synonyms: coccygodynia, coccydynia,
Coccygodynia Etiology / Epidemiology / Natural History
- Definition: pain inthe region of the coccyx.
- Women>men, 5:1
- Mean age = 40
- May be caused by trauma such as difficult vaginal delivery.
- May be related to hypermobile or subluxatation tip of the coccyx. Patients with an immobile coccyx may have burisitis of the adventia at the coccygeal tip.
- Associated with obesity, antecedent trauma, childbirth.
Coccygodynia Clinical Evaluation
- Pain around the coccyx which may be exacerbated by sitting or arising from sitting.
- Evaluate for low back pain / radiculopathy.
- May feel frequent need to defecate or have pain with defecation.
- Ask about blood in stool, or any vaginal disorders.
- Evaluate surrounding skin for pilondial cysts/fistula.
- Rectal examination: feel for bony spicules, palpable masses, pain with coccygeal motion.
- Stool guaiac for occult blood.
Coccygodynia Xray / Diagnositc Tests
- Dynamic xrays: standing and sitting lateral views of the coccyx may demonstrate anterior hypermobility >25°, subluxation or posterior displacement when seated, or a spicule of the distal tip.
- Bone scan: may show inflammation in a subluxated or hypermobile segement but is not diagnostic.
- MRI: may demonstrate edema around coccyx but is not diagnositic. Aids in ruling out tumor etc.
- Local injection: releaf of symptoms with local anesthetic injection around the coccyx adds in diagnosis.
Coccygodynia Classification / Treatment
- NSAIDs, rest, hot baths, coccygeal cushion, stool softener. Physical therapy with diatherm and ultrasound.
- Steriod/local anesthetic injection (59% successful), Injection with manipulation under anesthesia (85% successful) (Wray CC, JBJS 1991;73Br:335).
- Coccyectomy: 88% excellent to good results (Postacchini F, JBJS 1983;65A:1116)
Associated Injuries / Differential Diagnosis
- Low back pain.
- Lumbar degenerative disk disease.
- Arachnoiditis of the lower sacral nerve roots.
- Coccyx/sacral tumor.
- Pilonidal cysts/sinuses.
- Perirectal abscesses.
- Perineal contamination of the wound (bowel prep indicated pre-operatively).
- Continued pain.
Coccygodynia Follow-up Care
- Post-Op: avoid any pressure on surgical incision.
- 7-10 days: wound check, remove sutures if healing has occur. Continue weekly follow-up until wound is well healed. Avoid prolonged pressure on coccyx.
- 6 Weeks: gradually resume activites. No sports.
- 3 Months: resume full activities if symptom free.
Coccygodynia Review References
- Fogel GR, JAAOS 2004;12:49