建议休息。

使用U型坐垫调整坐姿可以减轻尾骨的压力。

其他方法包括坐浴、热敷、针灸和推拿。[27]Mlitz H, Jost W. Coccygodynia. J Dtsch Dermatol Ges. 2007;5:252-254.http://www.ncbi.nlm.nih.gov/pubmed/17338803?tool=bestpractice.com[28]Polkinghorn BS, Colloca CJ. Chiropractic treatment of coccygodynia via instrumental adjusting procedures using activator methods chiropractic technique. J Manipulative Physiol Ther. 1999;22:411-416.http://www.ncbi.nlm.nih.gov/pubmed/10478774?tool=bestpractice.com这些方法可以放松盆底肌肉和减少疼痛和触痛，但确切的机制尚不明确。

针对经选择患者组全部患者的治疗推荐

如无禁忌症，所有患者应使用非甾体类抗炎药8周来减轻疼痛和炎症。[26]Fogel GR, Cunningham PY, Esses, SL. Coccygodynia: evaluation and management. J Am Acad Orthop Surg. 2004;12:49-54.http://www.ncbi.nlm.nih.gov/pubmed/14753797?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

对于有排便疼痛病史的患者，使用8周大便软化剂可以减轻排便疼痛和便秘。[26]Fogel GR, Cunningham PY, Esses, SL. Coccygodynia: evaluation and management. J Am Acad Orthop Surg. 2004;12:49-54.http://www.ncbi.nlm.nih.gov/pubmed/14753797?tool=bestpractice.com

首选治疗是按需每月注射皮质类固醇加局部麻醉药。

它们可以单独使用或在全麻下与有创操作组合（即，经直肠屈伸），后者被认为更好。[30]Wray CC, Easom S, Hoskinson J. Coccydynia. Aetiology and treatment. J Bone Joint Surg (Br). 1991;73-B:335-338.http://bjj.boneandjoint.org.uk/content/jbjsbr/73-B/2/335.full.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/2005168?tool=bestpractice.com

皮质类固醇加局部麻醉应被注入尾骨两侧的软组织和尾骨尖部（使用甲基强的松龙）或骶尾关节背侧骨膜（使用曲安奈德）。[31]Mitra R, Cheung L, Perry P. Efficacy of fluoroscopically guided steroid injections in the management of coccydynia. Pain Physician. 2007;10:775-778.http://www.painphysicianjournal.com/current/pdf?article=OTE5&journal=38http://www.ncbi.nlm.nih.gov/pubmed/17987101?tool=bestpractice.com

然而，如果局部注射和/或操作失败，建议行经皮骶髂关节注射，可在透视下或直肠指诊定位骶髂关节。[31]Mitra R, Cheung L, Perry P. Efficacy of fluoroscopically guided steroid injections in the management of coccydynia. Pain Physician. 2007;10:775-778.http://www.painphysicianjournal.com/current/pdf?article=OTE5&journal=38http://www.ncbi.nlm.nih.gov/pubmed/17987101?tool=bestpractice.com[32]Kersey PJ. Non-operative management of coccygodynia. Lancet. 1980;1:318.http://www.ncbi.nlm.nih.gov/pubmed/6101777?tool=bestpractice.com

皮质类固醇注射可以在全麻下与有创操作组合使用（即，经直肠屈伸），被认为比单独使用效果更好。[30]Wray CC, Easom S, Hoskinson J. Coccydynia. Aetiology and treatment. J Bone Joint Surg (Br). 1991;73-B:335-338.http://bjj.boneandjoint.org.uk/content/jbjsbr/73-B/2/335.full.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/2005168?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

