Causes of Tailbone Pain and Treatment Options

Everything you need to know about coccydynia

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Tailbone pain is called coccydynia. It can develop after injury to the tailbone. The tailbone is also called the coccyx.

The tailbone consists of three to five small bones. These are called coccygeal vertebral bones. They are located at the very end of your spinal column.

Various muscles, tendons, and ligaments attach to the tailbone. Ligaments connect bone to bone. Tendons connect muscle to bone. 

Tailbone pain varies. For some people, it's a faint, throbbing pain. Others have severe, sharp pain that can radiate to other areas. The pain can be disabling.

Tailbone pain tends to occur when sitting, standing for long periods, and rising from a seated position. Pain during bowel movements and pain during sex are also common.

This article discusses the causes, treatment, and prevention of tailbone pain. It also discusses how this pain is diagnosed, and when you should see a doctor.

tailbone pain causes

Verywell / Alexandra Gordon

Causes of Tailbone Pain

There are a few possible causes of tailbone pain. Some are more common than others.

Common Causes

The most common cause of tailbone pain is injury. The bones of the tailbone could be injured directly, such as in a fall. Injury could also occur over time, due to repetitive activities.

Many muscles and ligaments attach to the tailbone. Tailbone pain could also be caused by an injury to these muscles and ligaments.

Acute trauma: A sudden injury to your tailbone can cause this kind of pain. For example, you might fall hard on your bottom while skiing. This can cause inflammation or strain of the structures around your tailbone.

The injury may cause a bruise or a fracture of the bones. Rarely, the joint between your tailbone and your sacrum may be dislocated. This is the triangle-shaped bone at the base of your spine.

Repeated trauma: Activities like horseback riding or cycling can lead to tailbone pain over time. This is because these activities cause repeat pressure or friction on the tailbone. You may also get tailbone pain after sitting on a hard surface for a long period of time.

Vaginal childbirth: Vaginal childbirth can cause tailbone pain. This is especially true if the delivery is difficult. This is because the baby's head puts pressure on the top of the tailbone. The use of forceps can also contribute to this kind of pain.

Tailbone pain from childbirth is often caused by bone bruise or ligament strain. Sometimes, though, the tailbone can fracture.

Degenerative joint disease: Wear and tear from repetitive motions can cause osteoarthritis. This is a degenerative disease that can affect any joint in the body.

Recap

Tailbone pain is usually caused by injury. The injury can happen suddenly or as a result of repetitive activities. It may also be degenerative.

Unique coccyx morphology: Not everyone has the same number of tailbone bones. Some people also have a bone spur on the lowest tip of the tailbone. A bone spur is a small, bony growth.

A bone spur can irritate the tailbone area when you sit down. It can pinch the skin and the fatty tissue between the spur and the chair.

Some experts say scoliosis is a possible cause of tailbone pain. This is an abnormal curve in the spine.

Nerve pain: The ganglion impar is a bundle of nerves. It is located in front of the upper part of the tailbone. Overactivity or irritation of these nerves may cause recurrent tailbone pain.

Pelvic floor muscle spasms: The tailbone is where a deep layer of pelvic floor muscles attach. Pelvic floor muscles help support many of your body's internal organs.

Muscle spasms and irritation of these muscles can cause levator ani syndrome. This is a condition that causes a dull, aching pain. This pain is often felt in the tailbone. It may also be felt in the rectum, the last few inches of your large intestine.

Recap

Sometimes, bone spurs on the tailbone can cause pain. The pain may also be caused by nerve problems or spasms of the pelvic floor muscles.

Referred Pain

You may have referred pain to your tailbone. This means the pain feels like it is coming from your tailbone when it's really coming from another part of your body.

Conditions that may refer pain to the tailbone include:

Lumbar spine disease: In the lower spine, degenerative disc disease (DDD) may refer pain to the tailbone. If your pain is caused by DDD, you won't have tenderness in your tailbone.

Pelvic organ diseases: Pelvic organ disease may refer pain to the tailbone. Examples include:

Proctalgia fugax: This is severe but fleeting episodes of rectal pain. It can be caused by pudendal nerve compression. Your pudendal nerve is the main nerve of your perineum. This is the area between your tailbone and a joint called the pubic symphysis.

Rare Causes

Other causes of tailbone pain are less common. Still, these causes can be dangerous. They require urgent medical attention.

Cancer: In rare instances, a tumor can spread to the tailbone. This may happen with certain cancers such as:

When this happens, the tumor may cause tailbone pain.

Primary bone tumors may also occur on the tailbone or in the tailbone area. A primary tumor is a tumor that happens on its own and is not the result of cancer spread. This is also rare.

Infection: An infection may also cause tailbone pain. A pilonidal cyst is an example of this kind of infection. The infection can cause:

  • Swelling
  • Pain over the tailbone
  • Redness
  • Warmth
  • Pus, which is thick, whitish fluid

A bone infection called osteomyelitis may also cause tailbone pain. This is also rare.

This kind of bone infection can begin with a pressure ulcer. These ulcers form when long-term pressure limits blood flow to the area. Signs may include:

  • Fever
  • Warmth
  • Redness near the tailbone

Recap

Infection and cancer are rare causes of tailbone pain.

When to See a Healthcare Provider

See a doctor if:

  • Your pain is severe or gets in the way of daily activities.
  • Your pain doesn't go away even though you've tried treating it.
  • You have a lump or mass on your tailbone.
  • You have a fever or redness, warmth, swelling, or drainage near or on your tailbone.

