Quick answer: coccydynia is pain at the tailbone, the small curved bone at the very base of the spine. It is defined by one thing more than any other: sitting hurts, particularly leaning back, and standing up from a chair hurts. Most cases follow a fall, childbirth or prolonged sitting on hard surfaces, and most improve with conservative treatment over weeks to months. The single most useful practical change is the right cushion, and it is probably not the one you were about to buy.
When to Get Checked First
Tailbone pain is usually mechanical and settles. These features are different and need medical assessment rather than a cushion and patience:
- Pain that is constant and not clearly related to sitting, or that is worse at night and wakes you. Mechanical coccydynia is characteristically position-dependent. Pain that ignores position deserves investigation, because the sacrococcygeal region is one site where rare bone tumours such as chordoma occur, and MRI is used specifically to exclude this.
- Fever, redness, swelling, or any discharge near the top of the buttock crease. This suggests infection or a pilonidal sinus rather than coccydynia, and needs treating differently.
- Unexplained weight loss, or a history of cancer.
- Numbness around the groin, genitals or inner thighs, or new bladder or bowel changes. Same-day emergency assessment.
- Rectal bleeding, or pain during bowel movements that is new. Worth separate assessment, since several pelvic conditions refer pain to this area.
- Severe pain immediately after major trauma, such as a fall from height or a road accident, where sacral or pelvic fracture is possible.
The Pattern That Identifies It
Coccydynia has an unusually distinctive presentation, and recognising it saves people from being investigated for the wrong thing.
- Sitting brings it on, and leaning backwards while seated makes it markedly worse, because that tips more body weight onto the coccyx.
- Leaning forward relieves it. Many people discover on their own that perching forward on a chair, or sitting on one buttock, is the only tolerable way to get through a meal or a meeting.
- Standing up from sitting produces a sharp catch. This transition is often the worst single moment of the day.
- Pressing directly on the tailbone reproduces it, and the tenderness is precisely localised rather than spread across the lower back.
A useful confirmation: sit normally in a hard chair until the pain appears, then deliberately lean forward about 20 degrees and hold it. If the pain drops away within seconds and returns when you sit back, the load is going through the coccyx, and that is about as clear as a self-test gets for this condition.
| If the pain is | Consider instead |
|---|---|
| Just off the midline, under the dimple, worse on stairs and rolling in bed | Sacroiliac joint pain |
| Deep in the buttock or pelvis, worse with bowel movements or intercourse, with a sense of sitting on a ball | Pelvic floor muscle overactivity |
| In the skin at the top of the buttock crease, with swelling, redness or discharge | Pilonidal sinus or abscess |
| Spreading down the back of the leg, worse coughing or straining | Lumbar nerve root irritation |
| Worse standing and walking, eased by sitting — the reverse of the coccydynia pattern | Back pain when walking or standing |
Causes
Trauma
The most common cause. A direct fall onto the tailbone from a chair, stairs or a hard surface can bruise, fracture or partially dislocate the coccyx or the sacrococcygeal joint above it. Reassuringly, coccyx fractures are managed conservatively rather than with immobilisation or surgery, and typically settle over a couple of months.
Childbirth
The coccyx flexes backwards during vaginal delivery to allow the baby’s head through. Occasionally this results in ligament injury, partial dislocation or fracture. Postpartum tailbone pain is common, frequently attributed to something else, and often left untreated. It is treatable, and worth raising specifically.
Repetitive loading
Long hours on hard or narrow seating, cycling on a narrow saddle, and rowing all load the coccyx repeatedly. This produces a more gradual onset than a fall, with no single moment of injury to point to.
Abnormal coccyx mobility
The coccyx normally flexes slightly when you sit. Some are excessively mobile, some barely move at all, and either can cause pain through different mechanisms. Dynamic X-rays taken both standing and sitting are the way this is identified, though they are not routinely needed.
No identifiable cause
A substantial minority of cases, commonly cited as around a third, have no clear trigger. This does not mean the pain is not real or not treatable.
Contributing factors
Higher body weight increases sitting pressure on the coccyx, and very low body weight reduces the soft tissue padding over it. Overactivity of the pelvic floor muscles, which attach directly to the coccyx, can maintain pain long after any original injury has healed. Constipation is an underrated contributor, because straining loads the coccyx directly and repeatedly.
