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Treatments of Coccydynia; Tailbone Pain

Treatments of Coccydynia means the inflammation of the tailbone (coccyx or bony area located deep between the buttocks above the anus) is referred to as coccydynia. Coccydynia is associated with pain and tenderness at the tip of the tailbone between the buttocks. Sitting often worsens coccyx pain.

Treatments of coccydynia

Many studies find that non-surgical treatments are successful in approximately 90% of coccydynia cases.^1,2 Treatments for coccydynia are usually noninvasive and include activity modification.

The first line of treatment typically includes self-care that can be done without the assistance of a medical professional, such as some of the following

Rest
Avoiding re-injury to the affected area
Anti-inflammatory medications – Non-steroidal anti-inflammatory drugs (NSAID’s). Common NSAID’s used are ibuprofen, naproxen, COX-2 inhibitors – they help to reduce inflammation around the coccyx which is causing the pain
Other pain killers – Tramadol (strong painkiller) – may be required in chronic and severe coccydynia. It may cause side effects like constipation, headaches and dizziness. It is usually prescribed for a short time because it is habit-forming (addictive).
Avoid sitting for prolonged periods or placing pressure on the area as much as possible
Use a custom pillow to help take pressure off the coccyx when sitting. For some, a donut-shaped pillow works. Many prefer foam pillow that is more of a U or V shape (with the back open so that nothing touches the coccyx). In short, any pillow or sitting arrangement that keeps the pressure off the coccyx is welcome. A cushion with a cut-out at the back, under the coccyx, is recommended while sitting
If the tailbone pain is caused or increased with bowel movements or constipation, then stool softeners and increased fiber and water intake is recommended
Increased fibers, stool softeners and mild laxatives are advised if the tailbone pain persists with bowel movements
Anti-depressants such as Elavil (amitriptyline) – relieves the constant pain
Nerve block injection at the ganglion
If the pain is due to mal-alignment of the coccyx, manipulation by a chiropractor, osteopathic physician or physical therapist can offer relief

Additional non-surgical treatments (when the pain is persistent or severe)

Corticosteroid Injection – A local injection of a numbing agent like lidocaine and steroid (to decrease the inflammation) provides relief. These are done under fluoroscopic guidance. Relief lasts from 1 week to several years. More than 3 injections per year are not recommended
Manipulation – Manual manipulation Ex. Chiropractic treatment
Stretching – It involves gentle stretching of ligaments attached to the coccyx. A physical therapist, chiropractor, physiatrist or another trained healthcare practitioner can provide instruction on the appropriate stretches
Ultrasound – Physical therapy with ultrasound relieves pain

Corticosteroid injections

They reduce inflammation (swelling) and pain. They are sometimes combined with local anesthetic for better efficacy. The pain relief from these may last for several weeks.

These injections cannot cure the condition and too many injections can damage the coccyx and lower back. Thus corticosteroid injections can be taken once or twice a year.

Ganglion impar nerve block

Ganglion impairs – is a cluster of nerves next to the coccyx. It is through these nerves that many of the pain signals travel. A ganglion nerve block temporarily suppresses these nerves by injecting them with a local anesthesia to stop them from transmitting pain signals.
This can be permanent in a few people while in others the pain will return after a few weeks or months. But the level of pain is usually lower. It is usually safe to have repeated injections of local anesthesia.

Sacrococcygeal joint injections

When these joints are causing coccydynia, the joints are directly injected with a combination of corticosteroids and local anesthetic.

