Coccydynia


                 

                                                       
Coccydynia is a medical term meaning pain in tailbone area, usually brought on by sitting too abruptly.
Synonyms

Coccydynia is also known as coccygodynia, coccygeal pain, coccyx pain, or coccaglia.

The coccyx

The coccyx is referred to as the "tail bone". It's located just above the cleft in the buttocks, and curves forward so that it points towards the front of the body.

The coccyx is made up of three small bones, loosely fused together. They become more flexible in pregnant women to help them give birth more easily.

Various muscles, tendons and ligaments are attached to the coccyx and it bears weight when somebody is sitting down.


Who is affected

Coccydynia is uncommon. It is estimated around one in 100 cases of lower back pain are the result of coccydynia. Women are five times more likely to develop coccydynia than men due to the association with childbirth.

Older adults are more prone to coccydynia, but the condition can affect people of all ages, including children.

Diagnosis

A number of different conditions can cause pain in the general area of the coccyx, but not all involve the coccyx and the muscles attached to it. The first task of diagnosis is to determine whether the pain is related to the coccyx. Physical examination, high resolution x-rays and MRI scans can rule out various causes unrelated to the coccyx, such as Tarlov cysts and pain referred from higher up the spine. Note that, contrary to most anatomical textbooks, most coccyxes consist of several segments: 'fractured coccyx' is often diagnosed when the coccyx is in fact normal or just dislocated at an intercoccygeal joint.

A simple test to determine whether the coccyx is involved is injection of local anesthetic into the area. If the pain relates to the coccyx, this should produce immediate relief.

If the anesthetic test proves positive, then a dynamic (sit/stand) x-ray or MRI scan may show whether the coccyx dislocates when the patient sits.

Use of dynamic x-rays on 208 patients who gave positive results with the anesthetic test showed:

  • 22% Posterior luxation (partial dislocation of the coccyx backwards when sitting)
  • 5% Anterior luxation (partial dislocation of the coccyx forwards when sitting)
  • 27% Hypermobility (excessive flexing of the coccyx forwards and upwards when sitting)
  • 14% Spicule (bony spur) on the coccyx
  • 31% Not possible to identify the cause of pain

This study found that the pattern of lesions was different depending on the obesity of the patients: obese patients were most likely to have posterior luxation of the coccyx, while thin patients were most likely to have coccygeal spicules.

Natural history

One way of classifying coccydynia is whether the onset was traumatic versus non-traumatic. In many cases the exact cause is not known (called idiopathic coccydynia).

Coccydynia is often reported following a fall or after childbirth. In some cases, persistent pressure from activities like bicycling may cause the onset of coccyx pain.[5] Coccydynia due to these causes usually is not permanent, but it may become very persistent and chronic if not controlled.

Rarely, coccydynia is due to the undiagnosed presence of a sacrococcygeal teratoma or other tumor in the vicinity of the coccyx. In these cases, appropriate treatment usually involves surgery and/or chemotherapy.

Clinical features

Activities that put pressure on the affected area are bicycling, horseback riding, and other activities such as increased sitting that put direct stress on the coccyx. The medical condition is often characterized by pain that worsens with constipation and may be relieved with bowel movement. Rarely, even sexual intercourse can aggravate symptoms.

Treatment

Treating coccydynia

Painkillers, such as ibuprofen, are the first step in trying to treat coccydynia and in most cases the pain will resolve within a few weeks.

If this fails, stronger treatment, such as steroid injections (corticosteroids) will be recommended.

In a minority of cases the pain can persist for more than three months, which is known as chronic coccydynia. Chronic coccydynia is unlikely to clear up by itself and will probably require a combination of treatments.

There are a number of things you can do yourself to help with the pain, including using specially designed cushions to support the coccyx.

Spinal manipulation techniques such as physiotherapyosteopathy andchiropractic can also provide short-term relief from pain.

In a small number of cases surgery may be required to remove the coccyx (coccygectomy).

Read more about the treatment of coccydynia.

Sit on cushioned surface only.

If there is tailbone pain with bowel movements, then stool softeners and increased fiber in the diet may help. 

For prolonged cases, anti-inflammatory or pain-relieving drugs may be prescribed. The use of anti-depressants such as Elavil (amiltriptyline) may help alleviate constant pain.

Local nerve blocks/target injections are often beneficial. 

In rare cases, surgery to remove the coccyx (coccygectomy) may be required. Typically, surgery is reserved for patients with cancer (malignancy) or those whose tailbone pain has failed to respond to nonsurgical treatment (such as medications by mouth, use of seat cushions, and medications given by local injections done under fluoroscopic guidance, as noted above). .[6]

Look after your back

Tips to keep your back healthy and avoid back pain, including exercises and advice on good posture



http://www.nhs.uk/Conditions/coccydinia/Pages/Introduction.aspx

http://www.medicinenet.com/coccydynia/article.htm

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Skand Kumar,
7 Apr 2016, 04:55
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