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Tailbone pain (coccydynia)

Before anything else — 4 symptoms that need urgent care
  • •Fever with coccyx pain — possible pilonidal or deep infection
  • •Progressive bowel or bladder symptoms
  • •Night pain or pain unrelated to position — consider malignancy workup
  • •Pain with visible swelling, drainage, or a palpable mass
Full red-flag guide

Likely conditions

Common causes based on epidemiology alone — a physical exam and sometimes imaging are needed to identify which one applies to you.

Coccydynia

Most common after a fall or childbirth; more common in women, particularly post-childbirth

Condition detail

Who to see first

Primary Care Physician

Your general physician — family medicine, internal medicine, or DO.

When to see them: First visit for most non-emergent new pain — they can coordinate PT and determine whether specialist referral is needed.

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Treatment sequence

Published guidelines (NASS, AAOS, ACP, NICE) recommend a conservative-first sequence unless red flags are present. Each step below lists the evidence strength and the primary source.

  1. 1
    Week 1–4Moderate evidence

    Self-care: cushion, activity modification, NSAIDs

    A donut or wedge cushion offloads the coccyx while sitting. Short activity modification (limit prolonged hard-surface sitting). OTC NSAIDs as tolerated. Most acute post-traumatic coccydynia improves substantially within weeks.

    Source

  2. 2
    Week 4–12Moderate evidence

    Physical therapy

    PT with a pelvic-floor-trained clinician can address pelvic floor muscle tension, perform coccygeal mobilization, and restore normal mechanics. Intrarectal or transrectal manipulation is an evidence-supported adjunct for persistent pain.

    Source

  3. 3
    Month 3–6Limited evidence

    Interventional injection

    For coccydynia persisting beyond 3 months despite conservative care, a fluoroscopy-guided coccygeal corticosteroid injection (with or without ganglion impar block) can provide meaningful relief in a subset of patients. Typical response is weeks to months.

    Source

  4. 4
    >6 monthsLimited evidence

    Surgical consultation (coccygectomy — last resort)

    Coccygectomy (surgical removal of the coccyx) is considered only after 6+ months of failed conservative and interventional care, and only with imaging evidence of coccygeal instability or lesion. Outcomes are generally favorable in well-selected patients, but infection and wound healing complications are notable risks.

    Source

Common causes

  • •Trauma — a fall onto the buttocks is the most common single cause
  • •Childbirth-related coccygeal injury
  • •Prolonged or repetitive sitting (especially on hard surfaces)
  • •Idiopathic — no specific trigger in many cases
  • •Coccygeal disc degeneration or hypermobility

Your next steps

  • 1Screen yourself for red flags. If any apply, go to an emergency department before continuing with this Guide.
  • 2Start the first stage of the treatment ladder. Most new pain episodes improve significantly in the first 2–6 weeks with self-care and PT.
  • 3If symptoms persist, book with the specialist above. Bring: when it started, what makes it better or worse, medications tried, any imaging you have, and the questions from our surgery decision framework.
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