Tailbone pain when sitting (coccydynia): causes and treatment

The coccyx is the small bone at the bottom of the spine, near the top of the buttock cleft. The NHS describes tailbone pain as pain and tenderness there, often dull and achy most of the time with occasional sharp pains. The sitting position puts weight directly through this area, which is why many people first notice it when they sit on a hard chair, drive or stay at a desk.

The NHS lists the situations in which pain is typically worse: while sitting, when sitting down or standing up, when bending forward and when having a poo. NHS 111 Wales adds pain during sex and during a period. Disturbed sleep and difficulty with daily activities follow when the pain is persistent.

Many cases follow an obvious event. The NHS lists pregnancy and childbirth, and an injury such as a fall onto the coccyx. Others build up gradually from repeated or prolonged strain, for example sitting for a long time while driving or cycling. Poor posture, being overweight or underweight, and joint hypermobility or reduced flexibility of the joint that joins the coccyx to the base of the spine are also listed.

In some people no cause is found. A regional NHS referral guide from Scotland adds that coccydynia is around five times more frequent in women, and that predisposing factors include trauma, childbirth, obesity and rapid weight loss. It also advises that imaging is not recommended unless red flags are being assessed.

The NHS suggests sitting correctly with good posture and your lower back supported, using a specially designed coccyx cushion, and lying on your side to reduce pressure. Pelvic floor exercises are suggested, and an ice pack or bag of frozen peas wrapped in a towel can be placed on the area for 20 to 30 minutes; a heat pack can be used for longer. Anti-inflammatory painkillers such as ibuprofen may reduce pain, if they are suitable for you.

If the pain is worse when pooing, the NHS recommends asking a pharmacist for a laxative that softens the stool. It also advises not sitting for a long time. NHS 111 Wales adds that sitting on an exercise ball can help and that clothes tight around the bottom and lower back, like some jeans, are best avoided.

• Alternate between sitting and standing, and shift weight forward onto the thighs when you sit.

• Choose a firm seat with the lower back supported rather than a deep soft sofa.

• Lean forward slightly when sitting so weight goes through the sit bones, not the tailbone.

• Keep a note of which chairs and activities worsen the pain to guide a physiotherapist.

The NHS says two treatments may be recommended first when simple measures have not helped: physiotherapy, in which the muscles around the coccyx can be manipulated to help ease the pain, and corticosteroid and local anaesthetic injections into the joint that attaches the coccyx to the bottom of the spine. NHS 111 Wales says you will usually have a maximum of two injections given on consecutive months.

If physiotherapy and injections do not help, surgery to remove part or all of the coccyx may be recommended. The Scottish referral guide describes interventional options as only indicated for refractory cases. It also lists conservative measures such as rest from aggravating factors, cold or heat, wedge or doughnut cushions, pelvic floor exercises, TENS and acupuncture, noting there is no specific protocol for non-traumatic coccydynia.

In many areas the NHS says you may be able to refer yourself to a community musculoskeletal (MSK) service for physiotherapy without seeing a GP first.

The NHS says to see a GP if the pain has not improved after a few weeks of home treatment, if it is affecting your daily activities, or if you have a high temperature, tailbone pain and pain in another area such as your tummy or lower back.

Seek urgent assessment for new numbness in the legs or around the genitals or bottom, new problems controlling your bladder or bowel, severe pain after significant trauma, or a hot, swollen, tender lump with fever near the tailbone. These are not typical of simple coccydynia and the Scottish guide lists signs of infection and symptoms such as leg numbness and bladder or bowel disturbance among the reasons to look for a different cause.

The usual NHS route is self-help first, then GP or self-referral to community MSK physiotherapy, then specialist referral for injection or surgical opinion if pain persists. Injection treatments are delivered in a clinic or pain service, and surgery by an orthopaedic or spinal surgeon.

Private physiotherapy, pain management and orthopaedic or spinal consultants can offer quicker access to assessment and injections. If you go privately, ask what examination and imaging are planned, since the NHS-linked guidance suggests imaging is usually not needed unless red flags are present, and ask for an itemised cost for each stage of treatment.