Tailbone pain: causes, red flags and when to get it checked

The coccyx is a small curved bone at the end of the spine that supports weight when sitting back and anchors pelvic floor muscles. If the joint above it is bruised, inflamed, or moves abnormally, or the surrounding muscles are tense, sitting becomes painful.

• Direct injury from a fall onto the buttocks, sports or accidents, causing bruising or fracture.

• Childbirth: pressure on the coccyx during delivery.

• Prolonged sitting on hard or narrow surfaces and repetitive strain, for example cycling.

• Coccyx joint hypermobility or stiffness, and obesity or rapid weight loss changing sitting posture.

• Pelvic floor muscle tension or levator ani spasm.

• Referred pain from the lower lumbar spine or sacroiliac joint.

• Pilonidal cyst or abscess near the top of the buttock cleft, and anal conditions.

• Rarely, infection or a tumour of the sacrum and coccyx.

Fever, a red swollen or draining area near the cleft, a lump, unexplained weight loss, a history of cancer, bowel or bladder changes, numbness or weakness in the legs, severe night pain unrelieved by position, and pain after major trauma need examination.

• Call 999 or go to A&E: new bladder or bowel loss, saddle numbness or leg weakness.

• Same-day GP: a red, hot, swollen, painful area near the cleft with fever (possible abscess).

• GP within weeks: pain after a fall not improving, or lasting more than a few weeks.

• Routine: pain that is gradually improving.

The doctor asks about injury, childbirth, sitting habits, pain triggers, bowel movements, bladder function, fever and weight. They examine the spine, press on the coccyx and may perform a gentle rectal examination to check for tenderness or movement of the tip.

• X-ray, including seated and standing views: to look for fracture or abnormal angle.

• MRI: for persistent unexplained pain or red flags.

• Blood tests and swabs: if infection is suspected.

• Diagnostic injection: in specialist settings, to confirm the source.

• Pelvic floor assessment: if muscle tension contributes.

Use a wedge or ring cushion (coccyx cushion) to take pressure off the tailbone, lean forward when sitting, avoid prolonged sitting on hard surfaces, and take frequent breaks. Heat, simple painkillers and gentle stretching help. Avoid constipation, which worsens pain on straining. Pelvic floor physiotherapy is useful for muscle tension.

The NHS route is a GP with physiotherapy and pain clinic referral. Private physiotherapy, pain specialists and orthopaedic consultations offer injections and, rarely, surgery for resistant cases.