Do you suffer from severe pain in your tailbone?
Are you not able to sit or stand for long?
Are you tired of using strong pain killers and carrying coccyx cushions everywhere?
We can help. Coccydynia (tailbone pain) is becoming increasingly common due to changes in our lifestyle. For many it starts after a fall or injury to your tailbone but for a majority there are often no particular trigger factors.
It can cause disabling pain and at its worst, it can mimic sciatica like symptoms that is it can radiate into the legs.
Patients have often tried a number of treatments such as physiotherapy, osteopathic manipulation and even cortisone shots apart from medication.
We now know that many cases of tailbone pain can be due to hypersensitivity of the nerves in the area and doing a nerve block of the coccyx (called the impar ganglion) can help reset the pain and provide relief.
Since pain is the main issue and nerve blocks can help, pain specialists have gained importance in managing this condition.
Our Consultant at the Berkshire Pain Clinic, Dr. Ravindran has more than 10 years of experience treating patients in acute and chronic pain. He is a member of the British Pain Society and is a fellow of the Faculty of Pain Medicine and holds the Fellowship for Interventional Pain (FIPP).
At the first consultation, Dr. Ravindran will
- Work with you to arrive at a diagnosis. He can organize any further tests such as Xrays, CT scans or MRI scans as necessary.
- Suggest suitable medication taking into account other medications you might be on and plan an individualized treatment plan for you.
- Organize and refer you to suitable physiotherapists who can help you with this condition after the injection.
- Provide local anaesthetic and steroid injections into the bone or surrounding ligaments if that is considered a problem
- Perform the impar ganglion block and offer radiofrequency ablation as the next step
Coccydynia (Tailbone pain) can be managed much better with a combination of the above therapies and suitable lifestyle changes, thus improving your quality of life.
The Berkshire pain clinic aims to be a one stop resource and support for helping you with this condition.
Read the feedback from one of Dr.Ravindran’s grateful patients with coccydynia.
My experience started in 2009 with pain in the coccyx region, which progressively worsened. I had to give up spinning classes and the pain was becoming so extreme that I used to dread standing up as a release of pressure as I stood up was very painful. I was referred to a spinal consultant who diagnosed that I had coccydynia and advised a coccyx cushion and a cortisone injection with manipulation. This gave temporary benefit for 3-4 months and was done in 2010 and 2011. I struggled on using the cushion but the pain was becoming unbearable. In March 2012, I was referred to Dr. Ravindran who after reviewing my medical history recommended a different nerve block and a change of medication. This was done as a day case in May 2012. This was under X-ray and Dr. Ravindran showed me all the different stages which helped me to understand more about what was happening. I had about 50% success meaning I was able to sit for longer periods without pain. He advised me to try the same procedure but with added treatment of producing an electric current to go the coccyx again. It is now 6 months and I am pleased to say that I no longer need any medication or the cushion. I can safely say that the percentage of pain relief has been increased to 90%, I still get minor discomfort if I sit for longer periods but I feel like I have my life back again. I cannot thank Dr. Ravindran enough for what he has done for me. I would highly recommend anyone with this condition to seek medical advice as soon as possible.
Read other testimonials/feedback for Dr. Ravindran here.
What is it?
Coccydynia refers to any pain that starts or is present around the tailbone of the spine. It is also called coccygodynia.
It is a poorly understood condition which causes persistent and often disabling pain at the bottom of the spine and can impair and affect all daily activities. There are many causes for the condition to arise and it is often more common in women than men.
Most often these injuries do settle spontaneously but if a lot of the inciting factors persist, the pain stays on and intensifies.
What does it feel like?
Patients often complain of
- Pain on sitting down which is often worse when leaning backward
- Pain is often intense and localised to the bottom of the spine and seem to spread to the groin or go down one or both legs
- It is often very tender to touch
- Pain often feels worse on standing after sitting for a period of time
Why does it happen?
There are a number of reasons for pain to develop in the tailbone
- Idiopathic: Often the exact cause for the pain cannot be found or identified. This is known as an idiopathic cause.
