Tailbone pain or pain in the coccyx (the lowest portion of the spine) may occur suddenly after an obvious injury. It can also appear over time, with no apparent cause.
The pain may radiate to the hips, thighs, or even to the rectum. It can make sitting difficult, exercise painful, and may even disrupt sleep. The right treatment, as well as some home management strategies, can help.
This article explores the causes of tailbone pain, how it is diagnosed, and what can be done to treat it.
The technical term for tailbone pain is coccydynia. In most people, the pain is a dull, throbbing ache that feels like a muscle spasm.
Some people with tailbone pain also experience sharp, stabbing pain. This pain may occur when physically active or when sitting for extended periods of time.
The pain may radiate down the legs or up the back. It can feel like it is in the tailbone itself, or in the surrounding muscles and structures.
Sometimes, depending on the cause, tailbone pain may also coincide with:
- nausea and vomiting
- loss of sensation
- muscle weakness
- digestive discomfort, including pain in the rectum
A wide range of health issues, ranging from minor to serious, can cause tailbone pain.
The pain often goes away on its own, particularly with home management. So, if the pain is minor and there is no known cause, it is safe to wait a few weeks before seeking medical care.
The most common sources of tailbone pain include:
- A blow: This could be to the tailbone or the surrounding muscles. For example, falling from a bicycle may injure the tailbone, while running into the wall might cause pain radiating from other muscles to the tailbone.
- Sitting down: Especially for extended periods of time, or in awkward positions.
- Trauma during childbirth: The tailbone can be injured or even broken while delivering a baby.
- Degeneration: To nerves or joints.
- Compression: This can happen to nerves when pressure occurs during pregnancy.
- Pelvic floor dysfunction: Often due to childbirth.
- Levator syndrome: This is a condition that causes spasms in the muscles of the anus. The pain may radiate to the tailbone, hips, or other nearby areas.
- Straining: This could be due to constipation or hemorrhoids.
- Problems with the spine: For example spinal surgery or degenerative lumbar disc disease.
- Infections, tumors, bone spurs, and growths: Rarely, these may be the cause coccyx pain.
Some strategies can help with tailbone pain. These include:
- Over-the-counter medications: For example, ibuprofen, aspirin, or acetaminophen.
- Gentle stretches and exercise: If you are healthy enough to exercise, yoga or Pilates may stretch the muscles surrounding the coccyx, offering relief for pain related to minor injuries or sitting for too long.
- An interaction between injuries and lifestyle: A minor injury can cause lingering effects. A person who injures their tailbone may unconsciously tense surrounding muscles or avoid exercising. This can slow down healing, and may weaken or damage surrounding muscles. Over time, this can cause chronic pain, even when the original injury has healed.
- Increasing activity level: People who must sit at desks for most of the day should consider taking an hourly break to walk for a few minutes, or switching to a standing desk.
- Sitting on a donut pillow: This helps to avoid putting pressure on the tailbone.
- Applying ice or heat to the area: Alternating between hot and cold packs can increase blood flow and reduce inflammation, offering more rapid pain relief. Apply a hot pack for 15-20 minutes, rest for 15-20 minutes, and then apply a cold pack. Repeat the process for as long as desired.
- Gentle massage to the affected area: Massaging the muscles around the coccyx can help, particularly if the pain is due to sitting down for long periods or muscle injuries.
- Topical creams: Much like over-the-counter medications, these may reduce pain.
- Soaking the area in an Epsom salt bath: This strategy is particularly useful if the pain is referred pain from hemorrhoids, rectal pain, or Levator syndrome.
Tailbone pain is almost never an emergency. However, people should seek emergency care if the pain is due to a sudden trauma and they experience:
- a loss of sensation
- extensive bruising
- changes in movement or coordination
- tingling in surrounding areas could mean the tailbone or a nearby structure is broken
People should see a doctor to rule out potentially serious medical issues if:
- tailbone pain does not improve after a week or two
- chronic pain improves but then returns
- home treatment makes the pain worse
- tailbone pain is accompanied by other unexplained symptoms
- a fever develops
To make a diagnosis, a doctor will undertake a comprehensive assessment that includes a complete medical history.
The doctor may ask about:
- previous pregnancies and childbirth experiences
- a history of gastrointestinal problems
- any other muscle problems
Depending upon symptoms and medical history, some tests can evaluate the source of the pain. These include:
- a pelvic exam to assess the pelvic floor
- a rectal exam to determine whether a problem with these muscles is the culprit
- imaging tests, such as routine X-rays, magnetic resonance imaging (MRI) scans of the tailbone and spinal cord
- blood tests to rule out other causes, such as an infection or autoimmune condition
Treatment for tailbone pain usually focuses on managing symptoms. The most common strategies include:
- Physical therapy: The physical therapist may make recommendations for strengthening the surrounding muscles, supporting the pelvic floor, or moving and sitting in a way that is less likely to irritate the tailbone.
- Prescription pain medication: If symptoms are not responding to over-the-counter treatments, a doctor may prescribe opioids or other prescription painkillers.
- Surgery to address any structural problems: These may include pelvic floor prolapse or a herniated disc. Treatment may require removal of a portion of the coccyx.
- Injectable medications: Injecting a local anesthetic with or without a steroid can often alleviate pain. This may help with muscle tension while working with a physical therapist to address the underlying cause of the pain.
- Psychotherapy: This is a surprisingly effective treatment for chronic pain. Therapy can address psychological components of pain, help with pain tolerance, and tackle any barriers to healthy pain management, such as sedentary lifestyle.
- Treatment for underlying medical conditions: Coccyx pain caused by straining due to hemorrhoids, for instance, may improve with frequent sitz baths or surgery to correct the hemorrhoids.
Sometimes coccyx pain requires no treatment. Women who experience tailbone pain during pregnancy typically find that symptoms resolve within a few weeks of giving birth. Pain that is due to an injury may get better on its own, even without treatment.