A Pain in the Butt? Understanding Tailbone Pain

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3d render medical illustration of the sacrum bone
Often times we do not give much thought to various parts of our body until they start to hurt. The tailbone is no exception to this. Coccyx, the medical term for the tailbone, is located at the bottom of the spine that is composed of three to five bony structures held in place by joints and ligaments. It was named after the Greek word for cuckoo because it looks similar to the beak of a bird. Tailbone pain, also called coccydynia, is concentrated at the bottom of the spine, above the buttocks. It can range from dull and achy to sharp and intense.

Source of Tailbone Pain

The underlying causes of tailbone pain are likely from the following:

  • Most common source of pain is from falling on the tailbone in a seated position against a hard surface. This can cause bruising, dislocation, or  fracture.
  • A direct blow to the tailbone can injure the coccyx causing tailbone pain.
  • Sitting on a hard surface for extended periods of time. This can include activities such as, horseback riding, cycling, or rowing.
  • Joint damage from repetitive motion, aging, arthritis, or general wear and tear can all contribute to tailbone pain.
  • Being overweight can put pressure on the tailbone.
  • Women are five times more likely to experience tailbone pain because the ligaments connected to the coccyx are loosened during pregnancy to make room for the baby. Childbirth can also put a strain on the tailbone by forcing pressure on it when the baby’s head passes over the top of the tailbone.
  • Rarely, but not unheard of, a tumor, infection, bone spurs, or compression of nerve roots are the causes of tailbone pain.

What Does Tailbone Pain Feels Like?

Depending on the severity of the tailbone injury sustained, the pain will vary from mild to intense. The intensity increases when ordinary activities are performed like sitting, rising to a standing position, or any sitting for an extended period of time. Using the bathroom and sexual intercourse might become painful due to tailbone pain. In women, tailbone pain can cause menstruation to be even more uncomfortable.

Occasionally tailbone pain may result in shooting pain down your legs. Walking or standing can temporarily relieve the pain or pressure and ease discomfort.

When To Consult a Pain Management Physician

If pain does not subside after a few days, it is time to contact a Pain Management physician. Most commonly, your physician will tell you it is nothing serious but it is better to be safe than sorry, in the rare occasion it is an infection or tumor.

If your Pain Management physician cannot see you right away, here are some ways to lessen the pain in the meantime:

  • Over the counter pain relievers: aspirin, ibuprofen, acetaminophen, or naproxen.
  • Apply heat or ice to the affected area
  • Get a massage
  • Sit on a doughnut shaped pillow
  • Lean forward when you go to sit down
  • While sitting, poor posture can add pressure to your tailbone. Sit up straight with your back against the chair and feet flat on the floor.

What are my treatment options?

When you see your physician they will start by asking questions on when the pain started and how the injury occurred. Then they will perform an examination on your tailbone to assess pain levels and determine a course of actions.

A rectal exam might be done to rule out any other conditions. But most often an MRI will be ordered to see images of the tailbone. This will verify if there is a fracture, degenerative changes, or tumor.

Once this is complete the doctor might recommended an injection into the tailbone. Local anesthetic is the typical treatment option. Steroid injections are also conventional for tailbone pain. Surprisingly, antidepressants and anti-epileptic medications are known to relieve chronic tailbone pain. The doctor might do coccygeal manipulation, where he/she will insert a finger into the rectum to move the tailbone back and forth to shift it back into position.

Physical Therapy might be suggested to strengthen the muscles that support the tailbone, known as pelvic floor muscles. The physical therapist can demonstrate pelvic floor relaxation techniques such as, deep breathing and completely relaxing your pelvic floor, which is what you do when going to the bathroom.

There is a surgical procedure called coccygectomy that can be a treatment option. This is where the coccyx is removed. However, the pain may not go away after surgery right away and it is known in some cases not to work at all. This also increases risk of complications. It is only recommended when all other treatment options fail.


Having tailbone pain can be a real pain in the butt. Not being able to sit comfortably can affect everyday life and how you live it. At IMS Pain Management we strive to make your life easy and serene. Schedule an appointment today to relieve any pain you may have and enjoy the most out of everyday.

tarsal tunnel syndrome


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