Overview

The coccyx, or tailbone, is composed of three to five fused vertebrae located at the bottom portion of the spine beneath the sacrum. Coccydynia refers to any type of persistent tailbone pain. It is typically a localized pain that worsens when sitting or during any activity that places pressure on the bottom of the spine. Coccydynia is also known as coccygodynia, coccygeal pain, coccyx pain, and tailbone pain.

Ninety percent of tailbone pain can be treated without surgery. Rest is one of the most effective treatment options for this common ailment. Pain in the tailbone can be acute or chronic but is rarely lifelong. There are many causes of coccydynia, and a proper diagnosis is pivotal in treating it. For people with a uterus, menstrual cramps and pregnancy can exacerbate your tailbone pain. The most common causes of coccydynia are direct trauma to the coccyx or sitting too much. While you cannot completely prevent the former cause, you can avoid sitting for prolonged periods by changing positions more frequently or taking short walks, if able.

Treatment options 

• Rest and otherwise modifying activities to alleviate cumulative pressure off tailbone
• Medication: over-the-counter pain relievers or topical creams, prescription pain medications, or muscle relaxers 
• Yoga, functional mobility training, or gentle stretching
• Physical or chiropractic therapy
• Supportive pillows or using cushions on office chairs, car seats, etc.
• Heat or ice therapy
• Steroid injection
• Coccygeal nerve block
• Surgery

Because being overweight or underweight places increased pressure on the coccyx, your healthcare professional may ask you to lose or gain weight in conjunction with other non-surgical treatment options. Losing weight too rapidly may exacerbate symptoms of coccydynia.

Symptoms

• Localized pain and tenderness in tailbone
• Soreness or tightness around tailbone
• Sitting exacerbates pain
• Pain worsening pain when transitioning from sitting to standing or vice versa 
• Pain during bowel movements or sexual activities 

Diagnostic tests

Your healthcare provider will ask about the following information:

• The frequency, duration, and severity of your symptoms
• Your lifestyle habits and exercise regimen
• All medications you take, including over-the-counter medicine, supplements, vitamins, illicit drugs, or prescription medication
• Your medical history, including other medical conditions
• Any recent or past trauma to the lower back or coccyx
• Familial history of similar symptoms 

Your healthcare professional will conduct a physical examination to gauge your range of motion in your coccyx. They will look for any swelling, tenderness, bruising, or other physical deformities located on or around the coccyx. They may manually manipulate or stimulate the coccyx through the rectum to assess the limited or excessive mobility of the coccyx or sacrococcygeal joint.

Your medical professional may order diagnostic tests, such as:

• Dynamic x-ray imaging
• Coccygeal discogram
• CT scan
• MRI

Causes

Direct trauma to the tailbone and prolonged periods of sitting are the two most common causes of tailbone pain. Some coccydynia may be idiopathic, which means the pain has no identifiable origin. 

Other causes include:

• Hypermobility of coccyx
• Limited mobility of tailbone
• Dislocation of sacrococcygeal joint
• Repetitive stress
• Childbirth or menstrual cramps for those with a uterus
• Tumor or infection
• Referred coccyx pain: pain from elsewhere in spine or pelvis can be felt in coccyx

Risk factors include:

• Obesity or being underweight
• Sitting too much
• Biological sex

Facts 

Coccydynia is more common in those with a uterus than those without one.