Asked by Will, Denver, Colorado
I am an average person -- good health and slightly overweight. Last year on a dare/challenge from a friend I rode my bicycle 50 miles without any previous training. I successfully completed the 50 miles, although I had extreme pain in my tailbone following the ride. I assumed this was temporary and continued to live my life. However, a year or so later it still has pain when I sit down. I'm not sure where to start besides seeing my normal doctor. Is this something that can be cured or could I have done lifelong damage to my tailbone?
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
I think you already know that strenuous exercise without proper preparation through training is not a good idea.
That being said, the medical term for pain in the tailbone is coccydynia. It is usually caused by trauma and it usually gets better with conservative therapy over a period of several weeks, but it can sometimes take several months for it to improve.
The coccyx is a projection at the base of the spine. It is made of bone, cartilage and fibers. The coccyx bears weight when a person is sitting.
Some of the muscles that control defecation attach to the coccyx, and there may be pain in the injured tailbone upon defecation and when tightening the anal sphincter.
There are no national incidence numbers for this condition, but pain in the tailbone is a rather common problem. A busy primary care doctor usually sees a few cases per year. It is far more prevalent in women than men. It is rare in children.
The most common cause is traumatic injury from a fall backwards into a sitting position. Other causes include repetitive minor trauma from sitting a long time. People not only get it from long bike rides, but from sitting in a car or plane for a prolonged period. Sitting on hard surfaces is more likely to cause it.
Women can get coccydynia through trauma during vaginal birthing.
Obesity is a major risk factor in men and women. The diagnosis of coccydynia is made through the patient's history of the pain and trauma and from physical examination.
On examination, the physician can usually reproduce the symptoms through direct pressure on the tailbone. Initial treatment is conservative, using nonsteroidal pain medications such as ibuprofen or naproxen; protection of the area with a donut or wedge pillow; and alternating applications of heat and cold packs.
Patients with pain after more than three months of good conservative therapy merit further evaluation which might include X-rays of the pelvis and tailbone.
A very few patients will need to be treated with injections of local anesthetic, or local anesthetic and steroids, directly into the tailbone area. In a very rare case of protracted pain without improvement, the tailbone can be surgically removed. This operation is called a coccygyectomy.
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