Coccydynia - Treatment 

  • Overview

Treating coccydinia 

Back stretches

Back pain is a very common condition, affecting about 80% of people at some point in their lives. A physiotherapist demonstrates some simple back stretches to help prevent aches and pains.

Media last reviewed: 08/08/2013

Next review due: 08/08/2015

Self-care advice

The following advice may help with your everyday activities.

  • Sitting – specially designed gel-filled cushions can reduce pain when you are sitting down. It may also help to lean forward in your seat and rest your arms in front of you on a flat surface. This can help to take pressure off your coccyx.
  • Clothing – clothing, such as tight jeans or trousers, may make your coccydynia worse. Wearing loose-fitting clothes that will not squeeze the tissues around your coccyx is recommended. It can also help to wear flat, comfortable shoes.
  • Sleeping – many people with coccydynia find sleeping on their sides most comfortable. However, if you have severe pain, you may find it better to sleep on your front. You could also try sleeping with a pillow or cushion between your knees.
  • Warm and cold packs – applying either a warm or cold pack to the base of your spine may help ease your pain. Warm packs include hot water bottles and microwaveable heating pads. Cold packs are available as freezable gel-filled pads from most pharmacies.

NSAIDs

Non-steroidal, anti-inflammatory drugs (NSAIDs) can treat a wide range of symptoms such as headaches, toothache, muscle and joint pain, fever and inflammation

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.




Page last reviewed: 22/07/2014

Next review due: 22/07/2016

Ratings

How helpful is this page?

Average rating

Based on 116 ratings

All ratings

Add your rating

Comments

Pain: keep active

If you're in pain, keeping active will help as stiffening up can make pain worse.

Back pain guide

Back pain guide

Explore this guide for information about different types of back pain, ways of preventing it and advice on treatment