Overview
what it is and why it mattersCoccydynia is pain in your tailbone, the small bone at the very bottom of your spine. The most common causes are a direct fall onto your bottom, childbirth, or repeated low-grade impact (long hours on a hard bike seat, for example). In some patients no specific cause is ever found. The pain has a distinctive pattern: worst with sitting (especially on hard surfaces), sharper when you stand up from a chair, and sometimes worse during bowel movements.
Women get it about five times more often than men, and carrying extra weight raises the risk.
Symptoms
what you may noticeThe defining symptom is a deep ache right at your tailbone that gets worse the longer you sit, especially on a hard surface like a wooden bench or bleacher seat. Standing up from a chair often produces a sharp spike of pain at the moment of transition, then eases once you are fully upright and walking.
Some patients also feel increased pain during bowel movements or with prolonged driving. The area directly over the tailbone is usually tender to touch. In more persistent cases the pain can radiate into your lower buttocks or sacral region, making it difficult to find any comfortable seated position.
Diagnosis
exam first, imaging secondX-rays taken in both standing and sitting positions show whether the tailbone is fractured, dislocated, abnormally mobile, or sitting at an unusual angle. These side-by-side X-rays tell your surgeon much more than a single static film. MRI is added when there's concern for a hidden fracture, infection, or mass.
Treatment Path
how care progressesMost tailbone pain settles with simple, non-operative steps. We start with the measures that take pressure off the coccyx and quiet the pain, then add hands-on therapy if it is needed. The steps below are listed in the order we usually introduce them, each one added on top of the ones before, not instead of.
1
Coccyx cushion (donut pillow)
A donut-shaped cushion (or a U-shaped cushion with the tailbone area cut out) takes pressure off the coccyx during long stretches of sitting, often the single most useful thing you can do early on.
3
Physical therapy
Pelvic-floor physical therapy and gentle hands-on tailbone mobilization can be very effective, particularly in women, where pelvic-floor muscle tension is often a contributor.
If Surgery Is Truly Needed
rare for most patientsSurgery for tailbone pain is rare. The operation, removal of the tailbone (coccygectomy), is reserved for the few people whose pain does not settle after a long, complete trial of the non-operative care above. OSI does not perform coccygectomy. Our focus is getting your pain under control without surgery; in the uncommon case an operation is being considered, we make sure your imaging and records are in order for that conversation.
Frequently Asked
questions we hear in clinicWhat causes tailbone pain?
The most common causes are a direct fall onto your bottom, childbirth, or repeated low-grade impact, such as long hours on a hard bike seat. In some patients no specific cause is ever found.
Why does it hurt so much to sit?
Sitting loads the tailbone directly, so the pain is worst with sitting, especially on a hard surface like a wooden bench or bleacher seat. Standing up from a chair often brings a sharp spike of pain at the moment of transition, which then eases once you are fully upright and walking.
Who tends to get coccydynia?
Women get it about five times more often than men, and carrying extra weight raises the risk.
What kind of imaging will I need?
X-rays taken in both standing and sitting positions show whether the tailbone is fractured, dislocated, abnormally mobile, or sitting at an unusual angle. These dynamic side-by-side X-rays tell your surgeon much more than a single static film. An MRI is added when there is concern for a hidden fracture, infection, or mass.
What can I do at home to feel better?
A coccyx cushion, a donut-shaped pillow or a U-shaped cushion with the tailbone area cut out, takes pressure off the coccyx during long stretches of sitting and is often the single most useful thing you can do early on. Over-the-counter NSAIDs like ibuprofen or naproxen help with first-line pain control.
Will I need surgery?
Almost never. Most tailbone pain settles with non-operative care. Surgery helps only a small minority of patients, usually those with a specific structural problem plus a nerve issue that is not getting better with a structured non-operative trial.
Providers Who Treat Coccydynia
spine team
Further Reading
authoritative sourcesExternal patient-education references and related OSI pages for additional background: