Coccygodynia—Diagnosis and Treatment

Patients with coccygodynia have chronic pain in the area of the coccyx that is worse on sitting. The prevalence of this condition is unknown, but women are affected much more frequently than men, in a 5:1 ratio.

In this narrative review, we present the relevant diagnostic techniques and conservative, interventional, and surgical treatment options.

The mobility of the coccyx is assessed with dynamic x-rays in the seated and upright positions. Although there have been a number of small-scale randomized therapeutic trials, the evidence concerning the treatment of coccygodynia is derived mainly from observational studies. Manual therapies such as pelvic-floor training, the use of elastic therapeutic tape, analgesic drugs, and sitting cushions have reportedly yielded mixed results, with limited to clinically relevant efficacy. Interventional techniques, including local steroid infiltration, ganglion impar block, and radiofrequency therapies, can markedly improve symptoms for many patients. In intractable cases, surgical removal of the coccyx (coccygectomy) is an option. In a meta-analysis, 84% of patients obtained relief of pain and 76% returned to work. After at least 36 months of follow-up, the mean degree of pain relief was rated at 5.4 on a scale of 1 to 10. Wound dehiscence arose in 5% of patients, and 3% underwent repeated surgery.

Coccygodynia requires special diagnostic evaluation, including dynamic imaging and interdisciplinary pain assessment. Patients with coccygodynia are at risk for pain chronification. In such cases, multimodal evaluation is indicated. Conservative treatment should be tried first, potentially including interventional methods of reducing pain. Coccygectomy should only be considered in intractable cases with demonstrated instability.