Coccygodynia - Symptoms, Causes and Therapy

Pain in the coccyx - coccygodynia

Coccygodynia describes the occurrence of coccyx pain due to various causes, which in some cases remain unknown. The complaints can persist for a long time and severely limit those affected. In most cases, it is women who suffer from a rump pain. Common treatments are primarily symptom-related. However, the multitude of possible triggers means that very different therapeutic approaches are used to fight the disease.

contents

• Pain in the coccyx - coccygodynia
• A short overview
• definition
• symptoms
• causes
• diagnosis
• treatment
• Naturopathic treatment
• Also worth a try

A short overview

Occur coccyx pain, they can be perceived very differently and the course can be very different, which makes the coccygodynia not infrequently a lengthy medical history. Before the detailed description of the disease, here is a brief overview of the most important facts.

• definition: Coccygodynia describes pain that occurs directly on the coccyx or radiates into that body region (pseudo-variant). It is one of the diseases of the spine and the back, the disease triggers are very diverse.
• symptoms: The occurring coccyx pain varies widely in intensity and duration. As a rule, pressure and stress increase the symptoms. In some cases, the pain is also perceived in surrounding areas of the body.
• causesIn principle, a distinction is made between known causes due to trauma and unknown causes. In both cases, many triggers come into question, the traumatic pain usually resulting from a dislocation, bruise or fracture of the coccyx.
• diagnosisScanning and targeted movement of the coccyx can usually diagnose the presence of true coccygodynia. To clarify the causes and to exclude other possible diseases, X-ray examinations or further imaging procedures are often consulted.
• treatmentFirst and foremost, conservative symptomatic therapies are used to alleviate pain, for example, through warmth, relaxation and movement. There are many other approaches, such as the use of painkillers. Surgery and removal of the coccyx is basically considered the last option.
• Naturopathic treatment and alternative therapy methods: Musculoskeletal and manual therapies such as osteopathy and chiropractic can also be used to treat pain. Other alternative options include acupuncture or homeopathy.

The coccyx is considered to be a remnant of human evolution, but nevertheless plays an important role in body statics. (Image: yodiyim / fotolia.com)

definition

The term coccygodynia (Latin spelling: Coccygodynia) derives from the affected body region of the coccyx (Os coccygis) and describes with the word ending "-dynie" the occurrence of pain. Consequently, one also speaks of coccyx pain or a coccyx neuralgia. According to the International Classification of Diseases (ICD-10), coccygodynia is a disease of the spine and back.

The coccyx joins the sacrum and forms the lowest part of the spine, where various muscles and ligaments attach. In most people, the individual coccygeal vertebrae are fused into a bone (synostosis). The coccyx is considered a remnant of vertebrate caudal vertebrae that has regressed in human evolution. Nevertheless, the coccyx but plays an important role in the development of body statics.

Coccygodynia rarely occurs. Most often affected are middle-aged women. There are many possible causes, most of which can be attributed to trauma or other illnesses. But the trigger can not always be determined, the causes then remain unknown or are attributed to other diseases and psychosomatic reasons. The disease can be chronic and affect the sufferers in the long term.

In the disease can be distinguished between the real form and the pseudo-coccygodynia. While true coccyx neuralgia originates in the coccyx or sacrococcygeal joint (connecting the coccyx and coccyx), the pseudo-variant produces radiating pains elsewhere.

Local or radiating coccyx pain can lead to severe discomfort and impairment. (Image: absolutimages / fotolia.com)

symptoms

The coccyx pain can be short-lived or chronic. They occur directly on the coccyx or in the surrounding parts of the body or radiate out there. Partly the complaints are perceived as very strong. The pain is often pulling, stinging or burning and strengthen under certain loads and movements. Any pressure on the coccyx is perceived as particularly painful. Those affected report difficulties in sitting, sitting down, getting up and climbing stairs. It can also cause discomfort during bowel movements and sexual intercourse.

Radiation pain, sometimes referred to as backache (low back pain, sciatic pain), hip pain, groin pain or buttock pain.

causes

From a medical point of view, a distinction is made between traumatic and idiopathic coccygodynia.

Traumatic coccyx pain is usually caused by injuries. Any type of fall, accident, or natural (vaginal) birth may trigger dislocation (dislocation), contusion, or more rarely a coccyx fracture. Adjacent structures such as ligaments and muscle fibers can also be affected. Also in the context of pregnancies is increasingly reported on complaints on the coccyx. In this case, irritation or overstretching of ligaments that attach to the tailbone are suspected as a possible cause.

The causes of coccygodynia are manifold. Often, a fall or accident has led unnoticed to a bite injury. (Image: 9nong / fotolia.com)

In addition, congenital malformations or poorly healed cervical spine fractures can be painful or cause pain over time. Because excessive weight bearing (overweight) can cause pain in the coccyx, obesity is considered a risk factor.

