Tail Bone Pain(Coccydynia) 

If you have tail bone pain, problem with sitting, pain getting worse with sitting, then it could be disease called Coccydynia.
Tail bone plays special role in sitting. It is made of 3 bones and is attached to many ligaments and muscles. Just in front of the coccyx bone is a nerve bundle called Ganglion Impar. In the beginning, the symptoms could be tail bone pain only while prolonged sitting and when you are trying to get up from sitting position. As the disease progress, the pain sometime radiates to buttock and there could be a constant dull pain present at all times. This pain worse with constipation.

Causes

1. If there is history of fall and you had landed on your buttocks at the time of injury, then there could have been injury to coccyx too. Even if the fall was many years ago, this pain could come at any point of time.
2. After childbirth, if it was vaginal delivery in which forceps was used or was a difficult childbirth then later in life, this pain can come
3. There are some professions which require prolonged sitting like Drivers, students, software professional or students.
4. This prolonged sitting on hard surface for long time causes collection of multiple trivial traumas on coccyx and gradually causing coccydynia
5. Slouching while sitting then there is pressure on coccyx bone.

History – Symptoms of tail bone pain, radiating to buttocks, difficulty in sitting for prolonged period.

Investigations which can help are:-

• X ray which is dynamic x ray in this particular disease that is in sitting and standing position.
• CT scan or MRI is needed when we suspect associated spine problem infection /tumor /associated spine problem.

Home remedies which can help

1. Don’t sit on hard surface. If your job asks for sitting for prolonged hours, then choose a chair with a good cushion
2. And while sitting, posture should be straight as slouching also puts pressure on coccyx. Use of Cushion while sitting can also help. Special cushion is
3. needed which comes in two styles. Either a doughnut shaped cushion or a C shaped cushion which offloads weight on
4. Avoid constipation.
5. Sitz bath – filling tub with hot water with pinch of salt and sitting in this for 10-15 minutes. It should be done 2-3 times a day.
   Losing weight also decrease the pressure on the coccyx.
6. Certain kind of exercises also help a lot (link https://youtu.be/LTcp2Icv4lU)
7. I advise that these exercises is follow it exactly as shown and slowly increase your capacity to do it. Caution is if any exercises is causing pain, then please don’t do it.

Treatment

Medications – anti-inflammatory can be taken in short term. But long term needs to be avoided as it can causes gastritis, kidney problem.

If said treatment is done and not helping, then you can consult the Pain Physician. We do an Injection/Procedure which help in more than 90% of the patients. This procedure is called Ganglion Impar block.

Ganglion Impar Block – With the help of X ray, we see sacrococcygeal junction and nerve bundle in front is the target. Once needle reaches at the right spot, we inject a contrast agent to further confirm its position. Then a local anesthetic is injected. If this gives you a good relief then it works as a diagnostic confirmation. This is followed by Radiofrequency ablation. In this above said procedure is repeated but with RFA needle and with that needle we ablate the nerve fiber responsible for tail bone pain. The pain relief is then followed by rehab process to prevent any future episodes.