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Nervi Anococcygei – Anatomy and Clinical Relevance

The nervi anococcygei are small cutaneous nerves in the coccygeal region that provide sensory innervation to the skin between the coccyx and the anus, forming part of the coccygeal plexus.

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Things worth knowing about "Nervi anococcygei"

The nervi anococcygei are small cutaneous nerves in the coccygeal region that provide sensory innervation to the skin between the coccyx and the anus, forming part of the coccygeal plexus.

Definition and Anatomy

The nervi anococcygei (singular: nervus anococcygeus), also referred to as the anococcygeal nerves, are small sensory cutaneous nerves located in the region between the coccyx and the anus. They arise as branches of the coccygeal plexus, a small nerve network formed by the anterior rami of spinal nerves S4, S5, and Co1 (the fourth sacral to the first coccygeal segment).

These nerves pierce the coccygeus muscle and the anococcygeal ligament, subsequently providing sensory innervation to the skin overlying the coccyx and the perianal skin. Their fibers are exclusively afferent, meaning they carry sensory signals such as touch, pressure, and pain from the skin to the spinal cord.

Course and Innervation Territory

The course of the nervi anococcygei can be summarized as follows:

Origin from the coccygeal plexus (segments S4–S5 and Co1)
Passage through the coccygeus muscle and the anococcygeal ligament
Sensory supply to the skin overlying the coccyx (periosteal and subcutaneous regions)
Sensory supply to the perianal skin in the immediate vicinity of the anus

Although the innervation territory is small, it is clinically relevant, as pain in this region may indicate irritation or damage to these nerves.

Clinical Relevance

Coccydynia

The most important clinical association of the nervi anococcygei is coccydynia (coccygeal pain syndrome). This condition is characterized by chronic or recurrent pain in the region of the coccyx, often aggravated by sitting, rising from a seated position, or direct pressure on the tailbone. Irritation or involvement of the nervi anococcygei is considered one of the potential contributing mechanisms.

Perianal Complaints

Since the nervi anococcygei also supply the perianal skin, inflammation, abscesses, fistulas, or surgical procedures in this area can temporarily or permanently impair these nerves, resulting in numbness, tingling, or localized pain.

Trauma and Surgical Procedures

Coccygeal fractures, obstetric trauma (e.g., following prolonged or difficult labor), falls onto the buttocks, or pelvic floor surgery can all cause mechanical damage to the nervi anococcygei, leading to sensory disturbances or persistent pain in the affected region.

Diagnosis

Complaints in the innervation territory of the nervi anococcygei are typically evaluated through thorough clinical history-taking and physical examination. The following diagnostic approaches may be used:

Clinical examination: Palpation of the coccyx and perianal structures to localize the pain source
Imaging: X-ray, MRI, or CT of the pelvis to exclude structural causes such as fractures or tumors
Nerve block: Diagnostic infiltration of the coccygeal plexus or the nervi anococcygei with a local anesthetic to confirm the pain origin

Treatment

Treatment of complaints attributable to irritation or damage of the nervi anococcygei depends on the underlying cause:

Conservative therapy: Coccygeal cushions (pressure relief), physical therapy, and anti-inflammatory medications (NSAIDs)
Local anesthetic and corticosteroid injections: Infiltrations into the coccygeal plexus region for pain relief
Physiotherapy: Pelvic floor training and manual therapy techniques
Surgical intervention: In rare, treatment-resistant cases, removal of the coccyx (coccygectomy) may be considered

References

Standring, S. (Ed.) - Gray's Anatomy: The Anatomical Basis of Clinical Practice, 42nd edition, Elsevier, 2020.
Maigne, J. Y. & Doursounian, L. - Entrapment neuropathy of the medial superior cluneal nerve and coccydynia. Spine, 22(12), 1997.
Woon, J. T. & Stringer, M. D. - Clinical anatomy of the coccyx: A systematic review. Clinical Anatomy, 25(2), 2012.

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