In brief
- Tailbone pain, perineal burning, rectal pain, and pain after pelvic surgery or radiation are frequently carried by this one small structure.
- Relief confirms the ganglion is carrying your pain, which directs everything that follows: repeat block, radiofrequency ablation, or a change in direction.
- Expect tailbone soreness for 2 to 5 days. A coccygeal cushion helps considerably during the first week.
- Steroid effect peaks over 3 to 7 days and may keep building for 2 weeks; duration varies from weeks to many months.
Understanding your diagnosis
The two sympathetic nerve chains running the length of the spine converge and end in a single small ganglion in front of the tailbone, at the joint between the sacrum and the coccyx. This is the ganglion impar, literally the unpaired ganglion. It carries sympathetic and pain fibers from the perineum, the tailbone, the anus and lower rectum, the lower urethra, and the external genitalia. Tailbone pain (coccydynia), perineal burning, rectal pain, and pain following pelvic surgery or radiation are frequently carried by this one small structure.
The treatment
A small volume of local anesthetic, usually combined with a steroid, is placed directly onto the ganglion. Relief confirms that this ganglion is carrying your pain, information as valuable as the relief itself, because it directs everything that follows. For patients with good but temporary response, longer-lasting options include radiofrequency ablation of the ganglion or, in cancer-related perineal pain, chemical neurolysis.
Our approach
Performed face down under live X-ray, viewed from the side. A fine needle is passed through the small joint between the sacrum and the coccyx to reach the space immediately in front of it. Contrast dye is injected and produces a characteristic comma-shaped spread in front of the bone, confirming correct position. This approach uses a short, direct trajectory with bone as a landmark, and keeps the needle safely away from the rectum, which lies just in front of the target.
Before your procedure
Medication holds
Our office will tell you which medications to hold and for how long, following the same blood-thinner guidelines as our other procedures.
Fasting, sedation, and your ride home
- If you are receiving sedation, nothing to eat or drink for six hours before your appointment. Essential morning medications may be taken with a small sip of water only.
- We offer light or deep sedation. The level is decided by the physician and anesthesia team based on the procedure and clinical need.
- Any patient receiving sedation must be accompanied by a responsible adult driver to take them home.
Where to go
Procedures are performed at one of three facilities: our clinic at 1925 Hospital Place, ACOM at 6449 Central Park Blvd, or Hendrick South at 6399 Directors Pkwy, Suite 100. Your appointment paperwork tells you which one. Please arrive early for registration and pre-procedure preparation.
Procedure day
- Performed under live X-ray (fluoroscopy), viewed from the side.
- Contrast dye confirms position in front of the sacrococcygeal joint before medication is given.
- A very fine needle is used, and local numbing medication is placed first.
- The procedure takes 10 to 15 minutes.
- You will walk out and go home the same day.
Benefits
- Reduction in tailbone, perineal, and rectal pain.
- Diagnostic clarity: confirms the pain pathway and directs the next step.
- Opens the door to radiofrequency ablation for durable relief.
- Reduced need for oral pain medications.
Recovery
- Same-day discharge.
- Immediate numbing effect; steroid effect develops over 3 to 7 days.
- Expect tailbone soreness for 2 to 5 days.
- A coccygeal cushion helps considerably during the first week.
Afterward: what to expect
- The immediate window. The numbing medication typically gives several hours of relief. Note how much it helped and for how long; this is the diagnostic result.
- The flare. Tailbone soreness for 2 to 5 days is expected and can briefly feel worse than before the procedure. Ice 20 minutes on, 20 off for the first 48 hours, and use a cushion whenever seated.
- Steroid results. Peak effect develops over 3 to 7 days and may continue building for 2 weeks.
- Duration. Varies widely, from weeks to many months. Duration is what determines whether we repeat the block or move to radiofrequency ablation.
- Blood glucose. If a steroid was included, expect a temporary rise in blood glucose that usually resolves within a few days. Diabetic patients should monitor their sugar levels closely for 48 to 72 hours after the procedure.
Activity
Needle site care
Your procedure in one paragraph
You have undergone a ganglion impar block. Under live imaging with contrast confirmation, medication was placed onto the small terminal sympathetic ganglion in front of the sacrococcygeal joint, which carries pain signals from the tailbone, perineum, and lower rectum. The block is both therapeutic and diagnostic: how much relief you get, and how long it lasts, determines the next step.
Follow-up schedule
- 1
2 weeks
Assessment of degree and duration of relief. The next step depends on response: repeat block, radiofrequency ablation, or a change in direction. Record percent relief and days of relief.
Call us right away if you notice
- Rectal bleeding or passing blood
- Fever above 101.5°F, chills, or drainage at the needle site
- New numbness in the groin or inner thighs (saddle area)
- New difficulty controlling bowel or bladder
- Severe, escalating pain rather than gradually improving soreness
This guide is the same information as the printed handout from Abilene Pain. It is general information and does not replace the instructions your care team gives you at your visit. Your care team: Nicolas Pugh, MD · Adrianne Anders, NP · Ted Chaka, PA.