Spinal manipulation

Physiotherapy – In this form of treatment physical methods like massage and manipulation are used to promote healing
Osteopathy – It is a manipulation technique that can detect and treat problems related to the muscles, nerves and joints
Chiropractic – It is a manipulation technique based on the theory that many health problems are related to the misalignments of the spine. It helps dealing with these misalignments.
Depression and anxiety which might be present especially if the pain has been there for a long period of time should be treated simultaneously.
Ice or cold pack. Applying ice or a cold pack to the area several times a day for the first few days after pain starts can help reduce inflammation, which typically occurs after injury and adds to pain.
Heat or heating pad. Applying heat to the bottom of the spine after the first few days of pain may help relieve muscle tension, which may accompany or exacerbate coccyx pain. Common heat sources include a hot water bottle, chemical heat pack, long-lasting adhesive heat strip, or hot bath (as long as weight is kept off the tailbone in the bathtub)
Activity modification. Alterations to everyday activities can help take cumulative pressure off of the tailbone and alleviate pain. These activity modifications may include using a standing desk to avoid prolonged sitting, using a pillow to take the weight off the coccyx, or adjusting posture so weight is taken off the tailbone when sitting.
Supportive pillows. A custom pillow that takes pressure off the coccyx when sitting may be used. Pillows for alleviating coccydynia may include U- or V-shaped pillows, or wedge-shaped pillows with a cutout or hole where the tailbone is. Any type of pillow or sitting arrangement that keeps pressure off the coccyx is ideal and largely a matter of personal preference. A supportive cushion can be useful in the car, as well as in an office, classroom, or at home.
Using stool softener and increased water and stool softeners, when the tailbone pain is caused or increased with bowel movements or constipation;
Ultrasound. Physical therapy with ultrasound can also be helpful for pain relief.
Dietary changes. If tailbone pain is caused by or worsened with bowel movements or constipation, increased fiber and water intake, as well as stool softeners, is recommended

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If the above treatments do not help manage or alleviate coccyx pain, additional treatments administered by a doctor, chiropractor, or other medical professional may be necessary.

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Additional Non-Surgical Treatments for Coccydynia

If tailbone pain is persistent or severe, additional non-surgical treatment options for coccydynia may include

Manual manipulation. Some patients find pain relief through manual manipulation of the coccyx. Through manual manipulation, the joint between the sacrum and the coccyx can be adjusted, potentially reducing pain caused by inadequate coccyx mobility.
Massage. Coccydynia may be reduced or alleviated by massaging tense pelvic floor muscles that attach to the coccyx. Tense muscles in this region can place added strain on the ligaments and sacrococcygeal joint, limiting its mobility or pulling on the coccyx.

Stretching. Gently stretching the ligaments attached to the coccyx can be helpful in reducing muscle tension in the coccygeal area. A physical therapist, chiropractor, physiatrist, or another appropriately trained healthcare practitioner can provide instruction on appropriate stretches for relieving coccyx pain
TENS unit. Transcutaneous Electrical Nerve Stimulator (TENS) units apply electric stimulation that interferes with the transmission of pain signals from the coccyx to the brain. These devices can be a good option for patients who wish to keep their intake of medications to a minimum. There are many varieties of TENS units, with some using high-frequency stimulation that is worn for short periods of time, and others using low-frequency stimulation that may be worn longer.
After attaining sufficient pain relief so movement is better tolerated, daily low-impact aerobic activity is beneficial, as the increased blood flow brings nutrients to the area and encourages the body’s natural healing abilities. An additional benefit of aerobic activity is the release of endorphins, the body’s innate pain-relieving chemicals.

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If non-surgical treatments or pain management methods are effective, prolonged use of these methods is a reasonable treatment option. In rare cases, a patient’s pain does not respond to non-surgical treatments and surgery on the coccyx may be considered.

Surgery

Neurotomy to denervate the peripheral nerve going to the coccyx. Under fluoroscopic guidance, the peripheral nerves are burned through radiofrequency thermal lesioning;
Partial rhizotomy, which involves drilling holes through the sacral plate lesioning of the dorsal root ganglia to the S5; and/or
Coccygectomy. If all else fails, a surgical coccygectomy can be performed for patients whose tailbone pain failed to respond to more conservative measures. The procedure involves the surgical removal of all, or part, of the coccyx. The recovery period for the patient is quite involved, and infection is a significant concern. A 2011 University of California Medical Center clinical case series, the largest in North America, monitored 62 consecutive cases of coccygectomy for coccydynia between 1997 and 2009. 26 patients were contacted for follow-up, on average 37 months post surgery. The clinical results among the 26 patients were as follows: 13 excellent, 9 good, 2 fair and 2 poor. The overall favorable (excellent and good) outcome after coccygectomy was 84.6%. There were 3 wound infections. There were no rectal injuries. An overwhelming majority of the patients were satisfied with the procedure

Indications for Coccygectomy Success

Coccygectomy tends to be most successful in carefully selected cases. The following criteria have shown an increased chance of positive results after surgery:^6,7

Patients whose pain is caused by changes in the shape of the coccyx, such as the presence of a spicule (a small bone spur at the end of the coccyx)
Patients with excessive mobility of the coccyx
The presence of a bursa, or a fluid-filled sac at the joint between the sacrum and coccyx
A good response to injection treatments

Many studies have reported good or excellent results following coccygectomy surgery, but the procedure is not recommended for all patients. If a patient is not considered a good candidate for coccygectomy, non-surgical treatments will likely be adapted to the patient’s needs and attempted again.

