Tailbone Injury (Bruised Tailbone and Coccydynia)

What a tailbone injury feels like

• A deep ache or sharp pain right at the bottom of the spine, just above the buttock crease
• Pain that is much worse sitting, especially leaning back or on hard seats
• A sharp jolt of pain when standing up from sitting
• Pain during bowel movements or straining
• Pain during sex, mainly for women
• Tenderness when pressing directly on the tailbone
• Bruising over the area after a fall

Walking and lying down are usually comfortable, which helps distinguish tailbone pain from low back pain.

Causes of tailbone injury and pain

Injury

• Falling backward onto a hard floor, ice, stairs or the edge of a step
• Childbirth, when the baby's head pushes the coccyx backward, especially with a large baby or assisted delivery
• Contact sports and trampoline accidents

Repetitive strain

• Long hours of sitting on hard or narrow surfaces
• Cycling, rowing and horseback riding

Other contributors

• Weight: both higher weight (more pressure on the coccyx) and low weight (less padding) raise the risk
• An unusually mobile coccyx (hypermobility), which can slide or tilt painfully when you sit
• Female sex: women are about 5 times more likely to have coccydynia, partly because of pelvic shape and childbirth

Non-injury causes to rule out

• Pilonidal cyst: a painful, swollen lump in the buttock crease, sometimes draining
• Referred pain from the lower spine or sacroiliac joint
• Pelvic floor muscle spasm, or deep buttock pain from piriformis syndrome
• Rarely, infection or tumors such as chordoma

Bruised vs broken tailbone

It is often impossible to tell a bruise from a break without an X-ray, and the treatment is the same, so X-rays are often unnecessary. A fracture tends to hurt more and for longer. For more detail on breaks, see coccyx fracture.

How doctors assess tailbone pain

A doctor asks how the pain started and what makes it worse, then examines the lower back and tailbone. A rectal examination can check whether the coccyx is tender or moves abnormally. Tests may include:

• Standing and sitting (dynamic) X-rays, which show whether the coccyx dislocates or moves too much when you sit; useful for chronic pain
• MRI if infection, a tumor or a spinal problem is suspected
• Diagnostic injection of local anesthetic to confirm the coccyx is the source

Treatment for a recent tailbone injury

Sitting

• Use a wedge (coccyx) cushion with a cut-out at the back, so the tailbone does not touch the seat. Many people find it better than a round donut cushion.
• Lean forward slightly when sitting, and shift weight onto one buttock or the thighs.
• Avoid long periods of sitting; stand up and walk every 30 minutes.
• Choose soft chairs and avoid low sofas.

Pain relief

• Ice wrapped in cloth for 15 to 20 minutes several times a day for the first 48 hours, then warmth if it helps
• Ibuprofen, naproxen or acetaminophen (paracetamol), following the label dose

Bowel care

Straining hurts and can also worsen hemorrhoids. Drink plenty of fluids, eat fiber, and use a stool softener if needed to avoid constipation.

Activity

Keep walking and doing normal activities. Avoid cycling and rowing until sitting is comfortable.

Coccydynia: when tailbone pain lasts

About 9 in 10 people with tailbone injury improve with simple measures. If pain continues beyond 2 to 3 months, the following options help:

• Physical therapy: pelvic floor relaxation, stretching and postural work. Some therapists use gentle manual treatment of the coccyx, including from inside the rectum, which can relieve pain from a mobile coccyx.
• Steroid and local anesthetic injections around the coccyx, sometimes repeated.
• Ganglion impar block: an injection to numb a nerve cluster in front of the coccyx, used for persistent pain.
• Radiofrequency treatment of the same nerves in some centers.
• Coccygectomy: surgical removal of the coccyx, for severe, long-lasting pain that has not responded to other treatment. Success rates are reasonably high in carefully selected people, but recovery takes months and wound infection is a known risk.

Recovery time and outlook

Most bruised tailbones feel much better within 2 to 6 weeks, and fractures within 6 to 12 weeks. A small group develops chronic coccydynia, which often still improves with treatment. Tailbone injuries rarely cause permanent problems.

Prevention

• Use handrails on stairs and take care on ice.
• Wear protective padded shorts for snowboarding, skating and similar sports.
• Use a cushioned seat and take breaks during long periods of sitting.

Frequently asked questions

How long does a bruised tailbone take to heal?

A bruised tailbone usually heals in about 2 to 6 weeks. Pain when sitting is often the last symptom to go. If it is still painful after 6 to 8 weeks, see a doctor, as it may be a fracture, a mobile coccyx or coccydynia that needs specific treatment.

Why does my tailbone hurt when I sit?

Sitting presses the coccyx against the seat and makes it tilt, which stretches injured ligaments and bone. Leaning back increases the pressure. A wedge cushion with a cut-out at the back, leaning forward and taking breaks from sitting reduce the pain.

What is coccydynia?

Coccydynia is persistent pain in the tailbone, usually lasting more than 2 to 3 months. It often follows a fall or childbirth but can develop without injury. Treatments include cushions, physical therapy, steroid injections and nerve blocks, with surgery to remove the coccyx for severe cases that do not respond.

Should I go to the doctor for a tailbone injury?

See a doctor if the pain is severe, does not improve after a few weeks, or comes with numbness, leg weakness, bladder or bowel problems, fever or a swollen lump. Most minor tailbone injuries heal with home care, and X-rays are often not needed.

Can a tailbone injury cause pain during bowel movements?

Yes. Muscles attached to the coccyx tighten during bowel movements, which pulls on the injured area. Avoiding constipation with fluids, fiber and stool softeners if needed helps. Pain that persists, or any rectal bleeding, should be checked by a doctor.