Introduction
Coccygeal pain (coccygodynia) is pain that occurs in the lower spinal region (Os coccygis) and usually has a stabbing or pulling character and can radiate into adjacent body regions. Sometimes patients complain of such severe pain that defecation, sexual intercourse or even sitting seems almost impossible. About 80% of patients with coccyx pain are women.
Treatment by cause
Usually coccyx pain is the cause. Before an adequate therapy can be carried out, sufficient and targeted diagnostics are required in the form of a medical, clinical examination by means of an index finger insertion into the anus (digito-rectal examination) and also in the form of X-rays (coccyx target image), MRI examinations of the coccyx, CT examinations and a gynecological examination.
- Periostitis at the coccyx
- Fractures (fractures)
- Inflammation of muscles, tendons or bones
- Congenital coccyx malformations
- Coccyx fistulas, ulcers (tumors)
- Herniated disc of the lumbar spine
- Severe mechanical overstrain (accidents, births, pregnancy-related pressure of the child on the coccyx, chronic constipation) or
- Psychosomatic diseases
Treatment of coccyx pain
Coccyx pain often takes a long time to develop. First the cause of the pain must be identified so that it can be treated. If it is a fracture (fracture) of the coccyx, the first step is to use pain-relieving drugs such as paracetamol, ibuprofen or diclofenac (oral analgesics).
There is also the possibility of infiltration of local anaesthetics (local anaesthetics) or anti-inflammatory drugs (glucocorticoids/cortisone). Furthermore, the patient should maintain a bed rest that promotes healing or achieve a relief of the coccyx when sitting by means of a trough-shaped seating ring. Physiotherapy or psychotherapy can also help to alleviate the symptoms.
Studies show that alternative medical measures (complementary medicine) in the form of yoga, tai chi, meditation, osteopathy or acupuncture can also be an adequate additional therapy option. If no improvement in symptoms is achieved with these conservative measures for more than 3 months, surgical removal (resection) of bone parts (bone fragments) or the entire coccyx may be necessary. However, surgery can also lead to severe pain in the area of the scar and should therefore be carefully considered.
If there are bruises in the area of the coccyx (e.g. due to falls or direct violence), cooling or pain-relieving medication can bring about improvement. After a bruise, however, the coccyx should be examined regularly. If there is excessive fluid retention in this area, surgical relief may be necessary.
Coccyx pain can also occur in cases of lumbar spine herniations (disc prolapse of the lumbar spine) or lumbar disc protrusions (disc protrusion of the lumbar spine) in the lumbar spine area. This pain is often caused by nerve irritation of the sciatic nerve (sciatic nerve) or the annococcygeal nerve. Initially, an attempt should be made to treat the herniated disc in a conservative manner in the form of rest, massages, physiotherapy, warmth and exercise therapy, manual therapy or pain-relieving medication.
If the symptoms persist or if there are strong neurological deficits in addition to the coccyx pain or if an urgent need for action is known early on, surgical therapy should be considered. Coccyx pain can often be treated by the family doctor. The therapy usually consists of physical rest and painkillers if necessary.
These can be prescribed by the family doctor. Imaging may be necessary to rule out serious coccyx injury, especially after trauma such as falls. For this purpose, the family doctor usually first sends the affected person to an orthopedist.
The orthopedist can then arrange for the imaging to be performed by a radiologist. Since the coccyx is a bony structure, an x-ray is often sufficient; CT or MRI is rarely required. If an orthopedist is involved in the treatment of coccyx pain, he or she can prescribe additional physiotherapy.
In the case of coccyx pain, a seating ring is used to protect the coccyx while sitting.For this purpose, the seat ring is usually open at the back so that the load is taken off the coccyx when sitting. This form of therapy is often chosen after traumatic coccyx pain. In this way, the coccyx can be temporarily spared while sitting is still possible.
Seat wedges or soft seat cushions can also be used to treat coccyx pain. These are often very helpful in cases of rather chronic coccyx pain. They can not only be used in acute therapy, but also serve to prevent a recurrence of coccyx pain.
Chronic coccyx pain occurs more frequently during pregnancy, especially at advanced stages of pregnancy. In the course of pregnancy, the ligaments and muscles loosen and the pelvic floor becomes more and more strained as the weight of the child increases. This can lead to back pain, especially in the lower part of the back up to the coccyx.
Exercises that strengthen the pelvic floor muscles help to counteract this. Even without the presence of a pregnancy, the pelvic floor can become loose and thus cause coccyx pain. Often, surrounding muscles are also the cause of the complaints.
These can be too weak, in which case not only the strengthening of the pelvic floor but also of the buttock muscles is a good starting point. Which form of exercise is helpful can best be assessed by a well-trained physiotherapist. He can help you to learn certain exercises, which can then also be done alone at home.