How It Is Diagnosed
The diagnosis is primarily clinical. Localised tenderness directly over the coccyx, combined with the sitting pattern above, is usually sufficient.
- Dynamic X-rays, taken standing and then sitting, can reveal abnormal coccyx movement in persistent cases.
- MRI where symptoms are atypical, particularly to exclude tumour or infection.
- Internal examination via the rectum allows direct assessment of the coccyx, the sacrococcygeal joint and the pelvic floor muscles. It is diagnostically useful and used by clinicians who specialise in this area. It should always be explained and consented to first, and you can decline or ask for a chaperone.
Treatment: Start With How You Sit
The cushion, and a common mistake
Most people reach for a ring or doughnut cushion. For tailbone pain that is usually the wrong choice: a ring cushion supports the ischial tuberosities, the sitting bones, but can leave the coccyx suspended and in some cases increases the pressure around it.
What you want is a wedge cushion with a cut-out or U-shaped notch at the back edge, so the coccyx sits over empty space and bears no load at all. Sometimes sold as a coccyx cushion for exactly this reason.
- Check the notch reaches the back edge. A dip in the middle of the cushion does nothing; the cut-out has to be open at the rear so there is genuinely no contact.
- Choose firm over soft. A soft cushion compresses until you are sitting on the base again, which defeats the point.
- Take it with you. The car seat and the sofa matter as much as the office chair, and car seats are among the worst offenders because they recline.
Alongside it: sit upright rather than reclining, since leaning back loads the coccyx directly. Stand up every 20 to 30 minutes. Avoid very soft sofas, which allow you to sink into a reclined position. Our review of back pain relief products covers seating and support more broadly.
Physiotherapy
Three components are relevant:
- Pelvic floor assessment and downtraining. The levator ani complex attaches to the coccyx, and overactive pelvic floor muscles can sustain tailbone pain indefinitely. This is the most under-recognised part of coccydynia treatment, and it is particularly relevant after childbirth. Note that the goal here is usually relaxation rather than strengthening, so generic pelvic floor squeezing exercises can make matters worse.
- Manual treatment of the coccyx, performed internally or externally by a clinician trained in it. Reported outcomes are modest overall and better in some subgroups than others, but it is a reasonable option before considering injections.
- Posture and hip mobility work. Restricted hip and hamstring mobility changes how the pelvis is positioned in sitting and increases coccygeal loading. See tight hamstrings and lower back pain.
Pain relief and the bowel connection
Anti-inflammatory medication can help in the early weeks, and a topical gel applied over the area gives less systemic exposure than tablets. Suitability depends on your other conditions and medicines, so ask a pharmacist or doctor rather than self-prescribing. Warm baths help many people.
Keeping stools soft matters more than it sounds. Straining loads the coccyx directly, and a painful tailbone leads people to avoid opening their bowels, which worsens constipation and creates a loop. Adequate fluid and fibre, and a footstool to raise the knees above the hips on the toilet, both reduce the strain required.
Particular Situations
| If you are | What tends to help most |
|---|---|
| A desk worker | A firm wedge cushion with a rear cut-out, an upright rather than reclined chair angle, and standing every 20 to 30 minutes |
| A driver or commuter | Take the cushion to the car. Reclined car seats are one of the most reliable aggravators, and a long drive can undo a good week |
| Postpartum | Raise it specifically rather than assuming it is general recovery. Pelvic floor physiotherapy, side-lying to feed, and a cut-out cushion for feeding chairs |
| A cyclist | Saddle width and tilt, and a period off the bike. A saddle too narrow for your sit bones transfers load onto the coccyx |
| Recovering from a fall | Expect eight to twelve weeks. Cushioning and activity modification, not immobilisation, since fractures here are managed conservatively |
| Someone with constipation | Address it directly. Straining is a repeated direct load on the painful structure, and the loop is easy to miss |
If Conservative Treatment Is Not Enough
- Injection. A corticosteroid and local anaesthetic injection at the sacrococcygeal joint, or a block of the ganglion impar, the small nerve cluster sitting in front of the coccyx, helps a substantial proportion of people whose symptoms have not responded to conservative care. Reported success rates vary widely across studies, and relief is often temporary rather than permanent, so it is best viewed as creating a window in which rehabilitation becomes possible.
