Coccyx Pain - Coccygodynia
Coczygodynia describes the occurrence of coccyx pain due to various causes, which in some cases remain unknown. The complaints can persist for a long time and severely restrict those affected. In most cases, it is women who suffer from pain in the coccyx. Common treatment methods are primarily symptom-related. However, the large number of possible triggers means that very different therapeutic approaches are used to combat the disease.
A brief overview
If coccyx pain occurs, it can be perceived very differently and the course can be very different, which often makes coccygodynia a lengthy medical history. Before the detailed description of the clinical picture, there is a brief overview with the most important facts.
- definition: Coccygodynia describes pain that occurs directly on the coccyx or radiates into this region of the body (pseudo variant). It is one of the diseases of the spine and back, although the triggers for the disease are very diverse.
- Symptoms: The coccyx pain that occurs is very different in intensity and duration. As a rule, pressure and stress intensify the symptoms. In some cases, the pain is also felt in surrounding areas of the body.
- causes: A basic distinction is made between known causes due to trauma and unknown causes. In both cases, a variety of triggers are possible, with the traumatic pain mostly resulting from a contortion, bruise or fracture of the coccyx.
- diagnosis: As a rule, the presence of a real coccygodynia can be diagnosed by palpating and deliberately moving the coccyx. X-ray examinations or other imaging procedures are often used to clarify the cause and exclude other possible diseases.
- treatment: Conservative symptomatic therapies are primarily used to alleviate pain, for example by means of warmth, relaxation and exercise. There are also many other approaches, such as the administration of painkillers. Surgery and coccyx removal are generally considered the last option.
- Naturopathic treatment and alternative therapy methods: Muscle-skeletal and manual therapies such as osteopathy and chiropractic can also be used to treat pain. Other alternative options include acupuncture or homeopathy.
The term coccygodynia (Latin spelling: coccygodynia) is derived from the affected region of the tailbone (os coccygis) and describes the occurrence of pain with the word ending "-dynia". Accordingly, one speaks of coccyx pain or coccyx neuralgia. According to the International Classification of Diseases (ICD-10), coccygodynia is one of the diseases of the spine and back.
The tailbone joins the sacrum and forms the lowest section of the spine, to which various muscles and ligaments attach. In most people, the individual coccyxes are fused into a bone (synostosis). The tailbone is considered a holdover of the vertebrate tail vertebrae, which has regressed in human evolution. Nevertheless, the coccyx plays an important role in the development of body statics.
Coccygodynia is rare. Middle-aged women are most often affected. Many possible causes come into question, most of which can be traced back to trauma or other diseases. But the trigger cannot be determined in every case, the causes then remain unknown or are attributed to other diseases and psychosomatic reasons. The disease can be chronic in nature and affect the sufferer in the long term.
A distinction can be made between the true form and pseudo-coczygodynia. While a real coccyx neuralgia has its origin in the coccyx or in the sacro-coccygeal joint (connection of sacrum and coccyx), the pseudo-variant causes radiating pain that is caused elsewhere.
The coccyx pain can be short-lived or chronic. They appear directly on the coccyx or in the surrounding body areas or radiate there. Sometimes the complaints are felt to be very strong. The pain is often pulling, stinging or burning and intensifies under certain loads and movements. Any pressure on the tailbone is perceived as particularly painful. Those affected report difficulties sitting, sitting down, getting up and climbing stairs. There may also be complaints during bowel movements and sexual intercourse.
If the pain radiates, it is sometimes perceived as back pain (low back pain, sciatica pain), hip pain and groin pain, or as buttock pain.
From a medical point of view, a fundamental distinction is made between traumatic and idiopathic coccygodynia.
Traumatic pain on the tailbone usually arises from injuries. Falls of any kind, other accidents and a natural (vaginal) birth can trigger a dislocation (dislocation), contusion (contusion) or less often a fracture of the coccyx. Adjacent structures such as ligaments and muscle fibers can also be affected. Symptoms of the coccyx are also increasingly reported in the context of pregnancy. Irritation or overstretching of ligaments that attach to the coccyx are suspected as a possible cause.
In addition, congenital malformations or poorly healed spinal fractures of the coccyx can be painful or cause pain over time. Obesity is considered a risk factor because excessive weight (overweight) can also result in tailbone pain.
If no detectable cause can be found even after extensive examinations (in rare cases), the disease is described as idiopathic. Certain peculiarities in the anatomy (shape deviations) of the coccyx (positions and mobility of the coccyx vertebrae) can trigger pain. There is also a presumption that a fusion between the sacrum and coccyx (sacro-coccygeal connection) could be responsible for the symptoms that arise.
