Coccyx pain

Where the pain comes from

The coccyx is the small, curved bone at the bottom of the spine. Several pelvic floor muscles, ligaments and the gluteal muscles attach to it. When you sit, it takes part of your weight; when you stand, those muscles pull on it.

Common causes:

• Injury. A fall onto the bottom can bruise, fracture or dislocate the coccyx.
• Childbirth. The coccyx moves backward during vaginal birth and can be strained. See postpartum recovery.
• Repetitive pressure. Long hours sitting on hard surfaces, or cycling and rowing.
• A coccyx that moves too much or too little. Some people's coccyx shifts more than usual when they sit, which irritates the joint.
• Pelvic floor tension. Overactive pelvic floor muscles can pull on the coccyx and refer pain there, with no injury at all. This is often missed.
• Less common causes. A pilonidal cyst near the top of the buttock crease, infection, or, rarely, a tumor.

Sometimes no clear cause is found. That does not make the pain less real, and it often still responds to treatment.

The pelvic floor link

Coccyx pain and pelvic floor problems often travel together. Tense pelvic floor muscles can cause tailbone pain, and tailbone pain can make the pelvic floor guard and tighten. Clues that the pelvic floor is involved:

• Pain with bowel movements or after sitting on the toilet.
• Painful sex, especially pain at the vaginal opening or deep pain during sex.
• Trouble with tampons, see painful tampon insertion.
• A deep ache in the pelvis or a feeling of pressure in the rectum.

If several of these sound familiar, a pelvic floor therapist is often the right person to see first.

What you can try at home

• Change how you sit. Lean forward slightly so weight goes onto your thighs and sitting bones, not the tailbone.
• Use a cushion. A wedge or U-shaped cushion with a cutout at the back takes pressure off the coccyx.
• Break up sitting. Stand or walk every 20 to 30 minutes.
• Stand up carefully. Shift forward on the seat, lean forward and push up with your arms.
• Heat or cold. Cold packs can help after a fresh injury; warmth often eases muscle tension later.
• Avoid constipation. Straining on the toilet hurts. Fiber, fluid and a footstool help.
• Gentle stretching and relaxation. Breathing that lets the pelvic floor soften, plus stretches for the hips and buttocks, can help when muscles are tight.
• Pain relief. Over-the-counter pain relievers can help in the short term. Check the label and ask a pharmacist if unsure.

Sitting at work and in the car

Because sitting is the main trigger, small changes to daily setup make a big difference:

• Raise the seat so your hips are slightly higher than your knees. This tips weight forward off the tailbone.
• Use a lumbar roll or a rolled towel behind your lower back so you do not slump onto the coccyx.
• In the car, take the cushion with you and stop for short breaks on longer drives.
• A sit-stand desk, or simply standing for calls, cuts total sitting time.
• Avoid sitting on hard benches, floors and bleachers until pain settles.

Pain often eases within weeks once pressure on the coccyx is reduced. If it does not, that is a sign something else, often the pelvic floor, is involved.

How long does it last

Most coccyx pain improves within a few weeks to a few months. Pain after a fall or childbirth usually eases as the bruising and strain settle. Pain that lasts longer than two to three months is called chronic coccydynia and is worth assessing properly, because it often responds to targeted therapy once the cause, such as a mobile coccyx or tight pelvic floor, is identified.

What a clinician will check

A clinician will ask how the pain started and what makes it worse. They will usually examine the lower back and the area around the coccyx, and may do an internal rectal or vaginal exam to check the coccyx and the pelvic floor muscles. X-rays taken sitting and standing can show whether the coccyx moves too much. An MRI may be used if the cause is unclear.

Treatment options include:

• Pelvic floor physical therapy. Manual therapy, relaxation training and exercises. See finding a pelvic floor therapist.
• Injections. A steroid and local anesthetic injection near the coccyx can relieve stubborn pain.
• Manipulation. Some clinicians gently move the coccyx from inside the rectum.
• Surgery. Removing the coccyx (coccygectomy) is reserved for long-lasting, severe pain that has not responded to anything else. It helps many of the people selected for it but carries a real risk of wound infection.

Most people never need injections or surgery. Pain often eases within a few months, especially when sitting habits change and the pelvic floor is addressed.