Coccydynia
Pain in the tailbone (coccyx) at the very bottom of the spine, typically worse when sitting, that often follows a fall, childbirth, or prolonged pressure.
Quick Answer
Coccydynia is pain in the coccyx, or tailbone, at the base of the spine. It is usually worse when sitting, leaning back while seated, or rising from a seat. Common triggers include a fall onto the tailbone, childbirth, or prolonged sitting on hard surfaces, though sometimes no cause is found. Most cases improve with conservative measures such as cushioning, activity changes, and anti-inflammatory care.
Key Takeaways
- Coccydynia is pain in the tailbone at the very bottom of the spine.
- It is typically worse with sitting and when rising from a seat.
- Common causes include falls, childbirth, and prolonged pressure.
- Most cases improve with cushioning, activity changes, and medication.
- Injections are an option for persistent pain; surgery is rarely needed.
At a Glance
| What it is | Pain in the coccyx (tailbone) |
|---|---|
| Typical pattern | Worse with sitting and rising from a seat |
| Common causes | Fall onto the tailbone, childbirth, prolonged sitting |
| Diagnosis | History and exam, imaging in selected cases |
| First-line treatment | Cushioning, activity modification, anti-inflammatory medication |
| Further options | Injections; surgery only rarely |
Symptoms
The hallmark of coccydynia is localized pain at the tailbone that worsens with sitting, particularly on hard surfaces, and with the transition from sitting to standing. Leaning backward while seated often aggravates it. The area may be tender to touch.
Pain can range from a dull ache to sharp discomfort and may interfere with sitting for work or driving. In many cases the pain follows a specific event such as a fall or childbirth, though sometimes it develops without a clear trigger.
Common Warning Signs
- Tailbone pain worse with sitting
- Pain when rising from a seated position
- Tenderness over the tailbone
- Discomfort leaning back while seated
- Pain following a fall or childbirth
When to Seek Care Promptly
- Pain with fever or signs of infection
- A mass or swelling near the tailbone
- Numbness in the saddle area
- Loss of bladder or bowel control
- Severe pain after significant trauma
Diagnosis
Coccydynia is diagnosed mainly through history and a focused examination, including gentle palpation of the coccyx. The characteristic pattern of sitting-related pain is usually sufficient to make the diagnosis.
Imaging is used selectively. X-rays, sometimes taken sitting and standing, can assess coccyx position and mobility, and MRI may be used when there is concern for another cause such as infection, a mass, or a fracture. Most cases do not require extensive testing.
Treatment
Most coccydynia improves with simple measures. A cushion that offloads the tailbone, such as a wedge or ring cushion, activity modification to limit prolonged sitting, anti-inflammatory medication, and physical therapy that addresses the pelvic floor and posture help the majority of patients. Symptoms often settle over weeks to months.
For persistent pain, a targeted injection of local anesthetic and steroid around the coccyx can provide relief. Surgery to remove the coccyx (coccygectomy) is rarely needed and is reserved for severe, disabling pain that does not respond to thorough conservative treatment. At Atlantic Brain and Spine, persistent cases are evaluated to confirm the diagnosis and guide next steps.
The Diagnosis-to-Treatment Pathway
1. Clinical evaluation
History and gentle examination confirm tailbone pain.
2. Selective imaging
X-ray or MRI is used if another cause is suspected.
3. Cushioning and activity change
Offloading the tailbone and limiting prolonged sitting help.
4. Medication and therapy
Anti-inflammatory medication and targeted therapy reduce pain.
5. Injection for persistence
A coccyx injection can relieve stubborn pain.
6. Reassessment
Ongoing pain is re-evaluated to confirm the source.
7. Surgery if refractory
Coccygectomy is considered only in rare, disabling cases.
Frequently Asked Questions
Common causes include a fall onto the tailbone, childbirth, and prolonged sitting on hard surfaces, all of which can bruise or strain the coccyx and surrounding tissues. Sometimes coccydynia develops without an identifiable cause. Less commonly, an underlying problem such as infection or a mass is responsible.
Many cases improve over several weeks to a few months with conservative care. Some are more stubborn and persist longer. Using a supportive cushion and limiting prolonged sitting while the area heals can speed recovery.
A cushion that offloads the coccyx, such as a wedge or ring cushion, can make sitting much more comfortable. Taking breaks from prolonged sitting, adjusting posture, and using anti-inflammatory medication as advised also help.
Often not. The diagnosis is usually clear from the history and examination. Imaging is reserved for cases where another cause is suspected, such as a fracture, infection, or mass, or when pain is severe or does not respond to treatment.
Yes. When conservative measures are not enough, an injection of local anesthetic and steroid around the coccyx can relieve persistent pain. It can be repeated in some cases and is often combined with continued cushioning and therapy.
Rarely. Surgery to remove the coccyx is reserved for severe, disabling pain that has not responded to a full course of conservative treatment. Most people never need surgery for coccydynia.
Specialists Who Treat Coccydynia
Your care is provided by Atlantic Brain and Spine's spine team, including fellowship-trained neurosurgeons and orthopedic spine surgeons.
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