Coccydynia (Tailbone Pain)
Pain at the very base of the spine — the coccyx or tailbone
ICD-10: M53.3 · sacroiliac condition
Coccydynia refers to persistent pain localized to the coccyx (tailbone), the small triangular bone at the very bottom of the spine. The pain typically worsens with sitting, rising from a seated position, or prolonged pressure on the area. Women are five times more likely than men to develop coccydynia, largely due to the anatomy of the female pelvis and the risk of coccygeal injury during childbirth. Most cases resolve with conservative management, though a minority require procedural or surgical intervention.
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Women are approximately five times more likely than men to develop coccydynia, largely due to pelvic anatomy and obstetric injury.
Lirette LS et al., The Ochsner Journal (2014)Approximately one-third of coccydynia cases are idiopathic (no identifiable cause); another third follow direct trauma; and the remainder are associated with childbirth.
Maigne JY et al., Spine (2000)Symptoms
- Aching or sharp pain directly over the tailbone area
- Pain that worsens significantly when sitting, especially on hard surfaces
- Pain that increases when transitioning from sitting to standing
- Tenderness to direct pressure over the coccyx
- Discomfort during bowel movements or sexual intercourse
- Pain that may radiate to the lower back or buttocks
Causes & Risk Factors
- Trauma — a fall onto a hard surface (most common cause)
- Childbirth — pressure and stretching of the coccyx during vaginal delivery
- Repetitive strain from activities such as rowing or cycling
- Idiopathic (no identifiable cause — accounts for up to one-third of cases)
- Hypermobility or hypomobility of the coccygeal joint
- Degeneration of the coccygeal disc with age
Treatment Options
Conservative
- Donut or coccyx-relief cushions to reduce sitting pressure
- NSAIDs (ibuprofen, naproxen) for pain and inflammation
- Physical therapy — pelvic floor rehabilitation and stretching
- Coccygeal manipulation by a trained physical therapist or osteopath
- Intra-articular corticosteroid injections for refractory pain
- Ganglion impar nerve block for persistent pain
Surgical
- Coccygectomy (partial or total removal of the coccyx) — reserved for severe refractory cases
When to see a spine specialist
See a spine specialist if tailbone pain has persisted more than 4–6 weeks despite conservative measures, if pain is severe enough to limit daily function, or if there is associated bowel or bladder dysfunction. A spine or pain specialist can evaluate for dynamic instability or a displaced fracture that may require targeted injection therapy or surgery.
Specialists Who Treat Coccydynia (Tailbone Pain)
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Search spine specialists →Frequently Asked Questions
How long does coccydynia take to heal?
Most cases of acute coccydynia caused by trauma resolve within 4–12 weeks with conservative management. Chronic coccydynia lasting more than 3 months may require more targeted treatment such as corticosteroid injections, ganglion impar nerve blocks, or coccygeal manipulation. Only a small minority (less than 10% of patients who fail all conservative and injection therapies) ultimately require coccygectomy.
Can a coccyx injury be seen on X-ray?
Standard X-rays can detect coccygeal fractures and obvious malalignment. Dynamic X-rays taken in sitting and standing positions can reveal coccygeal instability (excessive movement) that is the underlying cause of pain in some patients. MRI is useful for ruling out tumors, cysts, or other soft tissue causes of tailbone pain.
Is coccygectomy effective?
Coccygectomy (surgical removal of the coccyx) has reported success rates of 80–90% in carefully selected patients who have failed all conservative and interventional treatments. Proper patient selection — confirming the coccyx is the pain source through a positive response to diagnostic injection — is the most important predictor of surgical success.