Coccyx pain (tailbone pain): causes, treatment and how long it lasts

Simple measures are usually recommended first. nidirect lists avoiding long periods of sitting, using a specially designed coccyx (doughnut) cushion, applying hot or cold packs to the lower back, wearing loose clothing, and over-the-counter anti-inflammatory painkillers such as ibuprofen. BASS also mentions naproxen, and says simple paracetamol taken beforehand can reduce discomfort if you expect to sit for a long time. These medicines are not suitable for everyone, so check with a pharmacist or GP if you are unsure.

BASS says the natural history is one of spontaneous recovery, though conservative treatment may take many weeks or months before significant relief is felt. It describes coccydynia as usually benign and self-resolving, taking a long time for symptoms to settle, and says very few people still have symptoms after five years, with no long-term health problems reported. For surgery, BASS says carefully selected patients have good or excellent results in about 60 to 70 per cent of case series, and that infection, persistent pain, scar pain and damage to nearby structures are risks.

Childbirth is one of the commonest causes listed by nidirect. The British Association of Spine Surgeons (BASS) explains that the joints around the pelvis become more flexible towards the end of pregnancy to allow delivery of the baby, which allows the coccyx to be pushed out of position more easily. Some women start getting the pain during the pregnancy, and some get it during and after delivery.

The same treatments apply as for other causes: self-care with less sitting and a cushion, and painkillers where suitable. In pregnancy or while breastfeeding, check any medicine, including ibuprofen or naproxen, with a pharmacist, midwife or GP first. Speak to your GP, midwife or health visitor if the pain is not improving, as nidirect advises seeing a GP if it does not start to improve within a few weeks.

The coccyx is the small, last bone at the bottom of the spine. Coccydynia simply means pain felt in that area. nidirect, which adapts its information from the NHS website, describes the main symptom as pain and tenderness in the area just above the buttocks, and says it can arise if you injure or strain the coccyx or the muscles and ligaments around it.

The British Association of Spine Surgeons (BASS) describes coccydynia as a collection of conditions that result in pain around the coccyx. It notes that in the majority of cases the pain occurs only in the sitting position, which is one reason the problem can be so disruptive.

nidirect says the pain may be dull and achy most of the time, with occasional sharp pains. It may be worse in a number of situations:

• When sitting down.

• When moving from sitting to standing.

• When standing for long periods.

• During sex.

• When going for a poo.

The pain can make it very difficult to sleep and to carry out everyday activities such as driving or bending over. Some people also have back pain, shooting leg pains (sciatica), and painful buttocks and hips. Because most of modern life involves sitting, even a moderate level of pain can be wearing, and it is reasonable to ask your GP or an occupational health service about adjustments such as a different chair, breaks from sitting, or a coccyx cushion at work.

The commonest causes listed by nidirect are childbirth, an injury or accident such as a fall, repeated or extended strain on the coccyx, poor posture, and being overweight or underweight. Less common causes include a bony growth on the coccyx, a coccyx that is too flexible or too rigid, and arthritis. Rare but serious causes include infection and cancer. In many cases no obvious cause is found, and age-related wear and tear may play a part.

BASS says the most common injury is a fall onto the bottom, such as slipping on stairs or a slippery floor. It explains that the joints around the pelvis become more flexible towards the end of pregnancy to allow delivery, which lets the coccyx be pushed out of position more easily, and some women start getting pain during pregnancy while others get it during or after the birth. BASS also describes pain in slim people who have little padding over the tip of the coccyx, and pain linked to obesity because of extra pressure when sitting. It adds that the cause of the common form with no clear trigger is poorly understood.

BASS says the diagnosis is almost always clinical: a full history and examination, with a classic pattern of pain brought on or made worse by sitting. The main purpose of seeing a doctor is to rule out other causes. Blood tests and X-rays do not help in diagnosing the condition, though they may be used to rule out other problems or for reassurance, and MRI or bone scans are only done in rare situations when the diagnosis is in doubt.

nidirect says your GP will examine you to check for more serious causes such as infection or a fracture, and may refer you for tests such as an X-ray or an MRI scan in some cases.

nidirect advises seeing your GP if the pain does not start to improve within a few weeks, simple home treatments do not help, the pain is very severe, or you also have bleeding, a high temperature or pain away from your coccyx. Back pain with new numbness around the genitals or anus, difficulty controlling your bladder or bowels, or weakness in both legs is a different situation, and the NHS back pain guidance says to call 999 or go to A&E for those symptoms.

Most people are managed by a GP, with referral to musculoskeletal physiotherapy or pain services if needed. A private spinal or pain specialist can arrange injections and review surgical options. Ask what the evidence is for the procedure suggested, how many people are expected to benefit, and what the alternatives are.