Coccydynia

Incidence 5 times higher in females, predisposing factors:

Trauma, childbirth, obesity, rapid weight loss, referred pain (MSK and /or visceral), coccyx morphology, abcess, chondroma (rare)

Exclude red flags including signs of infection, exclude lumbar spine, usually has localised tenderness. Evidence and local guidance advises imaging is not recommended unless assessing for red flags.

Treatment 

There is no specific protocol or guidelines for treatment of non-traumatic coccydynia; refer to clinical practice guidelines for acute and chronic musculoskeletal pain.

Conservative management 

• Rest/avoid aggravating factors 
• Cold or heat 
• Laxatives if constipated 
• Cushions – wedge or donut 
• Pelvic floor exercises – consider referral to specialist service if significant weakness of pelvic floor, associated with incontinence, post childbirth 
• NSAIDS/analgesia 
• TENS 
• Acupuncture.

Interventional management 

• Only indicated for refractory cases, refer to orthopaedic surgeon 
• Corticosteroid injection  
• Surgery – coccygectomy.

Suspected red flag cases should be referred to Orthopaedics urgently via SCI gateway.

Following conservative management referral can be made to MSK services via SCI gateway.

Imaging, see above: MRI if suspect malignancy/infection/ for intractable pain or associated with numbness in legs, bladder/bowel disturbance with lumbar cause excluded.

Any plain x-ray/dynamic imaging would be used in specialist centres only.

CT reserved for significant pelvic trauma.

British Association of Spine Surgeons. Coccydinia and operations for coccygeal pain.

BMJ Best Practice. Coccygodynia - symptoms, diagnosis and treatment. 

Mabrouk, A., Alloush, A., Foye, P. Coccyx pain. (Updated 2023 May1). In:StatPearls (Internet) Treasure Island (FL): StatPearls Publishing.

Fogel GR, Cunningham PY, Esses, SL. Coccygodynia: evaluation and management. J Am Acad Orthop Surg. 2004;12:49-54.