General information
Coccygeal pain (med. Kokzygodynie) refers to pain in the lowest part of the spine. This area is called the coccyx (Os coccygis) and reacts to pressure with a sharp, stabbing or pulling pain that can radiate into adjacent areas.
Overall, coccygeal pain is rather rare. The most common cause is chronic microtrauma. However, nerve pain or injuries can also lead to pain in the coccyx.
In addition, everyday clinical practice clearly shows that women are affected by coccyx pain much more frequently than men. Coccyx pain, which has rather harmless causes, usually lasts only a few days and can be treated well with mild painkillers (analgesics). In many cases, the problems occur spontaneously and disappear by themselves. However, depending on the cause of the disease, pain in the coccyx can last for weeks or months, put a lot of strain on the person affected and thus make medical treatment unavoidable.
Symptoms
Many people suffer from severe pain in the coccyx area (Os coccygis). This pain can occur temporarily in certain situations, for example when sitting, defecating or doing sports, or it can be chronic. This clinical picture is also called “coccygodynia”.
Causes
There are many different reasons for coccyx pain. The body region is supplied by the nerve plexus “Plexus Coccygeus” and is therefore very sensitive to pain. Even if in some cases no real trigger for the pain in the coccyx can be found and one speaks of a so-called psychosomatic pain, there are also events directly related to the pain.
This nerve plexus at the coccyx can be irritated, for example, by sitting for a very long time, i.e. staying in the same position. However, injuries to the coccyx, such as a fracture, soft tissue injuries to the pelvic floor muscles or lumbar disc herniations, and insufficient healing are much more common causes of pain. Furthermore, women experience such pain in connection with pregnancy and birth.
Bone skin inflammation at the tailbone Also intestine problems can exhibit these symptomatology. The pain at the coccyx does not only occur acutely in the phase of injury and healing, but can also remain long-term and thus become chronic. Then one speaks of coccygodynia.
With strong mechanical stress, such as sitting on hard chairs for a long time, but also on soft surfaces, coccygeal pain can occur in some people after a long period of time. The reason is small microtraumas, which cause stress on the bony coccyx and the surrounding soft tissues. These micro-traumas are among the most common causes of coccyx pain.
Not only after sitting for a long time do the affected patients experience an enormous increase in pain sensations, but also when lying down, walking and bending, the coccyx of many affected persons hurts. This fact is due to the trauma-induced damage to the tissue in the coccyx region. However, pain in the coccyx is usually not limited to the buttocks.
In some cases, patients report that the pain radiates into the thighs or lumbar spine. Inflammation of the tendons, muscles or bones can result from chronic strain or germs. Usually these inflammations are accompanied by other symptoms.
The chronic inflammation in the context of arthritis (inflammation of the joints) often develops over a long period of time and can usually only be cured by a consistent, long-term therapy. Long-lasting, monotonous movements also play a decisive role in coccyx pain, which is based on inflammation-related causes. Especially after long periods of sitting, lying down or walking, coccyx pain, which is caused by inflammation, is felt as particularly severe.
Coccyx pain often occurs in connection with a fall. The force exerted on the coccyx during the fall and the comparatively little padding of the coccyx bone can cause a bruise or even break. In the case of a bruise, the pain caused by the irritation of the nerve plexus “Plexus coccygeus” and possibly the “Plexus sacralis” is the first to come to the fore.In the course of the disease, damage to blood vessels results in a bruise which, together with the oedematous swelling of the surrounding tissue, causes an increase in pressure on the coccyx.
The irritated nerves react more sensitively to pressure and touch. Depending on the severity of the pain, it can be increased for weeks, but it subsides somewhat as the bruise subsides. If the coccyx is broken as a result of a fall, the pain can be much greater due to the damage to the very sensitive periosteum.
In addition, the healing process of the coccyx may increase the duration of the pain or the sensitivity to pain. In principle, the same thing happens after a fall with a fracture as with a bruise, except that the bone itself is more severely damaged and the bruise can be greater. Cooling and protection of the coccyx provide relief from the pain.
Somewhat less frequent but not negligible are coccyx luxations (displacement of the coccyx) due to a fall. The pain usually subsides again after successful dislocation. Even without injury from a fall, severe pain can occur in the coccyx.
The reason for this can be, for example, sitting on a hard surface for too long, as a high load presses on the relatively small coccyx for a long time. In addition, after a while the levator muscles, which attach directly to the coccyx, become tense in this position. In addition, the blood supply to the buttocks and coccyx region is reduced when sitting.
In order to avoid pain, it is therefore advisable to change position from time to time, take a few steps or choose another sitting position. But tissue damage in the coccyx region also causes pain. These include coccyx fistula, a sore spot, a so-called “decubitus“, and perianal vein thrombosis.
In addition, chronic inflammatory bowel diseases can promote the development of pain by permanently damaging the intestinal tissue, which leads to transmission pain in the coccyx due to the blurred connection of the intestinal nerves together with the other nerves to the spinal cord. Thus the coccyx can hurt even if it is not directly affected. A constipation in connection with pain in the coccyx can most likely be explained by the spatial proximity.
The last part of the large intestine and the rectum lie directly under the coccyx. If this section of the intestine is blocked and dilated, the internal pressure on the coccyx increases. In the long term, this can cause pain.
A herniated disc in the lower lumbar vertebrae or irritation of the corresponding nerve root (lumboischialgia) leads to severe pain in the coccyx area. The coccyx is also supplied by the sciatic nerve and causes pain when irritated. The nervus anococcygei also supplies an area between the coccyx and the anus.
If this area is irritated, if it is inflamed or irritated by a neurological disease, it also causes pain in the coccyx. Bone tumors can also affect the coccyx, as is the case with many other bones, and thus cause pain after a while. Gynecological tumors can also infiltrate the coccyx area due to their localization, or irritate or constrict the coccyx and surrounding soft tissues due to their growth in size.
The coccyx can also be highly irritated by the heavy strain on the woman’s entire pelvis during childbirth. This can lead to compressions or injuries from the inside and thus cause pain. Towards the end of the pregnancy, the child already begins to sink towards the pelvis and thus moves into an ideal birth position.
This process can also lead to severe stretching of the pelvic ring, irritating various anatomical structures and causing pain in the coccyx. Particularly during birth, the use of a so-called epidural anesthesia can help pregnant women to achieve effective pain relief. Epidural anesthesia is a special form of regional anesthesia, which can provide effective pain relief by injecting an anesthetic near the spinal cord. Pain in the area of the coccyx, which can occur during birth, can thus be substantially relieved.