Coccyx pain: symptoms, causes, who to consult, treatment?

The coccyx is a small bone located at the end of the spine, just above the « buttocks line ». It is made up of three to five small welded vertebrae, more or less mobile depending on the person. It can sometimes be the seat of severe pain, also called coccydynia, especially after a fall, childbirth, or in the event of sciatica, or even dislocation. They should not be minimized, especially when they persist or intensify. Who to consult? What support ? We take stock.

The coccydynia are most often benign, but can be extremely bothersome. At their peak, they can generate a burning or tearing sensation and radiate towards the perineum, sometimes towards the anus, often towards the buttocks, or even towards the lumbar region, the groins or the thighs.

The pain is often exacerbated in a seated position and when pressure is exerted on the tip of the coccyx. It can be aggravated when getting up, walking, going to the toilet, or during sexual intercourse. However, it subsides when lying on your side, one thigh bent, the other stretched out.

We generally distinguish:

• acute coccydynia that lasts for less than 8 weeks
• and chronic coccydyniawhich persists for more than 8 weeks.

It should be noted that these pains are more common in women than in men.

Beyond the mechanical discomfort, pain in the coccyx can cause in the medium and long term:

• reduced appetite,
• constipation
• and have an impact on the patient’s morale (weariness, worry, pessimism, etc.).

• Coccyx pain after a fall. Contrary to popular belief, coccydynia is not only linked to fractures. These are even rare. Most often it isdislocation or sprain of the coccyx, related to trauma (falls on the buttocks or blows), or even a micro-trauma (following a very hectic trip, on uncomfortable, hard, narrow seats, in a car, motorbike or bicycle). Cases of coccyx fractures, linked to osteoporosis, exist, but remain extremely rare.
• Coccyx pain after childbirth. Tailbone pain can result from internal trauma, especially during a difficult birth, if the passing of the baby displaces the tailbone.

When the coccydynias are not related to an internal or external trauma, they can be of osteo-articular origin and related, for example:

• to hyperlaxity,
• to rheumatism,
• to chronic bursitis at the level of the coccyx
• or to a bony growth (also called « coccygeal spine ») which leads to local inflammation.

More rarely, coccyx pain can also be so-called « projected » pain, linked to sciatica which can cause pinching of the pudental nerve, one of the main nerves that innervates the perineum, in other words, the area between the clitoris and the anus in women, and between the glans and the anus in men. But also to an infection, inflammation of the sacrococcygeal joint Where to a tumor.

Some people are more likely to suffer from pain, due to the position of their tailbone in relation to their sacrum : the less the coccyx is aligned with the sacrum, the more it is subject to trauma.

Moreover, obesity and rapid weight loss can weaken the area.

Note: coccydynia affects more women than men and are more common in adolescents and adults than in children.

Some pain in the lower back, related for example to the lumbar vertebrae, can be attributed, wrongly, to the coccyx. It is therefore essential to consult a doctor to identify the origin of the pain. The diagnosis rests, as always, on thephysical examination and analysis of symptom history. In some cases, a digital rectal examination to be necessary, to assess pain during contraction of the muscles of the anus.

Conventional X-rays are generally not very effective and do not show any abnormality, because coccydynia is a dynamic disorder. The doctor can prescribe a dynamic X-ray : the patient is x-rayed in different positions, standing, sitting, flexion, extension, etc. He can thus better assess the angles of mobility of the coccyx. Other examinations help to clarify the diagnosis: a coccygeal discography (to assess the condition of the joints), a MRI (to rule out a potential tumor or inflammation of the soft tissues in the area), or even a bone scan (to assess the state of the bones).

• If the pain intensifies and is accompanied by fever, nausea, sleep disturbances, etc., do not delay in making an appointment with your doctor.
• If the pain is accompanied by feeling of paralysis in the lower limbs, constipation, feeling unable to urinate and/or urinary or anal incontinencecontact the emergency services immediately!

• To limit coccyx pain, the first measure is to avoid any pressure on the painful area.
• Applying heat or cold to the painful area may also be beneficial.
• A muscle relaxant can be prescribed in addition to painkillersin order to limit the pain.
• Physiotherapy sessions also allow you to regain some mobility.
• On a case-by-case basis, if the pain is recalcitrant, cortisone injections will be offered.
• Finally, in very rare situations, an operation may be considered to reposition the coccyx, or even to remove it completely.