How to Relieve Tailbone Pain

Tailbone pain is felt at the base of your spine, along the gluteal cleft (buttcrack) to your anus. Known medically as coccydynia, it can occur due to a traumatic fall, vaginal childbirth, or a repetitive stress injury. Both obesity and sudden weight loss can be weight-related causes.

Symptoms of tailbone (coccyx) pain can vary. It can feel like a dull ache, a throbbing muscle spasm, or a sharp pain that radiates to other locations. Tailbone pain can make it difficult to sit comfortably, stand for extended periods, or exercise, but often is relieved with simple measures.

This article discusses tailbone pain symptoms, as well as trauma and other causes of tailbone pain without injury. It explains how tailbone pain is treated, why you may need to see a healthcare provider, and how more aggressive treatment, including surgery, may be necessary.

What Does Tailbone Pain Feel Like?

Tailbone pain is common and can range from mildly annoying to so disabling you are unable to sit upright, perform manual labor, or go about your daily activities. Coccyx pain (sometimes called coccydynia) and tenderness can occur with:

• Sudden onset, due to a history of an accident or injury
• Gradual worsening, sometimes with no identifiable cause (idiopathic pain)
• More severe symptoms if you sit for long periods, or briefly worse when you stand up
• Pain during bowel movements
• Pain during sex
• Increased pain during your period

Tailbone pain can also originate in other areas and radiate to your buttcrack or anus. For some people, coccydynia is a faint, throbbing pain or dull ache. Others experience severe, sharp pain that can radiate from the tailbone to the lower back, hips, or legs.

What Causes Tailbone Pain?

The most obvious cause of tailbone pain is acute trauma. However, it occurs in 1% to 2.7% of all people who see a healthcare provider for spinal and lower back pain that isn't due to a trauma-related cause.

Coccydynia can also be caused by an infection, osteoarthritis, and bone spurs which are all causes of tailbone pain without an injury. The pain can originate in the coccyx bones, the disks between the vertebral segments, or the surrounding muscles and ligaments.

Acute Trauma

A sudden injury to your tailbone can cause this kind of pain. For example, you might fall hard on your bottom while skiing. This can cause inflammation or strain of the structures around your tailbone.

The injury may cause a bruise or a fracture of the bones. In rare instances, a fall can cause the joint between your tailbone and your sacrum may be dislocated. If this happens, you may need to see an orthopedic surgeon to reset the bones.

Repetitive Stress Injury

Activities like horseback riding, cycling, or even riding in a bouncy vehicle for long periods can lead to tailbone pain over time. This is because these activities cause repeat pressure or friction on the tailbone.

You may also get tailbone pain after sitting on a hard surface for a long period of time or even sitting improperly at your desk chair.

Pain from repetitive stress injuries typically subsides after avoiding the activity for a while.

Overweight or Underweight

Tailbone pain can be due to weight-related causes, which often affect the spinal column and musculoskeletal system (your bones and muscles).

It's common for obesity and overweight to contribute to lower back pain, or for healthcare providers to consider weight loss as an early treatment option. Often, a person's weight may contribute to a co-occurring condition, like pelvic floor dysfunction, that ultimately leads to coccydynia.

On the other hand, low body weights and rapid weight loss can lead to tailbone pain, too.

Childbirth

Vaginal childbirth can put pressure on the tailbone and can cause lingering pain. This is especially true if the delivery is difficult. This is because the baby's head puts pressure on the top of the tailbone. The use of forceps can also contribute to this kind of pain.

Tailbone pain from childbirth is often caused by a bone bruise or ligament strain. Sometimes, though, the tailbone can fracture during childbirth.

Osteoarthritis

Wear and tear from repetitive motions can cause osteoarthritis. This is a degenerative disease that can affect any joint in the body.

Bone Spurs

Every tailbone is different. Some people also have a bone spur on the lowest tip of the tailbone. A bone spur is a small, bony growth.

A bone spur can irritate the tailbone area when you sit down. It can pinch the skin and the fatty tissue between the spur and the chair.

Scoliosis

Some experts report that scoliosis is a possible cause of tailbone pain. This is an abnormal curve in the spine.

Nerve Pain

Tailbone pain can also be due to compressed or irritated nerves.

Nerve pain at the top of the tailbone can be related to a bundle of nerves known as the ganglion impar. Overactivity or irritation of these nerves in front of the upper segment of the coccyx may cause recurrent tailbone pain.

