Pain Management Procedures
Coccyx, Sacrococcygeal, and Ganglion Impar Injections
Coccyx, Sacrococcygeal, and Ganglion Impar Injections
What are these procedures?
Pain at the tailbone is called coccydynia. A sacrococcygeal ligament or joint injection targets painful tissue around the connection between the sacrum and coccyx. A ganglion impar block targets the lowest sympathetic nerve cluster, located just in front of the sacrococcygeal junction, to treat selected tailbone, rectal, perineal, or genital pain.
When may they be recommended?
They may be considered after trauma, prolonged sitting, childbirth, degenerative change, or another condition causes persistent focal tailbone pain. Ganglion impar block may also be considered for sympathetically mediated pelvic or perineal pain, postherpetic neuralgia, or cancer-related pain. “Ischial pain” alone is too broad; the actual pain location and diagnosis determine which target is appropriate.
What happens?
You lie face down. Fluoroscopy guides a fine needle to the painful sacrococcygeal structure or through the sacrococcygeal region toward the ganglion impar. Contrast dye confirms the location before local anesthetic and, when appropriate, corticosteroid or another medication is injected.
What should I expect?
Temporary numbness or warmth in the tailbone, rectal, or perineal region may occur. Sitting may remain sore for a short time. A diagnostic response can guide future treatment. Longer relief varies.
Important risks
Risks include bleeding, infection, medication reaction, rectal perforation, injury to nearby nerves or blood vessels, and unintended epidural or intravascular injection. New bowel or bladder problems, fever, severe pelvic pain, or major weakness requires prompt evaluation.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.