What Is Tailbone Pain (Coccydynia)?
Trauma, infections, cysts, and tumors can cause tailbone pain. In select cases, a health care provider may prescribe narcotic pain medication for severe coccyx pain not relieved with over-the-counter pain medication.
The coccyx, or tailbone, is the triangular bony structure located at the bottom of the vertebral column between the buttocks. It is composed of three to five bony segments held in place by joints and ligaments. Pain in the area of the tailbone also termed coccydynia, can be caused by a variety of conditions and can lead to either acute or chronic discomfort in this area. Coccydynia occurs most commonly in adolescents and adults, and it is more prevalent in women than in men. Most cases of tailbone pain can be managed at home with conservative measures.
What Causes Tailbone Pain?
There are many different conditions that can lead to tailbone pain. Often, the cause of the pain is unknown (idiopathic) and never determined. Conditions known to lead to coccyx pain include the following.
Trauma: Injury to the coccyx is a very common cause of tailbone pain. Injury to the coccyx may lead to a bruise, fracture, or dislocation of the coccyx.
- A fall onto the tailbone in the seated position, usually against a hard surface, is a common cause of coccyx injury.
- A direct blow to the tailbone, such as those that occur during contact sports, can also injure the coccyx.
- The coccyx can be injured or fractured during childbirth.
- Repetitive straining or friction against the coccyx (as happens in bicycling or rowing) can injure the coccyx.
Less common causes of coccyx pain include bone spurs, compression of nerve roots, localized infections, pilonidal cysts, and tumors.
What Symptoms and Signs May Accompany Tailbone Pain?
The symptoms of tailbone pain are typically exacerbated by actions that exert pressure or directly contact the coccyx. The pain is usually relieved by removing pressure off the coccyx, such as occurs when standing or walking.
- Severe localized pain or a deep ache may be felt in the tailbone area when touched.
- If the injury is traumatic, a bruise may be visible in the coccyx area.
- The pain is generally worse when sitting for prolonged periods of time on a hard surface or with direct pressure to the tailbone area.
- Bowel movements and straining may be painful.
- Some women may experience pain during sexual intercourse.
When Should Someone Seek Medical Care for Tailbone Pain?
If someone has symptoms of coccyx pain or unexplained discomfort in the coccyx area, contact a health care professional. A physician may need to examine the patient to determine the underlying cause of the coccyx pain and to exclude any potentially serious conditions which can lead to tailbone pain. Furthermore, if there is a traumatic injury to the coccyx, imaging studies sometimes may need to be performed.
What Specialists Treat Tailbone Pain?
The vast majority of cases of tailbone pain can be managed by a primary-care physician, such as a family physician or internist. In the rare case of surgical intervention, a spine surgeon will be consulted. For those individuals who suffer from chronic, refractory coccyx pain, a physician who specializes in pain management may also be involved.
What Tests Do Health Care Professionals Use to Diagnose Tailbone Pain?
The cause of coccyx pain is largely determined based on a thorough medical history and a physical examination by a health care professional. He or she will inquire about recent injuries to that area as well as any factors that make the pain better and worse. Occasionally, X-rays or other imaging studies of the coccyx may be performed.
- The vertebral column (spine) will be examined for areas of tenderness, redness, swelling, or bruising. A neurologic examination may be performed. A rectal examination may also be performed. For this exam, the health care provider inserts a finger into the rectum to feel the area of the coccyx in order to determine if there is a dislocation or fracture that can be felt and if direct pressure against the coccyx reproduces the pain.
- X-rays may be taken to determine whether or not there is a fracture or dislocation of the coccyx, and this is usually done if there is a history of trauma or injury to this area. However, X-rays may not always reveal these injuries. Some physicians recommend X-rays in both the standing and seated positions to better determine the presence of a fracture or dislocation. Rarely, at the discretion of the health care professional, a CT scan, MRI, or bone scan may be ordered at a later time if X-rays do not reveal the cause of the continuing coccyx discomfort, or if there are concerns about a tumor or infection as the cause of the pain.
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What Is the Treatment for Tailbone Pain?
In addition to home care, a health care professional may be able to provide further relief of pain with other medical, and rarely, surgical interventions.
- In select cases, a health care provider may prescribe narcotic pain medication for severe coccyx pain not relieved with over-the-counter pain medication.
- Stool softeners medications may be needed to prevent constipation.
- Injections of local anesthetics or corticosteroids into the coccyx area may be performed in cases of continued coccyx pain that do not respond to other conservative treatment measures.
- Manipulation of the coccyx may be attempted to move the coccyx into the proper position and alignment.
- If the cause of the pain is a pilonidal cyst, incision and drainage of the cyst may be required.
- Infection of the tailbone may require antibiotics.
- Physical therapy may be recommended and helpful for some individuals.
- Rarely, in very select cases, the coccyx may be surgically removed (coccygectomy). However, surgical risks such as infection and poor wound healing need to be considered, and in some cases, removal of the coccyx may not provide the expected long-term pain relief.
Are There Home Remedies for Tailbone Pain?
Coccyx pain can often be extremely painful and debilitating, so home care is aimed at controlling the pain and avoiding further irritation to the coccyx. The vast majority of cases of coccyx pain can be managed at home.
- Avoid sitting down on hard surfaces for long periods of time. When on hard surfaces, alternate sitting on each side of the buttocks. Also, lean forward and direct weight away from the tailbone.
- For traumatic injuries, apply ice to the tailbone area for 15-20 minutes, four times a day, for the first few days after the injury.
- Use NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen (Advil), for pain control.
- Purchase a "doughnut" cushion or customized sitting cushion to sit on. This cushion has a hole in the middle of it in order to prevent the tailbone from contacting the flat sitting surface. This helps to avoid direct painful contact against the coccyx area.
- Eat foods high in fiber to soften stools and avoid constipation, which can sometimes cause worsening pain in the coccyx area.
Follow-up for Tailbone Pain (Coccydynia)
Follow-up is recommended at the discretion of the patient's health care provider. Continued medical management depends on the severity of the pain, the underlying cause of the pain, and the progress the patient is making with medical treatment.
- Most people do not require follow-up if their coccyx pain is improving with medical treatment.
- People with chronic coccyx pain, for whom medical therapy has not worked, may require more frequent follow-up evaluations and may be referred to other medical or surgical specialists.
Is It Possible to Prevent Tailbone Pain?
- Most coccyx injuries are accidental (such as a slip on ice) and therefore cannot be entirely avoided.
- Wear proper protective padding when participating in contact sports, which can potentially prevent some coccyx injuries.
What Is the Prognosis of Tailbone Pain?
Most cases of coccyx pain due to injury improve within several weeks with proper medical management and self-care at home. However, the prognosis for coccyx pain ultimately depends on many factors:
- The underlying cause of the coccyx pain (whether from trauma, tumor, or infection)
- If traumatic, the severity of the injury (a bruise, fracture, or dislocation)
- The patient's ability to comply with medical treatment
- The patient's underlying general health and natural ability to recuperate and heal
- A few people suffer from chronic coccyx discomfort despite proper medical treatment. This can be an extremely frustrating and debilitating problem.
Reviewed on 1/25/2022
Lirette, L.S., G. Chaiban, R. Tolba, and H. Eissa. "Coccydynia: An Overview of the Anatomy, Etiology, and Treatment of Coccyx Pain." Ochsner J 14.1 Spring 2014: 84-87.
Nathan, S.T., B.E. Fisher, and C.S. Roberts. "Coccydynia: a review of pathoanatomy, aetiology, treatment and outcome." J Bone Joint Surg Br 92 (2010):1622.