From the Research
Initial management for coccygodynia should focus on conservative measures, including NSAIDs, local heat application, and avoiding prolonged sitting, as these approaches can resolve most cases within weeks to months. The goal of treatment is to reduce pain and inflammation, and improve quality of life. Conservative measures are recommended as first-line treatment because they are non-invasive and can be effective in managing symptoms.
Some key conservative measures include:
- NSAIDs, such as ibuprofen 400-600mg three times daily or naproxen 500mg twice daily, to reduce pain and inflammation 1
- Local heat application to relieve pain and reduce muscle spasms
- Donut cushions to reduce pressure on the coccyx
- Avoiding prolonged sitting and advising patients to sit with proper posture, leaning forward slightly to reduce pressure on the coccyx
- Physical therapy targeting the pelvic floor muscles, incorporating stretching exercises and manual therapy techniques, can be beneficial 2
For more severe pain, local anesthetic injections, such as 1-2ml of 1% lidocaine with or without corticosteroids, into the painful area may provide temporary relief. These injections can be used in conjunction with conservative measures to manage symptoms. It's essential to note that more invasive interventions, like coccygectomy, are reserved for refractory cases that don't respond to conservative management after several months 3.
Recent studies, such as the one published in 2018, support the use of conservative measures as first-line treatment and highlight the importance of individualized treatment plans 2. Another study published in 2017 found that ganglion impar block can be an effective alternative modality for pain relief in patients with chronic coccydynia who do not respond to conservative management 4. However, the most recent and highest quality study, published in 2018, recommends conservative measures as the initial management for coccygodynia 2.