A 67-year-old man presented with a two-and-a-half-year history of worsening rectal pain developing an hour before defecation and lasting for several hours afterwards. Otherwise our patient had normal bowel habits. There was some pain when sitting on a hard surface that lessened when sitting on a soft cushion. No pain was experienced on walking or standing. Of note, our patient had type II diabetes and ischemic heart disease. He denied previous musculoskeletal problems, including back pain. The rectal pain was thoroughly investigated by a consultant colorectal surgeon. Rigid sigmoidoscope and endoanal ultrasound investigations were normal. A barium enema revealed mild diverticular disease and an anorectal examination under anesthesia and subsequent biopsy revealed only a benign polyp. Double contrast magnetic resonance imaging (MRI) of his pelvis revealed no soft tissue abnormality. Our patient was subsequently referred for consultation with an orthopedic surgeon. A physical examination revealed a patient of medium build with palpation tenderness over the tip of his coccyx, which was significantly anteverted and mobile. No tenderness was elicited over the sacroiliac joint or lumbar spine. A straight leg raise to 90 degrees was achieved and there was no neurovascular deficit in his limbs. A review of the MRI scans of his pelvis and plain X-rays confirmed the diagnosis of an elongated, anteverted coccyx protruding into the rectum. A standard coccygectomy was carried out, after which our patient’s symptoms settled and he was discharged two months after the surgery with a good outcome.