Is coccyx pain really linked to the seasons?

This article notes that coccyx fractures are most common in winter (about 30.8%), followed by summer, autumn, and spring, and that the lower the winter temperature, the higher the incidence, which is thought to relate to a greater risk of outdoor falls.

Why are women more prone to coccyx injuries?

Because women have a wider pelvis and the coccyx more readily contacts the ground, this article notes that the male-to-female ratio is about 1 to 2.6, with women affected notably more than men. Women also have two peak ages of onset, at 10 to 14 years and around menopause.

Does coccyx pain always need an X-ray or surgery?

Diagnosis relies mainly on history, physical examination, and X-ray (the lateral view shows a coccyx fracture most clearly), and MRI is needed only rarely. Surgery is usually not required; coccygectomy is considered only in rare situations such as a severe comminuted fracture.

What can I do at home to relieve a coccyx injury?

You can use symptomatic care, including rest when needed, oral pain relievers according to how severe the pain is, sitting on a donut-shaped cushion, warm baths, and pelvic-floor relaxation exercises. Laxatives may help if bowel movements are painful. These measures can support comfort during the healing period.

What happens if coccyx pain is left untreated?

This article notes that without treatment the healing process may be slower and there is a risk the pain becomes chronic. If the pain is severe, persistent, or accompanied by other symptoms, seeing a physician for an individual assessment and management is advised.

Coccyx Pain Linked to the Seasons? Causes, Diagnosis, and Relief

The coccyx is the triangular bony structure at the very end of the spine. A coccyx fracture, sometimes called a broken tailbone, can result from a fall onto the buttocks (for example while skating) or when a newborn passes through the birth canal. More often, childbirth-related coccyx pain is due to bruising rather than a true break.

Although the coccyx is small, it has several important functions. Beyond serving as an attachment point for a number of muscles, ligaments, and tendons, it also acts as one leg of a tripod, together with the ischial tuberosities, providing weight-bearing support when sitting. Leaning back while seated increases the pressure on the coccyx. The coccyx also provides positional support for the anus.

Coccyx fractures are most common in winter (30.8%), followed by summer (24.6%), autumn (24.1%), and spring (22.5%). The incidence in winter and summer correlates significantly with temperature: the lower the winter temperature, the higher the incidence, while the reverse is true in summer. This may relate to the risk of falls in the outdoor environment.

Epidemiology

Coccyx fractures are more common in women because women have a wider pelvis and the coccyx contacts the ground more readily. The male-to-female ratio is 1:2.6, with women affected significantly more than men.
Men have their highest incidence of coccyx fracture at 10 to 14 years, whereas women have two peaks, at 10 to 14 years and at 50 to 54 years (around menopause).

Pathophysiology

The coccyx is made up of 3 to 5 fused vertebrae and connects to several important muscles and ligaments. These muscles include the levator ani group, which supports the pelvic floor and maintains continence, and the gluteus maximus, which helps extend the thigh. The coccyx has a limited range of motion at the sacrococcygeal joint, and its tip curves inward toward the pelvis.
Attached to the anterior surface are the anterior sacrococcygeal ligament and fibers of the levator ani. On both sides of the posterior surface are the coccygeal cornua, which connect with the cornua of the sacrum to form the posterior sacral foramen.
The lateral edges of the coccyx are very thin, providing attachment points for the sacrosciatic ligament and the sacrococcygeal attachments, with fibers of the gluteus maximus anterior to the ligament.
Coccyx injuries are often overlooked by physicians, but it is worth remembering that the pain can be very severe and extremely distressing for patients. In addition, because the coccyx is a weight-bearing structure when sitting, a poorly managed coccyx fracture may lead the patient to place more weight on the ischial tuberosities, resulting in bursitis.

Risk factors

Older age
Osteoporosis
Reduced balance leading to more falls
Congenital skeletal disorders such as osteogenesis imperfecta
Participation in activities prone to falls, such as ice skating or skateboarding

Diagnosis

Diagnosis is made through history, physical examination, and appropriate imaging.
Other potentially life-threatening injuries, such as head injuries, must be ruled out, since they may be overlooked when attention is focused on coccyx pain.

Symptoms

The typical presentation of a coccyx fracture is localized pain over the coccyx.
Pain is usually worse with prolonged sitting, leaning back while seated, prolonged standing, and standing up from a seated position.
Pain may occur during intercourse or bowel movements.

Physical examination

Tenderness on palpation of the sacrococcygeal joint
Assessment of coccygeal mobility and/or crepitus by rectal examination
Examination of the entire spine to assess for associated injuries
Neurological examination of the lower limbs to assess for radiculopathy
X-ray to identify other suspected spinal injuries
A lateral coccyx X-ray can clearly show a coccyx fracture

Diagnostic tools

X-ray is most important (anteroposterior and lateral views)
Ultrasound may be added to assist injection therapy of the adjacent soft tissue
For traumatic coccyx injuries, other diagnostic imaging is rarely needed, and MRI is required only in very rare cases

Initial treatment

Symptomatic treatment, which may require bed rest until walking is tolerated
Oral pain medication is key, given according to the severity of the pain
If the pain is due to a strain of the surrounding ligaments or nerve compression, an ultrasound-guided injection may be considered and can help with pain relief
A small number of cases require targeting the ganglion impar, also known as the ganglion of Walther. This ganglion is the pelvic portion of the sympathetic trunk located in the anterior midline of the sacrococcygeal joint, and this approach may be useful for refractory cases and cases associated with pelvic pain
Warm baths
Laxatives may help reduce pain during bowel movements
Seat cushion (donut type): these cushions can provide comfort while the fracture heals, and they help even when there is only a bruise
Guidance and assistance with a gradual return to activity: activity can resume once the pain has resolved and the related muscles have regained normal movement and strength. Training the patient to adopt a correct sitting posture ensures that body weight is distributed through the ischial tuberosities, reducing the pressure transmitted through the coccyx
Pelvic-floor exercises, with particular emphasis on relaxing the levator ani
Reduction of a displaced fracture through the anus is unnecessary, because the coccyx cannot be fixed in place
If there is an associated rectal injury, urgent surgical consultation and antibiotics are needed

Surgery

Surgery is usually not required. In very rare situations where severe trauma causes a comminuted fracture, a coccygectomy may be needed.

Follow-up

Without treatment the healing process is slow, and the pain may become chronic
In rare situations, severe or chronic pain or instability may require a coccygectomy

References

Coccyx Fractures - Physiopedia (physio-pedia.com)

Injury. 2020 Oct;51(10):2278-2282.

Ochsner J. 2014 Spring; 14(1): 84–87.