Q. I was racing down the cellar stairs a few days ago when I slipped and fell on my tailbone. I've had pain ever since. What should I do about it?

The coccyx or tailbone is made up of three to five vertebrae at the lower end of the spine. Most people have a coccyx of four of these spinal bones. The coccyx functions as an attachment site for muscles, tendons and ligaments.

Coccyx comes from the Greek word for cuckoo. The coccyx's shape is like the beak of a cuckoo. The human coccyx is considered a vestige of what was once a tail.

Most coccyx injuries are bruises and ligament strains. The coccyx rarely breaks. The most common tailbone injuries occur from falling on a hard surface. Women suffer most coccyx injuries because the female pelvis is broader and the coccyx is more exposed than it is in males.

Pain in the coccyx is called coccydynia. Coccydynia can occur in children and adults. Degenerative changes of the coccyx seem to increase with age.

Usually, the cause for coccydynia is not known. Among the common known causes are falls, prolonged sitting, medical procedures such as colonoscopy, and childbirth. Substantial pressure may be placed on the coccyx as the baby descends through the mother's pelvis.

The pain is felt in a variety of circumstances. The most common distress comes from sitting on a hard surface. There can be intense pain when getting up from a seat. Bowel movements and sex can also produce pain.

Coccyx pain is treated in a variety of ways:

Ÿ Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation. These include ibuprofen, naproxen and aspirin.

Ÿ A customized seating cushion that shifts pressure away from the tailbone.

Ÿ Physical therapy that might include exercise to stretch ligaments and strengthen muscles in the tailbone area.

Ÿ Heat, massage and ultrasound.

Ÿ Injections of local anesthetics into the coccyx are sometimes given for continuing pain.

Ÿ Manipulation to move the coccyx back into its proper position.

Ÿ Surgery to remove the coccyx is recommended only in very severe cases. There is a high risk that surgery won't alleviate pain.

Coccyx pain can be especially taxing because substantial relief may not come for months. However, most cases of traumatic coccyx injury get better within several weeks.

With a long siege of pain, you may develop depression and anxiety. This emotional distress should be treated as soon as it is recognized.
