Differential Diagnosis for Tailbone Pain

• Single most likely diagnosis
  • Coccydynia: This is the most common diagnosis for tailbone pain, often resulting from a fall onto the tailbone, childbirth, or prolonged sitting. The pain is usually localized to the coccyx and may be exacerbated by sitting or standing.
• Other Likely diagnoses
  • Levator ani syndrome: A condition characterized by chronic pain in the region of the levator ani muscle, which is located near the tailbone. This pain can be exacerbated by sitting or straining.
  • Pilonidal cyst or abscess: An infected cyst or abscess near the tailbone can cause significant pain in the area.
  • Anal fissure: A tear in the lining of the anus can cause pain, especially during and after bowel movements, which may be mistaken for tailbone pain.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
  • Cauda equina syndrome: A serious condition where the nerves in the spinal canal are compressed, leading to pain, numbness, and weakness in the legs. It requires immediate medical attention.
  • Rectal cancer: Although rare, rectal cancer can cause pain in the tailbone area, especially if the tumor is large or has spread to nearby structures.
  • Spinal infection (e.g., osteomyelitis, discitis): Infections of the spine can cause severe back pain that may radiate to the tailbone area and are medical emergencies.
• Rare diagnoses
  • Tarlov cysts: Fluid-filled sacs that can form on the nerve roots in the spine, including near the tailbone, causing pain and other neurological symptoms.
  • Chordoma: A rare type of bone cancer that can occur at the base of the spine, including the coccyx, causing pain and other symptoms.