Compression of the pudendal nerve can cause a severe but fleeting episode of rectal pain known as proctalgia fugax, often related to pelvic floor problems. The pudendal nerve is the main nerve of your perineum, between your tailbone and the pubic symphysis joint.

Pelvic Floor Dysfunction

A deep layer of muscles known as the pelvic floor is attached to the tailbone. Pelvic floor muscles help support many of your body's internal organs.

Muscle spasms and irritation of these muscles can cause levator ani syndrome. This is a condition that causes a dull, aching pain often felt in the tailbone. It may also be felt in the rectum, the last few inches of your large intestine.

Hypermobility

People with joint hypermobility syndrome can experience tailbone pain. Joint hypermobility, also called double-jointed, is caused by lax connective tissue, which allows joints to move beyond the normal range of motion. This is often due to defective collagen production from a genetic disorder known as Ehlers-Danlos syndrome (EDS).

Lumbar Spine Disease

Degenerative disc disease (DDD) in the lower spine may refer pain to the tailbone. If your pain is caused by lumbar spine DDD, your tailbone likely won't be tender to the touch, but you may have lingering discomfort in the area.

Pelvic Organ Diseases

Sometimes pain in the tailbone area is caused by a disease in your pelvic organs. This can include:

• Endometriosis
• Pelvic inflammatory disease in people with a uterus
• Pelvic organ prolapse
• Prostatitis in people with a prostate
• Uterine fibroids
  

These issues are usually accompanied by other symptoms, such as painful urination, constipation, heavy menstrual periods, fever, or vaginal or penile discharge.

Infection

Tailbone pain can be caused by an infection, such as a pilonidal cyst or pilonidal sinus. The infection can cause:

• Swelling
• Pain over the tailbone
• Redness
• Warmth
• Pus, which is a thick, whitish fluid

In rare cases, tailbone pain can be caused by a bone infection called osteomyelitis. This kind of bone infection can begin with a pressure ulcer. These ulcers form when long-term pressure limits blood flow to the area. 

Signs of osteomyelitis include:

• Fever
• Warmth
• Redness near the tailbone

Cancer

In rare instances, a tumor can spread to the tailbone. This may happen with certain cancers, such as:

• Prostate cancer
• Ovarian cancer
• Cervical cancer
• Colon cancer

When this happens, the tumor may cause tailbone pain.

Primary bone tumors may also occur on the tailbone or in the tailbone area. A primary tumor is a tumor that happens on its own and is not the result of cancer spread. This is also rare. In addition to pain, tailbone cancer can cause weakness or numbness in the lower back and legs and a noticeable lump or mass.

Other signs of cancer include bleeding or bruising for unknown reasons, bowel changes, eating problems, painful urination, blood in the urine or stool, severe fatigue, and weight changes with no known cause. 

When to See a Healthcare Provider

Tailbone pain can be a minor inconvenience or a major pain in the butt. Even a bruised coccyx can take about four weeks to heal, while a fracture can take up to 12 weeks.

You don't want to wait too long to see a healthcare provider for a diagnosis. If you experience any of the following symptoms, seek medical attention:

• Your pain is severe or gets in the way of daily activities.
• Your pain doesn't go away even though you've tried treating it.
• You have a lump or mass on your tailbone.
• You have a fever or redness, warmth, swelling, or drainage near or on your tailbone.

What Kind of Doctor Treats Tailbone Pain?

The type of doctor to see for tailbone pain depends on the cause. An injury to the bone can be treated by an orthopedic specialist or surgeon.

Chiropractors and osteopathic physicians can also assess and treat tailbone pain. Muscle and ligament pain can be treated by a physiatrist (physical medicine specialist) or physical therapist.

If you are unsure of the cause of your tailbone pain, accompanying symptoms can provide clues for which specialist to see. For example, tailbone pain with heavy, painful periods may be assessed by a gynecologist. Urinary problems with tailbone pain can be diagnosed by a urologist.

When in doubt, check with your primary care provider or local urgent care clinic.

How Is Tailbone Pain Diagnosed?

Your medical history will help your doctor find the cause of your pain. Let your doctor know about any falls or other accidents that involved your tailbone. If your pain came on gradually, a physical exam might be necessary.

Physical Examination

During your exam your healthcare provider will look for:

• Bruising
• Swelling
• Rash
• Signs of infection, like warmth, redness, or discharge
• A skin dimple, which could be a sign of a bone spur

Your healthcare provider may also press on your tailbone. If the area is tender, it could mean there's a fracture.

