Pain in the you-know-what? If you have pain in your lower back near your rear end you may have coccyx (tailbone) pain, or coccydynia. Sometimes the cause is obvious, like a fall or going through labor and childbirth. Other times, tailbone pain can creep up on you, due to problems with your pelvic floor muscles or other musculoskeletal (MSK) issues. This can be a real pain and life disrupter, but lifestyle changes and exercises can treat it.

Read on to learn about tailbone pain causes and symptoms and tips for coccyx pain relief.

Tailbone Anatomy

The coccyx, or tailbone, is a small, triangle-shaped bone at the bottom of your spine. It’s located right above the cleft of your buttocks.

How can such a tiny structure be the cause of pain? Your coccyx is the attachment site for pelvic and gluteal muscles, tendons, and ligaments. Some of these structures play a role in pelvic floor support, pelvic pain conditions, and bladder and bowel control. Your coccyx is also one of three weight-bearing areas (along with your ‘sit bones’ on the bottom of your pelvis) that support you when you sit. So tailbone pain often means you also have pain while sitting. 

Tailbone Pain Symptoms

Tailbone pain can vary in intensity and includes many different types of pain. Symptoms often include:

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

• Tailbone or buttock pain with sitting or standing for long periods

• Pain when rising from sitting

• Pain when leaning forward

• Pain with bowel movements

• Pain with intercourse

Causes of Tailbone Pain

Some of the most common causes of tailbone pain include:

• 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 (due to loosening of pelvic ligaments and increased pressure from the growing baby)

• Childbirth (due to pressure on the tailbone during delivery) 

• Pelvic floor muscle pain 

• Obesity or underweight

• Constipation

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

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

When to See a Doctor

Many causes of tailbone pain are not serious, but some conditions require care by a physician. See your doctor if your pain is severe or doesn’t improve after several days. 

Diagnosing Tailbone Pain

Coccydynia is often diagnosed based on your symptoms. Your doctor may perform a physical exam to see if there is tenderness over your coccyx. They may also do a rectal exam to assess the mobility of your tailbone and rule out other possible causes of pain, like cysts, infections, and pelvic floor muscle spasms. X-rays or other scans might be suggested to look for fractures or greater than normal movement of your coccyx. 

Treatment of Coccyx Pain 

Treatment for tailbone pain will depend on the cause and the nature of your symptoms. Common treatments include:

• Self-care home remedies like heating pads, ice packs, baths, or massage

• Chair cushions or coccyx pillows with a cutout to relieve pressure in the tailbone area 

• Medication

  • Over-the-counter (OTC) pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for tailbone pain. It’s important to make sure that you are safely able to take these medications, based on your medical history. 

  • Prescription pain medications

• Physical therapy and exercise therapy

• Lifestyle strategies like relaxation techniques and improved sleep habits

• Behavioral modifications, including diet changes and smoking cessation

• Mental health support, including cognitive behavioral therapy

Most people get relief from coccyx pain with at-home treatments. In some cases, further interventions can help, including:

• Steroid and anesthetic injections

• Nerve blocks

• Surgery (rarely), including coccygectomy, or removal of your tailbone

Physical Therapy and Exercise for Tailbone Pain Relief

Regular exercise and physical therapy can help prevent and treat some types of pelvic pain and other pelvic symptoms, including tailbone pain. 

Some pelvic pain and tailbone pain conditions are caused by problems with your pelvic floor. Your pelvic floor is made up of layers of muscles, ligaments, and fascia (connective tissue) that stretch from your pubic bone in front of your body to your tailbone in the back. Your pelvic floor muscles can become tight, inflamed, weak, or stop working as they should. 

Issues with these muscles (such as spasms) can pull the tailbone out of alignment and cause discomfort. While there’s no such thing as “perfect” posture, alignment issues with your pelvis and low back or posture-related strain can also cause tailbone pain.

Pelvic floor physical therapy for tailbone pain and other symptoms is a comprehensive treatment that includes education, behavioral and lifestyle strategies, movement and exercise, and manual therapy. You can see a physical therapist (PT) in person or use a program like Hinge Health to access a PT via telehealth/video visit. Your Hinge Health physical therapist can customize your exercise plan to address tailbone pain related to musculoskeletal issues.

Depending on your symptoms, a pelvic floor physical therapist may recommend:

• Stretching exercises, including tailbone stretches, to relax tense muscles and increase flexibility

• Pelvic floor exercises

• Whole-body exercises to strengthen areas that support your pelvic floor 

• Stress management techniques

• Nutritional changes

• Sleep strategies

Many people with pelvic floor-related tailbone pain see improvement after a few weeks of pelvic floor physical therapy. Ask your doctor if pelvic floor physical therapy could be right for you. 

“Tailbone pain can have a huge effect on your everyday life and many people are surprised to learn that it can often be related to problems with your pelvic floor,” says Kandis Daroski, PT, DPT, a physical therapist at Hinge Health. “The good news is that many people find relief quickly— with approaches like movement, exercise, and lifestyle modifications.”

Tips for Tailbone Pain Relief

The following tips from our Hinge Health physical therapists and medical doctors can provide relief for coccyx 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 coccyx pillow 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 drugs (NSAIDs) 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.

• Modify 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). Modifications might include wearing padded bike shorts, breaking activities up into shorter sessions, or doing stretches before, during, or after the activity. 

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

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

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