents develop this condition more often than children and poor posture such as repeatedly leaning back while sitting puts excessive pressure on the coccyx, which can also cause pain.
Additional factors that are associated with an increased incidence of coccydynia are obesity and being of the female gender. The location of the tailbone also causes it to be susceptible to injury during childbirth, especially if the delivery is difficult. A number of different conditions such as degenerative disc disease, fractures, an infection, or sacroiliac joint pain may also contribute to the development of coccydynia. A tumor in the tailbone region has also been associated with coccydynia, but this does not occur very often. Imaging screenings (e.g., an X-ray) are typically utilized to identify the cause of coccydynia.
Treatments For Coccydynia
Once the underlying cause of coccydynia has been determined, then the appropriate form of treatment can be recommended. Pain relievers, such as paracetamol and acetaminophen, are effective at reducing acute pain and anti-inflammatory drugs, such as ibuprofen, target inflammation that may have developed in the tailbone. Another effective method is a wedge-shaped cushion called a coccygeal cushion, which is specifically designed to help relieve pressure on the coccyx when an individual is seated. This is not the same as the circular, donut-shaped cushion that is often suggested as a treatment for coccydynia. Reports have indicated that circular cushions do not properly support the coccyx and are instead a good treatment approach for rectal pain. Hot and cold compresses may also be suggested as these are quite helpful for some individuals. Clinical reports have repeatedly indicated that these types of conventional treatments are successful in 90% of all coccydynia cases. Opioids such as morphine may also be prescribed for severe cases of coccydynia that have not been responsive to other forms of treatment.
Additional treatment methods that have proven to be effective for resistant forms of coccydynia include:
- Physical therapy
- Pelvic floor manipulation
- Massage therapy and acupuncture
- Steroid injections
- Nerve blocks
- Transcutaneous electrical nerve stimulation
- Spinal cord stimulation
- Surgery (e.g., coccygectomy)
Conventional treatments such as pain medication are usually recommended in combination with physical therapy. A physical therapist usually performs specific stretches that help the injured muscles relax and heal. In addition, the therapy involves teaching patients strengthening exercises that help them avoid further injury and improve their posture as poor posture may worsen the symptoms of coccydynia. This type of treatment has been shown to shorten the recovery period and prevent individuals from reinjuring themselves.
Pelvic Floor Manipulation
Pelvic floor manipulation is another effective technique that focuses on improving the circulation and nerve signal transmission in the pelvic region. This technique has demonstrated the ability to help individuals regain their mobility and quality of life. Massage therapy also focuses on improving the blood flow to regions of the tailbone where inflammation and tension may be causing the pain. An alternative approach is acupuncture, which entails inserting needles into specific areas of the body in order to reduce muscle spasms, stiffness, and pain.
Steroid injections and nerve blocks prevent nerves from continuing to transmit pain signals to the brain. A steroid injection entails administering steroids and an anesthetic into the epidural space near the spine. Nerve roots are located in the epidural space and these structures are targeted because they initiate the pain response. A nerve block entails injecting a substance that destroys nerve tissue. Clinical reports have shown that the effects of this procedure last longer than steroid injections.
Transcutaneous Electrical Nerve Stimulation
Transcutaneous electrical nerve stimulation and spinal manipulation are slightly more invasive approaches than steroid injections that also target nerves. Electrical nerve stimulation involves placing electrodes onto the skin over regions where the pain is being felt and then an electrical pulse is emitted that controls the transmission of pain signals from nerves. Spinal manipulation involves a similar technique, but flexible wires that transmit the electrical pulse are implanted along the spinal column. A surgical procedure such as a coccygectomy may be recommended for severe cases and involves the partial or complete removal of the coccyx. This type of surgery, however, is rarely performed.
Coccydynia is a common condition that is characterized by pain, and in some cases, muscle spasms in the coccyx (tailbone). The coccyx is made up of three to five fused vertebrae. Due to the fusion of the vertebrae, this structure is not very mobile and although traumatic injuries generally cause this condition, poor posture may also contribute to pain in this region. Adults and adolescents suffer from coccydynia more frequently than children and being obese or of the female gender also increase the risk of developing this condition. There are numerous treatment methods that effectively reduce or alleviate the pain that is associated with coccydynia.
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