如果连续两个月注射皮质类固醇加局部麻醉无效，增加物理治疗作为有效的第二选择。

物理治疗方法包括经直肠盆底按摩和尾骨运动。[30]Wray CC, Easom S, Hoskinson J. Coccydynia. Aetiology and treatment. J Bone Joint Surg (Br). 1991;73-B:335-338.http://bjj.boneandjoint.org.uk/content/jbjsbr/73-B/2/335.full.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/2005168?tool=bestpractice.com[33]Thiele GH. Coccygodynia: cause and treatment. Dis Colon Rectum. 1963;6:422-436.http://www.ncbi.nlm.nih.gov/pubmed/14082980?tool=bestpractice.com[34]Maigne JY, Chatellier G. Comparison of three manual coccydynia treatments: a pilot study. Spine. 2001;26:E479-E483.http://www.ncbi.nlm.nih.gov/pubmed/11598528?tool=bestpractice.com[35]Maigne J, Chatellier G, Faou ML, et al. The treatment of chronic coccydynia with intrarectal manipulation: a randomized controlled study. Spine. 2006;31:E621-E627.http://www.ncbi.nlm.nih.gov/pubmed/16915077?tool=bestpractice.com证据 C控制症状：有较弱的证据表明直肠内的操作比外部的物理治疗对于慢性尾骨痛更为有效。[35]Maigne J, Chatellier G, Faou ML, et al. The treatment of chronic coccydynia with intrarectal manipulation: a randomized controlled study. Spine. 2006;31:E621-E627.http://www.ncbi.nlm.nih.gov/pubmed/16915077?tool=bestpractice.com低质量的观察性（队列）研究或者受试者＜200名且方法学存在缺陷的随机对照临床试验（RCT）。

针对经选择患者组全部患者的治疗推荐

慢性尾骨痛患者，保守治疗3到6个月失败，可由脊柱外科医生行尾骨切除术。

外科文献报道尾骨切除术后的成功率在60%至91%。[26]Fogel GR, Cunningham PY, Esses, SL. Coccygodynia: evaluation and management. J Am Acad Orthop Surg. 2004;12:49-54.http://www.ncbi.nlm.nih.gov/pubmed/14753797?tool=bestpractice.com

尾骨切除术对于创伤和产后尾骨痛患者的成功率要高于特发性尾骨痛的患者（75%对58%）[8]Bayne O, Bateman JE, Cameron HU. The influence of etiology on the results of coccygectomy. Clin Orthop Relat Res. 1984;190:266-272.http://www.ncbi.nlm.nih.gov/pubmed/6488643?tool=bestpractice.com

尾骨切除术对于动态X线下影像学不稳定的患者优良率为92%。[14]Maigne JY, Lagauche D, Doursounian L. Instability of the coccyx in coccydynia. J Bone Joint Surg (Br). 2000;82-B:1038-1041.http://bjj.boneandjoint.org.uk/content/jbjsbr/82-B/7/1038.full.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/11041598?tool=bestpractice.com

对于较瘦的患者，残余的尾骨碎片或者凸出的骶骨边缘可能导致预后不良，必须再次行手术治疗，可行尾骨再切除术或用骨钳咬掉骶骨的边缘。

直肠疝是尾骨切除术后罕见的并发症[36]Kumar A, Reynolds JR. Mesh repair of a coccygeal hernia via an abdominal approach. Ann R Coll Surg Engl. 2000;82:113-115.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503516/pdf/annrcse01624-0047.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/10743431?tool=bestpractice.com[37]McClenahan JE, Fisher B. Herniation of the rectum following coccygectomy. Am J Surg. 1951;82:288-289.http://www.ncbi.nlm.nih.gov/pubmed/14847090?tool=bestpractice.com

骶神经后跟切除术（切除S4和S5神经根）可考虑应用于疼痛仅局限在尾骨区且尾骨切除术失败的患者；然而，骶神经根切断目前在治疗中仍非主要手段。[38]Saris SC, Silver JM, Vieira JF, et al. Sacrococcygeal rhizotomy for perineal pain. Neurosurgery. 1986;19:789-793.http://www.ncbi.nlm.nih.gov/pubmed/3785627?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

伤口感染是术后最常见的并发症，其发生率为2%到22%。[26]Fogel GR, Cunningham PY, Esses, SL. Coccygodynia: evaluation and management. J Am Acad Orthop Surg. 2004;12:49-54.http://www.ncbi.nlm.nih.gov/pubmed/14753797?tool=bestpractice.com

同时使用引流和术后应用抗生素可减少感染等术后并发症的发生率。

抗生素应继续应用至术后72小时。