Coccydynia: Tailbone Pain Causes, Symptoms, and Treatment

What is Coccydynia?

Coccydynia is the medical term for pain localised to the coccyx region at the base of the spine. It produces a distinctive sharp, aching, or burning pain felt right at the tailbone or between the buttocks, almost always made worse by sitting.

One of the hallmark features of coccydynia is a spike of pain precisely at the moment of transitioning from sitting to standing. This happens because the coccyx is loaded by the pelvic floor muscles during the sit-to-stand movement.

Coccydynia is significantly more common in women, partly due to the shape of the female pelvis and partly because childbirth is a frequent cause. Most cases are highly treatable with interventional procedures.

Symptoms of Tailbone Pain

Common symptoms include:

1. Pain at the very tip of the spine or between the buttocks
2. Pain that is significantly worse when sitting, especially on hard surfaces
3. A sharp spike of pain when transitioning from sitting to standing
4. Aching that eases when standing or walking but returns promptly on sitting
5. Tenderness when the coccyx is pressed from outside
6. Pain during bowel movements or prolonged straining
7. Discomfort during sexual intercourse in some patients

See a specialist if tailbone pain has lasted more than 4 weeks, is limiting your ability to sit comfortably, or followed a fall or traumatic event.

What Causes Tailbone Pain?

The most common causes are:

1. Trauma: A fall onto the buttocks is the most frequent precipitating event. The coccyx may be bruised, fractured, or dislocated. Even minor falls can cause persistent pain if the coccyx is destabilised.
2. Childbirth: Prolonged labour, instrumental delivery, or macrosomia (large baby) can bruise or fracture the coccyx. Post-partum coccydynia can persist for months after delivery if untreated.
3. Repetitive Strain: Prolonged sitting on hard or narrow surfaces, cycling, and rowing can produce cumulative stress at the coccyx, leading to inflammation and pain without a single traumatic event.
4. Coccygeal Hypermobility: In some patients the coccyx has abnormally increased movement when sitting, causing painful dynamic instability that is visible on dynamic (sitting vs standing) X-rays.
5. Idiopathic: In a significant proportion of patients, no identifiable structural cause is found. Pain is thought to arise from sensitisation of the ganglion impar, the sympathetic nervous system cluster at the tip of the coccyx. A ganglion impar block addresses this directly.

Traumatic vs Idiopathic Coccydynia

Traumatic coccydynia follows a clear event such as a fall or delivery. Imaging often shows a fracture site or subluxation. This type typically responds well to targeted injections and usually has a favourable outcome.

Idiopathic coccydynia has no identifiable structural cause. It is thought to arise from central or sympathetic sensitisation and is mediated through the ganglion impar, a small sympathetic ganglion sitting directly in front of the coccyx tip. A ganglion impar block is the procedure of choice here and is often dramatically effective.

Both types can become chronic and self-reinforcing if left untreated. Early intervention produces better outcomes than waiting for spontaneous resolution, which may not occur.

How is Tailbone Pain Diagnosed?

Dr. Ashu Kumar Jain assesses the precise location of tenderness, movement patterns that provoke pain, and any associated pelvic floor symptoms before recommending imaging.

1. Clinical examination with careful localised palpation of the coccyx and sacrococcygeal junction
2. Dynamic X-rays (sitting and standing) to identify coccygeal hypermobility or subluxation
3. MRI pelvis to assess for fracture, soft tissue pathology, or other causes of pelvic pain
4. Diagnostic ganglion impar block to confirm sympathetically-mediated coccydynia before definitive intervention