Tailbone (coccyx) pain
The coccyx is a small bone made of several fused vertebrae at the very bottom of the spine, between the buttocks.
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Medicines commonly prescribed for Tailbone (coccyx) pain
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: MODIFIED-RELEASE TABLET, 800 mgActive substance: ibuprofenManufacturer: Viatris Healthcare LimitedPrescription requiredDosage form: INJECTABLE PERFUSION, 10 mg/mLActive substance: paracetamolManufacturer: Fresenius Kabi España, S.A.U.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 20 mg/mlActive substance: ibuprofenManufacturer: Laboratorios Cinfa S.A.Prescription not required
The coccyx is a small bone made of several fused vertebrae at the very bottom of the spine, between the buttocks. The pelvic floor muscles and several ligaments anchor to it, and its movable joint with the sacrum leaves it exposed: one bad landing when a chair is not where you thought it was, and finding a comfortable position becomes a project that lasts months. Tailbone pain is wearing and miserable, but it is almost always harmless, and in most people it settles by itself over weeks or a few months. It is considerably more common in women than in men, because of the shape of the pelvis. What follows is what can be done about it, and the situations in which something more serious sits behind it.
Where it comes from
Most of the time the cause is simple and the person already knows it:
- A fall onto the buttocks. A slippery staircase, ice, missing the chair. The coccyx can be bruised and sometimes cracked or shifted at its joint with the sacrum.
- Childbirth. During the pushing stage the coccyx bends backwards, and afterwards it not uncommonly aches for weeks or months, particularly after a long or a very fast labour or a big baby.
- Long periods of sitting and repeated strain. Desk work without breaks, long drives, cycling, rowing, a hard narrow saddle or seat. There is no single event here, only accumulation.
- A sharp change in weight. Carrying extra weight tilts the coccyx further back when sitting; marked weight loss removes the padding, and the bone presses straight onto the surface.
- Excess movement at the joint between the coccyx and the sacrum, sometimes as part of general joint hypermobility.
In a fair number of people no cause is ever found: the pain began with no fall and no obvious overload. On its own that is not alarming, but it is exactly the situation in which a doctor examines more carefully, for the reasons set out below.
How it behaves
The pain sits in one spot, right at the base of the spine between the buttocks. It is usually dull and aching, with sharper stabs on movement, and its defining feature is that it is tied to positions and actions:
- worse when sitting, especially on a hard surface and especially when leaning back;
- sharply worse at the moment of sitting down or standing up;
- worse when leaning backwards or trying to perch on one buttock;
- painful when opening the bowels, particularly when the stool is hard;
- it can hurt during sex and, in women, before and during a period;
- lying on the back and standing usually give relief, while at night it makes finding a position and turning over difficult.
The area can become tender to the lightest touch: a waistband or the back of a chair is enough. The discomfort may spread to the sacrum, the backs of the thighs and around the anus, but in ordinary coccydynia there is no true numbness and no weakness in the legs.
The main thing: take the weight off the coccyx
Everything else is secondary to this.
- A cushion with a cut-out. A wedge cushion with a notch or gap at the back, so that the coccyx sits over thin air and touches nothing. That shape works better than the classic ring, which sometimes raises the pressure instead. Carry it with you — to work, into the car, to other people's houses.
- Sit less and change position often. Get up every twenty to thirty minutes and do some tasks standing or on the move. Long unbroken sitting is the single biggest thing keeping the pain going.
- Lean slightly forward. When sitting, take the weight on the thighs and bring the trunk a little forward rather than back: that unloads the coccyx. A firm chair with an upright back is better here than a deep soft sofa.
- Lie on your side. The simplest way to give the coccyx a rest once sitting has become impossible.
Settling the pain itself
- Heat. A hot water bottle through a cloth, a warm shower or bath relaxes the pelvic floor muscles and usually brings more relief than cold. In the first day or two after a fall the opposite makes sense: an ice pack wrapped in a towel for fifteen or twenty minutes.
