The coccygeal plexus is a small network formed by the anterior rami of S4, S5 and the coccygeal nerve, lying on the pelvic surface of the coccygeus muscle. It supplies part of the coccygeus and levator ani and gives off the anococcygeal nerves. These pierce the sacrotuberous ligament to supply the small patch of skin between the coccyx and the anus.
| Origin | Anterior rami of S4, S5 and the coccygeal nerve (Co1) |
|---|---|
| Course | Forms on the pelvic surface of coccygeus near the tip of the sacrum; the anococcygeal nerves pierce the sacrotuberous ligament to reach the skin |
| Motor | |
| Sensory |
|
The coccygeal plexus is relevant to coccydynia (tailbone pain), which may follow falls, childbirth or prolonged sitting. Pain in this area can be treated with local injections, ganglion impar block or, rarely, coccygectomy. Sacral fractures and tumours of the lower sacrum such as chordoma may involve the plexus along with the S4-S5 roots, affecting perianal sensation.
Pain at the coccyx, worse when sitting or rising from sitting, often after a fall or childbirth. Most cases settle with cushions, physiotherapy and injections, and surgery is reserved for persistent cases.
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