Causes of Tailbone Pain and Treatment Options

Everything you need to know about coccydynia

Tailbone pain (coccydynia) can occur after trauma to the tailbone (a.k.a. coccyx) or another compromising issue, such as vaginal childbirth or degenerative joint changes.

It is one of the most uncomfortable sensations and can be disabling, considering it tends to occur when sitting, standing for a long period of time, and rising from a seated position. Pain during bowel movements and sex are also quite common. Discomfort can range from faint, throbbing pain to sharp pain that radiates up and/or down.

The tailbone is the point of attachment for various muscles, tendons, and ligaments. It consists of three, four, or five small bones, called coccygeal vertebral bones, that are located at the very end of your spinal column, below the sacrum (a triangle-shaped bone located between your two hip bones).

tailbone pain causes
Illustration by Alexandra Gordon, Verywell

Causes

There are multiple potential causes for tailbone pain, with some more common than others.

Common Causes

The most common cause of tailbone pain is trauma, including both direct, forceful trauma and repetitive trauma to the coccyx. But there are other possibilities to consider.

Trauma: Tailbone pain may be due to a fall backward on your bottom or another sort of trauma to your coccyx that inflames the ligaments in the tailbone area. The severity of the injury can range from a bruise to a fracture of the coccyx. Rarely, dislocation of the sacrococcygeal joint, which is located between the top of your sacrum and the base of your coccyx, may occur as a result of trauma and cause coccydynia.

In addition, activities, like horseback riding or cycling, can increase the risk of tailbone pain due to repetitive pressure or friction on the coccyx for long periods of time. Likewise, simply sitting on a hard surface during a long car ride or airline flight may cause tailbone pain.

Since the coccyx is the insertion site for many muscles and ligaments, any trauma resulting in a strain to the pelvic floor muscles or inflammation of the ligaments in the tailbone area may lead to coccydynia as well.

Vaginal Childbirth: Vaginal childbirth, especially if the delivery is difficult and forceps are used, can cause tailbone pain due to the pressure placed on the top of the coccyx from the baby's head. Typically, tailbone pain from childbirth is a result of a bone bruise or ligament strain, although sometimes the coccyx does fracture.

Degenerative Joint Disease: As with bones and joints in other parts of the body, wear and tear from aging or repetitive motions can cause degenerative joint disease of the coccyx, also known as osteoarthritis.

Unique Coccyx Morphology: As mentioned above, there is variability in the number of coccygeal bones a person has; more bones mean more opportunity for issues. In addition, some people have a bone spur or spicule (a bony growth) located on the lowest tip of the coccyx.

This growth can irritate the coccyx area when a person sits; specifically, it can pinch the skin and the fatty tissue between the spur and the chair. Besides a bony growth, some experts report scoliotic deformity as a potential cause of coccydynia.

Nerve Pain: A bundle of nerves called the ganglion impar is located in front of the upper part of the coccyx. Overactivity or irritation of these nerves may cause chronic coccyx pain.

Pelvic Floor Muscle Spasms: Since the tailbone serves as the attachment site for a deep layer of pelvic floor muscles (called levator ani), muscle spasms and irritation can cause a dull, aching pain, often felt in the coccyx and higher up in the rectum.

Rare Causes

Though less common, these other causes of tailbone pain may be considered by your doctor.

Cancer: In rare instances, a malignant tumor that has metastasized to the tailbone (for example, cancer from the prostate, ovaries, cervix, or colon) may be the source of tailbone pain. Also rarely, a primary bone cancer called a chordoma may arise on the coccyx or within the coccygeal region.

Infection: An infection located in the tailbone area, such as a pilonidal cyst, can cause swelling and pain over the coccyx, along with redness, warmth, and drainage of a thick, whitish fluid (pus).

An infection of the actual coccyx bones, called osteomyelitis, may also rarely cause coccydynia. Often, a person will have a history of a deep sacrococcygeal decubitus ulcer and have signs of an infection like fever, as well as warmth and redness along the coccyx.

When to See a Doctor

If your tailbone pain is severe and debilitating—for instance, you are not able to go to work or care for your children or home—be sure to see your doctor.

Other symptoms of tailbone pain that warrant seeing a doctor include:

  • Persistent pain, despite conservative measures
  • A lump or mass on your tailbone
  • A fever or redness, warmth, swelling, or drainage of an area near or on your tailbone

Diagnosis

While your medical history may reveal an inciting factor, like a direct fall or another sort of trauma to your tailbone, some people report more of a gradual onset of tailbone pain. In this instance, a physical exam plays a key role in diagnosing the "why" behind your tailbone pain.