If, on the other hand, tension of the muscles in the buttocks is a problem, relaxation techniques are more likely to be necessary to alleviate the symptoms. Warm baths, massages and, if necessary, acupuncture can therefore often have an additional positive influence on the treatment of coccyx pain. Taping is particularly useful for coccyx pain if the cause of the pain is a muscular imbalance.
The pelvic floor muscles are particularly affected by this, but it is difficult to treat them with tape. However, if the cause of the pain is in the gluteal muscles, tape can develop very good therapeutic powers. Especially the elastic Kinesiotape can be applied to the skin along the important muscles.
This way it supports the pulling of the weakened muscles and can counteract the pain. Occasionally the pain is caused by a pinched nerve. Here too, by supporting the muscles, tape can free the nerve from its constriction and thus alleviate the pain.
Inflammation of the muscles, tendons or bones in the area of the coccyx can also lead to severe coccyx pain. It is important to distinguish whether the inflammation is caused by a protracted (chronic) process, such as chronic joint inflammation (arthritis) or an acute or chronic inflammation of the bone (osteomyelitis). In arthritis, which frequently occurs in the region of the coccyx and is a rheumatological disease and thus a disorder of the immune system (psoriasis arthritis), local pain-relieving ointments (topical application), anti-inflammatory drugs (glucocorticoids/cortisone), and special immunosuppressive drugs can provide relief.
Inflammation of the bone (osteomyelitis) is usually caused by infections with bacteria, viruses or fungi. In about 75-80% of cases, the trigger is the bacterium Staphylococcus aureus. Therefore, in most cases it is necessary to start with an adequate antibiotic therapy and to clean/rinse the infected bone.
Coccyx pain can also occur in pregnant women during pregnancy or during childbirth. The coccyx pain caused by the child’s pressure on the bony pelvis usually disappears on its own, but can also be treated by sitting rings, physiotherapy or heat therapy. From the 2nd trimenon onwards, the use of some pain-relieving medication is also possible.
Even during childbirth, pain is often caused by irritation, compression or excessive stretching of the coccyx. In the case of very severe coccyx pain during childbirth, an anesthetic near the spinal cord (epidural/PDA) can provide relief. Another possibility for coccyx pain is coccyx fistula (sinus pilonidalis/sacraldermoid/ pilonidal cyst).
Here, hair usually grows in the coccyx area, but accidents or congenital malformations can also play a role. A connection (fistula) forms between the hair root and the deeper tissue. This connection represents a point of attack for intruders such as bacteria.The treatment of coccyx fistula can be started conservatively, i.e. wait and see, but in cases of severe pain or inflammation it should be treated surgically.
Since a recurrence of the fistula often occurs after the operation, in many cases a very well thought-out consideration is necessary. In the case of coccyx pain caused by a tumor, the type of tumor must first be determined in order to be able to plan the further procedure precisely. Often coccyx tumors are congenital malformations in childhood (teratoma, dermoid), but bone tumors, gynecological tumors or metastases of other tumors can also be found.
Depending on the type or size of the tumor or a possible already existing infestation of other structures of the body, various treatment options (surgery, chemotherapy, radiation) can be considered to improve the pain symptoms of the coccyx. If no physical causes can be found, some patients may be helped by psychotherapy. Painkillers, which ideally have an anti-inflammatory (antiphlogistic) effect, are particularly suitable for administering medication for acute coccyx pain.
These include, for example, the active ingredients diclofenac (Voltaren®), acetylsalicylic acid (Aspirin®) and ibuprofen. However, regular use of these active ingredients without medical supervision should be avoided, as the stomach lining is damaged by these drugs in the long term. These medications can also help with chronic pain in the breech area, but should be used primarily to ensure or further expand the range of motion.
After all, exercise is still the best remedy for back pain, regardless of its location. If the pain persists despite regular exercise, the family doctor can inject a local anaesthetic if he considers it indicated. Like taking medication, this serves to completely eliminate the cause of the pain through movement.
Depending on the cause, the use of heat or cold may be indicated. In both cases it is important not to injure the skin, i.e. to burn or freeze it. For this reason, the area should be checked regularly when applying heat or cold.
In addition, always place a towel or similar between the temperature source and the skin. Heat helps with tension in general. So if the coccyx pain comes from bad posture and a lot of sitting, heat can help here.
This is chronic pain that is only slightly noticeable at rest and can become even worse when moving. As a result, a relieving posture is often adopted, which reduces the range of movement more and more. To break this vicious circle, the application of heat can help initially.
Cold, on the other hand, should be applied to the coccyx in case of falls, i.e. bruises. The formation of a hematoma (bruise) can thus be reduced, since the blood vessels become slightly constricted locally due to the cold. In addition, it takes away at least some of the pain of the bruise.