- Trauma: this is one of the common causes. This can be due to a sudden fall on the bone during sport or fall from a height. Often this is due to injury to the ligaments or muscles around the coccyx than the actual bone itself. Rarely the bone itself sustains a fracture or dislocation.
- Pressure: often sustained pressure such as sitting on a hard surface for a prolonged period of time, poor posture or horseback riding can cause this problem.
- Childbirth and labour: a number of ligaments of the pelvis are attached the coccyx and during the latter stages of labour, excess stretching of the ligaments can cause this pain.
- Being obese or overweight: this can cause pain due to again excess pressure on the coccyx while sitting
- Age: often aging processes can affect the ligaments and the disc causing pain
- Malignancy (cancer): both primary and secondary. (Very rare indeed)
It is often more common in women due to different shape of the pelvis as compared to men putting the ligaments and the bone under greater stress and the higher risk of getting this problem during childbirth. It can occur in all age groups and in children as well.
How to diagnose it?
It is important to take a complete history of the pain and then conduct a thorough physical examination.
- Local tenderness on touching (palpation) is often a significant finding.
- Tests include Xrays of the pelvis from the front and side to rule out any fracture or dislocation.
- Scans such as MRI of your pelvis can help in ruling out any cancer or infection. Bone scans or CT scans do not often provide much added information.
Most often these investigations will come out normal and reassure the patients.
Treatment and prognosis:
Most acute episodes should heal on their own within a few weeks and only require simple pain killers. But if the pain persists for more than 3 months then it is likely to become a chronic problem and needs a combination of treatments.
Management of an acute episode of pain
- Use of medication such as paracetamol, NSAIDs(ibuprofen, diclofenac and naproxen)
- Use of ice pack or hot pack as suited
- Avoid sitting for prolonged periods
- Use of a coccyx pillow or cushion ie anything that can take the pressure of the coccyx
- If pain is worse on bowel movement or is associated with constipation, then use of stool softeners or laxatives
Management of chronic episode of pain
In addition to the above mentioned techniques for managing an acute episode, other measures include
- Specialist physiotherapy aimed at the pelvic muscle floor
- Sometimes pelvic muscle floor dysfunction can be responsible for the pain. Manipulation/Stretching
- Use of ultrasound therapy
- Stronger medication such as tramadol, strong opioids, anticonvulsants
- Injections of steroid and local anaesthetic
- Injections into the Impar ganglion (nerves lying in front of the coccyx)
- Surgery (coccygectomy)
What is the impar ganglion?
The ganglion impar refers to a group of nerves that lie just in front of your coccyx bone. When tailbone pain (coccydynia) has persisted for a few months, the nerves in this area get hypersensitised and can start to become over active.
These nerves form part of the sympathetic nervous system in your body. The sympathetic nervous system is a part of the nervous system that may often carry a lot of the pain signals. Therefore blocking these nerves with a local anaesthetic can often relieve the pain. Sometimes one shot may be adequate to turn down the hypersensitivity of the tailbone pain.
Often if an initial local anaesthetic block provides good relief then another form of injections called radiofrequency denervation can be done to provide prolonged pain relief. These injections are best done by experienced doctors using X-ray machines to guide the needles to the right place. These can be discussed with the pain specialist who provides these injections.
How can the Berkshire Pain Clinic help you?
- Tailbone (coccyx) pain can often be persistent and disabling. It can significantly affect quality of life. Fortunately there are a few new treatments that are available which can be helpful in reducing the symptoms.
- The pain specialist can work with you to arrive at a diagnosis. He can organize any further tests such as Xrays, CT scans or MRI scans as necessary.
- We can suggest suitable medication taking into account other medications you might be on and plan an individualized programme for you.
- We can organize and refer you to suitable physiotherapists who can help you with this condition.
- We can provide local anaesthetic and steroid injections into the bone or surrounding ligaments if that is considered a problem.
- We can offer the impar ganglion block using X-ray machine which can help tremendously in managing the pain.