The coccyx or tail bone is one or two small bones attached to the sacrum, just above the anus. It is more prominent in women due to the shape of the pelvis related to childbirth. Pain in the coccyx is called coccydynia – this occurs in four situations:
After childbirth – pain here usually settles after several weeks or occasionally months. Surgery to remove the coccyx (coccygectomy) is not usually required.
After direct trauma – for example falling off a chair or down stairs. Other causes of "injury” may include squatting down or prolonged sitting on a hard surface. When this pain fails to settle after several months an injection of steroid (usually long-acting hydrocortisone) see Non-surgical treatment – is worth trying. If the pain persists then coccygectomy may become necessary.
In association with lumbar disc disease or after spinal surgery. Here the pain is referred and coccygectomy doesn’t help.
Spontaneously. Where there has been no trauma and there is no other cause surgery does not help. An Xray should be done to exclude other causes such as chordoma, a rare tumour of the sacrum.
Coccygectomy, removal of the coccyx, is performed under a general anesthetic. Local anaesthetic is also injected for post-operative pain relief. A 4 – 5 cm incision is made in the buttock cleft, the bone is separated and removed from the sacrum and ligaments (which are repaired). The skin is closed with "invisible stitches”, sutures which do not require removal. The patient usually stays in hospital overnight. Many patients are better by two months but some take many months – see RESULTS.
COMPLICATIONS: Infection is common (up to 10% of cases). Removing the coccyx may not relieve the pain.