The patient fell on his tailbone and now complains of pain
which is worse with sitting, and perhaps with defecation.
There should be little or no pain with standing but walking
may be uncomfortable. On physical examination, there is
point tenderness, and perhaps deformity of the coccyx, which
is best palpated by a finger in the rectum.
What to do:
Verify the history (was this actually a straddle injury?)
and examine thoroughly, including the lumbar spine, pelvis,
and the legs. Palpate the coccyx from inside and out,
feeling primarily for point tenderness and/or pain on
X rays are optional. Any noticed variation can be an old
fracture or an anatomic variant, and a fractured coccyx can
appear within normal limits.
Instruct the patient in how to sit forward, resting his
weight upon ischial tuberosities and thighs, instead of on
the coccyx. A foam rubber doughnut cushion may help. If
necessary, prescribe anti-inflammatory pain medications or
Inform the patient that the pain will gradually improve
over a week, as bony callus forms and motion decreases, and
arrange for followup as needed. Chronic pain is rare but
treatable by surgically remiving the coccyx.