The coccyx—or tailbone—is the last bone of the vertebral column, and usually consists of three to five fused vertebrae that connect with the sacrum, a part of the pelvis.
Description
The coccyx consists of fused vertebrae, which are not flexible like the other vertebrae of the vertebral column which are all interspaced by intervertebral disks and joined together by elastic ligaments. Since the spinal cord ends just before the coccyx begins, coccygeal vertebrae also lack a central foramen (hole). In the coccyx, the vertebrae generally fuse together in early adulthood and may also fuse with the sacrum, the bone located between the 5th lumbar vertebra and the coccyx, as a person ages. In males, the coccyx curves downward, and in females, it is straighter to allow a baby to pass through the birth canal without impediment.
Pain in or around the coccyx is called coccydynia or coccygodynia. Coccydynia presents a range of symptoms associated to a variety of underlying causes and conditions.
Causes
Coccydynia can be caused by a number of factors. Usually, patients report pain after a fall onto their buttocks, as occurs when going down stairs or while skating. Others have pain during pregnancy or after childbirth. Some experience repetitive strain from rowing or cycling, and some cite anal intercourse as the cause of pain. In many cases, pain derives from a malformation of the coccyx itself. Sometimes bony spurs appear on the coccyx, but only seem to be painful in thin patients who do not have the padding to protect the region from the spur.
Other causes of coccydynia include cancer or damage to the sacrum that generates referred pain, meaning pain that appears in one region but originates from another. Muscle strain or tension, pinched nerves or damaged nerves, or dislocation of the coccyx due to gross obesity are other causes.
Symptoms
The most common symptom of coccydynia, irrespective of the cause of the condition, is pain when sitting, or when rising from a sitting position. If the condition lasts long enough, the patient may even experience pain when standing or lying down. Sometimes, numbness occurs in the lower part of the spine. Some patients will experience pain during bowel movements, sexual intercourse, or menstruation.
Secondary symptoms include back pain from sitting in odd positions in order to relieve pain, and painful feet from standing too much, because patients avoid sitting. Sometimes the entire buttocks experience pain. Rarely, exhaustion, depression, and lack of sleep may occur.
Diagnosis
Diagnosis of fracture is usually made by inserting a gloved finger in the rectum and pressing on the coccyx. X rays and magnetic resonance imaging (MRI) are also often used. Since coccyx pain may be the result of other factors like cancer, these must be ruled out through a variety of tests before treatment can begin.
Treatment
Treatment exists to either control the pain or eliminate the cause. Pain control may be dangerous if an underlying condition exists of which the pain is a warning sign. Nerve blocks and a variety of drugs are other options to control pain.
Elimination of the root cause of the pain is ideal. This is done through careful diagnosis and the application of manual treatments, corticosteroid injections into the coccyx vertebrae, or surgery. Injections into the fourth and fifth sacral nerves and coccygeal nerves often bring relief, but are considered more as a pain control measure than as curative treatment. Manual treatments have not been found to be effective. Surgery is a radical procedure whose indications are inconsistent and dependent on the subjectivity of the physician.
Prognosis
With current treatment, prognosis is good and patients usually are able to live pain free.
Prevention
There probably is no real prevention, expect weight control. Some women may choose to give birth through ceasarian section instead of vaginally after an episode of coccyx pain from a previous delivery.
Sacrum—The triangle-shaped bone located between the fifth lumbar vertebra and the coccyx that consists of five vertebrae fused together. The sacrum joins on each side with the bones of the pelvis.
Spinal cord—Elongated nerve bundles that lie in the vertebral canal and from which the spinal nerves emerge.
Vertebrae—Bones in the cervical, thoracic, and lumbar regions of the body that make up the vertebral column. Vertebrae have a central foramen (hole), and their superposition makes up the vertebral canal that encloses the spinal cord.
Vertebral column—The vertebral column, also called the spinal column or spine, consists of a series of vertebrae connected by ligaments. It provides a supporting axis for the body and protects the spinal cord. The vertebral column consists of seven cervical vertebrae in the neck, followed by 12 thoracic vertebrae that connect to the ribs, five lumbar vertebrae in the lower back, the sacrum, and the coccyx.