- Coccygectomy, surgical removal of the coccyx, is a last resort for pain that has resisted everything else. Most published series report good outcomes in the majority of carefully selected patients, but wound infection and slow healing are recognised risks given the location. It is generally considered only after at least six to twelve months of conservative treatment, and a second opinion is worth having.
For the wider picture on lower back and pelvic pain, see our lower back pain guide.
Terms You May Hear
| Term | What it means |
|---|---|
| Coccyx | The tailbone, three to five small fused or semi-fused segments at the base of the spine |
| Coccydynia | Pain at the coccyx. The clinical name for tailbone pain |
| Sacrococcygeal joint | The junction between the sacrum and the coccyx, a common site of injury |
| Ganglion impar | A small cluster of sympathetic nerves in front of the coccyx, targeted in nerve block procedures |
| Levator ani | The main pelvic floor muscle group, which attaches directly to the coccyx |
| Downtraining | Learning to relax an overactive muscle group. The opposite of strengthening, and often what the pelvic floor needs here |
| Dynamic radiographs | X-rays taken standing and then sitting, to measure how much the coccyx moves under load |
| Coccygectomy | Surgical removal of the coccyx |
Frequently Asked Questions
Most cases following a fall or childbirth improve substantially over several weeks to a few months with conservative management. A fractured coccyx typically settles over roughly eight to twelve weeks. A minority become persistent, and pain that has not improved after two to three months of sensible self-management is worth having assessed rather than waiting out.
A wedge cushion with a cut-out or U-shaped notch at the back edge, so the tailbone sits over empty space and bears no weight. A ring or doughnut cushion is the common choice and usually the wrong one for coccydynia, since it supports the sitting bones while potentially leaving the coccyx unsupported or increasing pressure around it. Choose a firm cushion rather than a soft one, and check the cut-out is open at the rear.
Sit upright rather than reclined, because leaning back transfers weight onto the coccyx. Leaning slightly forward relieves it, which is why perching forward feels better. Use a firm wedge cushion with a rear cut-out, keep the same setup in the car, avoid deep soft sofas, and stand up every 20 to 30 minutes rather than sitting through a long block.
You often cannot tell by feel, and in practice it matters less than people expect, because both are managed the same way. Coccyx fractures are not immobilised or operated on. They are treated with cushioning, activity modification and time. Seek assessment if the injury involved major trauma, if you cannot bear weight, or if there is numbness or bladder or bowel change.
The coccyx flexes backwards during vaginal delivery, and this can injure the ligaments, partially dislocate the joint or occasionally fracture it. Postpartum coccydynia is common and frequently goes unmentioned. It is treatable, and pelvic floor physiotherapy is particularly relevant, so raise it specifically with your doctor or midwife rather than assuming it is just part of recovery.
Not automatically, and standard squeezing exercises can make it worse. Tailbone pain is often associated with pelvic floor muscles that are already overactive, in which case the goal is learning to relax them rather than strengthen them. This is worth assessing properly with a pelvic floor physiotherapist instead of guessing.
Yes, and it is easy to miss. Straining loads the coccyx directly and repeatedly, while a painful tailbone makes people put off opening their bowels, which worsens the constipation and feeds the cycle. Adequate fluid and fibre, and a footstool that raises the knees above the hips on the toilet, both reduce the straining required.
Get it assessed if the pain is constant rather than triggered by sitting, if it wakes you at night, if there is fever, swelling, redness or discharge near the buttock crease, if you have unexplained weight loss or a history of cancer, or if there is new numbness around the groin or any bladder or bowel change. Mechanical coccydynia is characteristically position-dependent, so pain that ignores position deserves investigation.
Sources
- Foye PM. Coccydynia: tailbone pain. Physical Medicine and Rehabilitation Clinics of North America, 2017.
- Nathan ST, Fisher BE, Roberts CS. Coccydynia: a review of pathoanatomy, aetiology, treatment and outcome. Journal of Bone and Joint Surgery (British), 2010.
- Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. The Ochsner Journal, 2014.
- NHS — Tailbone (coccyx) pain.
- MedlinePlus — Tailbone trauma aftercare.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases — Back Pain.
Last updated: August 2026. Written by Aisha Desai, who covers back and musculoskeletal topics and is not a clinician. This page has been reviewed for accuracy by our editorial team but has not been reviewed by a named clinician. It is general information rather than a diagnosis. Tailbone pain has several possible causes, some of which need investigation, so please see a doctor or physiotherapist about your own symptoms.