Furthermore, it is discussed whether other diseases can also cause the symptoms of coccygodynia. There are indications that a deep herniated disc, various diseases of the muscles and ligaments in the pelvis and pelvic floor, a tumor or a cyst (or a fistula) can irritate, overload or inflame the structures on the coccyx and thus cause similar pain. A connection with rheumatic diseases can also be considered. Noticeably frequently, people suffering from ankylosing spondylitis suffer from coccyx neuralgia.
Some research suggests a connection to mental illnesses, such as depression. It happens that people with idiopathic coccyx pain are diagnosed with a psychosomatic illness.
According to a detailed patient history, the diagnosis is almost always based on a physical examination by palpation and targeted movement of the coccyx and especially the tip of the coccyx. The coccyx is felt from the outside and if necessary from the inside. If pain is triggered by the pressure caused, a real coczygodynia is generally assumed.
Additional investigations, such as X-rays or other imaging procedures, can be arranged to further clarify the cause and form of treatment or to rule out other diseases.
Changes in the bone can be seen on the X-ray images, the diagnosis being complicated by the variable anatomy of the coccyx (number, shape, position and fusion of the coccyx vertebrae). If an injury becomes visible, those affected often do not remember an accident. It is typical that there is a certain latency between the causal trauma and the occurrence of the pain.
If the X-rays do not show any abnormalities, depending on the patient's case, ultrasound examinations, computer tomography or magnetic resonance imaging are carried out. Among other things, tumors or internal inflammation can be detected. Since twice as many women as men are affected, a supplementary gynecological examination can be useful.
Clarifying the cause is an important part of a successful therapy. Depending on the cause, the treatment concepts differ relatively widely and have not yet been extensively tested for their effectiveness. If the pain is chronic and persists for months or even years, the treatment is significantly more difficult and usually very lengthy. In some cases, the pain will go away on its own.
Conservative symptomatic treatment, which primarily includes physical therapies, is often used. Thereby, heat treatments are often used by hip baths and fango packs as well as massages. If there is only slight pain, short-wave therapy can help against the symptoms.
If the discomfort predominantly occurs while sitting, certain seat cushions and seat rings can relieve pain. Measures such as dynamic sitting, moderate exercise and gymnastic exercises (physiotherapy) to strengthen the core muscles are also possible here, which are used for the treatment as well as for the prevention of back pain.
In addition to dynamic sitting, regular standing and movement should be incorporated into the work routine in a workplace that requires permanent sitting. If height-adjustable desks are available, the “40-15-5 rule” can easily be applied: 40 minutes work in dynamic sitting, 15 minutes in standing, five minutes in motion.
In addition to these treatment options, painkillers such as analgesics and anti-rheumatic drugs are often prescribed or local anesthetics (local anesthetics) are injected, which relieve pain and also inhibit inflammatory processes with additional active ingredients (corticosteroids). With a corresponding diagnosis in connection with coccygodynia, other drugs with very different spectrum of activity are also administered. For example, antidepressants are sometimes used for suspected psychosomatic causes.
The success of symptomatic forms of therapy is principally higher if there is no trauma. Coccyx injuries can also be treated surgically, but are not always successful and involve risks. Therefore, operations should only be considered if strictly indicated and only after conservative therapy attempts. Possible surgical measures include coccygotomy (bilateral tailbone incision), coccygectomy (removal of the coccyx or certain parts) and nerve surgery.
Overall, there is little scientific evidence of the success of individual therapeutic approaches.
Due to the multitude of possible causes and possible treatment concepts, which are sometimes difficult to determine and can favor a lengthy course, naturopathic treatments are also an alternative or a supportive measure for many sufferers.
Not only does heat therapy have a permanent place in naturopathy, but also other musculoskeletal and manual therapies (osteopathy and chiropractic) can be considered. The coccyx is mobilized and relieved by certain steps.
If psychological causes play a role, psychotherapy can be a useful addition to the therapy concept.
Also worth trying
Traditional Chinese Medicine (TCM) acupuncture can be very effective in relieving coccyx pain. In homeopathy, Hypericum perforatum (St. John's wort) is often used for nerve injuries or pain, such as after falling on the coccyx. (tf, cs)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. rer. nat. Corinna Schultheis
- National Health Service UK: Coccydynia (tailbone pain), (access: June 26, 2019), nhs.uk
- UpToDate, Inc .: Coccydynia (coccygodynia), (accessed: June 26, 2019), uptodate.com
- Mayo Clinic: Tailbone pain: How can I relieve it? (Retrieved: June 26, 2019), mayoclinic.org
- Walter de Gruyter GmbH: Kokzygodynie (access: June 26, 2019), pschyrembel.de
- Cleveland Clinic: Coccydynia (Tailbone Pain), (access: June 26, 2019), clevelandclinic.org
- Bischoff, Hans-Peter / Heisel, Jürgen / Locher, Hermann-Alexander: Practice of conservative orthopedics, Thieme, 2009
ICD codes for this disease: M53ICD codes are internationally valid encryption for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.