Tailbone Pain, Coccyx pain, Coccydynia, Coccygodynia
Coccydynia is the medical term for pain of the coccyx (tailbone). Coccydynia is
also known as coccygodynia. Patients will often simply refer to this as “tailbone
pain” or "coccyx pain". The coccyx, or tailbone, is a group of small bones. These
bones are the lowest part of the human spine. They are located at the back of the
pelvis, between the buttocks, above the anus. Coccydynia is an uncommon
painful condition that originates from the coccyx, the tailbone at the end of the
spine. Trauma and falls are the most frequent causes of coccydynia. In the vast
majority of cases, nonsurgical treatment, such as medications and physical
therapy work well to ease symptoms.
The spine is composed of a series of bones called vertebrae. Joints that allow
movement while providing stability connect the vertebrae. The end of the spine,
the coccyx, has 3-5 small bones.The coccyx bones align in a curve like a small
tail. Some of the coccyx bones may be fused together. However, fewer than
10% of people have a completely fused coccyx.Muscles, ligaments, and tendons
attach to the coccyx. It plays a role in weight bearing when seated.
The primary conditions they found to be associated with coccyx pain were:
coccyx angled sharply forward; coccyx side-bending more to one side than the
other; and coccyx completely rigid (all segments fused together and fused to the
Why some hurt and others don’t is unclear. In the case of a misaligned coccyx, it
might be that the pain is caused by the coccyx pulling on muscles, ligaments or
overstretching the filamen terminale (end of the dural tube). Connective tissues
called the filum durae spinalis enclose the end of the spinal cord and attach it to
the deep dorsal sacrococcygeal ligament.
A major source of hip and back pain occurs as fibrotic sacrococcygeal ligaments
anteriorly flex (hook) the coccyx and compress/overstretch the sensitive filum
terminale In the case of a rigid coccyx, it might be that the tissues under the
inferior segments might create a pad of irritated tissue (like a bunion) that can rub
the dura raw.
Coccydynia is caused by trauma to the coccyx, such as from a fall, injury during
childbirth, or prolonged sitting. Trauma can cause ligament inflammation or
injure the coccyx where it attaches to the spine. In some cases, the cause is
unknown. When sitting, the coccyx shifts forward and acts as a shock absorber.
However, falling on the tailbone or events such as childbirth can lead to
coccygeal pain, known as coccydynia. In most cases, the pain is caused by an
unstable coccyx, resulting in chronic inflammation of the sacrococcygeal joint.
Coccydynia also can be attributed to a malformed or dislocated coccyx and the
growth of bony spurs on the coccyx. Resulting pain often is resolved by
performing specific soft tissue techniques to release the levator ani muscle,
anococcygeal, sacrotuberal and sacrospinal ligaments, as well as the gluteus
Another common etiology is childbirth. The coccyx is considered by some to be
in the way during childbirth. At the end of the third trimester, certain hormonal
changes enable the synchondrosis between the sacrum and the coccyx to soften
and become more mobile. This increased mobility of three to five coccygeal
segments allows for more flexion and extension, which might permanently
change the resting tension of the surrounding ligaments and muscles. Unlike
fractures, which can remodel, injuries to the sacrococcygeal junction often
become inflamed as the joint is repeatedly forced out of its normal position.
Physical examination should include direct palpation of the coccyx for
tenderness. In true coccydynia, the coccygeal region usually is markedly tender.
Direct trauma to the coccyx can result in coccyx fractures, dislocations, alignment
abnormalities, etc.. Examples of trauma to the coccyx could include a fall onto
the tailbone, pregnancy (and especially childbirth, which can put substantial
pressure onto the coccyx as the baby moves down within the pelvis), prolonged
sitting (especially sitting on a hard surface, or sitting on a narrow surface such as
a bicycle seat, or increased sitting due to immobility because of an injury at a
totally unrelated body region).
Pain referred to the coccyx from nearby body regions: Sometimes pain can be
referred to the coccyx from medical conditions at adjacent body regions. Thus, it
is often worthwhile to consider whether any medical conditions within the pelvis
and rectum may actually be the underlying source of the pain that the patient
feels predominantly at the coccyx. Other conditions that present with pain in the
buttock region can include bursitis (inflammation of a bursa, which is a fluid-filled
sac, of which there are many throughout the body).
"Idiopathic" coccyx pain: In many cases, the exact cause of the coccydynia
remains unknown. In these cases, the patient may not have any history of trauma
to the region, nor any associated medical conditions in the pelvis or rectum.
