Coccydynia

Brief Overview: Coccydynia is pain localized to the tailbone (coccyx) at the base of the spine. It often results from trauma like a fall or childbirth, or from prolonged sitting on hard surfaces. The pain typically worsens when sitting or rising, and may be tender to touch or feel like a stab or ache in the tailbone area. Coccydynia is considered chronic when symptoms persist for >2 months.

Prevalence: The exact prevalence is unknown.

Etiology:

  • Traumatic causes: falls onto tailbone, direct compression, childbirth trauma
  • Mechanical strain: prolonged pressure, poor sitting posture, or cycling
  • Coccygeal instability: hyper- or hypomobility of the joint, influenced by obesity or coccyx shape
  • Idiopathic: diagnosed when no clear cause is found, possibly involving pelvic floor muscle spasm or bursitis.
  • Bone spicule/spur
  • Osteoarthritis
  • According to UpToDate, “Somatization, particularly in the setting of known depression”

Risk Factors:

  • Female
  • Obesity
  • Childbirth
  • Falls or repetitive impacts to the coccyx

Commonly Associated Conditions:

  • Degenerative joint issues at sacrococcygeal junction
  • Pelvic floor or ischial bursitis
  • Lumbar or sacral musculoskeletal pain (may co-occur)

Common Medications:

  • NSAIDs, Tylenol
  • Opioids or tramadol for severe pain
  • Coccygeal injection series – local anesthetic with or without glucocorticoid

Common Labs, Imaging, and Tests:

  • Labs, imaging, or tests may not be needed
  • X-ray or MRI may be indicated in some cases

Common Symptoms:

  • Coccyx (tailbone) pain – can be dull or sharp
  • Tailbone pain typically worsens when moving from sitting to standing
  • Pain may be worse when having a bowel movement, during intercourse, sitting (particularly when leaning back), bending forward

Common Treatments:

  • Wedge, or donut, cushions
  • Heat/ice therapy – avoid direct contact with skin
  • Pelvic floor physical therapy
  • Manipulation therapy
  • Extracorporeal shockwave therapy (ESWT)
  • Surgery may be indicated for some, but generally is reserved as a last resort option when no other treatment options have been effective

Physical Findings:

  • Pain/tenderness with palpation of the coccyx
  • Rectal exam may be needed for internal palpation of the coccyx

Potential Complications and Contraindications:

  • Chronic pain interfering with sitting and daily activities
  • Surgical risks: infection, poor wound healing, persistent pain
  • Rare underlying causes: infection or malignancy — imaging necessary when suspected

General Health and Lifestyle Guidance:

  • Use well-padded or cut-out cushions when sitting if needed
  • Maintain healthy weight to reduce tailbone pressure
  • Avoid prolonged sitting—frequent position changes help
  • Gradual activity and pelvic floor stretching may provide relief. Ask your healthcare provider for specific recommendations.

Suggested Questions to Ask Patients:

  • When does your tailbone pain begin and what makes it worse?
  • Does sitting or standing change how you feel?
  • Have you tried posture changes or a special cushion?
  • Any history of injury or childbirth related to your pain?

Suggested Talking Points:

  • Ask your healthcare provider if you should take a stool softener to help with pain during bowel movements
  • Avoid prolonged sitting or leaning back, change positions often if unable to ambulate
  • Report any new, worsening, or persistent symptoms to your healthcare provider
  • You may be managed by a Pain Management clinic for persistent pain

Sources:

This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.