Lumbar / Pelvis

Coccygodynia

Definition

Coccygodynia is painful condition of the coccygeal bone localised just above the anus. Both a traumatic and an idiopathic form can be seen.

There is a clear relationship between coccygodynia and the female gender. The male/female ratio of coccygodynia is 5:1. Moreover, there is also a relationship between weight and coccygodynia, indicating that a body mass index (BMI)  > 27.4 in females and > 29.4 in males increases the chance of developing coccygodynia.

Aetiology

In the vast majority of cases with the acute form of coccygodynia, trauma (usually falls in the sitting position) is the cause. Also, repetitive micro-trauma due to inadequate seating arrangements, or sports such as cycling and motor racing, can lead to coccygodynia.

In females, the trauma of childbirth can result in coccygodynia. In 70% of traumatic cases, the coccygeal joints are affected by four different causes: anterior luxation, hypermobility, coccygeal spicules, subluxation and dislocation.

Signs and symptoms

Most patients with coccygodynia complain about pain in the tailbone, usually provoked by sitting. Due to the direct pressure of the saddle on the tailbone, cycling is often impossible.

Diagnostics

Physical Examination

The diagnosis is usually made based on typical medical history, where the complaints are usually related to a previous trauma (including childbirth).

As well as standard physical and neurological examinations, manual examination of the coccygeal bone is also important. The absence or presence of painful mobilisation of the coccygeal bone can differentiate between nociceptive pain from the coccygeal bone, with its ligamentous and muscular structures, and referred pain from pathology in the pelvis.

In addition, a positive Vasalva manoeuvre indicates coccygodynia caused by the nerve tissues.

Additional Somatic Diagnostics

  • Lateral X-rays of the coccygeal bone are primarily indicated.
  • Dynamic X-rays according the Maigne method (difference between standing and sitting positions).  Coccygeal mobility of between 2o and 25o is normal.
  • The use of discography is controversial.
  • Estimation of the BMI index.
  • In idiopathic coccygodynia, infections and malignancies must be excluded.

Additional Psycho-cognitive Diagnostics

  • RAND-36 (quality of life)
  • VAS-Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment comprising various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

Other Treatments

Interventional Pain Treatment

Invasive Treatment

  • In the subacute and chronic phases of coccygodynia, surgical removal of the coccygeal bone is often recommended. This surgical intervention is strongly discouraged due to the very poor results in the long run and the risk of major complications.