What are the main causes of chronic coccyx pain?

Chronic coccyx pain, also known as coccydynia, is a condition that causes significant discomfort in the lower region of the spine. The causes of this pain can range from direct trauma to inflammatory conditions or structural abnormalities. Understanding these causes helps in determining the appropriate treatment plan.

Injuries and Trauma

Direct injuries to the coccyx are common causes of pain. These injuries often occur as a result of falling on a hard surface, such as slipping on ice, which can lead to bruising or stretching of the ligaments surrounding the coccyx. In very rare cases, a fracture of the coccyx itself may occur [1].

Pilonidal Cysts

A pilonidal cyst, or pilonidal sinus, is an inflammatory condition affecting hair follicles, typically occurring in the cleft between the buttocks, from the sacrum to the anus. This condition may appear as a small pit in the skin containing hair or dark spots, a fluid-filled cyst forming under the skin, or an abscess where pus collects due to infection [2]. Although the exact cause is not fully understood, it is believed to be caused by hair growing into the skin in that area. Associated symptoms include discharge from the skin pit, tenderness upon touch after sitting or activity, warmth, swelling, and rarely, fever [2].

Tarlov Cysts

Tarlov cysts are fluid-filled sacs typically found in the lower part of the spine (the sacrum), appearing on the nerve roots that grow from the spinal cord. Most of these cysts do not cause any symptoms. However, if these cysts compress the nerve roots, they can cause a variety of symptoms, including lower back pain, sciatica (a burning or shock-like pain in the lower back and buttocks that extends down the leg), loss of bladder control, headaches, constipation, sexual dysfunction, and loss of sensation or control over the movement of the legs and feet [3]. Compression of the nerves adjacent to the cysts can also lead to the deterioration of surrounding bone. Women are more susceptible to these cysts than men [3].

Diagnosis and Treatment

To diagnose the cause of coccyx pain, a doctor may perform a physical examination and inquire about medical history. Imaging tests may include X-rays of the bones, computed tomography (CT) scans of the spine, or magnetic resonance imaging (MRI) of the spine [1]. For pilonidal cysts that do not cause symptoms, immediate treatment may not be required, but removal can be discussed to prevent enlargement or progression to an abscess. Pilonidal abscesses require incision and drainage, and antibiotics may be used if the infection spreads [2]. In cases of Tarlov cysts causing chronic symptoms, lifestyle modifications may be required; if left untreated, nerve root compression can lead to permanent damage to the nervous system [3].

If you are experiencing persistent pain in the coccyx region, or notice any discharge, redness, swelling, or tenderness around a pilonidal cyst, it is important to consult a healthcare provider to evaluate your condition and determine appropriate treatment [2]. For more information on coccyx disorders and treatment options, you can visit Coccyx Disorders: Causes of Chronic Pain and Effective Treatment Options (Arabic).

Medical references

• Tailbone Disorders
• Pilonidal sinus disease
• Tarlov Cysts