What causes coccygeal pain? Coccyx or coccygodynia syndrome - diseases

What causes coccygeal pain? Coccyx or coccygodynia syndrome - diseases
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Coccygodynia, ie coccyx pain, is an unpleasant experience. In addition to problems in the coccyx, it is accompanied by other difficulties. We often associate it with an injury or prolonged sitting. It bothers women to a greater extent.


Coccygodynia is a term for coccyx pain . We also find it under the name coccygodynia, uropygial syndrome,  or coccyx syndrome.

It is an unpleasant painful condition, but in addition to pain, it can be accompanied by a number of other difficulties. Problems are transmitted to the other part of the body, or vice versa, from there towards the coccyx.

It doesn't always come from an accident or prolonged sitting.

It mostly affects women.

The coccyx is needed ... 

Many people may label a coccyx as an unnecessary growth. But the truth is different. 

What is a coccyx?

The coccyx is part of the spine. The spine plays an important role in holding body weight, movement, and spinal cord protection. 

Spine, so columna vertebral, the bonding of the vertebrae - vertebrae. And there are 33-34 of them. 

The spine is composed of vertebrae :

  • cervical vertebra  =  7 , vertebrae  C ervicales -  C1 - C7
  • thoracic vertebrae  =  12 , vertebrae  Th oracicae - Th1 - Th12 
  • lumbar vertebrae  =  5 , vertebrae  L umbales - L1 - L5
  • cross vertebrae  =  5  to  6 , vertebrae  S acrales - S1 - S5 or S6
    • they form the  sacrum and thus  the sacrum axis
  • coccyx  =  4  to  5  - vertebrae  Co ccygeae - Co1 - Co4 or Co5
    • connected to  coccygeae (coccygis) - coccyx

The coccyx is a continuation and termination of the spine, more precisely the sacral section of the spine, ie the sacrum. It has 3 to 5 vertebrae. These vertebrae have no arches like the others.

There is a ligament between the sacrum and the coccyx - syndesmosis. Such ligament connections are among the most common in the human body.

Thanks to this type of connection, the mobility of this part is possible in the forward and backward directions. It happens with age that this connection grows with the bone - synostosis. As a result, the mobility disappears and this section is immobile.

Along with the sacrum, it is an important part of the pelvis.

The coccyx and the pelvis are closely related, as the muscles of the pelvic floor are attached to the coccyx.

This unit is jointly responsible for the posture, the movement component. It participates in the creation of the abdominal press, which means that it is important for breathing, but also for coughing or sneezing.

Coccyx + muscles = posture and movement.

However, it happens that pathological changes occur in this area, which can be caused by various difficulties, such as pain, changes in the position of the pelvis, posture, and movement deviations.

Stump syndrome is further defined as:

Coccygodynia is not a disease, but rather a set of symptoms. These are unpleasant sensations, which arise on the basis of anatomical imbalances, shortening muscles, increasing tension, or changes in attachments and ligaments.

Increased muscle tone, tension, or muscle stiffness are the basis for destabilizing the entire pelvis and spine. From a long-term dimension, it is a risk factor for other serious musculoskeletal problems.

However, the problem is not just pain.

Back pain is one of the most common difficulties responsible for incapacity for work, it has an economic and social impact.

Some interesting facts: 
85% of the population has experienced back pain. 
A painful coccyx affects women 5 times more often than men. 
Increased risk of pregnancy and childbirth
46% of pregnant women have back pain. 
The 40th year of life is reported as the average for the occurrence of coccygodynia. 
In women, the coccyx is longer and more forward-facing.

In 1859, J. Simpson described: 
Coccygodynia = indescribable spontaneous pain in the coccyx area when sitting, when getting up, under pressure on the coccyx and during rectal examination.


What are the causes of coccyx pain?

The disproportion within the pelvis, pelvic floor, ie muscles, and coccyx, is reported. It is excessive tension, tension, stiffness, shortening of muscles or tendons in a joint relationship.


Impaired pelvic + spine stability.

Injury is mentioned as the main risk factor in this issue. This is related to a fall on a coccyx, an impact, or a fracture.

Often one does not remember the mechanism of injury from the past.

Furthermore, it is necessary to look for the cause in the wrong posture, in poor movement habits, but also in excessive and unilateral overloading of the spine. Long-term sitting, and thus a sedentary lifestyle or sedentary work,
also has a negative effect.

Today's lifestyle, long-term sitting, work for a PC, general inactivity, traveling in means of transport.

