Tailbone Pain-Seven things you need to know!

How to get to the bottom of you bottom pain

Dr.Darshana Naik PT, DPT

If you are a wiggle worm on hard surfaces because pain in your bum is bumming you along! If the pain in your butt is is being a real butt-kicker …this blog is for you !!  Have you had enough of my puns??? Alright alright I will stop and get down to business.…If you have bought more than one kind of seat cushion to get through the day you are probably familiar with tailbone pain or pain in your coccyx. 

Tailbone is the common name for the absolute tip or end of your spine. Our spine is made of a stack of vertebrae that can move, the last four vertebrae however are fused together making it the coccyx. Tailbone pain is hence also called coccyx pain or coccydynia or coccygodynia or in more sophisticated words- pain in the butt! And it can be a real bugger!! It tends to linger and become persistent but you can experience complete resolution by finding the right pelvic PT to treat it! Read on for more information about tailbone pain and some self-help tips to get you started.

What Causes Tailbone Pain? 

Some of the obvious causes of tailbone pain include injury to the bone itself during a fall, impact, childbirth, surgery etc. Tailbone pain can sometimes develop in absence of any direct bony injury. Common causes include muscle spasm, ligament injury around the sacrum or coccyx, low back related referred pain or pelvic floor issues. Tailbone pain is common in pregnancy due to the postural changes and increased demands on the pelvis. It is also seen with repetitive strain involved in sports such as bicycling and rowing. A lesser known cause of tailbone pain is constipation. The rectum is located right next to the tailbone and requires coccyx mobility for defecation. The strain on the coccyx with constipation can lead to pain. There are various factors at play and a thorough assessment helps us to find your “why”.

Some uncommon but potentially serious causes of tailbone pain include tumors or infections. Unexplained onset of persistent tailbone pain thus requires a medical consultation to properly diagnose and manage pain.

Symptoms of Tailbone Pain

Due to the location of the tailbone it can be challenging to “feel” the pain and locate it but most commonly it is felt as deep dull aching, nagging pain  located all the way at the bottom of the spine / in the crack of the buttocks/ behind the butthole and more pronounced after a period of sitting. Sitting is omnipresent in our lives making it impossible to avoid the aggravating activity i.e. sitting!

Sometimes the pain can radiate and spread over the buttcheeks, lower back or even back of the thighs. Coccyx pain can radiate in the front and cause genital pain such as pain over the labia in women and pain over the testicles for men. Tailbone movement is needed during penetrative intercourse and as a result pain can often be produced or aggravated with penetrative sex.

Pamela told me she had to pull over twice in her 45 min drive to come see me. I could feel her frustration as she paced back and forth through her entire evaluation appt… the thought of sitting down was in itself causing stress for her. Pamela developed pain in her bottom 8 months ago after an ice skating fall. Her injury went through the usual stages of an adult injury. She felt a bigger bruise on her ego from the fall than anything else. She stood up and went on with the rest of her time on the ice and didn’t think much of the fall. The next day however, her bottom was covered in all shades of black-blue-purple color bruise. Pam started with round the clock ice and pain meds to get ahead of her pain , thinking it will resolve in a week or two. She teared up as she counted how many doctors and massages and chiropractic adjustments had happened since that week 8 months ago with little to no change in her pain. Her job was affected due to her inability to sit without pain, her travels were canceled as the thought of sitting still in a seat for hours was enough to make her anxious and the biggest bummer for her was missing out on sitting on the floor and playing with her littles. “ It’s been so long I don’t remember being pain free..I am afraid this is my new normal!!”  It is not uncommon for persistent pain to make people feel scared, hopeless and anxious. Tailbone pain can be nagging but more often than not it is fixable! Pam received  six Pelvic PT treatments over the next three months and has returned to enjoying road trips with her family. 
A patient review about successful PT outcome for her tailbone pain
A sketch of the vertebral column showing tailbone

What can I do to help myself ?

  1. Motion is Lotion– Frequent changes in posture and positions can be helpful. Avoiding direct pressure on the bottom and using pillows with a cut out for the coccyx help with redistributing the weight on the bottom during sitting.I recommend a wedge shaped cushion that tips you forward and has a cut out in the back to offload the tailbone.
  2. Hot and cold– Improving blood flow to the area can provide temporary relief. Using warm compress or ice packs and alternating between the two can decrease the dull aching pain. The skin of your bottom needs to be protected by always keeping a layer of clothing between heat/ice and the skin. Also I recommend never sitting or lying on a heat/ice pack. Accidentally falling asleep or putting undue pressure can cause burn / frostbite.
  3. Rock and Roll– Pelvic rocking exercises with pelvic tilts along with foam rolling or massaging the muscles around the buttocks can significantly decrease pain and tightness around the coccyx.

Tailbone pain routine 1

  1. Slow Flow– Yoga flows to stretch hips, lower back and inner thigh muscles can relieve tension and pain in the bottom of the spine.

Tailbone pain routine 2

  1. Posture Police– butt tucking and slouched postures put more strain on the coccyx. Being mindful of postural stresses can help decrease pain through the day.
  2. Smooth Move– Constipation and hard stool put strain on the coccyx during elimination and are found to increase pain. Managing diet / fiber/ fluids to facilitate soft stool can go a long way in decreasing tailbone flare ups.
  3. Let’s talk! – If you have tried these things, you are still hurting. It’s time to seeked expert care..let’s get on a phone call to sort this out.

How Does Pelvic Floor PT Help Tailbone pain?

Pelvic muscles are like muscular underwear and in this case imagine a thong- underwear. All the muscles in the pelvis gather in the back to insert into a soft tissue sling called the anococcygeal raphe. This tendon then anchors all the pelvic muscles onto the coccyx or tailbone. This bone literally has attachments from ALL the pelvic muscles and as a result it gets pulled and pushed by these muscles during every breath, every movement and every bowel movement. Pelvic muscle issues can cause tailbone pain and tailbone pain can cause pelvic muscle problems. Sometimes lack of mobility in the tailbone is the root cause of pain while other times too much mobility in the tailbone is the problem! This nuanced difference requires expert care by a pelvic PT who is trained in assessing and training this interrelated system. 

A patient review about successful PT outcome for her tailbone pain
Read all reviews here

Kegels and Tailbone pain-

Like most conditions causing pain, tailbone issues are more likely to create muscle tension, trigger points and a general sense of overactivity in surrounding muscles. If you have developed tight/ overactive pelvic muscles, doing kegels will exacerbate your original pain. Kegels are not a bad exercise however, that recommendation is made on an individualized level after a muscle assessment with a pelvic PT. In the clinic I often see reverse kegel or a practice in relaxing your pelvic muscles is more beneficial in decreasing pain. It can be tricky to learn how to lengthen your pelvic muscle on your own and a skilled pelvic PT can be a game changer in your healing journey.

Coping with Tailbone pain can be exhausting!  It is challenging to find specialists to treat tailbone pain and often it takes a long time to fully heal. It is an embarrassing issue for many people and it makes you feel awkward in social situations.

If you are in pain and don’t know where to start, you are not alone and it is in fact a fixable problem. Let’s talk soon!



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