Coccydynia (Tailbone Pain): Causes, Symptoms & Treatment
Coccydynia is pain in the tailbone (coccyx), the small bone at the base of the spine. Coccydynia typically hurts when you sit, especially leaning back, and when you stand up from a chair. This guide explains what causes tailbone pain, how coccydynia is diagnosed, and the treatment options, from cushions and therapy to image-guided injections.
What Is Coccydynia?
Coccydynia is pain in the coccyx, the small triangular bone at the very bottom of the spine. The coccyx is made of three to five small segments and serves as an anchor for pelvic floor muscles, tendons, and ligaments. Because you partly sit on it, coccydynia is usually worse when sitting, particularly when leaning back, and when standing up from a chair.
Causes of Tailbone Pain
- Falls: landing on the buttocks can bruise, sprain, or fracture the coccyx.
- Childbirth: pressure on the coccyx during delivery can strain its ligaments.
- Prolonged sitting: long hours on hard or narrow seats, or cycling, can irritate the area.
- An unstable or bent coccyx: a coccyx that moves too much (hypermobile) or partially dislocates when you sit.
- Bone spurs on the tip of the coccyx.
Sometimes no clear cause is found. Pain referred from the lower spine, pelvic floor muscles, or the pudendal nerve can also feel like tailbone pain, which is why a careful exam matters.
Symptoms
- Pain and tenderness right at the tailbone
- Pain when sitting, especially when leaning back
- A sharp pain when moving from sitting to standing
- Pain that eases when standing or walking
- Sometimes pain with bowel movements or intercourse
Coccydynia vs Pudendal Neuralgia vs Low Back Referred Pain
Coccydynia usually causes pain you can point to with one finger, right over the tailbone. Pudendal neuralgia tends to cause burning or electric pain in the genital or rectal area that worsens with sitting and is not focused on the coccyx. Pain from the lower back usually changes with spine movement and may be accompanied by back stiffness; see lower back pain when sitting. A Tarlov cyst in the sacrum and other causes of buttock pain are also considered.
Diagnosis
- A history of how the pain started and what makes it worse
- An exam, including gentle pressure on the coccyx to locate the pain
- Standing and seated (dynamic) X-rays, which can show a coccyx that moves too much
- MRI when the cause is unclear or to rule out other problems
A diagnostic injection near the coccyx can help confirm that it is the source of pain.
Treatment Options for Coccydynia
Most people with coccydynia improve with conservative care, and treatment is tailored to the cause and to how much the pain limits daily life.
Conservative Care
- Cushions: a wedge cushion or one with a cutout at the back.
- Sitting changes: leaning slightly forward, taking breaks, and avoiding hard seats.
- Medications: anti-inflammatories when medically appropriate.
- Pelvic floor physical therapy and manual therapy to relax tight muscles attached to the coccyx.
Image-Guided Injections
When pain persists, a coccyx (tailbone) injection or ganglion impar block can reduce pain. In selected cases, radiofrequency treatment of the ganglion impar is considered.
Relief from injections varies and is not permanent for everyone. Potential risks include soreness, bleeding, infection, and medication side effects.
Dr. Amit Sharma & our minimally invasive pain & spine team.
When Is Surgery Considered?
Surgical removal of the coccyx (coccygectomy) is reserved for carefully selected patients whose coccydynia remains disabling after thorough non-surgical care. Wound healing problems and infection are recognized risks, so the decision is made carefully with a surgeon.
When to Seek Medical Care
Seek prompt care for fever, a red, swollen, or draining lump near the tailbone (a possible pilonidal infection), new bladder or bowel changes, numbness in the groin or inner thighs, unexplained weight loss, or a history of cancer.
Schedule an evaluation if tailbone pain lasts beyond several weeks or keeps returning.
Coccydynia Care at SpinePain Solutions
At SpinePain Solutions, Amit Sharma, MD, Chief, Division of Pain Medicine, Good Samaritan University Hospital, and our team evaluate coccydynia and other causes of tailbone pain, and offer image-guided, minimally invasive care at our Bay Shore, Commack, and Farmingdale offices. Call 631-310-0000 to schedule.
Frequently Asked Questions
Why does my tailbone hurt when I sit?
Sitting, especially leaning back or sitting on a hard surface, puts direct pressure on the coccyx and the ligaments and pelvic floor muscles attached to it. When the tailbone or those tissues are irritated, that pressure is painful.
Why does tailbone pain get worse when I stand up from sitting?
Moving from sitting to standing makes the coccyx shift as the pelvic floor muscles pull on it. If the tailbone is unstable or inflamed, that movement often causes a brief, sharp pain.
How long does coccydynia last?
It varies. Many people improve over weeks to a few months with cushions, sitting changes, and therapy. Pain that lasts beyond several weeks or keeps returning deserves an evaluation.
Can you get tailbone pain without a fall or injury?
Yes. Coccydynia can follow childbirth, long periods of sitting on hard surfaces, or an unstable coccyx, and sometimes no clear cause is found.
Do coccyx cushions help with tailbone pain?
Many people find that a wedge cushion or a cushion with a cutout at the back takes pressure off the tailbone and makes sitting more tolerable. It works best combined with posture and sitting-time changes.
Dr. Amit Sharma & our minimally invasive pain & spine team.
What is a coccyx (tailbone) injection?
It is an image-guided injection of a local anesthetic, often with a steroid, near the painful coccyx or the ganglion impar, a small nerve cluster in front of the tailbone. It can relieve pain and also help confirm where the pain is coming from.
When is tailbone pain a sign of something serious?
Seek prompt care for fever, a red, swollen, or draining lump near the tailbone, new bladder or bowel changes, numbness in the groin, unexplained weight loss, or a history of cancer.
Medical References
- Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. 2014. PubMed.
- Foye PM. Coccydynia: Tailbone Pain. Phys Med Rehabil Clin N Am. 2017. PubMed.
- Coccyx Pain. StatPearls. NCBI Bookshelf.
