coccygodynia

Introduction

Pain in the region of or originating from the coccyx.

Etiology

• any injury to the coccygeal region
  • direct fall on the buttocks

Epidemiology

• occurs with greater frequency in women

Pathology

• injury that causes the coccyx to be tipped anteriorly, or deviated laterally, may cause the coccyx to become more mobile than normal

Physical examination

• pelvic exam to rule out gynecologic disease
• bimanual rectal exam (see below)

Clinical manifestations

• mobile &/or painful coccyx may be observed with bimanual exam with the index finger in the rectum and the other hand over the coccyx

Radiology

• x-ray of pelvis, including coccyx

Management

• conservative management
  • NSAIDs
  • donut-shaped pillow or a gel cushion to decrease coccygeal pressure & local irritation
  • hot sitz-type baths
  • corticosteroid injections
  • physiotherapeutically applied topical corticosteroid & analgesic combination (ultrasound phonophoresis or iontophoresis)
  • acupuncture reflex therapy
  • radiofrequency thermocoagulation after localizing painful sacral nerves with lidocaine injection
• surgery
  • coccygectomy
  • limited coccygectomy involving only resection of the mobile or hypermobile segment of the coccyx, identified by fluoroscopy & local anesthetic injection prior to surgery

More general terms

• pain [odyn-]