The primary symptom of coccydynia is pain. You may experience increased
sensitivity to pressure, especially when sitting and leaning backwards. The area
around your tailbone may ache. Coccydynia can cause pain that shoots down
the legs. It can also contribute to pain during sexual intercourse or bowel
movements. Certainly the classic, defining symptom for coccydynia is exquisite,
focal pain at the coccyx. The pain from the coccyx may travel (radiate) down into
the floor of the pelvis (e.g., into the lower genital region). Coccydynia is
frequently exacerbated by sitting, and especially by prolonged sitting or sitting on
a hard surface. Initial movement into the standing position (after sitting) may also
be painful. Most patients are able to locate their own coccyx bones, and will
indicate this spot as the primary focus of their pain. Patients will recognize the
coccyx location as being in the midline between the gluteal muscles (buttocks). A
patient wearing a belt would generally find their coccyx to be perhaps 4 to 7
inches below where the belt-line crosses the middle of their lower back. The
coccyx is located just slightly above the anus, and sometimes coccyx pain can be
exacerbated by defecation, especially if the bowel movement is particularly large
or hard. Unfortunately, coccydynia can be severe and persistent, and can
substantially decrease the quality of life for the affected patient.
A doctor can diagnose coccydynia by reviewing your medical history and
examining you. You should tell your doctor if you have fallen or given birth
recently. Imaging tests, such as X-ray or MRI, may be used to rule out other
sources of pain. Electromyography (EMG) and nerve conduction studies may be
used to assess nerve function. Usually, an experienced physician can make the
diagnosis of coccydynia based upon a careful history and physical examination.
Additional diagnostic tests can include x-rays and other imaging studies.
Consultations with other physicians may be helpful if it is felt that the coccyx pain
is originating from medical conditions of the gastrointestinal tract (e.g., the
rectum), or originating from medical conditions of the reproductive organs
(uterus, ovaries, etc.).
Coccydynia is typically first treated with non-steroidal anti-inflammatory
medications. Your doctor may recommend that you sit on a donut shaped pillow
to help relieve tailbone pressure. It may take several weeks or months for the
pain to decrease.
For persistent or severe pain, your doctor may prescribe pain medications. Local
medication injections are used to place numbing and anti-inflammatory
medications near the source (joint or bursa) of the pain. Nerve blocks are used
to interrupt a nerve’s ability to transmit pain signals.
Your doctor may gently move (manipulate) the coccyx after you receive a pain
relieving injection. You may be referred to physical therapy for gentle stretching.
Ultrasound therapy may be used, which soothes pain with warmth.
If treatments fail to relieve symptoms, surgery may be used to remove a portion
of the coccyx (coccygectomy). The short outpatient surgery is successful for
relieving symptoms for most people. However, surgery is very rarely used
There are a wide variety of treatments available for coccyx pain. Often, a
combination of treatment approaches is necessary in order to give adequate
Avoiding exacerbating factors: Patients can avoid exacerbating factors by
minimizing prolonged sitting and by avoiding sitting on hard surfaces.
Cushions: Sitting on cushions can be helpful, and especially sitting on "donut"
cushions (which have a hole cut out in the center, where the coccyx would
otherwise be pressing) or "wedge" cushions (which have a wedge-shaped
triangle cut out in the rear of the cushion, where the coccyx would otherwise be
Medications taken by mouth: Pain may be decreased by the use of a variety of
medications taken orally. These include anti-inflammatory medications,
opioid/narcotic analgesics, medications used to treat nerve pain, and a variety of
Medications given by local injection: In patients who are not receiving adequate
relief via cushions and oral medications, medications given by local injection may
provide substantial relief and may provide complete resolution of the pain. Unlike
caudal (epidural) steroid injections, nerve blocks for coccydynia may focus on
using a local anesthetic to block (temporarily shut-off) the nerves that carry
painful signals from the coccyx. These injections may especially target the
ganglion Impar, which is part of the sympathetic nervous system.
Coccyx surgery: Various surgeries of the coccyx have been considered
somewhat controversial, and may carry significant risks. Coccyx surgery would
generally only be considered in patients who have severe, persistent coccyx pain
despite non-surgical treatments, including the use of oral medications and focal
injections performed under the guidance of fluoroscopy. There are a small
percentage of patients with tailbone pain who may require surgical removal of the
coccyx (coccygectomy). Fortunately, most patients respond well enough to nonsurgical
treatments (especially including the injections) that they no longer need
to consider undergoing surgical treatment.