Tailbone pain (coccydynia) is pain at the very base of the spine. It usually starts after a fall onto the buttocks or after childbirth.
What it is
The coccyx is the small three-sided bone at the end of the sacrum. A direct fall can bruise it, knock it out of place or break it.
Long sitting on hard seats also strains it. The pain can last long after the first injury.
How it usually presents
- Sharp pain in one spot at the tailbone.
- Much worse sitting, most of all leaning back, and on standing up from a seat.
- Pain with bowel movements.
- Relief when sitting leaned forward or on one buttock.
What helps tailbone pain go away?
- An exam, and imaging when we suspect a fracture.
- A coccygeal or ganglion impar block for cases that last.
- A wedge cushion and changes to how you sit. They sound minor, and they really work.
- Physical therapy including pelvic floor work.
To get checked, call us or request an appointment. If this began with a crash or a fall, see accident and injury care.
What usually gets missed
It is brushed off as bruising far more often than it is checked. Coccyx pain that lasts months after a fall is not bruising. Dynamic imaging (X-rays taken sitting and then standing) can show the coccyx moving in an abnormal way. Still films miss this completely.
The other miss is the pelvic floor. The muscles that attach to the coccyx can keep the pain going long after the bone has settled. Treating only the bone leaves them untouched.
What to expect over time
Most acute coccydynia (new tailbone pain) clears up within weeks to a few months with a wedge cushion and changes in activity.
Cases that last respond well to a ganglion impar block. It reaches the bundle of sympathetic nerves in front of the coccyx. It is an uncommon procedure. It is often the thing that finally works after months of cushions.
How do I know if my tailbone pain is serious?
Tailbone pain with fever, or with swelling and discharge near the crease of the buttocks, suggests infection. It needs a prompt check. Pain after a significant fall, most of all if you cannot sit at all, needs imaging to rule out a fracture.
What causes tailbone pain?
Tailbone pain usually follows a fall onto the base of the spine, childbirth, or long sitting on hard seats. Some people have no clear trigger. The coccyx normally moves only a little. Pain starts when it moves too much, or when it gets stuck and inflamed. The hallmark is pain on sitting. It is worse leaning back and often worse getting up from a seat.
What can be mistaken for tailbone pain?
It is often missed because it is rarely examined. The exam means pressing on the tailbone itself. Sometimes it also means comparing X-rays taken sitting and standing, which is rarely done. Pain sent from the lumbar spine (low back) or sacroiliac joint should be ruled out before treating the coccyx.
What the first appointment covers
Expect a longer talk than you may be used to. We ask what the pain does across a full day, what sets it off and what calms it. We ask what past treatment did and for how long. Partial and short-lived results tell us a great deal. The exam then tests the suspects your story raises. We tell you what we think is causing the pain and how sure we are.
Common questions
How long does tailbone pain last?
Most settle within weeks to a few months. Cases that last respond well to a targeted block.
There is more on this in Ganglion Impar Block.
Will it get better on its own?
Many do over months, most of all after a fall. Pain that lasts has treatment options, including a ganglion impar block.
What can I do about sitting?
A wedge cushion with a cut-out for the tailbone takes the load right off it. It is the simplest thing to try first.
Why does my tailbone hurt when I sit or stand up?
Sitting loads the coccyx directly, so pain on sitting is the hallmark of coccydynia. It is usually worse when you lean back and often worse when you rise from a seat. Leaning forward or sitting on one buttock takes weight off the bone, which is why those positions bring relief. A wedge cushion does the same thing and is the simplest first step.
Do I need an X-ray for tailbone pain?
Imaging is used when a fracture is suspected, mainly after a hard fall or if you cannot sit at all. For pain that lasts months, dynamic X-rays taken sitting and standing can show the coccyx moving in an abnormal way. Ordinary still films miss this completely. The exam itself, including feeling the tailbone directly, is what most often gets skipped.
What is a ganglion impar block?
It is an injection that reaches the ganglion impar, a bundle of sympathetic nerves just in front of the coccyx. We use it for tailbone pain that has not settled with a cushion, posture changes and physical therapy. It is an uncommon procedure, and it is often the thing that finally works after months of cushions.
Can pelvic floor muscles cause tailbone pain?
Yes. Several pelvic floor muscles attach to the coccyx, and they can keep the pain going long after the bone itself has settled. Treating only the bone leaves that part untouched. That is why physical therapy for tailbone pain includes pelvic floor work, alongside a wedge cushion and changes to how you sit.
Sources
- Daily D et al. Coccydynia: A Review of Anatomy, Causes, Diagnosis, and Treatment. JBJS reviews, 2024. PubMed 38709859
- Foye PM. Coccydynia: Tailbone Pain. Physical medicine and rehabilitation clinics of North America, 2017. PubMed 28676363
- Skalski MR et al. Imaging Coccygeal Trauma and Coccydynia. Radiographics : a review publication of the Radiological Society of North America, Inc, 2020. PubMed 32609598
- Blanco-Diaz M et al. Physiotherapy approaches for coccydynia: evaluating effectiveness and clinical outcomes. BMC musculoskeletal disorders, 2025. PubMed 40420056
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