How Are the Causes of Tailbone Pain Diagnosed?

Your medical history will help your doctor find the cause of your pain. Let your doctor know about any falls or other accidents that involved your tailbone. If your pain came on gradually, a physical exam might be necessary.

Physical Examination

During your exam your doctor will look for:

  • Bruising
  • Swelling
  • Rash
  • Signs of infection, like warmth, redness, or discharge
  • A skin dimple, which could be a sign of a bone spur

Your doctor may also press on your tailbone. If the area is tender, it could mean there's a fracture.

Your doctor may also decide to do a rectal exam. During this exam, the doctor inserts a lubricated, gloved finger into your anus and grasps your tailbone between thumb and forefinger.

This helps the doctor evaluate the range of motion in the joint and ligaments. It can also reveal tenderness in the area.

Imaging

Sometimes, but not always, x-rays can identify a tailbone injury.

These x-rays may be done while you're standing and sitting down. This can help find the extent of the injury. It may also find alignment problems, dislocations, or fractures.

In rare cases, your doctor may order a magnetic resonance imaging scan (MRI). During this scan, a magnetic field and radio waves create images of the internal structures around your tailbone. This can be used to find cancer or infection.

Recap

The cause of tailbone pain can often be found based on your symptoms, medical history, and an exam. In some cases, imaging can help.

Treatment of Tailbone Pain

Lifestyle changes can help most causes of tailbone pain. Recovery may take a while.

A bruised tailbone can take between a few days and a few weeks to completely heal. A fractured tailbone can take four to six weeks.

You should be able to return to normal daily activities over time as you heal. A full return to sports depends on the sport. Before you can go back to high-impact activities, you need to be able to sit, bend, and walk without pain.

Lifestyle Treatment Options

Here are some self-care strategies you can do at home. These can help ease pain and avoid further injury as you heal.

Avoid prolonged sitting: When you sit down, lean forward to take pressure off your tailbone. Do not sit on a "doughnut." This is a circular cushion with a hole in the middle. A doughnut can isolate your tailbone. This puts more pressure on it.

Instead, use a coccygeal cushion. This is a special wedge-shaped cushion available over the counter. These cushions help ease pressure on the tailbone.

Apply ice or heat: Apply ice to the tailbone area for 10 to 15 minutes several times a day. Do this for up to three days after the injury. This can help reduce pain.

You may want to try both ice and heat to see which works best for you. Neither has been shown to be better than the other.

Avoid constipation: Constipation can make tailbone pain worse. Eat high-fiber foods and drink plenty of water. This will help soften stools and make bowel movements easier.

Recap

Most causes of tailbone pain can be treated at home. Avoid sitting for long periods of time, use ice or heat, and avoid a diet that can cause constipation.

Medication

Your doctor may also recommend a topical or oral nonsteroidal anti-inflammatory drug (NSAID). This can help reduce pain and inflammation.

If your pain doesn't go away after at-home care, your doctor may prescribe a stronger pain medication. A steroid injection into the joint or ligaments in the tailbone area may also help control pain.

If your pain is caused by the ganglion impar, a nerve block may help. This is an injection that helps block pain signals.

Infection can be treated with antibiotics. It may also need to be surgically drained.

Physical Therapy

If your pain is caused by pelvic floor muscle spasms, physical therapy can help. This often includes:

  • Exercises to help you improve your posture
  • Stretching
  • Reverse Kegels, or relaxation exercises for your pelvic floor

Surgery

In very rare cases, you may need surgery to remove your tailbone.

Recap

Pain medication can help with your tailbone pain. Depending on the cause, other types of medication and/or physical therapy may also be helpful. In rare cases, surgery may be needed.

Preventing Tailbone Injury

Many tailbone injuries can't be prevented. Still, you can take steps to stop them from happening.

Use protective gear when you play sports. The right padding can often reduce the risk of tailbone injury.

Summary

Tailbone pain can have many causes. It may be degenerative. It may also happen because of a sudden injury or repetitive stress.

Bone spurs, nerve pain, and problems with the muscles of the pelvic floor can also cause tailbone pain. Rarely, tailbone pain may be caused by an infection or cancer.

See a doctor if your pain is severe and does not go away after self-care. A tailbone lump or signs of infection like fever and redness are also reasons to see a doctor.

Your doctor will diagnose the cause of your pain based on your medical history, symptoms, and a physical exam. You may also need imaging.

Tailbone pain can usually be treated at home. Medication may also help. Some causes of pain can be treated with physical therapy. Rarely, you may need surgery.

You can help protect yourself from sports-related tailbone injury by using protective gear.

Tailbone pain is common. Try not to feel embarrassed or self-conscious about it.

Frequently Asked Questions

  • How can I sleep comfortably with tailbone pain?

    Lying on your side takes pressure off of the tailbone. Other strategies that may work include using a soft foam mattress topper. Special pillows with a face cut out let you lie on your stomach with your head down.

  • Why does giving birth cause tailbone pain?

    Certain circumstances during childbirth put pressure on the tailbone and can cause tailbone pain. A difficult delivery increases the risk. The use of forceps increases it even more. It’s possible that mothers with a body mass index greater than 27 may also be more likely to suffer tailbone injuries.

  • Can you exercise when you have an injured tailbone?

    Yes, but contact sports that could re-injure the tailbone should be avoided. Also avoid sitting exercises like biking or rowing that put pressure on the area. Stretching is recommended. A physical therapist can offer exercises that can help you recover from your specific injury.

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15 Sources
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