Coccygodynia

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Last reviewed: May 2019

Last updated: March 2018

Summary

Disabling pain in the coccyx, usually provoked by sitting or rising from sitting.

May be traumatic (e.g., a fall or childbirth) or idiopathic in origin.

More common in women.

Conservative management includes pressure-relieving cushions, local corticosteroid injections, and/or coccygeal manipulation.

Surgery (coccygectomy) is highly effective in recalcitrant post-traumatic coccygodynia.

It is important to rule out local pathology, such as tumours or infection.

Definition

A disabling pain in the coccyx exacerbated by sitting or rising from sitting. The pain is often pulling or lancinating in quality, may radiate to the sacrum or buttock, and may co-exist with lower back pain. It may be traumatic or idiopathic in origin and is more common in women. Also known as coccydynia or coccygeal neuralgia.

History and exam

Key diagnostic factors

coccyx pain
coccygeal tenderness
spasm of pelvic floor musculature
relief of symptoms after corticosteroid injection

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Other diagnostic factors

guarding

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Risk factors

female sex
history of trauma to coccyx
obesity

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Diagnostic investigations

1st investigations to order

lateral sacrococcygeal x-ray
dynamic lateral sacrococcygeal x-rays

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Investigations to consider

MRI lumbosacral spine with contrast
CT lumbosacral spine
WBC
ESR

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Treatment algorithm

ACUTE

new diagnosis: acute or chronic disease

symptoms ≥2 months and failed acute management

Contributors

Authors VIEW ALL 

Rudolph J. Schrot, MD, MAS, FAANS

Rudolph J. Schrot

Neurosurgeon

Sutter Medical Group

Sacramento

CA

Disclosures

RJS declares that he has no competing interests.

Peer reviewers VIEW ALL 

Birender Balain, MBBS, FRCS, FRCS (Tr and Orth)

Specialist Registrar

Robert Jones and Agnes Hunt Orthopaedic and District Hospital

Oswestry

UK

Disclosures

BB is the author of some studies referenced in this monograph.

Stephen Esses, MD

Professor of Orthopedics

Brodsky Chair of Spinal Surgery

Baylor College of Medicine

Houston

TX

Disclosures

SE is the author of a study referenced in this monograph.

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