- Painkillers. Paracetamol and the non-steroidal anti-inflammatory group both help. Take them in short courses, and where there is stomach, kidney or heart disease, or other medicines are being taken, check the choice with a doctor or a pharmacist.
- Keep the stool soft. If the worst moment of the day is on the toilet, the cycle is broken with fibre, water and a softening laxative from the pharmacy: straining with a sore coccyx is exactly what you do not want.
- Work on the pelvic floor. Tight pelvic floor muscles keep the pain going by themselves. A physiotherapist who works with this area will teach you to release and gently stretch them, and where needed will use hands-on techniques. It is the most underrated part of the treatment, and it is often what finally shifts things.
What not to do
A few familiar habits drag the recovery out:
- staying seated "until it passes", enduring it slumped against the backrest;
- wearing tight clothing and stiff belts that press on the lower back and buttocks;
- applying heat or rubbing the area if there is redness, swelling or a temperature — that is not a bruise, that is inflammation;
- letting anyone without medical training massage or manipulate this region;
- taking to bed for a week: complete rest weakens the muscles and the pain comes back more readily afterwards. Walking, by contrast, is good for it.
When to be seen without delay
Coccydynia is almost always harmless, but pain in this area has a few causes that must not be missed. See a doctor the same day if:
- the pain followed a serious injury — a fall from a height, an impact in a road accident — or you cannot sit or stand after the fall;
- you have a temperature and the skin over the coccyx is red or swollen, is discharging, or there is a tender lump you can feel;
- the pain wakes you at night and comes with weight loss, marked weakness and sweats;
- the pain began for no reason at all and, far from easing, is building week by week;
- you have been treated for cancer in the past.
In those situations the aim is to rule out a fracture, an infection (an infected pilonidal sinus, infection in the bone) and a tumour: rare growths do occur in the sacral and coccygeal region, and what gives them away is precisely this persistent, worsening, night-time pain.
Something else calls for an immediate response — an ambulance (in Spain, Italy, Portugal, Poland and Ukraine the single European emergency number is 112) or emergency care. That is numbness appearing and spreading in the perineum, around the anus and on the inner thighs — the saddle area — or difficulty starting to pass urine, or losing control of the bladder or bowels, or increasing weakness in the legs. These are signs of pressure on the nerve roots at the bottom of the spinal canal, and here the clock runs in hours: whether the function recovers depends on how quickly that pressure is relieved.
If the pain drags on for months
When home measures and physiotherapy have brought nothing after a few weeks, the doctor examines the area — including from inside the rectum, which is how the movement and tenderness of the coccyx-sacrum joint is assessed — and orders an X-ray or a scan if needed; sometimes an X-ray is taken sitting down, to see how the coccyx shifts under body weight.
From there, several things can be offered:
- a further course of physiotherapy with hands-on work on the pelvic floor muscles;
- an injection of a corticosteroid with local anaesthetic into the joint between coccyx and sacrum; sometimes a block of the nerve ganglion that carries sensation from this region is done instead. These injections are repeated only a limited number of times, and that is usually enough;
- medicines aimed at nerve pain, if the pain has turned burning and electric in character;
- removal of the coccyx — a last resort, used rarely, only for pain that has resisted everything else, and after an honest conversation: it does not help everyone, and recovery from it is slow.
The encouraging part is that very few people ever reach surgery. The great majority get better without it, even if sometimes it takes not a month but half a year.
Online consultation
Tailbone pain is exactly the kind of problem that works well remotely. The doctor will ask how it started, what makes it worse and what helps, and the first job is to go through the warning signs and make sure there is no fracture, infection or nerve compression behind it — that is the main thing gained by asking a professional rather than a forum. After that the conversation turns practical: how to choose and use the cushion properly, how to rebuild your desk setup and your long drives, which painkiller suits you given your other conditions, what to do about painful bowel movements, and who to see for pelvic floor work. Timescales are worth discussing too: simply knowing that it may still hurt in a month, and that this is normal, takes away half the worry. And if the pain has run on for months, the doctor can advise which investigations are worth doing and whether it is time to consider an injection.
This material is for information only and does not replace medical advice.
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