Coccydynia

Definition/diagnostic criteria Coccydynia is defined as pain in the region of the coccyx. Pain is often provoked by sitting or by activities that put pressure on the bottom part of the spine. There are no specific diagnostic criteria, but the pain is usually localised and can be reproduced by palpation of the coccyx.

Epidemiology Coccydynia is a relatively uncommon condition. It is more prevalent in women than in men, particularly in middle age. The exact prevalence in the UK is not well documented, but it is a recognised cause of chronic pain after injuries or childbirth.

Diagnosis
Clinical features: The hallmark of coccydynia is pain at the base of the spine, which is aggravated by sitting or by any activity that puts pressure on the coccyx. The pain may radiate to the buttocks, thighs or even the perineum. Patients may also report difficulty with bowel movements and discomfort during sexual intercourse.

Investigations: Investigations are typically reserved for cases where the diagnosis is uncertain or if there is suspicion of an underlying pathology. Standard investigations include X-rays or MRI to exclude fractures, malignancy or other structural abnormalities. However, these imaging tests often yield normal results, as coccydynia is frequently idiopathic.

Treatment Treatment of coccydynia is primarily conservative. The first line of management includes:

• Non-pharmacological:
  • Use of a cushioned seat or a doughnut-shaped pillow to relieve pressure on the coccyx.
  • Tailoring activities to avoid prolonged sitting.
• Pharmacological:
  • Paracetamol and NSAIDs for pain relief.
  • In cases of severe pain, local injections of corticosteroids or anaesthetics may be considered.

Other treatment options include physiotherapy, particularly pelvic floor strengthening and mobilisation exercises, and behavioural therapies for pain management. In rare cases where conservative treatments fail and the pain is debilitating, surgical options such as coccygectomy may be considered.

Prognosis The prognosis for coccydynia is generally good, with many patients responding well to conservative treatments. Most people experience significant improvement within a few weeks to months. However, a small percentage of patients may develop chronic pain, requiring more extensive management.