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Understanding Coccyx (Tailbone) Pain

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If you have pain in your lower back near your rear end that makes it hurt to sit down, you may have coccyx (tailbone) pain. The coccyx is a small, triangle-shaped bone at the end of your spine, right above the cleft of your buttocks. Sometimes the cause of tailbone pain is obvious, like a fall or going through labor and childbirth. Other times, tailbone pain can come on more subtly, resulting from issues with your pelvic floor muscles or other musculoskeletal (MSK) issues. This can be a real pain in the you-know-what, but lifestyle changes and exercises can treat it.

Symptoms of Tailbone Pain

  • Sharp or dull and achy pain in your bottom, directly over your tailbone

  • Tailbone or buttock pain with sitting or standing for long periods, or with changing positions

  • Pain with bowel movements

  • Pain with intercourse

Causes of Tailbone Pain

  • Falling onto your back or bottom

  • Repetitive pressure or strain to the area (e.g, biking, horseback riding, or prolonged sitting)

  • Sitting on hard surfaces

  • Pregnancy and childbirth

  • Pelvic floor muscle pain

  • Obesity or underweight

  • Constipation

  • Other issues with the coccyx (bone spurs, nerve pain, and degeneration from arthritis)

In serious cases, a fracture or cyst can cause tailbone pain. Rarely, it can be from infection or cancer.

Tailbone Pain and Your Pelvic Floor

Your pelvic floor muscles (a bowl-shaped group of muscles that nestles like a hammock at the bottom of your pelvis) all attach at the tailbone. Issues with these muscles (such as spasms) can pull the tailbone out of alignment and cause discomfort. Alignment issues with your pelvis and low back or posture-related strain can also cause tailbone pain. Your Hinge Health physical therapist can customize your exercise plan to address tailbone pain related to musculoskeletal issues.

Tips for Managing Tailbone Pain

  • Work with your Hinge Health physical therapist to include exercises that improve the mobility of your coccyx and relax muscle spasms that may be causing pain.

  • Use a pillow when sitting to help relieve pressure on this area. You can buy a special pillow (“coccyx seat cushion”) with a cutout in the tailbone area for extra cushioning.

  • Take frequent breaks when sitting.

  • Apply ice or heat to the area.

  • Take nonsteroidal anti-inflammatory medication (NSAID) like ibuprofen as needed (and if approved by your doctor).

  • Change your sleeping position. Try sleeping on your side instead of your back.

  • Prevent constipation by staying hydrated, eating high-fiber foods (fruits, vegetables, whole grains, beans, and legumes), exercising, and taking stool softeners as needed.

  • Avoid activities that increase tailbone pain, such as cycling, horseback riding, or those that require a lot of up-and-down movement (gardening or squats and lunges).

  • Avoid tight clothing that can be uncomfortable on your tailbone area.

  • Practice diaphragmatic (belly) breathing, which can help relax a tight pelvic floor.

  • Take a hot bath to relax your muscles and ease pain.

If making these adjustments and doing your physical therapy exercises doesn't improve your pain, speak with your provider about other medication or surgery options.

Key Takeaways

  1. The coccyx (or tailbone) is a small, triangle-shaped bone at the end of your spine, right above the cleft of your buttocks.

  2. Tailbone pain can be due to an obvious reason (like a fall on your bottom) or a more subtle reason (like a pelvic floor problem).

  3. Pelvic floor physical therapy can be very effective for tailbone pain because it addresses an issue with the pelvic floor muscles (which attach to the tailbone) when they pull the tailbone out of alignment.

References

  1. Frustrated with tailbone pain? Pelvic Floor PT Helps!- Purple Mountain PT. (2021, April 12). Purple Mountain Physical Therapy. https://purplemountainpt.com/2021/04/12/tailbone-pain-solved-with-pelvic-floor-pt/

  2. How to relieve tailbone pain. (n.d.). Mayo Clinic. https://www.mayoclinic.org/tailbone-pain/expert-answers/faq-20058211

  3. Tailbone Pain (Coccydynia): Causes, Treatment & Pain Relief. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/10436-coccydynia-tailbone-pain