Coccyx Fracture (Broken Tailbone)

What the coccyx is

The coccyx is made of 3 to 5 small fused or partly fused vertebrae at the end of the spine. It supports your weight when you sit and leans back, and it anchors several muscles, tendons and ligaments of the pelvic floor and buttocks. That is why tailbone injuries hurt with sitting, standing up, bowel movements and sometimes sex.

Symptoms

• pain and tenderness right at the top of the buttock crease
• pain that is worse when sitting, especially leaning back on a hard surface
• sharp pain when standing up from sitting
• bruising and swelling over the area
• pain with bowel movements or straining
• pain during sex, more commonly in women

Pain is usually most intense in the first 1 to 2 weeks.

Causes

• Falls backward onto a hard surface, ice, stairs or the edge of a step
• Contact sports, gymnastics, skating, horse riding, and cycling impacts
• Childbirth, particularly difficult or instrumental deliveries, when the baby's head presses on the coccyx
• Car accidents
• Repetitive strain, such as long periods on a bicycle or rowing machine

Women are more often affected than men, partly because the female pelvis is wider and the coccyx more exposed. Osteoporosis increases the risk of fractures from minor falls.

Fractured vs bruised tailbone

Because treatment is the same for all three, many doctors do not order an X-ray for a simple tailbone injury. X-rays are useful if the pain is severe, the injury was high-energy, or the pain is not settling. Standing and sitting X-rays (dynamic X-rays) can show abnormal movement in persistent pain. CT or MRI is used if a sacral fracture, pelvic fracture or another cause is suspected.

Treatment

Sitting comfortably

• Use a coccyx cushion: a wedge or U-shaped cushion with a cutout at the back so the tailbone does not touch the seat. Doughnut-shaped rings are less effective because they still press on the coccyx.
• Lean forward when sitting to shift weight onto the thighs.
• Sit on soft surfaces and avoid long periods of sitting. Stand or walk regularly.

Pain relief

• NSAIDs such as ibuprofen or naproxen, or acetaminophen (paracetamol). Follow the label dose. Avoid NSAIDs with stomach ulcers, kidney disease or heart failure.
• Ice wrapped in a cloth for 15 to 20 minutes several times a day for the first few days, then heat to relax muscles.

Bowel care

• Eat plenty of fiber, drink fluids, and use a stool softener to avoid straining.
• Opioid pain medicines worsen constipation, so they are best avoided or used briefly.

Physical therapy

A pelvic floor physical therapist can help when pain lasts, by releasing tight pelvic floor and buttock muscles, and with posture and sitting strategies.

Persistent pain (coccydynia)

If pain lasts more than 2 to 3 months, this is called chronic tailbone pain (coccydynia). Options include:

• local steroid and anesthetic injections around the coccyx
• ganglion impar nerve blocks
• manual therapy
• coccygectomy (surgical removal of the coccyx) for severe pain lasting more than 6 months despite other treatments. It helps most people who need it, but infection risk is notable because of the location.

Recovery time

Return to sports gradually as pain allows, using padding for contact sports.

Complications

• chronic coccydynia
• constipation from avoiding painful bowel movements
• in rare cases, nerve injury, which causes numbness or bladder or bowel problems and needs urgent assessment

Tailbone pain without any injury can come from other causes, such as a pilonidal cyst, arthritis, referred low back pain, or rarely a tumor, so it should be checked if it persists.

Frequently asked questions

How do I know if I broke my tailbone?

A broken tailbone causes pain and tenderness at the base of the spine, worse when sitting or getting up, often with bruising after a fall. It feels the same as a severe bruise. Only an X-ray can confirm a fracture, but treatment is the same either way.

How long does a broken tailbone take to heal?

Most broken tailbones heal in 6 to 12 weeks. A bruised tailbone usually improves in 2 to 4 weeks. If pain lasts longer than 2 to 3 months, see a doctor about treatment for chronic coccydynia.

Do you need an X-ray for a tailbone injury?

Often not. Because treatment is the same for a bruise or fracture, X-rays are mainly used for severe pain, high-energy injuries, numbness or bladder problems, or pain that does not improve. Dynamic sitting and standing X-rays help with persistent pain.

How should I sit with a broken tailbone?

Sit on a wedge cushion with a cutout at the back, lean slightly forward to shift weight onto your thighs, and avoid hard seats and long periods of sitting. Get up and move every 20 to 30 minutes.

Can a broken tailbone cause long-term problems?

Most heal without lasting problems. A minority develop chronic tailbone pain (coccydynia) that lasts months. Injections, physical therapy and, rarely, surgery to remove the coccyx can help when home care is not enough.