Coccygodynia refers to pain over the ‘tail-bone” (coccyx). It is more common in women, and can result from trauma such as occurs following a fall or childbirth. It may result from an abnormally large coccyx, or may result from a mobile coccyx. Occasionally it results in chronic arthritis, or bursitis, or the development of a bony spicule that can lead to more chronic pain.
Diagnosis
Examination will typically reveal pain localised to the coccyx, which may even be felt to be mobile, or to have a palpable spur.
Plain x-rays, may reveal bony abnormalities (spicules, tumours, degeneration, metastases). Dynamic x-rays in both the sitting and standing position may reveal a mobile coccyx.
Management
Analgesic, and non-steroidal anti-inflammatory medication may help reduce pain and inflammation.
Hot Sitz baths, heat packs, and donut cushions for sitting, to reduce direct pressure on the coccyx, can often alleviate pain.
Resistant cases
For persistent cases, injection of local anaesthetic with steroids may help.
Surgery
Surgical removal of the ‘tail-bone’ (coccygectomy) is reserved for resistant cases despite the above strategies. Success rates are as high as 90%.
References
- Wray CC, Eason S, Hoskinson J. Coccydnia: Aetiology and treatment. J bone Joint Surg Br 1991; 73:335-338.
