Coccygodynia
What is coccygodynia?

Coccygodynia (pain in the tailbone) is a painful condition of the lowest bones of the spine (coccyx). This pain is localized in the crease of the buttocks and is normally caused by a fall onto the buttocks.

Causes
In the majority of cases, coccygodynia is caused by an accident, usually a fall in the sitting position. Certain sports can also such as cycling and motor sport can lead to coccygodynia. In women childbirth may also be regarded as the 'accident' that causes coccygodynia.

Signs and symptoms
Most patients with coccygodynia complain of pain in the tailbone, usually aggravated by sitting. Often cycling is impossible due to the pressure of the saddle on the tailbone.

How is coccygodynia diagnosed?
The diagnosis is usually made on the grounds of the pain that arises after an accident or following childbirth. In addition to the standard physical and neurological examination, it is important to examine the tailbone with the hands. When making the diagnosis, it is important to see if pain is present when the tailbone is moved.

Do I need additional examinations?

What are my treatment possibilities?
Conservative treatment
Conservative treatment remains the mainstay of treatment. The spectrum of treatment ranges from simple measures such as the use of laxatives, non-steroidal anti-inflammatory drugs, hot baths, ring-shaped cushions, ergonomic adaptations to physical therapy, manipulation, sacrococcygeal injections, ganglion impar blocks, psychotherapy and coccygectomy (partial or complete). Conservative management is successful in approximately 90% of patients.

INTERVENTIONAL TREATMENTS FOR COCCYX PAIN

Pericoccygeallinjections with local anaesthetic and steroids can be helpful.

Coccyx injection
Injection of local anaesthetic and steroid can be helpful in patients who do not respond to conservative management. The injection is performed under fluoroscopy or ultrasound guidance to target the sacrococcygeal junction as well as the tip of the coccyx.

Caudal epidural injections
Caudal epidural injections can be considered in patients who do not respond to injections around the coccyx or if they get only short term pain relief from coccyx injections.

Ganglion impar block
Ganglion impar block can be performed in patients who fail to respond to coccyx injections and caudal epidural injections.