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What is the Coccyx?

The coccyx, commonly known as the tailbone, is a small triangular bone located at the very bottom of your spine. It's actually made up of 3-5 fused vertebrae and is considered an evolutionary remnant of the tail that many of our animal ancestors possessed. While we no longer need a tail for balance like our distant relatives, the coccyx still serves an important role in the human body. It acts as an attachment point for various pelvic floor muscles and ligaments that help control bowel movements and maintain pelvic stability.

What is Coccyx Pain?

Coccyx pain, also known as coccydynia, is discomfort or pain around the tailbone area. This condition can range from a mild ache to severe pain that makes everyday activities like sitting, standing up from a seated position, or using the toilet uncomfortable. While it might seem like a minor part of our anatomy, coccyx pain can significantly impact our quality of life.

What are the Symptoms of Coccyx Pain?

The main symptoms of coccyx pain include:

• Sharp or dull pain at the bottom of your spine, in the tailbone area to press upon and that worsens when sitting particularly on hard surfaces.
• Tailbone area pain that can intensify when you transfer from sitting to standing
• Discomfort when you use the toilet to empty your bowels. This can lead to constipation due to fear of pain
• Discomfort during sexual intercourse, worsening at orgasm due to increase in the pelvic floor muscle tension during climax.

What Causes Coccyx Pain?

Trauma:

• The most common cause is a fall onto the tailbone, such as sliding down a flight of stairs
• Sports injuries, including cycling, horse riding, and motorcar racing. This can be from a fall or the repetitive trauma of "being in the saddle" for prolonged periods
• Trauma during childbirth (vaginal delivery)

Repetitive Strain:

• Prolonged periods of sitting on hard surfaces 
• Coupled with a poor posture whilst sitting. Common causes of coccydynia  in Sim-racers
• Being overweight doesn't help as it puts extra pressure on the area when sitting

Other Causes Include:

• Hypermobility syndrome - excessive laxity of your connective tissue can result in excessive movement of the coccyx
• Pelvic floor dysfunction - an imbalance of the pelvic floor muscles, many of which are connected to the coccyx, can lead to pain
• Bone spurs or cysts can develop between the coccyx and sacrum, commonly due to joint degeneration
• Rare cases of infection or tumours

How is Coccyx Pain Treated?

Treatment usually follows a stepped approach:

Conservative Management:

• Seating cushions to protect the tailbone - Cushions with a tailbone cut-out seem to be more effective than the doughnut-type cushions
• Physical therapy exercises - to address the pelvic floor muscle imbalance and improve your posture
• Ice or heat therapy may help but beware od skin damage from prolonged exposure to extremes of temperatute.
• Pain relieving medications

Advanced Treatment:

• Extracorporeal shockwave therapy - a new strategy for treating this stubborn condition has been shown to be effective.
• Manual manipulation by a specialist, usually performed through the rectum!
• Local steroid injections for inflammation
• Nerve blocks for severe pain, usually performed by a pain management specialist or radiologist

Surgery:

Surgical removal of the coccyx (coccygectomy), is typically considered only as a last resort due to the potential for significant complications. This option is reserved for severe cases that have not responded to other treatments, usually after at least six months of conservative therapy.

How Can I Prevent Coccyx Pain?

Prevention strategies include:

• Maintaining good posture while sitting
• Maintaining a healthy weight
• Regular, Kegel style, exercise to strengthen core and pelvic floor muscles
• Using appropriate protective gear during high-risk sports
• Taking regular breaks from prolonged sitting
• Using ergonomic seating when possible

What are the Complications of Coccyx Pain?

If left untreated, coccyx pain can lead to:

Chronic pain, which in turn can result in depression and anxiety due to ongoing discomfort.

Disturbances of daily activities (including bowel movements), sexual dysfunction and sleep disturbance can have a significant effect on one's quality of life.

When Should I See a Doctor About Coccyx Pain?

Seek medical attention if:

• Your pain persists for more than a few weeks
• The pain is severe or getting worse
• You've experienced recent trauma to the area
• You have unexplained weight loss
• You develop fever or redness in the area
• Pain is accompanied by loss of bowel or bladder control
• The pain significantly affects your daily activities

Remember, while coccyx pain can be frustrating and uncomfortable, most cases improve with appropriate treatment and time. Don't hesitate to seek professional help if you're experiencing persistent symptoms.