Have you been diagnosed with a coccyx (tail bone) fracture or are you just feeling pain around the tailbone? Are you eager to learn about cause, treatment and pain relief tips? You are in the right place!
As a diagnostic radiographer, I answer the most common questions from my patients on this topic! And I also summarise the key findings from scientific literature on coccyx pain.
The aim of this article is to provide you with some basic simple information about coccyx fracture treatment and how you can manage pain at home.
Happy reading!😀
Any comments or questions I will be glad to answer in the comments section.🙏
Last updated March 2024.Written by Juliet Semakula: Diagnostic radiographer.
Disclaimer no affiliate links:
I will briefly review a bit of the anatomy of the tailbone before delving into your questions.
Anatomy of coccyx (tail bone)
The coccyx is also known as the tailbone and sits at the very bottom of the spine. It is made up of a few bones that have become fused together. It is attached to the bottom of the sacrum bone and sits within the pelvis.
Structures attached to the coccyx include the pelvic floor muscles, part of the buttock muscles and ligaments. Image below demonstrates it well.
Despite the size of the tailbone, it has several important functions. It is the insertion site for multiple muscles, ligaments, and tendons.
These ligaments and muscles help support the pelvic floor and contribute voluntary bowel control. Also supports our weight-bearing seated position. That’s it with the anatomy lesson!💁
▶️How do you know that you have injured your tailbone?
Sometimes it is very difficult to know that you have injured your tailbone due to the nature of the coccyx structure, many tailbone fractures sometimes go untreated because they are not immediately diagnosed.
You could think you have bruised pain, yet you have a fracture or something else.
Coccyx pain is known as coccydynia! So when you come across this medical word it means pain.
What could be some of the causes of coccyx pain/ fracture.
♦️️Having had a fall, landing on your bottom for example slipping on ice, missing a chair when trying to sit down can cause a fracture or bruise on your tailbone.
♦️️ Sometimes women do put pressure on the coccyx while giving birth and can injure the coccyx in the process.
♦️️Being over or under weight can impact on your coccyx which could cause pain when sitting down. Women are 5 times more likely to develop coccydynia than men. (Maigne,2000)
♦️When you have had minor trauma from repetitive or prolonged sitting on hard, narrow, or uncomfortable surfaces.
▶️What are the symptoms of a damaged coccyx?
When you start feeling these symptoms on your tailbone you know you might have injured or bruised it.
🟢Pain during or after sitting.
🟢Acute pain when getting up from sitting.
🟢Deep ache around the coccyx (between the buttocks)
🟢Tenderness on pressing the tip of the coccyx.
🟢Pain during daily activities such as bending and those which include sitting e.g. Driving, office work or relaxing on the sofa.
🟢Shooting pains, like sitting on a marble
🟢Pain during sexual intercourse
🟢Pain during a bowel movement or when the bowel is full.
▶️What can doctors do to help you ease pain with a fractured or bruised tailbone?
Coccyx injuries are normally treated conservatively, and many cases resolve without medical treatment.
Caution! Treatment of the coccyx can be difficult and sometimes controversial because of the multifactorial nature of coccygeal pain!
Before the doctor decides which treatment is best for you, other causes of coccyx pain will be first ruled out, such as infection etiologies, masses, and pelvic floor muscle spasms.
Usually, when you go to your doctor complaining of pain being worse with prolonged sitting, leaning back while seated, prolonged standing and rising from a seated position.
Your doctor will examine you and sometimes x-ray imaging will be requested to rule out a fracture if you say you had a fall .If no fracture is identified this can create diagnostic confusion and leave you without a proper diagnosis.
So more imaging may be required to get a clear diagnosis so MRI or CT scan will be requested.
Image below shows a fractured coccyx:
⚠️Caution!⚠️ Due to the nature of the coccyx structure, many tailbone fractures may go untreated because they are not immediately diagnosed.
▶️Treatment options of a fractured tailbone.
1️⃣Multiple conservative treatment options are available for coccyx (coccydynia) pain.
You can try these simple self-help measures at home to ease the pain. (NHS recommendation).
🟩You will be advised to rest and stop any physical activity that could cause you pain. The more you rest, the quicker the injury can heal.
🟩Your doctor may recommend modified wedge-shaped cushions (coccygeal cushions) that can help relieve the pressure on the coccyx while seated.
An example of a wedge-shaped cushion:
Image from amazon, no affiliate links.
🟩You can apply Ice or heat over the site; this has been proven beneficial to ease pain. You can try both as one has not been shown to be superior to the other.
🟩If you are having constipation, try to Increase fluid and/or fibre intake. It helps you open your bowel without pain.
🟩Wear comfortable clothing.
🟩 Activity modification such as avoiding sitting for too long and utilising towels/cushions.
✅Good sitting position reduces stress on your coccyx.❌ Bad sitting position puts pressure on you coccyx.
🟩Nonsteroidal anti-inflammatory drugs are the most common analgesic prescribed for coccyx pain. You will be given an Injection of anti-inflammatory and steroid to help ease the pain.
Evidence-based literature supporting the effectiveness of interventional injections is lacking, however many specialists advocate these procedures’ use in cases of chronic tailbone coccydynia but without reaching clear consensus on the best site of injection.
Imaging guidance, such as fluoroscopy or ultrasound, is recommended for injections around the coccyx because of its position (Gupta 2010).
