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Coccydynia occurs in both men and women, but females are affected more often. Childbirth is one gender-specific risk factor for women. In addition, degenerative changes to the sacro-coccygeal junction and the intra-coccygeal junction seems to increase with age, causing tailbone pain.

Coccydynia can have an identifiable cause, or the etiology can be unknown. Causes include:

. Trauma - This includes a direct blow to the coccyx, which bruises or fractures the bone. This is the result of falling onto the buttocks or being hit on the tailbone.
. Inflammation - Coccyxdynia can be caused by inflammation of the sacro-coccygeal joint.
. Referred pain - The pain can be referred from the lumbar spine facet joints, the low back muscles, the pelvic floor muscles, the buttocks, or the ligaments.
. Tumors - Secondary spread of cancer to the sacrum and/or coccyx bones can cause pain. In addition, tumors of the lower rectal area or anus can result in tailbone pain.

The purpose of diagnosing the cause of tailbone pain is for proper treatment. Tests used to assess coccyxdynia include:
. X-rays - These films can reveal or rule out a coccyx fracture.
. MRI - Spinal magnetic resonance imaging scans are used to rule out a ruptured disc or spinal abnormalities, which can cause referred pain.

Coccyx pain is notoriously hard to treat. However, once the source of pain is identified, the doctor will focus on treatment. Options for pain relief include:

Sacro-coccygeal (SC) joint injection - This involves injecting a local anesthetic and a corticosteroid into the SC joint to decrease inflammation and relieve pain.

Trigger point injections (TPIs) - The doctor can inject an anesthetic agent into the muscles of the buttocks and/or the pelvic floor muscles. In addition, Botox can be injected to offer long-term relief and decrease muscle spasms.

Manipulation - After a coccyx injury, the doctor can manually manipulate the coccyx via the rectum. Moving the coccyx can release a catch in the SC joint, which alleviates pain.

Facet joint injections - If the pain is related to degeneration of the lower spine facet joints, the doctor can insert small needles into the joints using x-ray guidance. An anesthetic and/or steroid can be instilled into the joints and near the lower spinal nerves.

Ganglion impar block - The cluster of nerves at the front of the SC joint is the ganglion impar. The doctor can inject an anesthetic agent, with or without a steroid, near the nerves using x-ray guidance. In a recent clinical study, this block had a 95% success rate.

Radiofrequency ablation (RFA) - To destroy a portion of the nerve tissue in the coccyx region, the doctor can use radiofrequency waves delivered by an injection probe. In a recent review of studies, many patients reported significant pain reduction following RFA, which lasted for around six months.

Donut cushion - If a fracture occurs, the patient can use a special cushion that takes weight off the coccyx, to relieve pressure and promote healing.

Medications - For chronic coccyxdynia, the doctor may prescribe analgesics to relieve pain and NSAIDs to reduce inflammation.