Coccydynia (Coccyx Pain)

What Is Coccydynia?

Coccydynia is the medical term for pain arising from the coccyx or its surrounding structures.

The coccyx is a small bone at the base of the spine, immediately below the sacrum. It consists of several small vertebral segments that are usually joined together or connected by small joints.

Although it is a relatively small structure, the coccyx provides attachment points for ligaments and muscles, including structures associated with the pelvic floor.

Pain may arise from the coccygeal joints, surrounding ligaments, local soft tissues or changes in the movement of the coccyx.

What Are the Symptoms of Coccydynia?

The most common symptom is localised pain or tenderness at the base of the spine, usually near the top of the crease between the buttocks.

Symptoms may include:

• Pain when sitting, particularly on hard surfaces
• Discomfort when rising from a seated position
• Tenderness directly over the coccyx
• A dull ache with occasional sharp pain
• Pain after sitting for prolonged periods
• Discomfort when bending forwards
• Pain during bowel movements in some patients
• Difficulty sitting comfortably at work or while driving

The severity of symptoms varies considerably. Some patients have occasional discomfort, while others experience pain that significantly restricts everyday activities.

What Causes Coccyx Pain?

There are several possible causes of coccydynia.

1. Injury or a Fall

Falling backwards onto a hard surface can injure the coccyx and surrounding tissues.

An injury may cause bruising, inflammation or, less commonly, a fracture or displacement of the coccyx.

Symptoms may develop immediately after the injury or persist after the initial bruising has improved.

2. Pregnancy and Childbirth

Coccyx pain can develop during pregnancy or following childbirth.

The coccyx and surrounding pelvic structures are exposed to additional forces during pregnancy and delivery. In some cases, stretching or injury to the supporting tissues can cause persistent pain.

3. Prolonged Sitting

Extended periods of sitting can place pressure on the coccyx and surrounding soft tissues.

People who spend long periods driving or working at a desk may notice that symptoms increase throughout the day.

4. Repetitive Strain

Activities such as cycling and rowing can produce repeated pressure or movement around the coccyx.

In some individuals, this may contribute to irritation of the surrounding tissues.

5. Changes in Coccyx Movement

The coccyx normally has a limited degree of movement.

Excessive movement, reduced movement or abnormal positioning may contribute to pain in some patients.

6. Body Weight and Local Pressure

Both increased pressure associated with excess body weight and reduced soft-tissue cushioning in very slim individuals can contribute to coccyx discomfort.

7. No Identifiable Cause

In some cases, coccyx pain develops gradually without a previous injury or other clear explanation.

Can Coccydynia Cause Lower Back Pain?

Coccydynia generally causes pain lower down than typical lumbar back pain.

The discomfort is usually concentrated around the tailbone rather than across the lower back.

However, some patients experience associated discomfort in the lower back, buttocks or surrounding pelvic region.

Identifying the precise location and pattern of symptoms helps distinguish coccyx pain from conditions affecting the lumbar spine.

Read more: What Causes Lower Back Pain?.

Is Coccyx Pain the Same as Sciatica?

No.

Coccydynia usually causes localised pain around the tailbone, particularly when sitting.

Sciatica generally involves irritation or compression of a nerve root in the lower back, resulting in pain that can travel into the buttock, leg or foot.

Although some symptoms may overlap, these are different conditions and may require different investigations and treatments.

Read more: What Causes Sciatica?.

How Is Coccydynia Diagnosed?

Diagnosis usually begins with a detailed medical history and physical examination.

A clinician may ask:

• When did the pain begin?
• Was there a fall, injury or childbirth before symptoms started?
• Is the pain worse when sitting?
• Does moving from sitting to standing cause discomfort?
• Is there tenderness directly over the coccyx?
• Are there associated lower back, leg or pelvic symptoms?
• Has the pain improved or worsened over time?

The examination may assess tenderness, movement and signs suggesting another source of pain.

It is also important to consider other conditions that can cause pain in the same region, including local skin or soft-tissue problems, sacral conditions and referred pain.

Do I Need an X-ray or MRI for Coccyx Pain?

Not everyone with coccyx pain requires imaging.

For straightforward symptoms that are improving, investigations may not be necessary.

Imaging may be considered when:

• Pain persists despite appropriate initial treatment
• There has been a significant injury
• A fracture or abnormal coccyx movement is suspected
• The diagnosis remains uncertain
• Symptoms suggest another underlying condition
• Further intervention is being considered

X-rays can help assess the bony anatomy and may identify fractures or changes in coccyx alignment.

In selected cases, specialist assessment may include sitting and standing X-rays to investigate abnormal movement of the coccyx.

MRI may be useful when soft-tissue abnormalities, inflammation or another cause of pain is suspected. The choice of investigation depends on the clinical findings.

Can Coccydynia Get Better Without Surgery?

Yes. Many cases of coccydynia improve without surgery.

Some patients recover over several weeks, while others experience symptoms lasting several months or longer.

The initial approach usually focuses on reducing pressure on the coccyx, managing pain and allowing irritated tissues to recover.

What Is the Best Treatment for Coccydynia?

Treatment depends on the underlying cause, duration and severity of symptoms.

Reducing Pressure on the Coccyx

One of the most useful initial measures is avoiding prolonged direct pressure on the painful area.

This can include:

• Taking regular breaks from sitting
• Using an appropriately designed coccyx cushion
• Adjusting sitting posture and working arrangements
• Lying on the side when resting
• Temporarily reducing activities that aggravate symptoms

Coccyx Cushions

A coccyx cushion is designed to reduce direct pressure on the tailbone while sitting.

