Are there any complications related to anal sphincter control with coccyx (tailbone) removal?

Coccyx Removal and Anal Sphincter Control

Coccygectomy does not cause complications related to anal sphincter control or fecal incontinence. The procedure is anatomically distant from the anal sphincter complex, and the published literature on coccygectomy does not report sphincter dysfunction as a recognized complication.

Anatomical Considerations

• The coccyx is located posterior to the rectum and anus, separated by the anococcygeal ligament and levator ani muscles 1, 2
• The anal sphincter complex (internal and external anal sphincters) lies anterior to the coccyx and is not involved in the surgical dissection during coccygectomy 1, 2
• The surgical approach—whether midline or paramedian—stays posterior to the rectum and does not violate the sphincter mechanism 2

Evidence from Coccygectomy Studies

Multiple case series examining coccygectomy outcomes have not identified anal sphincter dysfunction as a complication:

• In a large retrospective cohort of 184 patients undergoing coccygectomy, the main complication was wound infection (10% reduced to 2% with extended antibiotic prophylaxis), with no mention of sphincter control issues 1
• A 2024 case series of 41 patients using the paramedian approach reported a 12.1% complication rate consisting entirely of wound infections and erythema, with no sphincter-related complications 2
• A 2017 review of 70 patients with coccygodynia found that 8 patients underwent coccygectomy with only one case of superficial wound infection reported; no sphincter dysfunction was documented 3
• A 2013 study of 28 consecutive coccygectomies for traumatic coccygeal instability reported complications related to wound healing and pain relief, but no sphincter control problems 4

Actual Complications of Coccygectomy

The primary concern with coccygectomy is wound infection, not sphincter dysfunction:

• Infection rates range from 2-12% depending on antibiotic prophylaxis duration 1, 2
• The proximity to the anus increases infection risk but does not threaten sphincter function 1, 5
• Other complications include delayed wound healing, persistent pain, and rarely rectal perforation during surgery (which is a technical error, not a sphincter injury) 5

Critical Distinction from Anorectal Surgery

It is essential to distinguish coccygectomy from anorectal procedures that DO affect sphincter function:

• Anal sphincterotomy, manual anal dilatation, and hemorrhoidectomy can cause sphincter injury and incontinence 6
• Manual dilatation has a 30% temporary incontinence rate and 10% permanent incontinence rate 6
• These procedures directly manipulate or divide the anal sphincter, unlike coccygectomy 6

Clinical Reassurance

• Success rates for coccygectomy range from 71-86.7% for pain relief, with high patient satisfaction (89% would consent again knowing the outcome) 1, 2
• The procedure does not compromise bowel control or anal sphincter function based on available evidence 1, 2, 3, 4
• Patients can be counseled that while wound complications may occur, sphincter dysfunction is not an expected risk of this surgery 1, 2