A tailbone injection, often referred to as a coccygeal nerve block or a caudal epidural injection, is a targeted, minimally invasive procedure intended to relieve persistent pain at the base of the spine. This pain, commonly known as coccydynia, is typically caused by trauma, prolonged sitting, or inflammation of the tissues and nerves surrounding the coccyx. The purpose of the injection is to deliver a long-acting corticosteroid and a local anesthetic directly to the inflamed area. This treatment is generally considered when conservative therapies, such as anti-inflammatory medication or specialized cushions, have failed to provide adequate comfort.
How Pain is Managed During the Injection
The procedure is designed to minimize discomfort. Before the therapeutic needle is introduced, a small amount of local anesthetic, such as lidocaine, is injected to thoroughly numb the skin and the underlying soft tissue. This initial injection may cause a brief, sharp sting or a temporary burning sensation that quickly fades as the numbing agent takes effect.
Once the area is completely numb, the physician proceeds with the main injection. Patients typically report feeling a sensation of deep pressure rather than sharp pain as the needle is guided toward the target area near the coccyx. If any significant discomfort occurs during this stage, the patient is encouraged to communicate it immediately so the physician can adjust the needle position or apply more local anesthetic. The entire process is usually well-tolerated, focusing on pressure and dullness rather than acute pain.
Getting Ready for Your Appointment
Preparation is a fundamental step in ensuring the safety and effectiveness of the injection procedure. Because the injection site is near the spine, you will need to stop taking certain medications that can increase the risk of bleeding. This typically includes blood thinners, such as warfarin or clopidogrel, and often non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, for a specified period, sometimes up to two weeks before the appointment.
You must also arrange for a responsible adult to drive you home after the procedure. Although the injection is minimally invasive, the local anesthetic may temporarily cause numbness or weakness in your legs, making it unsafe for you to operate a vehicle. If intravenous (IV) sedation is administered to help you relax, it is mandatory to have an escort, as the sedatives can impair judgment and coordination for several hours. You should arrive at the clinic with a complete list of your current medications and report any signs of fever or active infection, as this could lead to a necessary postponement.
What Happens During the Procedure
Upon arrival, you will likely be asked to change into a gown and then positioned comfortably on the procedure table, usually lying face down. The physician or nurse will place monitoring devices on you to track your heart rate and blood oxygen levels throughout the injection. The skin area over the tailbone is then cleansed with an antiseptic solution to prevent the introduction of bacteria.
The physician uses an imaging machine, such as fluoroscopy (live X-ray) or ultrasound, to guide a thin needle precisely to the target area. This real-time imaging ensures that the medication is delivered exactly where the inflammation is occurring, minimizing the chance of hitting unintended structures. A small amount of contrast dye may be injected first to confirm the correct spread pattern around the nerves or within the caudal epidural space.
Once the physician confirms the optimal needle placement, the therapeutic solution—a corticosteroid mixed with a local anesthetic—is slowly administered. The steroid works to reduce inflammation over the long term, while the anesthetic provides immediate, though temporary, relief. The entire injection process often takes between 10 and 20 minutes from start to finish.
After the Injection: Short-Term Recovery
Immediately following the injection, you will be moved to a recovery area for a brief monitoring period, typically lasting 15 to 30 minutes, before being discharged. It is normal to feel some temporary numbness or heaviness in your buttocks or legs due to the initial spread of the local anesthetic. You must refrain from driving, operating heavy machinery, or signing legal documents for the rest of the day.
For the first 24 to 48 hours, it is common to experience localized soreness or tenderness at the injection site. Some patients also notice a temporary increase in their original tailbone pain, often referred to as a “steroid flare,” which can be managed with ice and rest. You should avoid strenuous activities, heavy lifting, or returning to work that requires physical exertion during this initial recovery window.
The immediate pain relief felt in the first few hours is solely from the local anesthetic and will wear off. The lasting therapeutic effect from the corticosteroid usually begins to take effect within two to seven days after the procedure. You should contact your physician immediately if you experience signs of infection, such as fever, excessive redness, or drainage at the injection site, or if you develop a severe, persistent headache.