Symptoms of coccygodynia

The most common symptom of coccygodynia is strong pain while sitting. Pain is often described as a burning pain in the rectal area. Beside pain, numbness could also occur in lower parts of the spine. In most cases, pain is aggravated by bowel movements, sexual intercourse or menstruation.
Diagnosis of coccygodynia

The most common method of diagnosis is definitely a radiographic imaging, which usually includes a lateral view of the coccyx. There are four radiographic types of pelvis:

   1. With the coccyx curved slightly forward
   2. Similar to type 1 with the tip almost pointing straightforward
   3. The coccyx is sharply angled on the anterior side
   4. Type with subluxation of either the sacrococcygeal joints or the coccygeal joint

Patient should avoid sitting for five to ten minutes before the X-rays examination. The problem with this method is that the patient must feel the pain in order to get the right diagnosis. If the pain is not present, no sound conclusion should be drawn.

Although CT and MRI are much more sensitive diagnostic tools, they do not add any significant information to the standard standing and sitting radiographic imaging. In more then 40% cases the coccyges are found without any radiographic abnormality.

In these cases, doctor has to think about several possibilities:

   1. The cause of pain could be intradiscal inflammation. This could be tested easily with application of intradiscal injection. If the pain disappears after it, the cause is definitely a chronic joint inflammation
   2. Chronic bursitis, inflammation of subcutaneous tissues could also be the cause. It can also be treated with subcutaneous injections.
   3. Psychogenic pain is also a very common cause of pelvic pains. Hysteria, neurotic pain or depression are the most common causes among these. This could be easily distinguished from coccygodynia because in most cases the pain is permanent and not enhanced by sitting.
   4. The sacroiliac joint or the lumbosacral area can sometimes radiate pain into this area making the diagnosis much more complicated.

Coccyx can also be palpated. This examination is performed rectally with the patient lying on their left side. This way the doctor examines how the coccyx is positioned, and whether it is movable.

Abnormality in the form of a small bony excrescence on the dorsal aspect of the tip of the coccyx is called coccygeal spicule. Good thing about it is that when it is present, it can always be easily palpated! It is considered to be a form of embryonic malformation.