Coccyx Doctor

Coccyx pain (Tailbone pain): Coccydynia, coccygodynia

2006-03-01T00:49:00.000-05:00

Coccyx pain (Tailbone pain): Coccydynia, coccygodynia

In order to help patients with coccydynia, and their treating physicians, Dr. Foye has written a brief summary, below, outlining the causes, symptoms and treatments for coccydynia. As with any medical condition, it is recommended that patients seek care from a physician who is knowledgeable and experienced in treating other patients with the same condition or similar diagnoses. Unfortunately, some patients report difficulty finding physicians with expertise at evaluating or treating coccydynia. Hopefully, the information below will provide some basic education for patients, their families, and their caregivers.

Dr. Foye’s office phone (in New Jersey) is # 973-972-2802. (This number is ONLY for making appointments for in-person evaluations. Medical advice can NOT be given by phone to patients who have not been evaluated within the office here.)

COCCYDYNIA DEFINITION:

Coccydynia is the medical term for pain of the coccyx (tailbone). Coccydynia is also known as coccygodynia, or simply referred to as "coccyx pain".

The coccyx is a collection of small bones which represent the lowest portion of the human spine.

CAUSES:

Pain of the coccyx (coccydynia) can be due to a variety of causes:

Ø Direct trauma to the coccyx can result in coccyx fractures, dislocations, alignment abnormalities, etc.. Examples of trauma to the coccyx could include a fall onto the tailbone, pregnancy (and especially childbirth, which can put substantial pressure onto the coccyx as the baby moves down within the pelvis), prolonged sitting (especially sitting on a hard surface, or sitting on a narrow surface such as a bicycle seat, or increased sitting due to immobility because of an injury at a totally unrelated body region).

Ø Pain referred to the coccyx from nearby body regions: Sometimes pain can be referred to the coccyx from medical conditions at adjacent body regions. Thus, it is often worthwhile to consider whether any medical conditions within the pelvis and rectum may actually be the underlying source of the pain that the patient feels predominantly at the coccyx. Other conditions that present with pain in the buttock region can include bursitis (inflammation of a bursa, which is a fluid-filled sac, of which there are many throughout the body).

Ø “Idiopathic” coccyx pain: In many cases, the exact cause of the coccydynia remains unknown. In these cases, the patient may not have any history of trauma to the region, nor any associated medical conditions in the pelvis or rectum.

SYMPTOMS:

Ø Certainly the classic, defining symptom for coccydynia is exquisite, focal pain at the coccyx. The pain from the coccyx may travel (radiate) down into the floor of the pelvis (e.g., into the lower genital region). Coccydynia is frequently exacerbated by sitting, and especially by prolonged sitting or sitting on a hard surface. Initial movement into the standing position (after sitting) may also be painful. Most patients are able to locate their own coccyx bones, and will indicate this spot as the primary focus of their pain. Patients will recognize the coccyx location as being in the midline between the gluteal muscles (buttocks). A patient wearing a belt would generally find their coccyx to be perhaps 4 to 7 inches below where the belt-line crosses the middle of their lower back. The coccyx is located just slightly above the anus, and sometimes coccyx pain can be exacerbated by defecation, especially if the bowel movement is particularly large or hard. Unfortunately, coccydynia can be severe and persistent, and can substantially decrease the quality of life for the affected patient.

MAKING THE DIAGNOSIS:

Ø Usually, an experienced physician can make the diagnosis of coccydynia based upon a careful history and physical examination. Additional diagnostic tests can include x-rays and other imaging studies. Consultations with other physicians may be helpful if it is felt that the coccyx pain is originating from medical conditions of the gastrointestinal tract (e.g., the rectum), or originating from medical conditions of the reproductive organs (uterus, ovaries, etc.).

TREATMENT:

There are a wide variety of treatments available for coccyx pain. Often, a combination of treatment approaches is necessary in order to give adequate relief.

Ø Avoiding exacerbating factors: Patients can avoid exacerbating factors by minimizing prolonged sitting and by avoiding sitting on hard surfaces.