If even after extensive examinations (in rarer cases) no demonstrable cause can be found, the illness is called idiopathic. Certain peculiarities in the anatomy (form deviations) of the coccyx (positions and motility of the coccygeal vertebrae) may be painful. It is also suspected that a fusion between the coccyx and tailbone (sacrokokzygeal connection) could be responsible for any symptoms.

Furthermore, it is discussed whether other diseases can cause the symptoms of coccygodynia. There are indications that a deep herniated disc, various diseases of adjoining muscles and ligaments in the pelvis and pelvic floor, a tumor or a cyst (or a fistula) can overstretch, overload or inflame the structures on the coccyx and thus cause similar pain. Likewise, a connection with rheumatic diseases comes into consideration. It is strikingly common for ankylosing spondylitis patients to suffer from coccygeal neuralgia.

Some research suggests a link to mental illnesses such as depression. It happens that sufferers with idiopathic coccyx pain are diagnosed with psychosomatic illness.

diagnosis

The diagnosis is based on a detailed patient history almost always on a physical examination by palpation (palpation) and targeted movement of the coccyx and especially the coccyx tip. The coccyx is felt from the outside and possibly from the inside. If pain is triggered by the pressure, it is generally assumed that it is true coccygodynia.

For further clarification of the cause and treatment or to exclude other diseases, additional examinations may be initiated, such as X-rays or other imaging techniques.

On the X-ray images, changes in the bone can be detected, whereby the diagnosis is made more difficult by the variable anatomy of the coccyx (number, shape, position and fusion of the coccygeal vertebrae). When an injury becomes visible, people often do not remember an accident. It is typical that there is some latency between the causative trauma and the onset of pain.

If the radiographs show no abnormalities, ultrasound examinations, computed tomography or magnetic resonance tomography are performed, depending on the patient case. Among other things, tumors or internal inflammations can be detected. Since twice as many women as men are affected, a supplementary gynecological examination may be useful.

Manual therapies, along with heat treatments, are often the first pain relief therapies. (Image: kritchanut / fotolia.com)

treatment

The explanation of the cause is an important part of a successful therapy. Thus, the treatment concepts vary widely depending on the cause and have not yet been comprehensively tested for their effect. If the pain is chronic and persists for months or even years, the treatment is much more difficult and usually very tedious. In some cases, however, the pain also goes back by itself.

Frequently a conservative symptomatic treatment is used, which primarily includes physical therapies. Heat treatments through sitz baths, fango packs and massages are often used. If only mild pain occurs, a shortwave therapy can help against the symptoms.

If the discomfort occurs predominantly while sitting, certain seat cushions and seat rings can have an analgesic effect. Also here are measures such as dynamic sitting, moderate exercise and gymnastics exercises (physiotherapy) to strengthen the core muscles in question, which are also used for the treatment and for the prevention of back pain.

In addition to dynamic sitting, in a workstation that requires permanent sitting, regular standing and exercise should be incorporated into the work routine. If height-adjustable desks are available, the "40-15-5 rule" can easily be used: 40 minutes working in dynamic sitting, 15 minutes standing, moving five minutes.

Measures to prevent and relieve back pain also help with coccyx pain. (Image: heilpraxis.de/Trueffelpix/fotolia.com)

In addition to these treatment options, painkillers such as analgesics and antirheumatics are often prescribed or local anesthetics (local anesthetics) are injected, relieve the pain and also inhibit inflammatory processes with additional active ingredients (corticosteroids). In a corresponding diagnosis in the context of a coccygodynia but also other drugs are administered with very different activity spectra. For example, suspected psychosomatic causes sometimes include antidepressants.

The success of the symptomatic forms of therapy is in principle higher if there is no trauma. Coccyx injuries can also be treated surgically but are not always successful and risky. Therefore, surgery should be considered only on strict indications and after conservative therapeutic trials. Possible surgical procedures include coccygotomy, coccygectomy (coccyx removal or certain parts), and nerve surgery.

Overall, there is little scientific evidence about the success of individual therapeutic approaches.

Naturopathic treatment

Due to the large number of possible causes and possible treatment concepts, some of which are difficult to determine and can promote a protracted course, naturopathic treatments are also an alternative or supportive measure for many sufferers.

Not only does heat therapy have a permanent place in natural medicine, but also other musculoskeletal and manual therapies (osteopathy and chiropractic) can be considered. The coccyx is mobilized and relieved by certain manipulations.

If psychological causes play a role, psychotherapy can be a useful addition to the therapy concept.

Also worth a try

Traditional Chinese Medicine (TCM) acupuncture may be very effective in relieving coccyx pain. In homeopathy Hypericum perforatum (St. John's Wort) is often used for nerve injuries or in pain, as for example after falls on the coccyx. (tf, cs; updated on 01.02.2019)