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Pain at the very base of the spine, usually worse when you sit and sharpest as you stand up. Most tailbone pain settles without surgery — once it is clear the tailbone is actually the source.
The tailbone, or coccyx, is a small triangle of three to five fused bones at the bottom of the spine, below the sacrum. It is an anchor for several muscles of the buttock and pelvic floor, and when you sit leaning back it takes part of your weight. It is meant to tilt forward slightly each time you sit down.
The coccyx is the small tip below the sacrum, seen here from the front through the ring of the pelvis. The muscles of the pelvic floor and buttock attach around it.
What the picture cannot show is movement. When you sit, the tailbone tilts forward slightly. Too much or too little of that tilt is one of the causes of pain, which is why X-rays are compared sitting and standing.
Tailbone pain — coccydynia — is pain arising from the coccyx or the joint and tissues around it. It can follow an injury, or develop when the tailbone moves too much or too little as you sit. In some people no single cause is found.
It is more common in women, partly because of the shape of the pelvis and partly because childbirth can strain the area.
Several other problems cause pain in the same area. Telling them apart comes first, because the treatment is quite different.
| Tailbone | Referred from the lower back | Skin or bowel | |
|---|---|---|---|
| Where it hurts | A spot at the very tip of the spine, between the buttocks | Across the low back or buttock, sometimes down a leg | In the skin near the tailbone, or around the back passage |
| Pressing on the tailbone | Reproduces the pain | Usually does not | Tender in the skin or a lump, not the bone |
| Worse with | Sitting, leaning back, and getting up from a chair | Bending, standing, walking | Bowel movements, or constant |
| Other clues | Often after a fall, childbirth or long sitting | Back stiffness, leg pain or numbness | A swelling or discharge, bleeding, or a change in bowel habit |
A tender, swollen lump near the tailbone can be a pilonidal sinus, a skin condition. Bleeding from the back passage, a change in bowel habit or unexplained weight loss need checking with your GP. Pain from the lower back is covered under lower back pain and sciatica.
The moment of getting up is often the worst. As you rise, the tailbone moves and the muscles attached to it pull. Pain at that moment is one of the more characteristic features of coccydynia.
Call us on +65 8849 0677. We will see you the same day and arrange imaging if it is needed.
If we are closed, go to an emergency department — we are shut on Sundays and after 1pm on Saturdays. For the first symptom, go straight there whether we are open or not.
Call +65 8849 0677An ordinary X-ray often looks normal. It is taken lying down or standing, when the tailbone is not under load. Comparing sitting and standing views shows how it behaves when you sit — which is often where the answer is.
Most tailbone pain improves with simple measures. Treatment builds up only if it does not.
A wedge or U-shaped cushion with a cut-out at the back, so the tailbone does not touch the seat. Sit leaning slightly forward, break up long periods of sitting, and use heat or ice for flare-ups.
Anti-inflammatories, and a stool softener if bowel movements are painful.
Relaxing and stretching the pelvic floor and buttock muscles that pull on the tailbone, and posture work. Some physiotherapists also use gentle manual treatment of the tailbone itself.
A steroid and local anaesthetic injected around the tailbone, or a block of the small nerve cluster in front of it, under image guidance. Relief varies; for some people it lasts.
Removing part or all of the tailbone (coccygectomy) is considered only for pain that has persisted for many months despite everything above, usually with a tailbone that moves abnormally. Results in carefully chosen patients are often good, but the wound is prone to infection because of where it is, and recovery takes months.
Tailbone pain sits at the meeting point of bone, joint, muscle and nerve. For most people it is a pain problem first.
Persistent tailbone pain, pain that may be coming from the lower back or nerves, and image-guided pain treatment.
A neurosurgeon trains on the nervous system first. Dr Mathew Tung sees tailbone pain alongside back pain and sciatica, and works with radiologists on CT-guided pain interventions.
A fall onto the tailbone, a suspected fracture or dislocation, or weak bone.
An orthopaedic spine surgeon trains on the musculoskeletal system first. Dr Lim Heng Hing treats trauma and fractures, including fractures of the spine.
For tailbone pain on its own, Dr Tung is the natural start. After a fall, either is a sound first appointment. Having both surgeons in one clinic means the answer is not shaped by whichever one you happened to book.
More on how the two differ: neuro spine and orthopaedic spine surgery.
It often improves over a few weeks to a few months. Pain after a fall usually eases as the bruising or fracture heals; pain from long sitting improves once the pressure is taken off.
On a wedge or U-shaped cushion with a cut-out at the back, leaning slightly forward so your weight is on your thighs rather than your tailbone. Stand up and move every half hour or so.
After a hard fall it can be, but a bruised and a broken tailbone are usually treated the same way. An X-ray shows a fracture or dislocation if the answer would change the plan.
As you rise, the tailbone shifts position and the muscles attached to it pull. That movement is often what triggers the sharpest pain.
Very rarely. Surgery is considered only when pain has lasted many months despite cushions, physiotherapy, medication and injections.
No. Bring any X-ray or scan reports, and mention any fall, childbirth or change in how much you sit.
Lower back pain · Back pain · Sacroiliac joint dysfunction · Piriformis syndrome · Sciatica · Slipped disc · Spinal compression fracture
If the pain started after a fall or childbirth, say so when you book. It changes what gets checked first.