Ø Cushions: Sitting on cushions can be helpful, and especially sitting on "donut" cushions (which have a hole cut out in the center, where the coccyx would otherwise be pressing) or "wedge" cushions (which have a wedge-shaped triangle cut out in the rear of the cushion, where the coccyx would otherwise be pressing).

Ø Medications taken by mouth: Pain may be decreased by the use of a variety of medications taken orally. These include anti-inflammatory medications (such as ibuprofen, etc.), opioid/narcotic analgesics (such as Percocet, etc.), medications used to treat nerve pain, and a variety of other medications.

Ø Medications given by local injection: In patients who are not receiving adequate relief via cushions and oral medications, medications given by local injection may provide substantial relief and may provide complete resolution of the pain. Unlike caudal (epidural) steroid injections, nerve blocks for coccydynia may focus on using a local anesthetic to block (temporarily shut-off) the nerves that carry painful signals from the coccyx. These injections may especially target the ganglion Impar, which is part of the sympathetic nervous system. Dr. Foye very strongly recommends the use of fluoroscopic guidance (which is similar to x-ray images viewed live on a video monitor during the procedure) for any such injections, in order to most accurately place the injection and thus minimize the patient’s risks and maximize the patient’s benefits. If the initial injection does not provide enough relief, then it may be repeated to achieve further benefit for the patient.

Ø Coccyx surgery: Various surgeries of the coccyx have been considered somewhat controversial, and may carry significant risks. Coccyx surgery would generally only be considered in patients who have severe, persistent coccyx pain despite non-surgical treatments, including the use of oral medications and focal injections performed under the guidance of fluoroscopy. Fortunately, most patients respond well enough to non-surgical treatments (especially including the injections) that they no longer need to consider undergoing surgical treatment.

Disclaimer: The descriptions above are for informational purposes only. They should not be considered as medical advice. The information above should not be considered as a substitute for appropriate in-person care by a healthcare provider with knowledge and expertise in the evaluation and treatment of coccydynia.

Patrick M. Foye, M.D.
Assistant Professor of Physical Medicine & Rehabilitation (PM&R),
UMDNJ: New Jersey Medical School, Newark, N.J., USA
Co-Director, Outpatient Musculoskeletal Medicine, PM&R.
Co-Director, Musculoskeletal/Pain Fellowship, PM&R.
Co-Director, Back Pain Clinic, PM&R, at University Hospital, Newark, NJ
Chairman, Undergraduate Medical Education Committee, PM&R.
Director, Medical Student Clerkships, PM&R. UMDNJ: New Jersey Medical School.
National Managing Editor, eMedicine, PM&R division.
Member of the Medical Examiners’ Panel for the State of New Jersey
Board Certified: American Board of Physical Medicine and Rehabilitation (PM&R)
Board Certified: American Board of Independent Medical Examiners, 1999
Board Certified: American Board of Electrodiagnostic Medicine (EMG, Nerve Studies, etc)
Board Certified: Pain Medicine (Sub-Specialty Pain Board certification, via the American Board of PM&R and the American Board of Anesthesiology)

Patrick M. Foye, M.D.
PM&R at UMDNJ: New Jersey Medical School
90 Bergen St, DOC Suite 3100,
Newark, New Jersey 07103

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Coccyx Pain: Coccydynia

2006-03-01T00:15:00.000-05:00

This blog is currently under construction.

Meanwhile, information on non-surgical treatment of tailbone pain (coccyx pain, also called coccydynia or coccygodynia) can be found at the following web sites:

www.Tailbone.Info "For Tailbone Information, go to Tailbone.Info"
www.TailboneDoctor.com (This is the newer/upcoming web site of Dr. Patrick Foye, M.D., a specialist in treating tailbone pain without surgery. He is in New Jersey.)
www.Doctor-Foye.medem.com (This is the older web site of Dr. Patrick Foye, M.D. At that web site, in the left-hand margin, click the Link that says: - Coccyx pain: Coccydynia)