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What is Coccydynia and why it’s a pain in a butt

WHAT IS COCCYDYNIA?

Coccydynia refers to pain in the coccyx (tailbone). Tailbone pain can be a debilitating condition affecting your ability to do simple things like sitting, standing, pooping or having sex.

Coccyx pain (coccydynia) affects women 5x as much as men and is more prevalent in obese persons (Fogel, Cunningham & Esses 2004). It may start on its own or can be related to trauma due to childbirth or a fall.

The tailbone itself can be very tender to touch but the pain may be coming from surrounding structures such as bottom of the spine, muscles, ligaments, or soft tissue (Patel, Appannagari & Whang 2008). If the pain is long-standing (> 3 months), there may be some central sensitisation (click here for an explanation) at play as well.

WHY IS IT IMPORTANT TO UNDERGO A PELVIC FLOOR ASSESSMENT IF I HAVE TAILBONE PAIN?

Management involves a holistic approach- not just poking around of the coccyx. It is important to look at the spine, tummy muscles, sitting and moving postures, understanding the history of how it started, and a pelvic floor examination.

As seen in the picture below, the pelvic floor muscles attach to the coccyx. If these muscles are overactive, they may tug on the coccyx resulting in pain. Sometimes women will also complain of difficulties with bowel movements or painful intercourse due to this overactivity of the muscles.

Note: Not all physios are the same. Make sure you get assessed by a Women’s Health Physiotherapist who has the ability to perform a detailed pelvic floor assessment.

I often find women always needing to remind themselves of the sharp pain by poking or contorting themselves, like a kid who keeps poking you to remind you that they are STILL there. Newsflash ladies- this IS NOT helpful.

I’VE JUST GIVEN BIRTH AND CANNOT SIT TO FEED MY NEWBORN

If you’ve just given birth and you cannot sit soon after due to coccyx pain, speak to your doctor as you may have suffered trauma to your coccyx. This is especially so in the case of difficult deliveries that require the use of forceps. In the case report by Maigne, Rusakiewicz & Diouf (2012), they noted in 57 patients, a 50.8% incidence of postpartum coccydynia. “Luxation and fracture of the coccyx were the two most characteristic lesions” (Maigne, Rusakiewicz & Diouf 2012).

On the other hand, as a mum, you find yourself slumping on your couch to feed your baby or YOU JUST WANT TO SINK INTO YOUR COMFY COUCH TO CHILL. Repeated over time, this can aggravate the coccyx and surrounding areas as the coccyx is not designed to be a primary weight-bearing structure.

WHAT CAN I DO TO EASE MY COCCYX PAIN?

Applying ice packs to the area may help with pain management in the initial angry stages as well as avoiding the purchase of expensive shaped cushions

Try this instead: 2 rolled-up towels, positioned like train tracks so that the sit bones and upper thighs are supported and parallel to them. This will help to offload pressure on your coccyx, ease pain and also help to normalise your sitting position.

Addressing coccyx pain is not simple and takes time to heal with the right assessment and management. 90% of cases can be managed conservatively, sometimes including the use of NSAIDs and/or steroid injections (Lirette et al. 2014), whilst others may require surgery.

If you are experiencing a pain in the butt that’s not resolving, please call/WhatsApp on 9780 7274 or get in touch over email to make an appointment with a qualified Women’s Health Physiotherapist.

You can also visit our website to learn about other women’s conditions we treat through physiotherapy and how we can help you.

Note: Although I am a physiotherapist, I am not YOUR physiotherapist. The content of this website is for informational purposes only and is not intended to serve as individual medical advice.

References:

Fogel, GR, Cunningham, PY, 3rd & Esses, SI 2004, ‘Coccygodynia: evaluation and management’, J Am Acad Orthop Surg, vol. 12, no. 1, pp. 49-54.

Lirette, LS, Chaiban, G, Tolba, R & Eissa, H 2014, ‘Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain’, The Ochsner journal, vol. 14, no. 1, pp. 84-87. Available from: PubMed. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24688338

Maigne, JY, Rusakiewicz, F & Diouf, M 2012, ‘Postpartum coccydynia: a case series study of 57 women’, Eur J Phys Rehabil Med, vol. 48, no. 3, pp. 387-92.

Patel, R, Appannagari, A & Whang, PG 2008, ‘Coccydynia’, Current reviews in musculoskeletal medicine, vol. 1, no. 3-4, pp. 223-226. Available from: PubMed. Available from: https://www.ncbi.nlm.nih.gov/pubmed/1946890 

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