Coccydynia: Causes, Symptoms, and Treatment Options

Coccydynia (pain in the coccygeal region)

Hello Doctor: Last year, while riding a stationary bike, I developed pain in the coccygeal area (the end of the spinal cord between the buttocks) due to poor posture.
At the beginning of this year, I went to Yadong Hospital's Orthopedic Department for an X-ray, but the results showed "no issues." Now, whenever I sit for too long or ride the bike for an extended period, especially when I stand up after riding, the pain is very intense.
Even sneezing causes pain.
A few months ago, I visited a traditional Chinese medicine practitioner and tried some folk therapies, which provided some temporary relief, but I have not been able to fully resolve the issue.
If I go a few weeks without chiropractic treatment, the pain gradually increases.
I would like to ask the doctor what this might be and which Western medicine clinic would be most appropriate for me to visit.
Thank you.

Robles, 20~29 year old female. Ask Date: 2015/11/30

Dr. Lai Zhaokang reply Neurosurgery

Hello, generally speaking, coccyx pain in young individuals is often related to injury in that area, as it is considered the "degenerate tail" of humans.
Oral medications may not be effective, especially if there is an injury, making it difficult to heal with just oral medication.
It is recommended to undergo localized rehabilitation therapy and to use a seat with a central suspended soft cushion to avoid direct pressure on the coccyx.
If discomfort persists, topical application or injection of anti-inflammatory medications may be considered.
You may want to consult with a neurosurgeon, orthopedic specialist, or rehabilitation physician.
If you still have concerns, you can also see a colorectal surgeon to rule out any anal or rectal issues.
Wishing you well, Lai Chao-Kang.

Reply Date: 2015/11/30

More Info

Coccydynia, or tailbone pain, is a condition that can arise from various causes, including trauma, prolonged sitting, or poor posture, as you have experienced while cycling. The tailbone, or coccyx, is a small, triangular bone at the base of the spine, and it can become inflamed or irritated due to several factors. Understanding the causes, symptoms, and treatment options for coccydynia can help you manage your condition more effectively.

Causes of Coccydynia
1. Trauma: Direct injury to the coccyx, such as falling or sitting hard on a surface, can lead to inflammation and pain.

2. Prolonged Sitting: Sitting for extended periods, especially on hard surfaces, can put pressure on the coccyx and lead to discomfort.

3. Poor Posture: As you mentioned, improper posture while cycling can contribute to the pain. This can include leaning too far forward or not having adequate support.

4. Childbirth: Women may experience coccydynia after childbirth due to the pressure exerted on the coccyx during delivery.

5. Infections or Tumors: Although less common, infections or tumors in the area can also cause pain.

Symptoms of Coccydynia
The primary symptom of coccydynia is pain in the coccyx area, which can be exacerbated by sitting, standing up from a seated position, or during activities like cycling. Other symptoms may include:
- Pain when sitting, especially on hard surfaces
- Increased pain during bowel movements
- Pain that radiates to the lower back or buttocks
- Discomfort when moving from sitting to standing

Treatment Options
1. Lifestyle Modifications:
- Posture Correction: Adjusting your posture while sitting and cycling can alleviate pressure on the coccyx. Consider using a cushion or a specially designed coccyx cushion when sitting.

- Activity Modification: Limit activities that exacerbate the pain, such as prolonged sitting or cycling.

2. Physical Therapy: A physical therapist can provide exercises to strengthen the pelvic floor and improve posture, which may help alleviate pain.

3. Medications: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage pain and inflammation. In some cases, a doctor may prescribe stronger medications or corticosteroid injections.

4. Alternative Therapies:
- Chiropractic Care: As you have experienced some relief from chiropractic adjustments, continuing this treatment may be beneficial.
- Acupuncture: Some patients find relief through acupuncture, which can help reduce pain and inflammation.

5. Surgery: In rare cases where conservative treatments fail, surgical options may be considered, such as coccygectomy (removal of the coccyx).

When to See a Doctor
If your symptoms persist or worsen despite conservative treatment, it may be time to consult a healthcare professional. A visit to an orthopedic specialist or a pain management clinic would be appropriate, as they can provide a comprehensive evaluation and recommend further diagnostic tests, such as MRI or CT scans, if necessary.

Conclusion
Coccydynia can be a challenging condition to manage, especially if it interferes with daily activities. By understanding the underlying causes and exploring various treatment options, you can work towards finding relief. It’s essential to communicate openly with your healthcare providers about your symptoms and treatment progress to tailor a management plan that works best for you. If you continue to experience pain, consider seeking a referral to a specialist who can provide a more targeted approach to your treatment.

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