What is the Pelvic Floor?
The pelvic floor is a set of muscles that spread across
the bottom of the pelvic cavity like a hammock. The
pelvic floor has three openings that run through it, the
urethra, the vagina, and the rectum. The functions of
the pelvic floor include:
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To support the pelvic organs, specifically the
uterus, the bladder, and the rectum
To help provide sphincter control for the
bladder and bowel
To withstand increases in pressure that occur
in the abdomen such as coughing, sneezing,
laughing, straining, and lifting
To enhance the sexual response
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What is Coccydynia?
Coccydynia is pain in and around the tail-bone (coccyx).
The tail-bone is positioned at the bottom of your spine and is
composed of 3 to 5 small fused vertebrae. It is triangular in
shape with the tip pointing downward. The exact shape, size,
and position of your tail-bone is individual. The tail-bone is
the attachment point for many muscles and ligaments
including the large muscle of the buttocks (gluteus maximus),
as well as the levator ani muscle group, a major component
of the pelvic floor. The tail-bone also supports the position of
your anus.
Symptoms of coccydynia include pain between the
buttocks, in the region of the tail-bone. The pain often
occurs:
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When pressure is applied to the tail-bone, such
as in sitting on a hard surface
During transitions from sitting to standing
During a bowel movement
During sexual intercourse
What Causes Coccydynia?
For many the cause for coccydynia remains unknown. However, common causes for coccydynia include:
Trauma or dislocation from a
fall or childbirth
Trauma can cause the coccyx to dislocate and become unstable. If the
coccyx is unstable it may move when you sit down or upon returning to
standing. This movement of the tail-bone can cause intense pain.
Excessive mobility of the
tail-bone
In some people the coccyx is loose and unstable. During pregnancy
the relaxing effects of hormones can lead to instability of the tailbone. If
the coccyx is unstable it may move when you sit down or upon returning
to standing. This movement of the tail-bone can cause intense pain.
Fractures of the tail-bone
The tail-bone can become fractured due to a fall, car accident, or during
childbirth.
Coccyx spurs
A spur can develop on the tip of the coccyx. The spurs point backwards
and can be felt through the skin
Abnormal shape of the
coccyx
Normally the coccyx curves slightly forward. If your coccyx is not
shaped like this you are more likely to experience pain. Examples of an
abnormally shaped coccyx include:
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Coccyx that is straight
Coccyx that angles too sharply forwards
Coccyx that angles to one side
Misalignment of the
sacrococcygeal or sacroiliac
joints
When the sacrococcygeal joint or the sacroiliac joints are out of
alignment, pain may result due to inflammation in the area, the muscles
being pulled improperly, or tissues being abnormally compressed and
stretched.
Pilonidal cysts
A pilonidal cyst is a small fluid filled abscess that is located just above
the buttocks cleft. It can become infected and often contains hairs.
Pain referred from elsewhere
in the spine
Injury to the spine or sacrum can refer pain to the tailbone region
causing symptoms of coccydynia. Examples of sources of referred pain
include:
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Muscle spasm
A spasm in the pelvic floor muscles can lead to pain in the coccyx. The
spasm may be due to an injury or past surgery. Example sources of
injury include:
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Tumors in the area
Lumbar disc herniation
Sacroiliac joint dysfunction
Scoliosis
Nerve impingement due to arthritic changes in the spine
Pelvic surgery with trauma to the pelvic muscles or blood and
nerve supply to the muscles
Childbirth injury
Lumbar disc surgery
Sexually related injuries
Pelvic inflammation of infection
Strenuous physical activity
Repeated improper postural positioning
A tumor anywhere in the area may cause pain in the coccyx
How is Coccydenia treated?
The main component of treating coccydynia includes a sitting cushion, a special cushion with a cut-out to
remove pressure from the tail-bone when sitting. Other components of treating coccydynia include:
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Non-steroidal anti-inflammatory medication
Steroidal injection to the tail-bone area
Massage to stretch the ligaments and muscles that attach to your tail-bone
Trigger point release of the pelvic floor muscles
Tail-bone (coccygeal) manipulation
Addressing any spinal misalignments
If referred pain is the source of coccyx pain, surgery to relieve pressure on nerves from a
herniated disc or arthritic changes, may help
Surgical removal of the tail-bone (coccygectomy). This is reserved for very severe cases where
conservative management does not work. The surgery often does not decrease the pain.
If pain from coccydynia has been prolonged, depression and anxiety are often present. This also needs to
be addressed and treated properly with medication and counseling.