Tailbone pain is most often caused by sitting for prolonged periods of time, cycling for long distances, poor posture or as a result of pregnancy. In these cases, tailbone pain is expected and normal. However, pain in the tailbone can also be a sign of a herniated disc, pilonidal cyst or fracture, which are conditions that should be assessed by the doctor.

You should particularly see a doctor if the pain in your tailbone (also referred to as the coccyx) is very intense, impedes with walking, lasts for more than 1 week or if it is accompanied by other symptoms such as local swelling or fever. The doctor may order additional testing to help confirm a diagnosis and guide treatment.

Treatment may vary according to the cause of tailbone pain. Some treatment measures include rest, physiotherapy, use of analgesic and anti-inflammatory medications and, in some cases, surgery.

What causes tailbone pain?

The main causes of tailbone pain are:

1. Fall or direct blow

Accidents that result in a strong impact on the end of the spine, such as falling while sitting or being kicked during sports, are one of the most common causes of tailbone pain. In most cases, this pain disappears within a few minutes, however there are instances where it can last for a few hours or days, and then gradually decrease over time.

Tailbone pain that becomes more intense with time or becomes intolerable when sitting, for example, could of a fracture, however, which requires immediate assessment and treatment.

What to do: The best way to relieve the tailbone pain caused by a fall or direct blow is to relieve pressure on the area. Avoid sitting or lying on your back while you experience pain. In the first 48 hours of the injury, cold compresses can also be applied to the area to reduce inflammation and relieve pain.

2. Repetitive strain

Exercise requiring frequent movements, such as cycling or rowing, or exercising for prolonged periods of time can result in a repetitive strain injury. This type of injury is associated with stretching and straining of the muscles and ligaments, making it more difficult for them to hold the bone in its correct location. This can lead to a sudden onset of pain.

What to do: Apply an anti-inflammatory ointment over the area, like diclofenac topical. Avoid performing any activities that put additional pressure on the tailbone.

3. Pregnancy

During the last 2 months of pregnancy, the bones in the lumbar spine region, as well as the tailbone, become more flexible to allow the baby to pass during birth. Due to increased flexibility, the spinal structure moves more freely which may lead to increased pain, especially when sitting or standing up.

What to do: Applying cold compresses to the area and lightly massages can help to relieve mild pain. Tailbone pain can be prevented by making small changes in your daily routine, such as sitting and standing up slowly or using a donut-shaped pillow to reduce pressure on the tailbone when sitting.

4. Bad posture

Having poor posture, especially when sitting when working at a desk or driving, for example, can put increased pressure on the tailbone. This increased pressure can lead to pain throughout the day.

What to do: Lightly massage the area of pain and avoid prolonged sitting to help relieve pain. You should consider maintaining appropriate posture throughout the day, which can be corrected with awareness training, exercise and physiotherapy.

5. Pilonidal cyst

A pilonidal cyst is a small infection that appears in the tailbone region. It is associated with the accumulation of hair and dead cells under the skin. In these cases, in addition to the pain in the area, which worsens with time, a small lump may also appear which gradually increases in size.

What to do: If you notice a pilonidal cyst, you should proceed to an emergency room or urgent care center to drain the pus from inside the cyst. In some cases, this treatment may be sufficient, however, if the cyst reappears, a small surgery may be recommended for full removal.

6. Herniated disc

In some cases, pain in the tailbone may be caused by problems in other locations along the spine. One of the most common spinal problems that causes tailbone pain ia herniated disc in the lumbar region of the spine.

What to do: If you suspect that the pain is related to a spinal problem, you should see an orthopedic for assessment and imaging to identify the underlying cause and start the best treatment.

7. Excess weight

Being overweight can overload almost the entire body, and is especially felt by the coccyx when sitting. Over time, persistently excessive pressure on the coccyx can lead to mild but constant pain, which worsens when sitting.

What to do: In these cases, the ideal approach is to lose weight to relieve excess pressure on the coccyx. You may benefit from using a donut-shaped cushion to sit on whenever you sit, as this also help reduce pressure on the area. Furthermore, sleeping on your side at night, instead of on your back, also helps the area to recover.

8. Staying in bed for a long time

People who need to remain in bed for prolonged periods due to surgery, serious accidents, coma, or reduced mobility may have pain in the coccyx due to the time they remain in the same position. This can also cause pressure ulcers or bedsores.

What to do: It is important to change lying positions regularly and promote joint movement to prevent tailbone pain as well as pressure ulcers.

9. Physical activity

Performing physical activities such as horse riding, weight lifting, martial arts, or contact sports such as rugby or American football can cause tailbone pain due to the physical impact this joint receives. In addition to pain, there may be inflammation of the area, difficulty in moving, a tingling sensation and/or weakness in the legs.

What to do: You should adhere to an exercise routine guided by a professionally-trained instructor to avoid injuries to the coccyx or other joints. It is also important to warm up properly before high-impact activity to prevent injuries.

10. Arthritis

Arthritis is characterized by inflammation of the joints that causes symptoms like pain, deformity, stiffness and difficulty moving. These symptoms can affect any joint, but are more common in the hands, feet, neck and knees, in addition to the coccyx.

What to do: Treatment for arthritis is aimed at relieving symptoms and improving joint function. Your doctor may recommend medication and lifestyle changes to help manage this condition.