We take our spine and the support it offers for granted. Indeed, we might not even think too much about it until that first twinge of pain makes us wince. When it comes to tailbone pain, that twinge can quickly become a long-term ache that affects daily life. Here’s what you need to know about causes and treatments.

What causes tailbone pain?

When we think about our spine, most of us think mainly about the vertebrae above the waist – the ones that support our back and neck. The spine travels well below the waist, though. Understanding the anatomy of the end of your spine can help you better understand tailbone pain.

The coccyx (what is often referred to as the tailbone) is found at the base of the spine, just below the sacrum. This group of three to five individual coccygeal vertebrae is curved and gets narrower towards the end. This shape resembles a bird’s beak and is the origin of the word “coccyx” (the Greek word for cuckoo). In humans, the coccyx is referred to as the tailbone because it is believed to be a vestigial remnant of a tail.

The coccyx has two main functions:

  1. Serving as an attachment point for muscles, ligaments, and tendons
  2. Bearing the weight of the body in conjunction with the ischial tuberosities (sitting bones at the base of the pelvis)

Tailbone pain, also called coccydynia, coccygodynia, or coccyx pain, is as the common name suggests discomfort located at the tailbone.

coccyx anatomy

Tailbone pain causes

Possible causes of tailbone pain include:

  • Injury to the tailbone after a fall
  • Long periods spent seated on a hard surface
  • Injury during vaginal childbirth
  • Degenerative joint conditions

Coccyx pain usually resolves after a few weeks or months without treatment. Chronic, unrelenting tailbone pain may be a sign of an underlying condition, and should be evaluated by a physician.

Tailbone pain symptoms

Tailbone pain is often described as either a constant dull ache or a sharp pain accompanying various actions.

Long periods of standing or sitting and the movements of getting up from a chair, sex, and defecation may increase the sensation of pain.

When is tailbone pain serious?

As noted above, most tailbone pain cases resolve with limited or only minor interventions. However, sometimes tailbone pain is serious. Talk to your doctor if you:

  • Experience persistent, unrelieved pain
  • Find a lump on your tailbone
  • Have redness, warmth, or fever in your tailbone

In rare cases, tailbone pain can be a sign of infection or a specific tailbone tumor called chordoma. Patients diagnosed with cancer in the bones or organs near the coccyx may also suffer from chronic neuropathic pain of the coccyx that is difficult to treat.

Diagnosing tailbone pain

The first step towards diagnosing tailbone pain is a complete, detailed medical history and physical exam. Your doctor will try to determine the onset, location, and severity of your pain, as well as what makes the pain worse and how the pain affects your daily life.

Though most coccyx pain is benign and heals on its own, your doctor will look to rule out other causes related to conditions of the gastrointestinal system, urinary tract, and nervous system. Women with children will be asked about their history of childbirth. Depending on the patient’s symptoms, a colonoscopy may be performed to rule out cancer.

During the physical examination, your doctor may press the sacrococcygeal junction and coccyx (where the sacrum and coccyx meet) to determine pain levels in that area. They may also take an internal/external approach by placing a glove on one hand and inserting one or two fingers into the rectum, applying pressure to the coccyx externally at the base of the spine. This action may be briefly uncomfortable but is important to test the mobility of the sacrococcygeal junction. It can also give your doctor more information about an injury and tenderness of the coccyx.

They’ll also examine other nearby anatomical regions, like the joints, connective tissues, and muscles found in the pelvic area. They’ll test your range of motion, neurological response, and the appearance of skin around the coccyx, too.

Imaging studies, such as magnetic resonance imaging (MRI), may help your doctor take a closer look at the bones and tissues surrounding the coccyx. An MRI can show degeneration of the bone, fractures, or a tumor.

10 tailbone pain treatments

Initially, tailbone pain treatments focus on comfort measures in the hopes that the pain will resolve on its own. For example, your doctor may suggest the following comfort measures first:

  1. Use heating pads or ice packs to reduce pain and inflammation
  2. Try over-the-counter pain medications, such as acetaminophen or ibuprofen
  3. Sit on a cushioned surface, such as a doughnut-shaped pillow, to reduce pressure on the coccyx
  4. Lean forward while seated (rather than reclining backward) so the sitting bones bear the majority of body weight
  5. Maintain proper posture while sitting by pressing your back against the chair, keeping knees level with the hips with relaxed shoulders and feet flat on the ground

If your pain is chronic and you don’t find relief from these comfort methods, other treatments may be necessary. These include:

  • Physical therapy
  • Chiropractic manipulation
  • Prescription medications
  • Injections
  • Surgery

Physical therapy

Physical therapy helps a patient strengthen the muscles of the abdomen and pelvis.

Other times, tight, stiff muscles exacerbate pelvic pain. Relaxation techniques that involve deep breathing and focusing on relaxing the pelvic muscles may also be effective in preventing or relieving coccyx pain.

Manipulation

Another treatment that focuses on the muscles is manipulation, a massage technique performed through the rectum to ease tailbone pain.

Prescription medications

Pain that has been present for more than six months becomes especially resistant to treatment and requires a comprehensive medical treatment plan.

Medications may help relieve acute pain, such as gabapentin, an anticonvulsant, is given to relieve neuropathic pain, or antidepressants.

Injections

Medication may also be injected locally to the tailbone for pain relief and to decrease inflammation. Local anesthetic injections can provide weeks of pain relief, with or without steroids to help reduce inflammation.

For patients suffering from complex regional pain syndrome that also presents as tailbone pain, a ganglion impar block is an often effective treatment for chronic, neuropathic pain. This procedure is an outpatient nerve block that’s performed with the visual guidance of ultrasound or fluoroscopy. If the nerve block is successful, patients report profound pain relief. You can learn more about this procedure in the following video.

Surgery

Surgery is a treatment of last resort. A coccygectomy fully or partially removes the coccyx. This is not ideal as the coccyx serves as an attachment point for several muscles, tendons, and ligaments. The procedure also carries risks that the rectum or ganglion impar (a bundle of nerves) may be injured. Additionally, patients who have undergone coccygectomy have high rates of infection after the procedure, as well as problems with wound healing.

Researchers recommend exhausting all other treatment options before considering surgical treatments.

You don’t have to live with tailbone pain. Contact Arizona Pain today to discuss all of your options for pain management.

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