It is necessary to think about inappropriate work ergonomics or sports overload. Sports activities with frequent falls, such as volleyball, handball, skating, but also cycling or horseback riding.

Women are affected more often due to pregnancy or childbirth ...

In women, pregnancy, childbirth, and especially recurrent births + menopause pose an increased risk and a greater proportion of difficulties.

Among others, gynecological and urological operations, operations on the spine, as well as various inflammatory processes in the pelvic area (gynecological inflammations, inflammation of the urinary tract) are included.

The risk factor is also ...

Stress is also mentioned as an important factor.

Long-term stress increases the tension of the body's muscles, especially the pelvic floor, chest, or face. Excessive muscle tension over time leads to impaired stability.

Of course, overweight and obesity also have an effect. Interesting information about overweight in the article  What is the difference between overweight and obesity?

Poor eating + obesity + poor posture and exercise habits + inactivity
negative impact on joints and health.

Various coccygeal disorders are mentioned in the literature:

  • fixed nutation of the pelvis - ie blockage in the pathological position
  • OUTFLARE (external) or INFLARE (internal) rotation - also change the position of the pelvis
  • painful coccyx
  • irritated coccyx
  • coccyx pain due to pelvic floor spasm

symptoms may spring directly from the coccyx, 
2. stem from organs in the pelvis. 
The spine transmits pain to the abdominal cavity and internal organs, 
but vice versa, 
pain from the organs is transmitted to the spine. 
Organ diseases can cause pseudoradicular syndrome in a given segment, dermatoma.

Accordingly, the coccygeal syndrome is divided into primary and secondary.

Primary coccygeal syndrome and its causes

This form is due to direct action or irritation on the coccyx. Alternatively, it is the coccyx's own disease.

Here are some risk factors for difficulty:

  1. injury - fall, strong impact on a hard surface, crushing of soft structures, fractures, dislocations 
  2. long-term sitting - a sedentary lifestyle, sedentary work, bending the coccyx backward, and a longer coccyx
  3. pressure on the coccyx when cycling - especially for professional cyclists, narrow and hard saddle
  4. childbirth - during physiological childbirth the head of the fetus stretches the entire pelvis, muscle overload, especially in first-time mothers
  5. gynecological operations - conducted through the vagina
  6. gynecological examination - less often
  7. coccyxitis - spondylitis
  8. tumor process (from bone, cartilage, ligaments)
  9. cysts

Secondary coccygeal syndrome

In this case, the cause is outside the coccyx. The difficulties are similar, however, they are moving into this area. For example, from the organs of the pelvis.

The organs of the pelvis are in close proximity to the structures of the pelvic floor. And this relationship may be the reason for the problem.

Plus ...

Pain can spread through nerves.

These are parasympathetic sensitive fibers in the spinal segment S2 - S4. These ensure the innervation of organs such as part of the colon, genitals, and bladder (inflammation, oncological process, and others)

Another group is pain originating from the upper part of the spine or the surrounding joints and lower limb.  

In this case, an example is:

  • SI joint pain - sacroiliac joint
  • of coxy, hip joint
  • sciatic muscle spasms
  • blockages and stiffness of the muscles in the lower limbs
    • they are transmitted upwards to the coccyx
    • similarly, the pain can move to a higher part of the body from the coccyx
  • blockade of the spine - lumbago
  • degenerative changes of plates and vertebrae
  • hernia disk
  • psychogenic coccyx syndrome - depression, anxiety (increased muscle tension)

Read interesting information about:
Degenerative plate changes
Degenerative vertebral segment segment
Hernia disc - intervertebral disc arch
Degenerative changes of small intervertebral joints


The main symptom is pain.

The coccyx is examined by examination per rectum - and thus through the rectum. In this case, a painful coccyx is present during palpation.

People rather report the difficulties present ...

Pain is described more in the area of ​​the lower back and hips. One usually describes it as pain in the lower part of the crosses. About 1-fifth of those affected have both pain and coccyx.

It can have a band direction of propagation, on each side. 

It spreads to the hips, from the center of the backcrosses upwards to the lumbar spine, through the chest to the head. Alternatively, down to the lower limbs to the region of sciatic muscles - buttocks, thighs, calves.


The pain may radiate to the groin - groin or in the lower abdomen.

The pain is aggravated by sitting on a harder surface, it is also exacerbated by a change of position, movement when getting up, walking.

In women during menstruation.

