Coccydynia (aka Coccyygodynia) is an inflammation of the tailbone, a bony area located deep between the buttocks and above the anus. This area is also termed as the coccyx. Common causes include recent fall or trauma, fracture, or childbirth. Risk factors include being under or over-weight and having poor posture.
What are the symptoms of Coccydynia?
Coccydynia is associated with severe pain and tenderness at the tip of the tailbone. The pain will usually be worse with prolonged sitting, prolonged standing, and while rising from a seated position. Pain may also be present with sexual intercourse or defecation.
What are the risk factors in developing Coccygodynia?
History may be significant for a recent trauma with an acute onset of pain, or the onset of pain may have been insidious with no clear inciting factor.
What are other causes of tailbone Pain?
There are many causes of tailbone pain that can mimic coccydynia. These include pain originating from the lower back due to an inflamed nerve, infectious processes, cystic structures, sacroiliitis, and tailbone fracture.
How do doctors diagnose Coccydynia?
Coccyx inflammation is usually diagnosed based solely on the symptoms and the examination findings of local pain at the tailbone. Other conditions can be excluded by ordering imaging such as MRI or CAT scan.
What are the treatments for Coccydynia?
- Physical therapy targeting Pelvic floor muscles.
- Prescription anti-inflammatory medications.
- Ganglion Impar Block- Image guided injection of a steroid and local anesthetic around the tailbone. This generally produces fast pain relief.
- Pudendal nerve block- Image guided injection of a local anesthetic and steroid around the pudendal nerve.
- Sympathetic Nerve Blocks- Image guided injection of a local anesthetic and steroid around the nerves in the spine. This is generally reserved for chronic pain that is refractory to other treatments.
Procedures used to treat Coccydynia
Ganglion Impar Block
A ganglion Impar Block is a type of injection that eases pelvic pain. The ganglion impar is a collection of nerves that sits just in front of the sacrum and provides innervation to pelvic area.
A ganglion impar block is a simple office procedure. It can be done with local anesthesia or with IV sedation for comfort. This procedure involves injection of a steroid under image guidance into the area near the tailbone. This procedure will target the affected area and greatly reduces inflammation and pain around the tailbone region.
Pudendal Nerve Block
The Pudendal nerve provides the majority of sensation and functions to the pelvic floor. Pudendal nerve blocks are useful to evaluate and manage pain in the pelvic area.
Pudendal Nerve Block is a safe procedure performed in the office. Its use is well documented in treating a variety of pelvic pain conditions. This procedure involves identifying the are where the pudendal nerve lies under X-ray, and directing a small needle towards the nerve. A local anesthetic and a small dose of steroid is injected around the pudendal nerve. This will numb the nerve and provide much needed pain relief. This procedure can be done under local anesthesia, or intravenous sedation for comfort if desired. Your doctor will explain all your options to you before the procedure.
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