Tailbone (Coccyx) Injury: Causes, Symptoms, and Treatments

Medically Reviewed by Jabeen Begum, MD on June 04, 2024
Written by Kathryn Whitbourne
9 min read

This is an injury to the coccyx or tailbone area. The coccyx is the triangular bony structure found at the bottom of the spine. It's composed of three to five bony segments held in place by joints and ligaments (tissue that connects bone to bone). The tailbone helps to steady you when you sit down. The medical term for a tailbone injury is coccydynia.

Tailbone injuries may result in a bruise, dislocation, or fracture (break) of the coccyx and cause a lot of pain and discomfort. Although they can be slow to heal, most coccyx injuries can be managed at home.

Women are five times more likely to have coccyx injuries than men because the female pelvis is broader and the coccyx is more exposed.

Tailbone injuries are usually caused by one of the following:

  • You slip and fall backward on your tailbone, usually on a hard surface, like a floor. This is the most common cause of coccyx injuries.
  • You take a direct blow to your tailbone while playing a contact sport.
  • You fracture or injure your coccyx during childbirth.
  • You hurt it while doing repetitive motions or causing friction, as happens while bicycling or rowing.
  • You sit for long periods of time, especially on a hard surface.

Less common causes of coccyx injuries include bone spurs, wear and tear on the joints, injuries to other parts of the spine, infections, and tumors. And sometimes, the cause is unknown. This is called idiopathic coccydynia.

Among the symptoms you may have if your tailbone is injured are:

  • Dull, achy pain and tenderness at the base of your spine (with occasional bouts of sharp pain)
  • A visible bruise, if the injury was severe
  • Worsening pain when you move from sitting to standing
  • Pain when you poop 
  • Pain during sex
  • Pain during your period
  • Pain during prolonged sitting or prolonged standing

 

Your doctor will determine the cause of your coccyx injury from your medical history and a physical exam. During the history, they'll ask you whether you injured yourself, perhaps from a fall, or had a difficult childbirth.

  • During the physical exam, your doctor will examine your spine to feel for tenderness. They may also do a rectal exam where they insert a finger into your rectum to feel the area of the coccyx and find out if there is a dislocation or a fracture. Direct pressure against the coccyx reproduces your pain.
  • Rarely, if the cause of your discomfort is unknown, your doctor may inject a local anesthetic into the tailbone area to see whether the origin of the pain is from the coccyx or another part of your spine. 
  • Your doctor may also recommend an X-ray or CT scan to discover whether there's a fracture or dislocation. However, X-rays occasionally may not reveal these injuries. 
  • Your doctor may recommend an MRI or bone scan to check for inflammation, abscesses, or tumors.

In 90% of cases, home remedies successfully treat tailbone injuries. Here are some tips:

  • Take nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen to reduce pain and improve your ability to move around. Don't take NSAIDs if you have kidney disease, a history of bleeding in your digestive system, or are also taking a blood thinner -- such as warfarin -- without first talking with your doctor. In those cases, it's safer to take acetaminophen, which helps lessen pain but does not reduce inflammation.
  • Take stool softeners to prevent constipation.
  • Avoid sitting down for long periods of time. When seated, avoid sitting on hard surfaces, and alternate sitting on each side of the buttocks. Also, lean forward and direct your weight away from the tailbone.
  • Buy a "doughnut" cushion or pillow to sit on. This cushion has a hole in the middle to prevent the tailbone from contacting the flat surface.
  • Use a standing desk for working.
  • For severe injuries, apply ice to the tailbone area for 15-20 minutes, four times a day, for the first few days after the injury. If ice doesn't help, try a heating pad.
  • Eat foods high in fiber to soften stools and avoid constipation. Drink lots of water too.

Fiber supplements for coccyx pain relief

Straining to have a bowel movement can increase your tailbone pain. If eating high-fiber foods is not helping enough, take a fiber supplement like Benefiber or Metamucil. These can help to soften your stool so you can poop easier.

Most of the time your tailbone will heal on its own, though it might take several weeks. If home remedies aren't working, your doctor may:

  • Prescribe stronger pain medications, like opioids
  • Inject local anesthetics into the tailbone for severe, continuing pain
  • Mobilize the coccyx via the rectum 
  • Prescribe massage therapy or physical therapy, including TENS (transcutaneous electrical nerve stimulation)
  • Prescribe psychotherapy if they think the problem is psychological in nature.
  • Recommend surgery (very rarely). A partial coccygectomy removes part of your coccyx, while a total coccygectomy removes all of your coccyx. Surgery won't always stop your pain, so it's only a last resort when nothing else works.

A 2017 study found that exercises that stretched the piriformis and iliopsoas muscles helped reduce pain for people with coccydynia (tailbone pain). These are muscles that connect the leg to the spine and can cause your back to hurt if they're tight. Here are some tailbone injury exercises that can stretch these muscles. Before beginning them, talk to your doctor to see if they're right for you and when to start. 

Knee to chest

  • Lie on your back on the floor, legs straight.
  • Lift one leg and bring the knee toward your chest. Hug your knee and pull your leg in as far as it will go. 
  • Tighten your abdominals and press your spine to the floor. Hold for 5 seconds. 
  • Repeat on the other side, then pull both legs in together. 
  • Do this sequence 10 times.

