Coccyx or tailbone as the name suggests, is the bone at the very bottom of your spine. A localized pain around your tailbone is medically called coccydynia or coccyx pain or coccygeal pain. In simple terms it is called tailbone pain. Tailbone pain often worsens when sitting or with any physical activity that exerts pressure on the bottom of the spine. In this health article we discuss the causes, symptoms, and treatment of tailbone pain. 

Causes of tailbone pain

  • Direct trauma to the coccyx such as dislocation, bruising, fracture, or dislocation
  • Damage to the ligaments or bony segments of the coccyx
  • Trauma to the buttocks, such as accidental falls with landing in a seated position or falling from the stairs 
  • Extreme pressure on the coccyx leading to forceful backward movement/push of the coccyx beyond its normal range of motion
  • Being pregnant or overweight 
  • Anatomical changes in the coccyx
  • Coccyx bone spurs - Thickened or bony overgrowth near the tip of the tailbone leading to change in its length and/or normal angulation
  • Coccygeal arthritis
  • Hyperactivity of the pelvic floor muscles
  • Coccygeal infections and tumors (very rare)

Symptoms of tailbone pain

The primary symptoms of tailbone pain include:

  • Pain while sitting -  Sitting on both soft and hard surfaces may elicit localized pain around your tailbone
  • Pain while partly reclining
  • Pain on standing up from a seated posture

Based on the cause and severity, the pain can be mild to severe and can vary between sharp shooting pain, dull ache, or a stabbing pain. 

More specific symptoms of tailbone pain include:

  • Pain around the tailbone that is relieved by decreasing the amount of weight on the tailbone by leaning on one buttock or leaning forward
  • Localized pain or an aching soreness that can range from mild to severe, generally confined to the tailbone and does not radiate through the pelvis or to the lower extremities
  • Constant discomfort or tightness around the tailbone, or intermittent pain that may come and go with movement or pressure
  • Pain that worsens when moving from sitting to standing
  • Pain that may increase with sexual intercourse or bowel movement

Treatment of tailbone pain

In about 90% of cases, tailbone pain can be successfully treated by non-surgical treatments. The treatments often include activity modification and non-invasive measures such as:

  • Painkillers and common non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or COX-2 inhibitors 
  • Applying heating pads or cold-pack (ice-pack) several times a day 
  • Alterations in everyday activities such as using a pillow to take the weight off the coccyx while sitting, standing desk to avoid prolonged sitting, or adjusting posture so weight is taken off the tailbone when sitting
  • Supportive customized pillows - Wedge-shaped or U- or V-shaped pillows, or pillows with a cutout or hole where the tailbone is to keep pressure off the coccyx 
  • Increased fiber and water intake, or using stool softeners to avoid worsening of the pain due to bowel movements
  • Consultation and treatment by healthcare providers including physical therapy or chiropractic sessions to help manage or alleviate coccyx pain

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