Women report an increase in the intensity of difficulties before and during menstruation. They locate it in the area of ​​the lower abdomen, in the crosses, groin up to the inside of the thighs.

Other accompanying symptoms:

  • headache, it is reported up to 50%, it has a migraine or tense character, without aura and findings during examinations
  • pain in the rest of the spine - shaft, chest, between the shoulder blades, neck
    • the pain between the shoulder blades spreads to the chest
    • fear of heart disease
    • associated with a feeling of difficulty breathing - subjective dyspnoea, shortness of breath
    • no findings in examinations
  • lumbar pain
  • mild pain may be present when standing or lying down
  • changes in pelvic position, SI joint, scoliosis
  • change in the length of the lower limbs
  • increased tone of the muscles of the back and pelvis
  • bloating
  • traffic jam
  • pain on defecation, bowel movements
  • the feeling of fullness of the rectum
  • pain during sexual intercourse
  • functional sterility - a problem with the pregnancy

Sitting on one side of the buttocks can be a relief.


Kokcygodýnie the diagnosis is a very important history.

It will provide most of the necessary information. It is important to ask about the accident, its mechanism, or the form of work and lifestyle. The location or spread of pain is important, as are the associated difficulties.

For women, it is important to ask for information about:

  • regularity of the menstrual cycle
  • menstrual pain
  • use of hormonal contraception
  • inflammation of the genital and urinary tract
  • discharge
  • the pain of sexual intercourse
  • childbirth, first-born, physiological childbirth or section (cesarean section)
  • abortions, curettage
  • gynecological procedures
  • other gynecological diseases
  • frequent conservative treatment of appendicitis - appendicitis, even in men

Subsequently evaluated by looking posture, walking, exercise habits, pelvic position, the curvature of the spine, knees, leg length, conditions in the curves of thighs and buttocks.

Palpation is important , ie palpation. Skin (moisture, tension,), reflexes are evaluated. As well as muscles, joints. Connects examination mobility, pelvic tests (Spine sign, Rosina, sacroiliac shift, etc.). 

Imaging methods are also important in diagnosis:

  • X-ray
  • CT
  • MRI magnetic resonance imaging
  • USG - SONO
  • EMG

Of course, differential diagnosis is important. Its task is to reveal the true cause of the difficulties. Without treatment of the primary problem, no improvement can be expected.

Among the health problems that can cause problems are, for example, a problem with the SI joint, disc herniation, lumbago, vertebral displacement, but also organ diseases. Addressing the root cause will be important.


The course of the disease is variable and also depends on the underlying cause.

Pain in the coccyx and rectum occurs after the injury, however, it may not manifest immediately after it, but with an interval of months.

It also arises as a result of long-term sitting. Inactivity or a sedentary lifestyle has a negative effect on the entire musculoskeletal system.


Connecting pain in the lower back area

The cause of coccygodynia is not always clarified.

Difficulties are exacerbated by long-term sitting on a harder surface, followed by a change of position and movement when getting up. Traces are also noticeable on mobility.

In women, the course typically worsens about 2 days before menstruation, with abdominal pain and weakness in the lower back or thigh. The cause can also be a physiological birth, during which the penetration of the fetal head overloaded the pelvic muscles.

Pain radiates to any side of the human body from the feet to the head. The headache resembles a migraine, it can be tense. However, it does not contain an aura component and is not found on examination. 

Stump syndrome is accompanied by muscle stiffness, bloating, and constipation. The overall course worsens the state of mental condition. Conversely, psychological problems, such as depression or anxiety, can also be a source of the difficulty. 

How it is treated: Coccygeal pain

Treatment of coccygodynia: Medications, exercises, physiotherapy and rehabilitation

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Interesting resources

  • ncbi.nlm.nih.gov  - expert article from the US National Libary of Medicine National Institutes of Health
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  • Patel, Ravi, Anoop Appannagari, and Peter G. Whang. "Abstract." National Center for Biotechnology Information. U.S. National Library of Medicine, 07 May 2008. Web. 21 May 2013.
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  • Kim NH, Suk KS (June 1999). "Clinical and radiological differences between traumatic and idiopathic coccygodynia". Yonsei Medical Journal40 (3): 215–20. 
  • Marx, Fred A. (1996). "Coccydynia/Levator Syndrome, A Therapeutic Test". Techniques in Coloproctology4 (1).
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  • Foye, P; Buttaci, C; Stitik, T; Yonclas, P (2006). "Successful injection for coccyx pain". Am J Phys Med Rehabil85 (9): 783–4. 
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