Figure 4 stretch

  1. Lie on your back on the floor with knees bent.
  2. Cross your right ankle over the left knee, so your right foot is resting on your left knee.
  3. Bring the left knee toward your chest, hugging it.
  4. Pause wherever you feel a stretch in your hip and breathe. Hold it for about 30 seconds.
  5. Repeat on the other side. 
  6. A variation is to cross the legs but keep the left foot on the floor and gently push the crossed right leg away from you.

Sitting rotation stretch

  1. Sit up tall on the floor with both legs straight out in front of you. 
  2. Bend one leg and cross it over the straight leg. 
  3. Slowly twist toward your bent leg, putting your hand behind you for support. 
  4. Put your opposite arm on the side of your bent leg, so you can twist further. 
  5. Look over your shoulder and hold the stretch for 30 seconds. Slowly return to center.  
  6. Repeat on the other side. Do this sequence four times.

Pelvic floor exercise

If your tailbone injury is related to being pregnant, you may want to try pelvic floor exercises. You can do this exercise sitting, standing, or lying down.

  1. Imagine you're trying to stop the flow of urine midstream. That's the muscle you want to target. It's a "squeeze and lift" motion.
  2. Breathe and hold the position for 2 seconds. Then relax. 
  3. Don't squeeze your legs, tighten your buttocks or hold your breath while doing this exercise. You may feel your lower stomach gently pull in.
  4. Repeat 10 times. 
  5. Work your way up to holding the position for 10 seconds and doing three sets of 10 repetitions in a day.

Most people don't need follow-up if their coccyx injury is improving with medical treatment or home remedies.

Follow-up is at the discretion of your doctor and depends on the severity of the injury and the progress you're making with treatment.

If your tailbone pain is chronic (ongoing) and medical treatment and home remedies aren't working, you may need more frequent follow-up or a referral to other specialists.

If you've bruised your tailbone, it might take 4 weeks to be healed.

If you fractured your tailbone, it might take 8-12 weeks to be healed.

Surgery becomes an option only 6 months or more after the injury with no healing.

While you're waiting for your tailbone to heal, continue to do the home remedies described earlier. Let the injury fully heal before getting back to physical activities.

Most children injure their tailbones in the same ways that adults do: mainly from falls or while playing sports. The injury is quite rare in children. If it does happen, your child will feel pain in the tailbone area while sitting or may strain while trying to poop.

If your child injures their tailbone, take them to the doctor to get advice. Treatment is usually similar to that for adults:

  • Try over-the-counter (OTC) children's ibuprofen or other pain relievers (check with your doctor before giving).
  • Get a doughnut cushion for your child to sit on. Have them avoid sitting on hard surfaces.
  • Apply ice or an icepack to your child's tailbone area for 10 to 20 minutes every 2 hours while your child is awake, for the first 3 days after the injury. You could also try alternating ice treatment with a warm bath for 20 minutes, three or four times a day. Put the cushion or a towel under your child's buttocks in the bathtub.
  • Tell your child not to strain when doing a bowel movement. Have them eat food with a lot of fiber and drink a lot of water to avoid constipation. 
  • Your doctor may suggest specific stretching exercises or physical therapy.

It will take a few weeks to see results. In rare instances, your doctor may suggest surgery if these remedies have not worked and your child is still in pain. 

Call 911 and avoid moving the person if they have signs of spinal cord injury along with a tailbone injury caused by a fall.

Symptoms of spinal cord injury include:

  • Severe neck or back pain
  • Paralysis in part of the body
  • Loss of bowel or bladder control
  • Weakness in the legs or arms
  • Numbness

If you have the signs and symptoms of a coccyx injury or unexplained discomfort in the tailbone area, contact your doctor. It may be necessary for the doctor to decide if the injury is traumatic (from a fall, etc.) or if the pain is caused by other, more serious, problems.

Most tailbone injuries are accidental (such as slipping on ice) and can't be entirely avoided. But there a few ways you can lessen your chances of injury.

  • Wear proper protective padding when participating in contact sports that can potentially lead to coccyx injuries.
  • Avoid sitting in the same position for very long periods of time.
  • Keep the staircase in your house well lit and install a railing if it doesn't have one.
  • Don't look at your phone while walking.
  • Be very careful when walking on slippery ice. Wear boots with traction. 

The outlook for tailbone injury depends on many factors, including:

  • The original cause of the problem (whether trauma, tumor, or infection; trauma refers to physical injuries that are sudden and need medical attention)
  • If traumatic, the severity of the injury (a bruise, fracture, or dislocation)
  • Whether you're following doctor's orders as far as medical treatment
  • Your natural ability to recuperate and heal

Most of the time, coccyx injuries get better in several weeks with proper medical treatment.

A few people have from chronic discomfort despite proper medical treatment. This can be extremely frustrating.

How can you tell if your tailbone is just bruised or broken?

There's often no way to tell without doing an X-ray. Pain is usually worse with a broken tailbone than one that's bruised, but not always. Most tailbone injuries are bruises and rarely are they fractures. Treatment for both conditions is the same. A fracture will just take longer to heal. 

Will a tailbone injury heal on its own?

Usually, but it will take 4-12 weeks, so be patient. Talk to your doctor to get advice on treatment.

How do you relieve coccyx pain?

Taking OTC pain relievers, applying ice, and doing gentle stretching can help relieve coccyx pain while your tailbone is healing.