The coccyx area is most easily evaluated by rectal examination. The most common causes of coccydynia include direct trauma, intrapelvic neoplasm, colorectal cancer, childbirth, and previous spinal surgery. A movable coccyx palpated on rectal examination suggests a fracture, which should be further evaluated by radiographic imaging studies. If results of the rectal examination are normal, proctologic, gynecologic, and urologic evaluation should be strongly considered. If results of a neoplastic work-up are negative, initial treatment should be conservative, using NSAIDs and a sitting cushion. In the posttraumatic setting, patients who do not respond to conservative therapy can be considered for coccygectomy.
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