What Is Coccydynia? (Tailbone pain)

Coccydynia refers to pain originating from the coccyx, the small triangular bone at the lower end of the spine. Pain is often worse when sitting on hard surfaces, leaning backward, or transitioning from sitting to standing. In some cases, the pain may radiate slightly into the buttock region.

What Are the Symptoms?

• Sharp or aching pain at the tailbone region
• Pain when sitting, especially on hard or narrow surfaces
• Discomfort when leaning backward or slouching
• Pain when moving from sitting to standing
• Localised tenderness over the coccyx on pressure
• Pain during bowel movements in more severe cases
• Occasionally, pain during sexual intercourse

What Causes Coccydynia?

• Direct trauma, such as a fall onto the buttocks
• Sports injuries or repetitive impact to the coccyx
• Prolonged sitting, especially on hard surfaces
• Poor sitting posture or slouching
• Hypermobile or immobile coccyx joints
• Degenerative changes or arthritis at the coccyx
• Bone spurs or local inflammation
• Pregnancy and childbirth-related strain on the pelvic floor
• Idiopathic causes, where no clear trigger is identified

How Is Coccydynia Diagnosed?

• Clinical examination of the coccyx, pelvis, and surrounding structures
• Palpation to assess tenderness and coccyx mobility
• X-ray of the coccyx to evaluate alignment, fractures, or deformity
• MRI when soft tissue inflammation or other pathology is suspected
• Diagnostic injections to confirm the coccyx as the primary pain source

What Are the Treatment Options?

Non-Surgical Management

• Activity modification and avoidance of prolonged sitting
• Use of coccyx cushions (donut or wedge cushions) to offload pressure
• Posture correction and ergonomic adjustments at work
• Physiotherapy focusing on pelvic floor, core stability, and posture
• Oral anti-inflammatory medications where appropriate
• Manual therapy or mobilisation in selected cases

Interventional Procedures

• Coccygeal steroid injections to reduce local inflammation and pain
• Ganglion impar block for chronic or severe tailbone pain

Surgical Management

• Coccygectomy (removal of the coccyx) is reserved for rare, severe cases
• Considered only after failure of comprehensive non-surgical treatment

When Should You See a Spine Specialist?

• Pain persisting for more than 6–8 weeks despite simple measures
• Difficulty sitting for work, travel, or daily activities
• Pain affecting sleep, mobility, or quality of life
• Tailbone pain after a fall or direct trauma
• Symptoms that worsen over time or are associated with other red flags

Conclusion

Coccydynia can be painful and disruptive, but in many cases it is treatable with structured, stepwise management. At The Scoliosis & Spine Clinic (SG), we provide careful assessment, imaging when appropriate, and personalised treatment plans for patients with tailbone pain. Early evaluation helps rule out other causes, guide targeted therapy, and support a safe return to comfortable sitting and daily activities.

Frequently Asked Questions: Coccydynia

1. Is coccydynia always caused by a fall?
No. While falls onto the buttocks are a common trigger, coccydynia can also arise from prolonged sitting, repetitive strain, degenerative changes, childbirth, or without a clear identifiable cause.

2. How long does coccydynia usually take to improve?
Many patients improve over several weeks to a few months with activity modification, cushions, and targeted therapy. Persistent or severe pain may require injections or further evaluation.

3. Do I always need an MRI for tailbone pain?
Not always. Initial assessment often starts with clinical examination and X-rays. MRI is considered when symptoms are atypical, severe, or when other causes need to be excluded.

4. Are injections safe?
Coccygeal steroid injections and ganglion impar blocks are commonly used procedures when performed by experienced clinicians. They are typically done under imaging guidance to improve accuracy and safety.

5. Will I need surgery for coccydynia?
Surgery is rarely required and is reserved for patients with severe, persistent pain that does not respond to comprehensive non-surgical treatment. Most patients improve without needing coccygectomy.

6. Can cushions really make a difference?
Yes. Properly designed coccyx cushions can significantly reduce pressure on the tailbone and improve sitting tolerance, especially during the early phases of recovery.

7. Can coccydynia be related to posture or work setup?
Poor sitting posture, prolonged sitting, and non-ergonomic workstations can aggravate tailbone pain. Addressing ergonomics is often an important part of treatment.

8. Can the clinic assist with insurance or medical claims?
The clinic can help with medical reports, documentation, and coordination with insurers where applicable, to support a smoother administrative process for eligible patients.