Injections around the coccyx, usually at the sacrococcygeal junction or around the sacrococcygeal ligaments, of local anaesthetic with steroid have been both diagnostic and therapeutic. (Mitra.2007)
Physiotherapy!
Physiotherapy will be recommended to help manipulate the muscles around the coccyx to relieve pain.
Manual manipulation and massage can be both diagnostic and therapeutic. It can help relieve associated muscle spasms or ligament pain.
Pelvic floor rehabilitation can be helpful for coccydynia that is associated with pelvic floor muscle spasms.
2️⃣Surgery to remove the coccyx could be another option.
Surgical procedures for the treatment of coccyx (coccydynia) pain are used only as a last resort once all other treatment options have failed.
A coccygectomy is the surgical amputation of the coccyx just proximal to the sacrococcygeal junction.
Caution! This procedure is associated with a high complication rate and failure to relieve the pain!
Consequently, based on current available information, this procedure generally is not recommended.
In all my years of experience I have not seen a patient undergo surgery of the coccyx. All treatment has been conservative so I believe if you are experiencing pain your doctor may advise you to follow the home remedies before thinking about surgery.
Limited data support this procedure, with most of the available literature being case reports and retrospective case series.
The current literature suggests that a coccygectomy may provide relief in an appropriate subset of patients who have failed all other treatments.
We are yet to learn more of such studies. If you have had surgery on your coccyx, I would love to hear from you ,to learn from your experience.
▶️What happens if a broken tailbone goes untreated?
Without proper medical care, you may continue to suffer due to pain and discomfort.
If your symptoms persist, worsen, or linger indefinitely, you should consult with your doctor. Together, you can decide if conservative treatment is still the best option.
Long-term effects of fractured coccyx
Most cases of traumatic coccyx injury get better within several weeks of the injury with proper medical treatment.
A few people suffer from chronic discomfort despite proper medical treatment. This can be an extremely frustrating and debilitating problem.
I can only advise you to try to follow the simple home remedies to help you reduce pressure on your coccyx.
▶️What is the fastest way to heal a sore tailbone?
A tailbone injury can be very painful and sore to heal. Healing time for an injured tailbone depends on the severity of the injury.
If you have a fracture, healing can take 8 to 12 weeks or more.
If your tailbone injury is a bruise/ sore, healing could take about 4 weeks or more
Remember healing is different for everyone, you can also help with your healing by reducing smoking if you do so because smoking has been cited to slow bone healing.
▶️ What causes tailbone pain even after years of treatment?
However, tailbone pain can become chronic (lasting longer than three months), if instability, soft tissue strain and inflammation aren’t treated. Some people live with the pain for months or even years.
A rectal exam may be needed to rule out any other conditions. Sometimes MRI testing is used to find out if you have any other issues such as joint changes or, in rare cases, a tumour.
There are some possible hypotheses as to why you can feel pain years later.
Lack of vascularity
The coccyx has a relatively low blood supply compared to other body parts. Reduced blood flow can slow down the healing process by providing less nutrients and oxygen needed for tissue regeneration.
Constant
Pressure on the coccyx when sitting. Can prolonged healing when it is injured, bruised or inflamed.
Lack of rest
The coccyx bone faces a lot of stress in everyday simple life activities such as sitting, standing and walking.
Nerve sensitivity
The coccyx is surrounded by many nerve endings, and irritation of these nerves can prolong the sensation of pain which can make recovery slower and more persistent.
▶️Can you walk around with a fractured tailbone?
Unfortunately for broken tailbone sufferers, many pelvic floor muscles go into the coccyx, which can make everyday functions like walking, running, and sitting painful and even defecation difficult.
As your pain goes away, you can begin light physical activities, such as walking and sitting but you should avoid sitting for long periods.
Sometimes your doctor will advise you to use crutches to help you walk to ease pressure on your legs.
▶️Can you work with a fractured coccyx?
When you have fractured your coccyx bone it will be difficult for you to go to work unless your pain is treated. You could be off work for several weeks if not longer depending on the severity and complexity of your fracture and your ability to heal.
I believe you have policies in work to guide you through your sick leave.
This is what I wanted to tell you about coccyx pain. I wish you a quick recovery !🙋
These are some of the articles I have relied on to write this article. Feel free to leave a question in the comments section. Thanks for reading!🙏
📚SOURCES:
Maigne JY, Doursounian L, Chatellier G. Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine (Phila Pa 1976) 2000 Dec 1;25(23):3072–3079. [PubMed] [Google Scholar] [Ref list]
Maigne JY, Chatellier G. Comparison of three manual coccydynia treatments: a pilot study. Spine (Phila Pa 1976) 2001 Oct 15;26(20):E479–E483. discussion E484. [PubMed] [Google Scholar] [Ref list]
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Mitra R, Cheung L, Perry P. Efficacy of fluoroscopically guided steroid injections in the management of coccydynia. Pain Physician. 2007 Nov;10(6):775–778. [PubMed] [Google Scholar] [Ref list]
Wray CC, Easom S, Hoskinson J. Coccydynia. Aetiology and treatment. J Bone Joint Surg Br. 1991 Mar;73(2):335–338. [PubMed] [Google Scholar] [Ref list]
Image source: www.emedicine.medscape.co