Causes of Tailbone Pain and Treatment Options

Everything you need to know about coccydynia

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Tailbone pain (coccydynia) can develop after injury to the tailbone (a.k.a. coccyx), which can occur due to degenerative joint changes, or as a result of acute or repetitive trauma. Horseback riding and vaginal delivery are among the common causes of coccydynia.

It is an uncomfortable sensation that can range from a faint, throbbing pain to severe, disabling, sharp pain that radiates up and/or down. The pain and discomfort tend 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.

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

Verywell / Alexandra Gordon

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. Since the coccyx is the insertion site for many muscles and ligaments, this may include direct, forceful trauma, or repetitive trauma to the bones of the coccyx or to the surrounding muscles or ligaments.

Acute trauma: Falling backward on your bottom or any trauma to your coccyx can cause inflammation or strain of the structures in your tailbone area.

The injury may cause a bruise or 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.

Repeated trauma: 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.

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 can fracture.

Degenerative Joint Disease: Wear and tear from repetitive motions can cause osteoarthritis, a degenerative joint disease that can affect any joint in the body, including the coccyx.

Unique Coccyx Morphology: There is variability in the number of coccygeal bones a person has. 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. 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 levator ani syndrome, a condition that causes a dull, aching pain, often felt in the coccyx and higher up in the rectum.

Rare Causes

Though less common, other causes of tailbone pain can be especially dangerous and require urgent medical attention.

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 chordoma, which is a primary bone tumor, 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 pus (thick, whitish fluid).

Osteomyelitis, a bone infection, may also rarely cause coccydynia. This can begin with a deep sacrococcygeal decubitus ulcer and can produce signs of an infection, including fever, warmth, and redness near the coccyx.

When to See a Healthcare Provider

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 healthcare provider.

Other symptoms of tailbone pain that warrant seeing a healthcare provider include:

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

Diagnosis

Your medical history may reveal an inciting factor, like a direct fall or another sort of trauma to your tailbone. Or you may have had 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 your physical exam, your healthcare provider will first inspect your tailbone for signs of bruising, swelling, rash, or infection (warmth, redness, or a discharge). A skin dimple can be an indication of a coccyx bone spur. Your healthcare provider will press on your tailbone to see if you have any localized tenderness, which could indicate a fracture.

In addition, in some cases, your healthcare provider may perform a rectal exam. During this exam, your healthcare provider would insert a lubricated, gloved finger into your anus, grasping the coccyx between their thumb and forefinger to evaluate your sacrococcygeal joint and the surrounding ligaments for tenderness and joint range of motion.

Imaging

X-rays don't always identify a tailbone injury, but your healthcare provider 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 detect cancer or infection of the coccyx.

Differential Diagnoses

Referred pain to the tailbone feels like it is coming from your tailbone when it's really coming from another area of the body.

Medical conditions that may refer pain to the tailbone include:

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 disease is that there will not be tailbone tenderness with spine disease.

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

Proctalgia Fugax: Proctalgia fugax refers to severe, fleeting episodes of rectal pain. It can be 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 between several days and several 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 on the sport you play, but you need to be able to sit, bend, walk without pain before you can resume high-impact activities.

Lifestyle Treatment Options

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

Avoid Prolonged Sitting: While sitting, 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—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 healthcare provider may also recommend a topical or an oral nonsteroidal anti-inflammatory (NSAID) to reduce pain and inflammation.

If your pain persists despite conservative measures your healthcare provider may prescribe 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 your pain.

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

Physical Therapy

If pelvic floor muscle spasms are the cause of your 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 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.

Frequently Asked Questions

  • How can I sleep comfortably with tailbone pain?

    Doctors often recommend lying on your side to take pressure off of the tailbone. Other strategies that may work include using a soft foam mattress topper or special pillows with a face cut out so that you can 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 coccydynia, or tailbone pain. A difficult delivery increases the risk, and the use of forceps for those deliveries 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 along with sitting exercises such as biking or rowing that apply pressure on the area. Stretching is recommended, and a physical therapist can offer exercises that can help you recover from your specific injury.

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17 Sources
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