Coccydynia

Coccydynia is pain localized to the coccyx, or tailbone, at the end of the spine. The condition is often the result of trauma but can also occur without a clear cause. The coccyx is the small bone at the bottom of the vertebral column, and pain is typically felt with sitting, rising from a chair, or leaning back. Women are more commonly affected than men, and symptoms may follow childbirth, prolonged sitting, or a fall onto the buttocks.

Causes and risk factors include trauma to the coccyx (such as a fall or childbirth), repetitive strain from prolonged sitting on hard surfaces, heavy lifting, or improper lifting technique, degenerative changes in the coccygeal joints, obesity, and pelvic floor muscle spasm. In some cases, the cause remains idiopathic. Coccydynia can be associated with tenderness over the coccyx that is aggravated by palpation and by sitting.

Diagnosis is primarily clinical, based on history and a focused physical examination that reproduces the pain with palpation of the coccyx and with pressure during sitting. Imaging, such as X-ray or MRI, is not routinely required but may be used if there is suspicion of fracture, infection, other spinal or rectal pathology, or persistent symptoms beyond several months.

Management is usually conservative. This includes education and activity modification (avoiding prolonged sitting and pressure on the tailbone), use of a cushioned or doughnut-shaped seat cushion, nonsteroidal anti-inflammatory drugs or acetaminophen, and physical therapy focusing on pain-relieving modalities and pelvic floor exercises. Injections around the coccyx or ganglion impar block may be considered for persistent pain. Coccygectomy, the surgical removal of the coccyx, is rarely performed and reserved for severe, disabling cases after failure of conservative and interventional therapies.

Prognosis varies; many cases improve over weeks to months, but some become chronic or recur.