The coccyx, a tiny, triangular bone at the base of the spine is made up of fused vertebrae. Also known as the tailbone, this is a vestige of the tail that our evolutionary ancestors once had. It serves as a point of support and attachment for several muscles and is an extremely sensitive area, prone to injuries and pain. Coccydynia, the pain experienced in this area, can make even everyday tasks challenging.
According to experts, minor actions like coughing, sneezing, or sitting in one position for a long duration can trigger tailbone pain in those with this pre-existing condition. This is due to the sensitivity and vulnerability of the coccyx region to even minute pressure variation or unnatural movement.
Causes of coccydynia
Injury to the tailbone: The most common cause of coccydynia is tailbone injury after a fall. “When people fall on the lower back, landing on the buttocks, it could damage the coccyx,” says Dr Ananya Puttaraju, orthopaedic surgeon, HOSMAT Hospital, Bengaluru.
People with a slim build or those with a protruding coccyx are more vulnerable to tailbone injury from falling. Some may have a slightly elevated or protruded coccyx by birth, making them prone to such injuries.
Wrong posture and sedentary lifestyle: Poor posture due to the absence of proper ergonomics and an inactive lifestyle also contribute to coccydynia. “In such a scenario, the tailbone is under constant pressure,” explains Dr Pavan Chebbi, senior consultant orthopedic surgeon at Apollo Spectra Hospitals, Bengaluru. “This pressure will cause it to get irritated and inflamed. And this irritation will worsen as they sit again and again. It is common in employees with desk jobs, where they sit in a crouched or laid-back position on a bed or beanbag instead of ergonomic chairs.”
Even though it is not associated with coccydynia, anal conditions like piles, fissures and fistula could result in pain and similar symptoms around the coccyx.
Acute and chronic coccydynia
An acute case of coccydynia happens after an injury. In such instances, the healing process requires 45–90 days. “It is a very sensitive area and has a partially cartilaginous bone. Hence, every time you sit on the injured area, it hurts, and healing takes a long period,” explains Dr Chebbi.
Chronic coccydynia is when a person has pre-existing coccyx pain, which can occasionally flare up due to factors like body posture, nutrition and body weight.
How to treat coccydynia?
Conservative treatment can successfully treat 99% of coccydynia cases, say experts. The treatment involves resting the affected area (keeping the pressure off that area), taking painkillers and using a coccyx cushion seat. “The coccyx cushion on the seat acts as a shock absorber. The center of the cushion has a hole in it. As a result, the pressure is distributed equally,” explains Dr Puttaraju.
For those suffering from chronic pain, the treatment can be different. Dr Chebbi informs, “As recovery takes longer than usual, you might need to take long-term painkillers and calcium or collagen supplements,” says Dr Chebbi.
Whether the coccydynia is acute or chronic, pelvic floor exercises and sacroiliac joint muscle strengthening exercises help in treatment. Ideally, such exercise should begin after six weeks of rest and medication. “For someone with chronic coccydynia, these exercises must become a regular part of their daily routine,” adds Dr Chebbi.
Even though most cases of coccydynia are managed through conservative treatment, a procedure of manipulating the coccyx has been used in a few rare instances. “In such cases, we basically realign the coccyx and put it back in position,” explains Dr Puttaraju. Surgery, which involves removing the affected part of the coccyx, is prescribed in extreme situations when the damage is severe and results in ulcers or skin abnormalities. “This rare surgery may have complications like pelvic floor weakening, infections, wound healing problems or weakness of the vertical gluteal muscles,” informs Dr Chebbi.
The preventive measure
Coccydynia can affect anyone. The most important precaution to take is to pay attention to how you sit.
On busy workdays, people tend to continue sitting for long hours at a stretch. They may also lean on the seat backrest, the bed, or recline on the sofa. This practice has long-term implications and could cause coccydynia. It is important to ensure good posture while sitting. Moreover, it is crucial to ensure good ergonomics both at home and in the office.
- The coccyx or tailbone is a small, triangular bone at the base of the spine.
- Falling injuries and postural issues can damage the coccyx, which causes pain, commonly known as coccydynia.
- 99% of cases of coccydynia are managed through conservative treatment. This includes rest, pain medication, and using a coccyx cushion seat while sitting.
- Surgery or coccyx manipulation is only advised in rare cases.