Tailbone pain, known medically as coccydynia, is pain at the very base of the spine. It is usually worst when you sit, worse again when you lean back while seated, and sharp when you stand up from a chair. Standing and walking often ease it. It is common, the causes are a short list, and there are real treatment options, including some most people have never heard of.

What and where is the coccyx?

The coccyx is a small triangular set of fused bones at the bottom of the spine, just below the sacrum, the broad bone at the back of the pelvis. In most people it is three to five tiny segments joined together.

When you sit, and especially when you lean back, part of your body weight passes through it. It also anchors several pelvic floor muscles and ligaments, so the ache can feel spread across the pelvic floor.

What causes tailbone pain?

Most cases come from one of these:

• A fall landing on your bottom, on stairs, ice or a hard floor.
• Childbirth, which puts direct pressure on the coccyx as the baby passes.
• Repetitive strain from long hours on hard or backward sloping seats.
• A bruised or fractured coccyx after direct impact.
• A coccyx set at an unusual angle, or one that moves more than it should.
• Degenerative change in the small joint where the coccyx meets the sacrum.
• Weight change either way. Gaining weight loads the coccyx differently, and losing it quickly removes padding that spreads that load.

Sometimes no cause is found. That does not make the pain less real, or stop treatment helping.

Tailbone pain in pregnancy and after childbirth

This is a genuinely common cause. During pregnancy, hormones soften the pelvic ligaments so the birth canal can open. The coccyx, normally fairly stiff, becomes more mobile, and a growing bump changes how you sit.

In labour the coccyx bends backwards as the baby passes. That can leave it bruised, strained at its joint, or occasionally fractured. Discomfort often settles in the weeks after delivery as the ligaments firm up, but it can persist.

Practical help: feed on your side or leaning forward rather than reclined, use a cushion with a cut-out, and break up long sitting.

Why does my tailbone hurt when sitting?

The pattern is easy to recognise:

• Worse sitting, especially on a hard surface.
• Worse when you lean back while seated.
• Sharp when rising from a chair.
• Better standing, walking, or sitting upright and leaning slightly forward.

That separates it from ordinary lower back pain, which flares with bending, lifting or long standing rather than sitting. Coccydynia also sits in the midline, not to one side.

What is not coccydynia

• Pain to the side, at the sitting bones. More likely hamstring origin tendinopathy, irritation of the tendon where the hamstring attaches to the sitting bone. It hurts on one side, not the middle.
• Pain spread across the back of the pelvis. More often the sacroiliac joint, where the spine meets the pelvis.
• Pain that travels down the leg. That points to a nerve in the lower back rather than the coccyx.

How to relieve tailbone pain at home

Most of it is about changing how the coccyx is loaded.

• Use a coccyx cushion, a wedge or ring with a cut-out at the back, so your weight rests on the sitting bones.
• Sit upright, or lean slightly forward. Reclining pushes weight straight onto the coccyx.
• Stand up regularly. Short, frequent breaks beat one long one.
• Avoid hard chairs, backward sloping seats and low sofas that let you sink back.
• Try heat over the area to settle muscle guarding around the pelvic floor.
• If opening your bowels makes it worse, keeping stools soft with fluid and fibre reduces straining. Ask your pharmacist or doctor first.

Give these a few weeks before judging them.

How is coccydynia assessed?

Assessment starts with your history, especially any fall or delivery, and an examination. The coccyx is checked by feel, and sometimes by an internal rectal examination, the only way to assess directly how it moves.

Imaging is added when a fracture or structural problem is suspected. X-rays taken both sitting and standing, called dynamic X-rays, show whether the coccyx moves too much or shifts position under weight.

What an interventional pain clinic adds

When time and self-management have not been enough, there are targeted options.

The first is an image-guided injection around the coccyx. Using fluoroscopy or ultrasound to see the exact spot, local anaesthetic and steroid are placed near the joint at its base. That does two jobs: it can calm inflammation, and the response tells us whether that joint is the source.

The second is a ganglion impar block. Just in front of the coccyx sits a small cluster of nerves called the ganglion impar, which carries pain signals from the coccyx and nearby structures. Medication is placed next to that cluster to interrupt those signals. It is a straightforward image-guided injection and one of the more useful tools for stubborn cases. You can read how nerve blocks work.

If blocks ease the pain and confirm the source, radiofrequency ablation is sometimes used. It applies heat through a fine needle to quiet the nerves carrying those signals, aiming for longer relief.

None of these suit everyone. Which one fits depends on your examination and your response to earlier steps.

How long does coccydynia last?

Many cases settle over weeks to a few months, especially when the cause was one fall or a delivery and sitting habits change early. Some take longer. Lasting a while does not mean nothing can be done, it is usually the point at which targeted treatment is worth considering.

Warning signs that need urgent care

Most tailbone pain is not dangerous, but get medical attention promptly if you have:

• Pain after a significant fall, with an inability to sit or walk.
• Numbness in the groin or saddle area, the part that would touch a bicycle seat.
• New problems controlling your bladder or bowels.
• Fever, with swelling or redness over the area.
• A lump or mass at the base of the spine.
• Unexplained weight loss.
• Pain that steadily worsens, especially at night.

Saddle numbness with new bladder or bowel changes needs emergency assessment the same day.

Common questions

What are the symptoms of a broken tailbone?

A broken tailbone usually follows a clear impact, such as a heavy fall onto the bottom. Expect sharp pain at the base of the spine, bruising or swelling, severe pain on sitting, and discomfort passing a bowel movement. Bruising and fracture feel much the same at first, so only imaging reliably separates them.

Can I still exercise with a sore tailbone?

Usually yes. Walking, standing work and most upright movement are well tolerated because they keep weight off the coccyx. Cycling, rowing, sit-ups and reclined sitting tend to aggravate it. Activity that does not increase your pain during or the next day is generally fine.

Does coccydynia go away on its own?

Often it does. Many cases improve over weeks to months with a cushion, better sitting posture and regular standing breaks. When symptoms last beyond a few months despite those changes, or keep returning, that is a reasonable point to ask for an assessment.

Should I see a doctor about tailbone pain?

See your family doctor if it follows a significant fall, if it has lasted more than a few weeks despite changing how you sit, or if it interferes with work, driving or sleep. Any of the warning signs above should be checked promptly, not watched at home.

This article is general information, not medical advice. It cannot diagnose your pain. If your symptoms are new, worsening, or worrying you, speak with your family doctor or contact us for an assessment.

Talk to us about tailbone pain

If sitting has been uncomfortable for months despite a cushion and posture changes, an assessment can identify whether the coccyx, the joint at its base or a nearby nerve is responsible. Silver Pain Centre in Toronto offers image-guided injections and nerve blocks for coccydynia, and most services are covered by OHIP with a physician referral.

Ask your family doctor to send a physician referral, or use our self referral form to start without waiting for one.