Physical Examination

During a physical exam, your doctor will first inspect your tailbone for bruising, swelling, rash, or signs of an infection (warmth, redness, or a discharge). Your doctor may also look for a skin dimple, which may be present over a coccyx bone spur. Lastly, your doctor will press on your tailbone to see if there is any localized tenderness, which could signify a potential fracture.

In addition, in some cases, your doctor may perform a rectal exam, in which he inserts a lubricated, gloved finger into your bottom, grasping the coccyx between his thumb and forefinger. This allows him to evaluate the sacrococcygeal joint and surrounding ligaments for tenderness and joint range of motion.

Imaging

X-rays don't always reveal a tailbone injury, but your doctor may take them while you're in the standing and seated positions to assess the extent of a tailbone injury and note any alignment problems, dislocations, or fractures of the tailbone. A magnetic resonance imaging scan (MRI) may be ordered to diagnose cancer or infection of the coccyx.

Differential Diagnoses

When seeing your doctor for tailbone pain, your doctor will consider referred pain to the tailbone, which is pain that feels like it is coming from your tailbone when it's really coming from another area of the body.

Here are some medical conditions that may refer pain to the tailbone:

Lumbar Spine Disease: Degenerative disc disease in the lumbar spine can refer pain to the tailbone. The key to distinguishing lumbar spinal disease from true tailbone pain is that on physical exam, with spine disease, there will be no tenderness when pressing on the tailbone.

Pelvic Organ Diseases: Diseases of the pelvic organs, like pelvic inflammatory disease in women or prostatitis in men, may refer pain to the coccyx.

Proctalgia Fugax: Proctalgia fugax refers to severe, fleeting episodes of rectal pain, potentially caused by pudendal nerve compression. Your pudendal nerve is the main nerve of your perineum, which is the area between your coccyx and your pubic symphysis.

Treatment

Most cases of tailbone pain can be treated with lifestyle modifications.

Keep in mind, a bruised tailbone may take several days to weeks to completely heal while a fractured tailbone can take four to six weeks. In general, you should be able to return to activities slowly as you heal. A full return to sports may depend upon the sport you play, but you need to be able to sit, bend, walk without pain.

Lifestyle Treatment Options

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

Avoid Prolonged Sitting: It may sound obvious, but avoid long periods of sitting. If you must sit, lean forward to take the pressure off your tailbone. Some people sit on a "doughnut," a circular cushion with a hole in the middle of it, to relieve tailbone pressure during sitting, although this can actually isolate the tailbone, placing more pressure on it. Instead, choose a modified wedge-shaped cushion (called a coccygeal cushion) to ease pressure on the tailbone. These are available over the counter.

Apply Ice or Heat: Ice can be applied to the tailbone area for 10 to 15 minutes several times a day for up to three days after the injury to help reduce pain. Using a heating pad may also be beneficial. Experts recommend trying both ice and heat to see which strategy works for you, as neither has been proven to be better than the other.

Avoid Constipation: Eating high-fiber foods and drinking plenty of water can help soften stools and make bowel movements easier.

Medication

Your doctor may also recommend a topical or an oral nonsteroidal anti-inflammatory (NSAID) to reduce pain and inflammation. If your pain persists despite taking an NSAID and engaging in the above conservative measures, be sure to see your doctor. He may prescribe a stronger pain medication, or inject a steroid into the joint or ligaments surrounding the sacrum and coccyx to control chronic pain. A ganglion Impar nerve block may also provide relief if deemed the source of a person's pain.

If an infection is the cause of your tailbone pain, antibiotics and potentially surgical abscess incision and drainage may be required.

Physical Therapy

If pelvic floor muscle spasms are the cause behind a person's coccydynia, physical therapy is the treatment of choice. Therapy interventions often include postural retraining exercises, stretching, and reverse Kegel exercises.

Surgery

Very rarely, a surgery called a coccygectomy (in which the coccyx is surgically removed), is used to alleviate pain.

Prevention

While many tailbone injuries cannot be prevented, it's important to use the appropriate protective equipment and gear for your sports. The right padding can often reduce the risk of injuries to the tailbone.

A Word From Verywell

Tailbone pain is a relatively common ailment, so try not to feel embarrassed by it or self-conscious about it. Hopefully, your mind is at ease knowing that in the vast majority of cases, tailbone pain gets better with simple measures like avoiding exacerbating factors (e.g. prolonged sitting) and taking oral pain medications.

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