Coccydynia

What is it?

Trauma, childbirth, or prolonged sitting damages coccygeal joints, ligaments, and pelvic floor, producing persistent pain.

Commonly affected: Coccyx and sacrococcygeal joint

How it develops

1. Inciting InjuryFalls, childbirth, chronic stress
2. Joint DysfunctionSacrococcygeal hypermobility/subluxation
3. Soft Tissue InflammationLigamentous and pelvic floor inflammation
4. Pain ChronificationSitting load perpetuates pain cycle

Symptoms

• Worse with sittingEspecially worse on hard seats
• Focal coccyx painTenderness directly over coccyx
• Pain rising from seatSharp pain on standing from sitting
• Pain with defecationPressure during bowel movement
• Dyspareunia (possible)May occur in women

How it is examined

• External coccyx tendernessDirect pressure reproduces pain
• Digital rectal examAssess coccygeal mobility/hypermobility
• Sitting provocationSitting reproduces pain
• Pelvic floor tensionLevator ani tenderness may coexist

Imaging

Dynamic (sit/stand) lateral coccyx X-ray evaluates subluxation/hypermobility.

• Anterior coccyx subluxation
• Abnormal angulation (>25° change)
• Rule out fracture
• Spicule formation

MRI rules out fracture, tumor, or infection; often normal.

• Peri-coccygeal edema (acute)
• Coccygeal cyst (rare)
• Sacrococcygeal joint changes
• Rule out tumor/abscess

When surgery is considered

Conservative failure >6–12 months with structural lesion

Procedures that may be discussed

• Coccygectomy
• Partial coccygectomy

Outlook

90% improve with conservative care; coccygectomy 80% successful but wound complications possible.