Potential Risks and Complications of Coccyx Surgery

Perhaps the biggest risk is continued pain in the coccyx post-operatively, meaning that the patient has endured the long healing process and still has not had improvement in the symptoms. For this reason, patient selection is crucial to a positive surgical outcome.

A possible but uncommon risk of coccygectomy is injury to the rectum as the coccyx is being removed. While it is unlikely, it is possible that if this were to happen, a diverting colostomy would be necessary to allow the rectum to heal.

Other potential risks include wound healing difficulties and/or local infection, which can delay the overall healing process. Unlike most other spine surgeries, there are no significant nerve roots in the region that would be at risk

Prevention:

Body positioning and alignment so as to produce less stress in the coccyx region, correcting daily activities like sitting etc that contribute to pain
Avoiding bad postures during daily activities
Not carrying excessive weights can reduce tension and pressure on the coccyx. We should also avoid sitting while carrying heavyweights
Maintaining body weight also reduces tension and pressure on the coccyx because over body weight and obesity are risk factors for Coccydynia
Avoidance of contact sports like basketball, football and or hockey can decrease the risk of coccydynia because it can help to reduce the chances of falling
Use of proper safety equipment to prevent coccyx pain. Example – Hockey pants provide an extra cushion that protects the thigh, coccyx and buttock. These will help in less falls which will reduce damage to the coccyx
Stretches and strengthening exercises

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Home Remedies of Coccygodynia

Epsom Salt

This home remedy can surely provide you quick relief. To try this you need to take a bath in the bath tub. Add two cups Epsom salt in the bath tub, when it is full of water. Mix the Epsom salt effects and then sit inside the bathtub for at least ten minutes. Epsom has ability to reduce pain occurring in the tailbone and it can effectively shrink the cyst.

Levator Ani Massage

Your tailbone pain can be easily terminated by applying Levator Ani massage. You have to take effective pain relief massage oil and do massage in the surrounded area of tailbone. It is how you can preciously reduce the pain and feel better for the work.

Avoid Tight Jeans

You should avoid wearing clothing like tight jeans, when you are suffering from tailbone pain. It increases inflammation and pain of tailbone, which is not good for your health. Wear lose clothes and sleep properly during the night to avoid increment in tailbone pain.

Tea Tree Oil

Tea tree oil can be an efficient cure for infected tailbone. This oil has ability of reducing infection plus increasing the healing process. You can apply tea tree oil as massage oil over an infected region and wear loose clothes to speed up healing process. It works and preciously reduces pain.

Use Special Cushions For Sitting

Dealing with tailbone pain can be daunting and irritating. Sitting and sleeping also becomes quite difficult with this pain that’s why special cushions are available for you. These cushions offer effective relief in sitting and thus you can complete your work without getting worried about tailbone pain.

Walking

Muscle strain is quite common during tailbone pain. This condition may turn into a very painful condition and it is quite important to relax muscles. You can do it by walking. Regularly walk, at least for ten minutes because it unblocks strained muscles. Walking can also help you in fixing tailbone’s displacement.

Turmeric

Famous as an efficient antibiotic ingredient, turmeric can also help you with healing tailbone pain. It prevents you from suffering from swelling around the tailbone. You should drink one-glass milk with turmeric daily. It is the cheapest way of reducing pain and avoiding infection.

Change In Sleeping Position

You need to prevent pressure on tailbone, which can be a little bit difficult during sleep. You should sleep on the stomach because thus you can easily prevent your tailbone from pressure. Some people prefer to sleep inside pose, but it is not a way of reducing tailbone pain.

Lime

Tailbone pain may come with infection around the tailbone. You should apply slaked lime with turmeric powder to treat it. Prepare a paste of slaked lime with turmeric and water and then apply it over the tailbone, you will get relief from the pain.