Treatments for coccydynia are usually noninvasive and local. The first line of treatment typically includes:
- Non-steroidal anti-inflammatory drugs (NSAIDs). Common NSAIDs, such as ibuprofen, naproxen and COX-2 inhibitors, help reduce the inflammation around the coccyx that is usually a cause of the pain.
- Applying ice or a cold pack to the area several times a day for the first few days after the pain starts.
- Applying heat or a hot pack to the area after the first few days.
- Avoiding sitting for prolonged periods, or placing any pressure on the area, as much as possible.
- A custom pillow to help take pressure off the coccyx when sitting. Some find a donut-shaped pillow works well, and for others it is not the right shape and still puts pressure on the coccyx. Many prefer a foam pillow that is more of a U-shape or V-shape (with the back open so nothing touches the coccyx). Any type of pillow or sitting arrangement that keeps pressure off the coccyx is ideal.
- If the tailbone pain is caused or increased with bowel movements or constipation, then stool softeners and increased fiber and water intake is recommended.
Additional Non-Surgical Treatments for Coccydynia
If the pain is persistent or severe, additional non-surgical treatment options for coccydynia (tailbone pain) include:
- Injection. A local injection of a numbing agent (lidocaine) and steroid (to decrease inflammation in the area) can provide some relief. Fluoroscopic guidance is recommended. Relief can last from 1 week up to several years. No more than 3 injections per year are recommended. For more information, visit the Injections Health Center.
- Manipulation. Some patients find pain relief through manual manipulation (e.g. chiropractic treatment).
- Stretching. Gently stretching the ligaments attached to the coccyx can be helpful. A physical therapist, chiropractor, physiatrist or other appropriately trained healthcare practitioner can provide instruction on the appropriate stretches.
- Ultrasound. Physical therapy with ultrasound can also be helpful for pain relief.
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Provided that infection and tumor has been ruled out as a cause of pain (through exam, x-ray and MRI scan), then prolonged non-surgical treatment for pain relief and activity modification is a reasonable option.
After attaining sufficient pain relief so that movement is not too painful, daily low-impact aerobic activity is beneficial, as the increased blood flow brings healing nutrients to the area and encourages the body’s natural healing abilities. The additional benefit of aerobic activity is the release of endorphins, the body’s inherent pain relieving process.