By Mr Ahmed-Ramadan Sadek, Neurosurgeon · Last reviewed October 2026 · 6 min read

What is coccydynia?

The coccyx, or tailbone, is the small bone at the very bottom of the spine. It is made of two or three tiny segments linked by joints and attaches above to the sacrum, the triangular bone at the back of the pelvis. Several ligaments and the muscles of the pelvic floor (the sling of muscle supporting the bladder, bowel and, in women, the womb) are anchored to it.

Coccydynia simply means pain in this area. It is a description of a symptom rather than a single disease, and it can arise for several reasons. the British Association of Spine Surgeons (BASS) patient information notes that women are around five times more likely to develop it than men.

Symptoms

• pain right at the base of the spine, made worse by sitting, especially when leaning back;
• a sharp twinge when standing up from or lowering into a chair;
• discomfort with long periods of standing still;
• a constant ache with occasional stabbing pains;
• pain when opening the bowels or during sex;
• difficulty driving, bending or getting comfortable at night.

What causes it?

Many cases follow a clear event, while others appear for no obvious reason. Recognised causes and contributors include:

• a backward fall onto the bottom, for example slipping on stairs or ice;
• childbirth, particularly a difficult delivery, as the pelvic joints loosen late in pregnancy and the coccyx can be pushed out of place;
• repeated strain on the ligaments attached to the coccyx, similar in nature to tennis elbow;
• pelvic floor problems or poor posture;
• body weight: being overweight increases pressure when seated, while being very slim or losing weight quickly removes natural padding;
• age-related wear, or a coccyx that moves too much or too little.

Very rarely, infection, a cyst or a growth is responsible, which is one reason a medical assessment is worthwhile if pain persists.

How is it diagnosed?

The diagnosis is usually made from your description and an examination. Pain that is clearly triggered by sitting, together with tenderness over the tailbone, is very characteristic. Neither blood tests nor X-rays can confirm coccydynia but may be used to exclude other conditions. An MRI or bone scan is reserved for the occasional case where the diagnosis is uncertain.

Self-help and simple treatments

The outlook is good. BASS booklets state that around 9 out of 10 people improve on their own, often within a few weeks, although in some the pain takes many months to fade. Helpful measures include:

• a coccyx cushion (a wedge with a cut-out at the back) to take pressure off the tailbone;
• avoiding long spells of sitting and getting up regularly;
• anti-inflammatory tablets such as ibuprofen or naproxen, if suitable for you, or paracetamol taken before a long sit;
• heat or cold packs;
• physiotherapy, especially pelvic floor exercises, stretching or massage.

Injection treatment

When pain is severe and has not settled with self-help, your specialist may offer an injection around the coccyx. It combines local anaesthetic, which numbs the area for a few hours, with a steroid to calm inflammation. If even short-lived relief follows, this also helps confirm where the pain is coming from. According to the BASS web page, injections may be given as a course of up to three.

What happens

This is normally a day-case procedure under sedation and local anaesthetic, and sometimes a general anaesthetic. You lie on your front or side, the skin is cleaned, and X-ray guidance is used to place the needle. While you are asleep, the surgeon may also gently manipulate the coccyx using a gloved finger in the back passage.

Pain may briefly return, or feel a little worse, once the numbness wears off; the steroid can take days or weeks to work. If the first injection helped, BASS advises that a repeat is not usually offered for about six months. After sedation or anaesthetic, do not drive for 48 hours, and have an adult with you overnight.

Risks of injection

BASS describes coccygeal injections as low-risk and gives no numerical rates. Uncommon problems include bleeding (particularly if you take blood thinners), infection (more likely if the skin over the buttocks is inflamed), temporary facial flushing or changes to periods, a few days of raised blood sugar in people with diabetes, and allergic reaction to the medicines.

Surgery: coccygectomy

A coccygectomy means removing all or part of the coccyx through an incision just above the cleft between the buttocks. It is only considered when all other treatments, often repeated, have failed, and very few people with tailbone pain ever need it.

Results vary. The BASS coccygectomy booklet suggests good pain relief in about 50% of cases, while the BASS web page cites case series reporting good or excellent results in around 60 to 70% of carefully chosen patients. Better results are more likely in people whose pain followed an injury, who gained relief from an injection, or whose coccyx moves abnormally. Improvement is gradual and BASS indicates it may take three months to a year.

Risks of coccygectomy

Risk	Approximate frequency (BASS coccygectomy booklet)
Ongoing pain despite surgery	One of the main risks; relief occurs in only about half of cases
Wound infection	Up to 10 in 100
Blood clot in leg or lung (DVT/PE)	Fewer than 1 in 700
Injury to the rectum, possibly needing a temporary colostomy	Rare
Pelvic floor prolapse affecting bladder, bowel or sexual function	Reported; no figure given
Fatal complication of general anaesthetic	About 1 in 250,000

Infection is more common than in most spinal surgery because the wound lies close to the back passage. Careful hygiene and avoiding constipation (laxatives are often needed) are important while it heals. Bleeding and pressure injuries from positioning on the operating table are also possible.

Recovery after surgery

• Most people go home the day after surgery.
• Sitting is often painful for up to a month; a special cushion helps.
• BASS advises avoiding driving for at least four weeks.
• Most people need around two weeks off work, but those in seated jobs may need six weeks or more.
• Your surgeon may suggest avoiding flying for six weeks because of the clot risk.

Outlook

Coccydynia is a benign condition. It can be slow to settle, but the BASS web page notes that it very rarely persists beyond five years and has no known long-term health consequences.

• BASS: Coccydynia and operations for coccygeal pain
• BASS patient booklet: Coccydynia injection treatment
• BASS patient booklet: Coccydynia surgical coccygectomy
• NHS: Tailbone (coccyx) pain

This guide is general information and is not a substitute for advice about your own situation. Please speak to your GP or specialist.