Coccydynia is the medical term for tailbone pain, affecting the coccygeal region at the base of the spine. This discomfort is frequently caused by direct trauma, such as a fall, or by repetitive strain from prolonged sitting or activities like cycling. For women, the stress of childbirth can also strain the ligaments and muscles around the coccyx, leading to pain. Because the condition can be caused by various factors, from inflammation and misalignment to nerve issues, treatment often requires a coordinated approach involving several medical specialists.
Initial Assessment: Primary Care Providers
The first step for most people experiencing tailbone discomfort is a visit to their Primary Care Provider (PCP), such as a family physician or internist. The PCP’s role is to conduct an initial evaluation to determine the likely cause of the pain and rule out more serious conditions. They assess for “red flags” that might indicate non-coccydynia issues, like a tumor, infection, or a complex fracture requiring immediate attention.
Conservative management is typically initiated at this stage, focusing on simple, non-invasive treatments. This often includes prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain. Patients are also advised on rest, sitting modifications using specialized cushions, and activity avoidance to minimize pressure on the coccyx. If the pain persists beyond a few weeks or a month, the PCP will facilitate a referral to a specialist for more targeted care.
Diagnosis and Rehabilitation: Physiatrists and Orthopedists
When conservative, first-line treatments fail, specialized non-surgical doctors become involved, particularly Physiatrists and Orthopedic Specialists. Physiatrists, who specialize in Physical Medicine and Rehabilitation (PM&R), focus on restoring function and improving the quality of life through comprehensive non-surgical management. They are experts in diagnosing musculoskeletal pain and developing tailored rehabilitation plans, often prescribing physical therapy specifically for the pelvic floor muscles attached to the coccyx.
Orthopedic Specialists concentrate on structural issues affecting the bones, joints, and ligaments. If imaging, such as dynamic X-rays, reveals instability, fracture, or abnormal hypermobility of the coccyx, an orthopedist may guide the next steps. While both types of doctors treat musculoskeletal issues, the physiatrist’s approach is centered on functional improvement through conservative means, whereas the orthopedist maintains a focus on structural integrity and may offer surgical solutions if non-operative methods fail.
Advanced Relief: Interventional Pain Management Specialists
For individuals with chronic, severe coccydynia that does not respond to physical therapy or oral medications, Interventional Pain Management specialists offer minimally invasive procedures. These physicians, often anesthesiologists or radiologists, specialize in targeted injections to interrupt pain signals and reduce localized inflammation. They use image guidance, such as fluoroscopy or ultrasound, to ensure precise delivery of medication to the target area.
One common procedure is a coccygeal injection, which administers a mixture of local anesthetic and corticosteroid directly around the coccyx or the sacrococcygeal joint. Another treatment is a ganglion impar block, which targets the terminal sympathetic nerve plexus located just anterior to the coccyx. Blocking this ganglion is often effective for chronic coccydynia because it interrupts the transmission of pain signals from the pelvic area. In cases of persistent nerve pain, the specialist may also perform radiofrequency ablation, which uses heat to temporarily deactivate the pain-transmitting nerves.
Surgical Consultation for Coccydynia
Surgery, known as a coccygectomy, involves the partial or complete removal of the tailbone and is reserved as a last resort for chronic pain. This option is only considered when pain has been persistent and debilitating for six months to a year, and all conservative and interventional treatments have failed to provide lasting relief. The specialists who perform this procedure are typically specialized Orthopedic Surgeons or Neurosurgeons with expertise in spine surgery.
Patient selection is a careful process, as the success of the operation is highest in those with documented coccyx instability or a bony spur causing the pain. Due to the coccyx’s location near the rectum and the attachment of pelvic floor muscles, the procedure carries risks, including infection and prolonged wound healing. A surgeon will only recommend a coccygectomy after a thorough review confirms a clear anatomical cause and a high probability of success.