Coccydynia - Treating coccydinia

The treatment for coccydynia will vary depending on what is causing your condition and how painful it is.

Various treatment options are described below.

Medication

Anti-inflammatory painkillers (NSAIDs)

If your pain and discomfort is mild to moderate, treatment with painkillers may be enough to relieve your symptoms.

Your GP may recommend or prescribe a type of painkiller known as a non-steroidal anti-inflammatory drug (NSAID). As well as easing pain, NSAIDs will also help reduce inflammation (swelling) around your coccyx. They are most effective when taken regularly, rather than when your symptoms are at their most painful. Ibuprofen is a type of NSAID available over-the-counter without a prescription.

Some people can't take NSAIDs because they are allergic to them, or have an increased risk of developing stomach ulcers. If this is the case, you can use the over-the-counter painkiller paracetamol.

Other painkillers

In cases of more severe or long-term (chronic) coccydynia, a stronger painkiller called tramadol may be required. Tramadol may cause side effects, such as constipation, headaches and dizziness.

Tramadol is usually prescribed for a short time as it can be addictive. If it's prescribed for longer, the dose will have to be reduced gradually before being stopped to avoid withdrawal symptoms.

Injections

If the coccydynia doesn't respond to painkillers, the doctors may try injecting medication into your lower back to help relieve pain.

Different types of injections can be used, and they are described below.

Corticosteroid injections

Corticosteroids reduce inflammation (swelling) and pain. Sometimes, corticosteroids are combined with local anaesthetic to make them even more effective.

Corticosteroid injections relieve the symptoms of coccydynia, although the effects may only last for several weeks at a time.

Corticosteroid injections can't cure your condition and too many corticosteroid injections can damage your coccyx and lower back, so you may only be able to have this type of treatment once or twice a year.

Ganglion impar nerve block

The ganglion impar are a cluster of nerves next to your coccyx. It is through these nerves that many of the pain signals travel.

A ganglion impar nerve block temporarily suppresses these nerves by injecting them with a local anaesthetic to stop them transmitting pain signals.

This can be permanent in some people. In others, the pain will return after a few weeks or months, although the level of pain is usually lower.

Unlike corticosteroid injections, it is usually safe to have repeated injections of local anaesthetic.

Sacrococcygeal joint injections

The two main joints that hold the coccyx and the rest of the spine in place are known as the sacrococcygeal joints.

In cases where it is thought inflammation or other damage to the sacrococcygeal joints are causing coccydynia, the joints may be directly injected with a combination of corticosteroids and local anaesthetic.

Spinal manipulation

There is limited evidence that spinal manipulation may be effective in providing short-term pain relief in some people with coccydynia.

Types of spinal manipulation include:

physiotherapy – a treatment that uses physical methods, such as massage and manipulation, to promote healing and wellbeing
osteopathy – a manipulation technique that some people claim can detect and treat problems with the muscles, nerves and joints
chiropractic – a manipulation technique that is based on the theory that many health problems are related to misalignments of the spine

Osteopathy and chiropractic are what are known as complementary and alternative medicines (CAMS), as they differ in important ways from more conventional treatments. Unlike conventional treatments, the use and principles of CAMS are not always based on scientific evidence.

If you decide to use a form of CAM to treat coccydynia, always ensure your therapist is fully qualified and an accredited member of the appropriate organisation, such as the General Chiropractic Council or the General Osteopathic Council.

Surgery

Surgery for coccydynia is uncommon and is usually only recommended when all other treatments have failed.

Your coccyx may need to be completely removed in an operation called a coccygectomy. Alternatively, you may only have part of your coccyx removed in a procedure known as a partial or limited coccygectomy.

A coccygectomy is carried out under general anaesthetic. Your surgeon makes a small cut in the skin over your coccyx, so it can be removed. The muscles, tendons and ligaments attached to the coccyx are reattached to other parts of your pelvis to preserve their function.

The most common complication of a coccygectomy is a post-operative infection, which occurs in around a third of cases. It is thought infections are so common because the coccyx is located next to the rectum and anus, making it easy for bacteria from these areas to spread to the site of the operation.

Minor to moderate infections can be treated with antibiotics. However, more serious infections may need additional surgery to remove or repair diseased tissue.

Following surgery, around 80% to 90% of people will experience a marked improvement in their symptoms, although it can take several months.

The remaining 10% to 20% will continue to experience pain.

It is important to be aware that a coccygectomy has a long recovery time. It can take anywhere from a few months to a year to recover.

Anaesthetic: Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Anti-inflammatory: Anti-inflammatory medicines reduce swelling and inflammation.
Corticosteroid: Corticosteroid is a naturally occurring hormone produced by the adrenal gland, or a synthetic hormone having similar properties. It is used to reduce inflammation, so reducing swelling and pain.
Incision: An incision is a cut made in the body with a surgical instrument during an operation.
Inflammation: Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Pain: Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Spine: The spine supports the skeleton, and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.