Cushions with a cut-out at the back can be particularly helpful for some patients.

Pain Relief

Appropriate pain-relieving medication may help manage symptoms while the condition improves.

Anti-inflammatory medication may be considered when suitable, although it is not appropriate for everyone. Patients should seek advice from a pharmacist or clinician about medication safety and interactions.

Hot and Cold Treatments

Some patients find relief from a wrapped cold pack or gentle heat applied to the painful region.

Physiotherapy

Physiotherapy may help address contributing muscular or pelvic floor problems and provide guidance on movement, posture and appropriate rehabilitation.

The programme should be tailored to the individual rather than assuming that every case is caused by poor posture or weak muscles.

Can Injections Help Coccyx Pain?

For persistent symptoms that have not improved with appropriate conservative treatment, targeted injections may be considered.

Depending on the diagnosis, these can involve local anaesthetic, corticosteroid or other specialist pain-management techniques.

Injections may help reduce inflammation or provide temporary pain relief. In selected cases, they may also assist in identifying the source of the pain.

A specialist may consider an injection around the sacrococcygeal region or, in selected patients, a ganglion impar block.

The suitability, potential benefits and risks of injections should be discussed individually.

When Does Coccydynia Require Surgery?

Surgery for coccydynia is uncommon and is generally considered only when substantial pain persists despite appropriate non-surgical treatment.

Before surgery is considered, it is important to establish that the coccyx is the likely source of symptoms and to assess whether the proposed operation is likely to provide meaningful benefit.

Factors that may influence the decision include:

• Persistent, severe pain affecting daily activities
• Failure of appropriate non-surgical treatments
• Clinical findings consistent with coccygeal pain
• Relevant imaging findings, where applicable
• The patient's general health and individual circumstances

The operation most commonly discussed for selected severe cases is called a coccygectomy.

What Is a Coccygectomy?

A coccygectomy is an operation to remove part or all of the coccyx.

It is usually reserved for carefully selected patients with persistent coccydynia who have not responded to appropriate non-surgical treatment.

Although some patients obtain meaningful pain relief, outcomes vary and the operation carries risks.

Potential complications include wound-healing problems, infection, persistent pain and the possibility of further treatment.

The decision to consider coccygectomy requires a detailed discussion of expected benefits, limitations, alternatives and risks.

How Long Does Coccydynia Last?

Recovery varies considerably.

Some cases improve within a few weeks, especially when symptoms follow minor irritation or injury.

Other patients may experience pain lasting several months or longer.

Symptoms that persist, worsen or interfere significantly with daily activities should be assessed to confirm the diagnosis and consider appropriate treatment.

When Should I See a Specialist for Coccyx Pain?

Medical assessment may be appropriate when:

• Pain has not improved after several weeks
• Symptoms significantly affect sitting, driving or working
• Pain developed after a substantial injury
• There is persistent focal tenderness
• Symptoms continue despite reasonable initial treatment
• The diagnosis is uncertain
• Imaging or an injection is being considered

A specialist assessment can help establish whether the coccyx is the source of pain or whether another condition requires investigation.

When Can Coccyx Pain Indicate a More Serious Problem?

Most coccyx pain is not caused by a serious underlying condition.

However, medical assessment is important when symptoms are associated with:

• Fever or feeling generally unwell
• Increasing redness, swelling or discharge near the painful area
• Unexplained weight loss or a history of cancer
• Persistent, unexplained pain that is worsening
• Significant pain following a serious injury

Seek emergency medical assessment for new bladder or bowel dysfunction, loss of sensation around the genitals or anus, or severe or progressive leg weakness, particularly when associated with back pain.

These neurological symptoms should not automatically be attributed to coccydynia.

Frequently Asked Questions About Coccydynia

What is coccydynia?

Coccydynia is pain affecting the coccyx or surrounding structures at the bottom of the spine.

Why does my tailbone hurt when I sit down?

Sitting places pressure on the coccyx. Pain may develop from local irritation, injury, abnormal coccyx movement or inflammation of surrounding tissues.

Why does my coccyx hurt when I stand up?

Moving from sitting to standing changes the pressure and forces around the coccyx. This can aggravate inflamed or injured structures.

Can coccydynia occur without an injury?

Yes. Coccyx pain can develop gradually following prolonged pressure, pregnancy or other contributing factors, and sometimes no clear cause is found.

Will coccydynia go away by itself?

Many cases improve over time with conservative measures. Persistent or worsening symptoms should be assessed.

Do I need an MRI for coccyx pain?

Not usually for straightforward, improving symptoms. MRI may be helpful if the diagnosis is uncertain, pain persists or another underlying condition is suspected.

Can physiotherapy help coccydynia?

Yes. Physiotherapy can be beneficial for selected patients, particularly where contributing muscular or pelvic floor problems are identified.

Can injections help persistent coccyx pain?

Targeted injections may be considered when appropriate initial treatment has not provided adequate relief.

Does coccydynia require surgery?

Rarely. Most patients are managed without an operation. Surgery is generally reserved for carefully selected cases of persistent, severe pain.

Further Information About Coccyx and Lower Back Pain

For further information about Professor Quraishi's assessment of coccyx conditions, please see the existing coccyx pain page.

Coccyx Pain (Coccydynia) – Condition Information

What Causes Lower Back Pain?
When Should I See a Spine Specialist for Back Pain?
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