Lower back
Coccydynia (Tailbone Pain)
Pain at the very bottom of the spine, worse when sitting or rising from a chair. Often follows a fall, childbirth or long periods of sitting.
Common symptoms
- Pain at the very bottom of the spine, just above the buttock crease
- Pain that is worse when sitting, especially leaning back or on hard seats
- Sharp pain when standing up from sitting
- Tenderness when the tailbone area is touched
- Pain during bowel movements or, sometimes, intercourse
- Relief when standing, walking or sitting on one buttock
Overview
The coccyx, or tailbone, is the small triangle of bone at the very bottom of the spine. Coccydynia means pain in or around it. It is usually felt as a deep ache or sharp pain right at the base of the spine, worse when sitting — especially leaning back on a hard surface — and often sharpest at the moment of getting up from a chair.
It is more common in women, partly because of childbirth and the shape of the pelvis, and often follows a fall onto the bottom. It can also build up gradually with long hours of sitting, which is why students and office workers sometimes develop it without any injury.
Many cases settle over weeks to a few months with sensible changes to sitting and the right treatment, although outcomes vary. If pain persists, your GP or a specialist may look for other causes or discuss further options.
Causes and risk factors
- A fall onto the bottom, for example on ice, stairs or while skating
- Childbirth, particularly a long or assisted delivery
- Long periods of sitting, especially on hard seats or slumped backwards
- Cycling or rowing, which put repeated pressure on the area
- Rapid weight loss (less natural padding) or higher body weight (more pressure when sitting)
- Tension in the pelvic floor and buttock muscles attached around the coccyx
- Rarely, infection or a growth — reasons your GP may investigate pain that persists
How we may be able to help
We take a careful history of how the pain started and screen for warning signs. We then examine your lower back, sacroiliac joints, hips and the muscles of the buttock and pelvis, as pain in this area can come from more than one place. If you have had a significant fall and a fracture is possible, or pain is not settling, we can arrange an online private GP consultation for an X-ray or specialist referral.
Physiotherapy includes advice on sitting and cushions, external soft-tissue release of the buttock and pelvic muscles, and exercises for the lower back, hips and breathing to reduce muscle tension around the coccyx. Our chiropractor may use gentle mobilisation of the lower back, sacrum and pelvis to reduce strain on the tailbone. Interferential therapy may help ease pain, and kinesiology taping can be a short-term comfort aid.
Some specialist pelvic floor clinicians use internal (rectal) techniques for the coccyx. We do not offer these; all our treatment is external. If we think an internal approach could help, we will tell you so you can discuss a referral with your GP.
What you can do at home
- Use a wedge or coccyx cushion with a cut-out at the back so the tailbone does not take your weight
- Sit upright or lean slightly forward rather than slumping back onto the tailbone
- Get up and move every 30 minutes when studying or working
- Lean forward and push up with your hands when standing up from a chair
- Use heat, or an ice pack wrapped in a towel, for 10–15 minutes to ease pain
- Avoid long cycle rides and hard seats until the pain settles
Frequently asked questions
Do I need an X-ray?
Not usually. Most coccydynia is diagnosed from your history and an examination. An X-ray may be considered after a significant fall, and a specialist may request sitting and standing X-rays if pain persists. We can arrange an online private GP consultation if imaging may help.
Which cushion should I use?
Many people find a wedge-shaped or U-shaped coccyx cushion with a cut-out at the back helpful, because it takes pressure off the tailbone. A ring (doughnut) cushion suits some people less well, as it can still press on the coccyx.
Do you use internal techniques?
No. Some specialist pelvic floor clinicians treat the coccyx internally (through the back passage). We do not offer this; our treatment is external. If we think it could help, we will tell you so you can discuss a referral with your GP.
Is tailbone pain common after childbirth?
Yes, and it often eases in the weeks to months after birth. If it persists, an assessment can help find whether the lower back, pelvis or pelvic floor muscles are contributing, and guide sitting, feeding positions and exercise.
This page is general information, not a diagnosis. A clinician will assess you before recommending any treatment. Outcomes vary from person to person. Written with reference to NHS and other peer-reviewed guidance.