Coccygodynia (Coccyx pain)

Dimitris Papadopoulos MD Fellow Of Interventional Pain Practice (FIPP)

Updated 04 January, 2011


Coccygodynia is a painful disorder of the last part of the spine, right above the rectum. The aetiology is usually post-traumatic and more rarely idiopathic. In some rare cases, pre-coccygeal epidermoid cyst may cause coccygodynia. There is a clear correlation between coccygodynia and gender.  The incidence ratio women/men is 5:1. There is also correlation between coccygodynia and body weight.  Female BMI >27,4 and male BMI >29,4 increase the risk for coccygodynia.  An injury, usually due to a fall in a sitting position, is the cause of the onset of symptoms in the majority of acute coccygodynia cases. Repetitive microtraumatic injuries due to a bad sitting position or due to activities, such as cycling, may in the end cause coccyx pain. In women, induced labor may be considered an injury sufficient to cause coccygodynia.


The spine is composed of 7 cervical, 12 thoracic, 5 -6 lumbar vertebrae. The last lumbar vertebra is connected with the sacrum, which is the fusion of 5 bones and has the shape of a triangle with the base upwards. The continuation of the sacrum is the sacrococcygeal joint , which connects the sacrum with 4-5 ossicles which compose the coccyx. The first two coccygeal levels may have rudimentary intervertebral discs inbetween the ossicles and may constitute a potential point for  post-traumatic hypermobilisation.  The next levels are co-articulated and do not present any mobility. The coccyx is longer in women than in men and that is the reason why coccygodynia is more frequent in women.


A detailed history is significant for identifying probable injury or habits or activities that could have induced the coccyx pain. Clinical examination includes hand palpation, pressure and mobilization of the coccyx to determine tenderness and reported pain.

Radiological examination is conducted dynamically with lateral views in the standing and sitting position (pressure position) and measurement of the angle in both positions. An angle of motion between 2 and 25 degrees is considered to be normal.

In case another non-traumatic cause is suspected, an MRI and more extensive workup has to be performed for ruling out potential infection, epidermoid cyst and malignancy.

In some cases, coccygodynia may be a radiated pain due to dysfunction of some visceral organ, such as the rectum, sigmoid and urogenitary system. In these cases, an infection, a primary tumour or a metastasis may imitate the clinical picture of coccygodynia and have to be further investigated.

As in most chronic painful syndromes, the clinical workup has to be supplemented with a psychiatric examination in order to rule out behavioural disorders, kinesiophobia, depression etc.



In the acute and subacute form, the treatment is conservative and includes non-steroid anti-inflammatory drugs and adjustment of the sitting position (with the use of an auxiliary cushion with a hole in the middle) in order to avoid pressure exerted on the coccyx.  Should the pain persist and transform into a chronic condition, the implementation of invasive treatment is recommended.


A. Local injection of corticosteroids and local anaesthetic

B.Diagnostic ganglion IMPAR block with long-action local anaesthetic and evaluation of the result.  If the patient reports significant pain relief (over 50%) during the local anaesthetic action, then follows treatment C.

C.  Radiofrequency Neurolysis (ablation) of ganglion IMPAR

According to existing studies, surgical removal of the coccyx does not secure definite long-term analgesia and, due to its potential severe complications, the method should be avoided.







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