Your healthcare provider may also decide to do a rectal exam. During this exam, the doctor inserts a lubricated, gloved finger into your anus and grasps your tailbone between their thumb and forefinger. This helps evaluate the range of motion in the joints and ligaments. It can also reveal tenderness in the area.

Imaging

Sometimes, but not always, x-rays can identify a tailbone injury.

These x-rays may be done while you're standing and sitting down. This can help find the extent of the injury. It may also find alignment problems, dislocations, or fractures.

In rare cases, your doctor may order a magnetic resonance imaging scan (MRI). During this scan, a magnetic field and radio waves create images of the internal structures around your tailbone. This can be used to find cancer or infection.

How Do I Get Rid of Tailbone Pain?

Lifestyle changes can help alleviate most causes of tailbone pain and allow it to heal on its own. Recovery may take a while. A bruised tailbone can take between a few days and a few weeks to completely heal. A fractured tailbone can take up to three months.

You should be able to return to normal daily activities over time as you heal. A full return to sports depends on the sport. Before you can go back to high-impact activities, you need to be able to sit, bend, and walk without pain.

Lifestyle Treatment Options

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

• Avoid prolonged sitting: When you sit down, lean forward to take pressure off your tailbone. A coccygeal cushion is designed to help ease pressure on the tailbone.
• Apply ice or heat: Apply ice to the tailbone area for 10 to 15 minutes several times a day. Do this for up to three days after the injury. This can help reduce pain. Try both ice and heat to see which works best for you. Neither has been shown to be better than the other.
• Avoid constipation: Constipation can make tailbone pain worse. Eat high-fiber foods and drink plenty of water. This will help soften stools and make bowel movements easier.
• Slowly increase activity: Walking can help to relieve pain from a tailbone injury, but don't over do it. As your pain lessens, you can slowly increase your activity. Let pain be your guide and rest if you experience discomfort.

If you are having trouble finding a comfortable position to sleep, try lying on your side to take pressure off of the tailbone. Other strategies that may work include using a soft foam mattress topper. Special pillows with a face cut out let you lie on your stomach with your head down.

Medication

Your doctor may also recommend a topical or oral nonsteroidal anti-inflammatory drug (NSAID). This can help reduce pain and inflammation.

If your pain doesn't go away after at-home care, your doctor may prescribe a stronger pain medication. A steroid injection into the joint or ligaments in the tailbone area may also help control pain.

If your pain is caused by the ganglion impar, a nerve block may help. This is an injection that helps block pain signals.

Infection can be treated with antibiotics. It may also need to be surgically drained.

Physical Therapy

If your pain is caused by pelvic floor muscle spasms, physical therapy can help. This often includes:

• Exercises to help you improve your posture
• Stretching
• Reverse Kegels, or relaxation exercises for your pelvic floor

Surgery

If tailbone pain persists after other treatments, surgery may be needed. In very rare cases, you may need surgery to remove your tailbone, known as a coccygectomy. This surgery is only performed as a last resort after more conservative treatments have failed.

Preventing Tailbone Injury

Acute tailbone injuries can't always be prevented. Still, you can take steps to stop them from happening.

• Be alert to situations that can cause a slip a fall, such as icy sidewalks and wet floors.
• Hold on to the railing when navigating stairs and avoid leaving items on staircases, which can become a tripping hazard.
• Lose weight if you are obese.
• Use protective gear when you play sports. The right padding can often reduce the risk of tailbone injury.
• Watch your posture when sitting. Avoid rounding your back when seated, which puts pressure on your tailbone. Instead, use a lumbar support pillow to keep a slight arch in your lower back, and make sure your weight is on your sit bones.
  

If you are prone to tailbone pain, avoid sitting exercises like biking or rowing that put pressure on the area. Stretching is recommended. A physical therapist can offer exercises that can help you recover from your specific injury.

Summary

Tailbone pain has many causes: sudden injury, repetitive stress, degenerative disk disease, bone spurs, nerve pain, pelvic floor dysfunction, or problems with pelvic organs. In rare cases, tailbone pain may be caused by an infection or cancer.

See your healthcare provider if your pain is severe or does resolve with self-care strategies. A tailbone lump or signs of infection like fever and redness are also reasons to seek treatment. Your healthcare will diagnose the cause of your pain based on your medical history, symptoms, and physical exam. You may also need imaging.

Tailbone pain can usually be treated at home. Medication may also help. Some causes of pain can be treated with physical therapy. Rarely, you may need surgery.