Coccydynia is Tailbone Pain

Common causes of coccyx pain, risk factors and treatment options.

Coccydynia is the answer to the question, "why does my butt bone hurt?" It's the medical term for pain in your coccyx, or tailbone. Tailbone pain can make sitting and leaning back very uncomfortable. But on the bright side, most people with tailbone pain respond very well to conservative treatment.

Is the Coccyx Part of the Spine or Lower Back?

The coccyx, or tailbone, is the lowest region of your spine, and it sits directly below the sacrum. Your tailbone is made up of 3 to 5 small bones that naturally fuse together by about age 30. It’s positioned at the bottom of your spine, and the coccyx helps support your weight while you sit.

coccyx shown in illustration of the sacrumThe coccyx, or tailbone, is the lowest region of your spine, and it sits directly below the sacrum. Photo Source:

Coccydynia Risk Factors

While the medical community doesn’t know the prevalence of coccydynia, they have found that the condition is more likely to affect:

  • Adolescents and adults
  • Women
  • People who are obese

Being female and obese are the 2 biggest risk factors. Women are affected by coccydynia 5 times more than men, which is likely due to injuries during childbirth. Also, the female coccyx is positioned farther back than its male counterpart, making it more vulnerable to trauma.

Researchers believe obesity causes coccydynia because extra weight can alter how a person sits. Plus, more weight puts additional pressure on the coccyx.

A common cause of coccydynia is repetitive movement, such as extensive bike riding. Photo Source:

Coccydynia Causes

Coccydynia has several possible causes, the 3 most common being:

  1. Trauma from falling or being bumped
  2. Repetitive action, such as extensive bike riding or rowing
  3. Childbirth

These activities can fracture, dislocate or bruise the tailbone. If this occurs, you may experience painful inflammation and muscle spasms in the tailbone area.

Other possible causes of coccydynia include:

  • Bone spurs on the coccyx: A small bone spur on the lowest part of the coccyx can pinch the surrounding area, and cause pain and discomfort while sitting.
  • Joint instability: Coccydynia can occur if the sacrococcygeal joint (which connects the coccyx and sacrum) allows too much or too little movement.
  • Osteoarthritis (eg, spinal arthritis)
  • Infection, metastatic cancer, chordomas, and arachnoiditis are rare causes.

Tailbone pain and lower back pain can mimic coccydynia in sciatica, infection, pilonidal cysts (a type of skin infection), and fractured bone. Your doctor will rule out these causes to make a coccydynia diagnosis.

How Doctors Diagnose Coccydynia

The doctor primarily relies on your medical history and a physical exam to diagnose coccydynia. While imaging scans are typically not needed, your doctor may order a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan if he or she suspects a separate bone, nerve or tissue problem to be the cause of your tailbone pain.

Your medical history is important, as your doctor wants to know whether you’ve been through a fall, accident, or other recent trauma that may have caused your tailbone pain.

After reviewing your medical history, your doctor conducts a physical exam and asks you about your symptoms. Coccydynia pain is usually localized to your tailbone area, which makes it relatively straightforward to diagnose. Your doctor wants to know whether you have tailbone pain when sitting or leaning back. He or she may also ask you to point to where you feel pain. Pointing to the tailbone may be enough to distinguish your pain as coccydynia (as opposed to another low back pain condition). Your doctor may also touch your tailbone area to feel for areas of inflammation.

Nonsurgical Treatment for Coccydynia

Fortunately, conservative therapy is extremely effective for coccydynia. In fact, 90% of people experience a reduction in pain using nonsurgical means or without any medical intervention.

Coccydynia is usually first treated with these noninvasive methods:

  • An ice pack or heating pad can help provide immediate, short-term relief.
  • A “donut” or “wedge” cushion provides extra padding to take pressure off your coccyx while sitting. These special cushions are readily available at retail pharmacies.
  • Avoid extended sitting (such as a long-haul flight) will help prevent additional pain and injury.
  • Rest also plays an important part to help avoid further injury to the tailbone during recovery.

If you still have tailbone pain after trying these conservative therapies, your doctor may recommend over-the-counter or prescription-strength non-steroidal anti-inflammatory drugs (NSAIDs) or other pain medications for relief. If your pain isn’t responding to oral medication, your doctor may give you a cortisone injection or local spine nerve block to send powerful pain relief directly to your tailbone area.

A Rare Option: Surgery for Coccydynia

If you’ve exhausted all other treatment options with no success, surgery may be the next step. The surgical procedure for coccydynia is called a coccygectomy, or removal of the tailbone.

Like all surgeries, coccygectomy bears potential risk that you and your surgeon will discuss before the procedure is performed. These risks include infection, hematoma (an abnormal collection of blood outside an artery or vein), and possible perineal hernia (weakened pelvic muscles supporting the rectum) later in life.

What to Do When Coccydynia Becomes Chronic

A small portion of people with coccydynia develop chronic coccydynia, which means tailbone pain that lasts for more than 2 months. Chronic coccydynia can take a major toll on your quality of life, so talk to your doctor if your symptoms aren’t going away. He or she may refer you to a doctor who specializes in coccydynia pain management.

Protect Your Tailbone

There is no definitive way to prevent coccydynia, but you can reduce your risk for tailbone pain by using caution while participating in certain sports (eg, skating [ice, inline, and roller], biking, and horseback riding) and by taking extra care when walking in icy or hazardous conditions to prevent falls.

Updated on: 10/16/20
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