Coccydynia

Coccydynia (from Greek kokkyx — cuckoo, coccyx and odyne — pain) is a polyetiological pain syndrome localized in the coccygeal region or the sacrococcygeal junction.

The condition is characterized by a chronic, debilitating course and significant reduction in the patient’s quality of life due to the inability to sit comfortably.

Etiology and pathophysiology

The most common cause (up to 70% of cases) is a history of closed trauma. A fall onto the buttocks (‘landing on the tail’) or a difficult childbirth with a large fetus leads to contusion, ligament sprain, subluxation, or fracture of the coccygeal segments. Less frequently, the cause may be degenerative joint changes or chronic pelvic floor muscle spasm.

The pathogenesis of pain is closely related to the disruption of normal biomechanics. Normally, the coccyx should slightly antevert (up to 20 degrees) when sitting, absorbing the load. Trauma results in pathological mobility (hypermobility) or, conversely, rigid fixation of the joint at an incorrect angle. This causes constant mechanical irritation of the periosteum and aseptic inflammation of the sacrococcygeal ligaments.

Clinical significance

The main symptom is sharp or aching pain in the intergluteal fold. It is characterized by a sharp increase in intensity with prolonged sitting on a hard surface and shooting pain upon standing. Local tenderness during defecation is also possible.

Diagnosis includes mandatory palpation of the coccyx through the rectum to assess mobility and dynamic radiography (comparison of images taken while standing and sitting). Treatment is primarily conservative: the use of orthopedic cushions for load reduction, physiotherapy, and medical blockades. In resistant cases, surgical removal of the coccyx is performed.