Tailbone Injury

Overview

A tailbone injury is damage to the coccyx, the small, triangular bone at the very bottom of the spine. The injury can range from bruising and strain of the surrounding tissues to an actual fracture or dislocation of the bone. The result is pain in the lowest part of the back, just above the buttocks, that is typically worse when sitting.

Tailbone injuries most often happen from a fall onto a hard surface, a direct blow, or, in women, during childbirth. Persistent pain in the area is called coccydynia. Although the pain can be quite uncomfortable and slow to settle, most tailbone injuries heal with simple self-care over a period of weeks, and serious complications are uncommon.

Symptoms

The main symptom is pain at the base of the spine, with features such as:

• Localized pain and tenderness over the tailbone
• Pain that is worse when sitting, especially on hard surfaces or leaning back
• Increased pain when going from sitting to standing
• Discomfort during bowel movements or sex
• Bruising or swelling over the area after a fall

Pain that is severe, that comes with numbness, tingling, or weakness in the legs, or that follows a high-impact injury should be evaluated, as these can indicate a more significant injury to the spine or nearby structures.

Causes

Tailbone injuries usually result from direct trauma or pressure on the coccyx. Common causes include:

• Falls: Landing on the buttocks on a hard surface, such as slipping on ice or stairs.
• Direct blows: A hit to the area during contact sports or an accident.
• Childbirth: Pressure on the coccyx during delivery can bruise, strain, or injure it.
• Repetitive strain: Prolonged sitting on hard or narrow surfaces, such as cycling, can irritate the area.
• Less common causes: Bone-thinning conditions can make injury more likely, and rarely other conditions cause coccyx pain without a clear injury.

Risk Factors

• Activities with a risk of falling, such as winter sports or skating
• Contact sports
• Pregnancy and childbirth
• Prolonged sitting on hard surfaces
• Older age and bone-thinning conditions such as osteoporosis
• Being underweight, with less natural cushioning over the bone

Diagnosis

Diagnosis is mainly based on history and examination:

• History and examination: Asking about the injury and pressing on the tailbone to check for tenderness; sometimes a gentle internal examination assesses the bone's position.
• X-rays: May be used to look for a fracture or dislocation, though tailbone fractures can be hard to see and treatment is often similar regardless.
• Further imaging: Occasionally used for persistent or unexplained pain to rule out other causes.

Treatment

Most tailbone injuries are treated with self-care measures that relieve pressure and pain while the area heals:

• Cushioning: Sitting on a wedge or doughnut-shaped cushion to take pressure off the tailbone.
• Pain relief: Over-the-counter pain relievers, used as directed.
• Posture and movement: Leaning forward when seated, avoiding long periods of sitting, and changing position often.
• Heat or ice: Ice early on for swelling and warmth later for comfort.
• Stool softeners: If bowel movements are painful.
• Further care: For persistent pain, options include physical therapy, injections, or, rarely, surgery, under a doctor's guidance.

Healing often takes several weeks, and pain may linger longer, but the great majority improve with patience and conservative care.

Prevention

Not all tailbone injuries can be prevented, but you can reduce the risk:

• Use protective gear and take care on slippery surfaces and stairs
• Use a cushion for prolonged sitting, including cycling
• Maintain strong bones with adequate nutrition and activity
• Address balance problems that increase the risk of falls

When to See a Doctor

See a doctor if you have:

• Severe tailbone pain or pain that does not improve over a few weeks
• Pain after a high-impact fall or accident
• Numbness, tingling, or weakness in the legs
• Loss of control of the bladder or bowels, which needs urgent evaluation
• Signs of infection such as redness, warmth, or fever over the area

Most tailbone injuries are minor, but new leg weakness, numbness, or loss of bladder or bowel control are warning signs that require prompt medical attention.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Tailbone pain (coccydynia).
2. MedlinePlus, U.S. National Library of Medicine. Coccyx injuries.
3. American Academy of Orthopaedic Surgeons (OrthoInfo). Coccydynia (Tailbone Pain).
4. National Health Service (NHS). Tailbone (coccyx) pain.