Understanding the Causes of Tailbone Pain

Coccydynia, commonly called tailbone pain refers to persistent pain at the very bottom of your spine. You may develop this pain after direct trauma or spontaneously without a specific inciting factor. The pain typically lasts for weeks to months and can become debilitating.¹Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. 2014;14(1):84–87. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963058/

This blog outlines all you need to know about your tailbone (coccyx), including the specific causes, symptoms, and treatments for tailbone pain.

The importance of your tailbone

This triangular bone at the terminal end of your spine typically consists of 3 to 5 fused bony segments.¹Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. 2014;14(1):84–87. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963058/ The bone forms a joint with the sacrum above and has limited movement. The primary functions of the tailbone are to:

• Provide attachment to several muscles and ligaments in your pelvic region¹Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. 2014;14(1):84–87. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963058/
• Support the floor of your pelvis¹Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. 2014;14(1):84–87. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963058/
• Provide voluntary bowel control¹Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. 2014;14(1):84–87. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963058/
• Facilitate natural childbirth (in women) by moving backward²Maigne JY, Rusakiewicz F, Diouf M. Postpartum coccydynia: a case series study of 57 women. Eur J Phys Rehabil Med. 2012;48(3):387-92. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22820826

The coccyx is well innervated and can become a significant source of pain if injured.

See Anatomy of the Coccyx (Tailbone)

5 possible causes of tailbone pain

Coccyx pain can develop from direct trauma, repetitive injury, or degeneration of the joint(s) of the coccyx. Here are 5 possible causes of tailbone pain:

1. Coccyx bruising, fracture, or dislocation

Damage to the bony segments or ligaments of the coccyx may occur due to¹Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. 2014;14(1):84–87. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963058/^,3Foye PM. Coccydynia. Physical Medicine and Rehabilitation Clinics of North America. 2017;28(3):539-549. doi:10.1016/j.pmr.2017.03.006:

• Direct trauma to the buttocks, such as by slipping on ice or falling from the stairs and landing in a seated position
• Childbirth, when the coccyx is forced backward beyond its normal range of motion

  See Common Causes of Back Pain in Pregnancy

Being pregnant or overweight may increase the chances of tailbone bruising from trauma.

2. Anatomical changes in the coccyx

Typically, a normal tailbone is tilted in a slightly forward position. If this position changes due to anatomical variations, the tailbone can³Foye PM. Coccydynia. Physical Medicine and Rehabilitation Clinics of North America. 2017;28(3):539-549. doi:10.1016/j.pmr.2017.03.006:

• Impinge on soft tissues, if placed more backward
• Obstruct bowel movements or childbirth, if placed more forward

The segments of the tailbone can also become unstable, resulting in coccygeal dynamic instability. This condition causes excessive movement of one or more segments, especially while sitting.³Foye PM. Coccydynia. Physical Medicine and Rehabilitation Clinics of North America. 2017;28(3):539-549. doi:10.1016/j.pmr.2017.03.006

3. Coccyx bone spurs

Thickened or overgrown bone (bone spurs) near the tip of your tailbone can change its length and/or normal angulation. The bone spur(s) can pinch on the skin and underlying tissues when you sit upright and/or lean backward, causing pain.³Foye PM. Coccydynia. Physical Medicine and Rehabilitation Clinics of North America. 2017;28(3):539-549. doi:10.1016/j.pmr.2017.03.006

4. Coccygeal arthritis

It is possible for degenerative arthritis (osteoarthritis) to develop in the joints of the coccyx due to wear and tear, resulting in tailbone pain.³Foye PM. Coccydynia. Physical Medicine and Rehabilitation Clinics of North America. 2017;28(3):539-549. doi:10.1016/j.pmr.2017.03.006

See Osteoarthritis of the Spine

5. Coccygeal infections and tumors

While rare, tumors or infections may affect the coccyx, causing pain. Chondroma, a malignant bone tumor has a tendency to occur in the coccygeal area.³Foye PM. Coccydynia. Physical Medicine and Rehabilitation Clinics of North America. 2017;28(3):539-549. doi:10.1016/j.pmr.2017.03.006

Osteomyelitis, a Spinal Infection may affect the coccyx in individuals who have medical conditions, such as immunodeficiency, sepsis, or previous coccygeal surgery.³Foye PM. Coccydynia. Physical Medicine and Rehabilitation Clinics of North America. 2017;28(3):539-549. doi:10.1016/j.pmr.2017.03.006

Hyperactivity of the pelvic floor muscles may also contribute to or increase tailbone pain.³Foye PM. Coccydynia. Physical Medicine and Rehabilitation Clinics of North America. 2017;28(3):539-549. doi:10.1016/j.pmr.2017.03.006

Read more about Coccydynia (Tailbone Pain) Causes

Tailbone problems make sitting painful

Tailbone injuries typically have classic symptoms. Depending on the cause and severity, pain from an injured tailbone can be mild to severe and range from a dull ache to sharp, stabbing pain.

Three unique symptoms of a tailbone injury include³Foye PM. Coccydynia. Physical Medicine and Rehabilitation Clinics of North America. 2017;28(3):539-549. doi:10.1016/j.pmr.2017.03.006:

• Pain while sitting. When you sit, a large portion of your body weight rests on your tailbone area. When you have coccydynia, sitting may be uncomfortable and cause localized pain in the region around your tailbone. Sitting on both hard and soft surfaces may elicit pain.
• Pain while partly reclining. If you lean back while sitting, the pain in your tailbone may increase due to additional weight on the coccyx.
• Pain when you stand up from a seated posture. Transitioning from a seated to standing posture may exacerbate your tailbone pain. This increase in pain may occur more in coccygeal dynamic instability—due to excessive movement of the coccygeal bones while sitting and a quick snap back into the normal position upon standing.

While in a seated position, tailbone pain may be relieved by leaning forward or leaning on one buttock, which decreases the amount of weight on the tailbone.³Foye PM. Coccydynia. Physical Medicine and Rehabilitation Clinics of North America. 2017;28(3):539-549. doi:10.1016/j.pmr.2017.03.006

Read more about Coccydynia (Tailbone Pain) Symptoms

Tips to relieve tailbone pain

Tailbone pain usually heals on its own. You can manage your tailbone pain at home by:

• Using coccyx cushions (doughnut, u-shaped, or wedge-shaped cushions) while sitting
• Applying heat and ice therapy to the painful area
• Considering over-the-counter (OTC) topical and oral non-steroidal anti-inflammatory drugs (NSAIDs)
• Taking OTC stool softeners to reduce the pressure on the coccyx during a bowel movement
• Modifying activities to include less sitting

If your tailbone pain does not reduce with these measures, consult a doctor for a more accurate diagnostic checkup and medical treatment. A doctor may recommend steroid or nerve block injections, coccygeal manipulation, and/or pelvic floor physical therapy to manage your tailbone pain.³Foye PM. Coccydynia. Physical Medicine and Rehabilitation Clinics of North America. 2017;28(3):539-549. doi:10.1016/j.pmr.2017.03.006 In rare cases and depending on the cause, surgical removal of the coccyx (coccygectomy) may be recommended.

Read more about Treatment for Coccydynia (Tailbone Pain)

Learn more:

Coccydynia (Tailbone Pain) Causes

Diagnosis of Coccydynia (Tailbone Pain)