The tailbone, or coccyx, is a group of small bones forming the lower end of your spine. Depending on the person, the tailbone is made up of between three and five vertebrae. This short grouping of bones ends in a soft point. Except for the first segment, the vertebrae are usually fused together.
The human coccyx is curved under, but the degree of curvature varies from person to person. When you sit down, part of your upper body weight rests on your coccyx. A break or injury to the coccyx can be very painful, especially when you sit down.
The tailbone attaches to the large gluteus maximus muscle, as well as several other muscles and ligaments.
Women are five times more likely to have tailbone pain than men, especially during and after pregnancy.
Car accidents are a common cause of injury to the coccyx.
Tailbone pain is usually localized. Actions that may set off the pain include:
- prolonged sitting
- leaning back while seated
- prolonged standing
- getting up from a seated position
- bowel movements or urination
- sexual intercourse
Lower back pain or pain radiating to the legs may occur, but isn’t common. You may feel a frequent need to defecate.
The medical term for pain in the tailbone is coccydynia. It can be due to a dislocation or a full fracture (break).
People who go to a doctor with tailbone pain may have had a recent traumatic injury to the tailbone from a fall or impact. But just as many can have pain without remembering any injury. Sometimes just sitting on a hard bench may be the trigger.
Coccydynia is about three times more common in obese people because of the anatomy of the coccyx in relation to the spine and buttocks. When seated, your tailbone and two buttocks form a tripod that supports the weight of your upper body.
In a thin or average-weight person, the coccyx rotates under the body when seated, so it can better absorb the weight. In a heavier person, with larger buttocks, the pelvis and coccyx rotate less when sitting. This puts more stress on the tip of the coccyx and leads more readily to dislocation or fracture.
Your doctor will use a physical exam and X-rays to diagnose your tailbone pain. It's important to know if something other than a traumatic injury is causing the pain.
To find out, your doctor will feel the soft tissue around your coccyx and the lower spine (sacrum). They may be able to detect a pointy growth of new bone, known as a bone spicule, which could be the source of the pain.
In a rectal examination your doctor grasps the coccyx between the forefinger and thumb. By moving it, they can tell if there's too much or too little mobility in the coccyx. The normal range of motion is about 13 degrees. Too much more or too much less, can be a sign of a problem.
X-rays are done in both standing and sitting positions. Comparing the angle of the coccyx in the two positions helps your doctor determine the degree of motion.
Broken tailbone vs. bruised tailbone
X-rays can also reveal if the tailbone is broken or just bruised. A fracture will usually be visible on an X-ray. Although the treatment may be the same, the recovery time is longer for a fracture than for a bruise.
Broken tailbone pictures
A broken or bruised tailbone is usually treated without surgery. It is successful in 90 percent of cases. Physical therapy and the use of special cushions are the most common and effective forms of treatment.
Other nonsurgical treatments include:
- pelvic floor rehabilitation
- manual manipulation and massage
- electrical nerve stimulation
- steroid injections
- nerve block
- spinal cord stimulation
A physical therapist can help you to learn exercises that stretch the ligaments and strengthen the muscles supporting the lower spine. They may use massage or alternating hot and cold compresses to lessen the pain. Your therapist may also guide you in proper posture for sitting.
These are specially designed cushions that support the buttocks, but have a cut-out section to relieve pressure on the coccyx. They're available online or at stores without a prescription. Here are some cushions available to purchase.
Circular (doughnut) cushions are not advised as they place extra pressure on the coccyx. They're more useful for rectal pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended for the pain associated with a bruised or broken coccyx. These include:
- ibuprofen (Advil, Motrin)
- acetaminophen or paracetamol (Tylenol)
- aspirin (Bayer, Ecotrin)
- naproxen (Aleve, Naprosyn)
Broken tailbone surgery
Surgery isn't often used, but may be necessary for people who don't respond to therapy.
Surgery can involve total removal of the coccyx (coccygectomy), or removal of only one or more of the segments. The best outcomes occur for two types of cases:
- those with hyper-mobility (too much freedom of motion) of the coccyx
- those with spicules (sharp-pointed, new bone growth) on the coccyx
Recovery time from a bruised or broken tailbone depends on your age and the severity of the injury. Children recover faster than adults, and young adults recover faster than older ones.
Rehabilitation will include physical therapy, home exercises, and possibly a special cushion for sitting.
Broken tailbone exercises
Your doctor or physical therapist can give you exercises to strengthen the muscles around the coccyx. These include your stomach muscles and those of the pelvic floor. Kegel exercises help strengthen the pelvic floor. They're helpful for both men and women.
Proper posture when sitting can also help. Sit with your back against the chair, and avoid slouching. Keep your feet flat on the floor, using a book or other support if your legs don't reach.
Sleeping with a broken tailbone
To lessen the pain of a broken or bruised tailbone, consider sleeping:
- on a firm mattress
- on your side with a pillow between your knees
- on your back with a pillow under your knees
Pain management includes massage, heat and ice, and nonsteroidal anti-inflammatory drugs. Keeping up with your exercises is also very important.
The flexibility of children's bones decreases the likelihood of injury to the coccyx. But injuries to the coccyx are still common in children, because of their level of activity in sports and play.
Recovery times are quicker for children than adults. Coccygeal surgery is rarely needed.
Women are five times more susceptible to tailbone pain than men. Much of this has to do with pregnancy and childbirth. Weight gain and the consequent changes to posture during pregnancy increase the risk of injury to the coccyx.
The location of the coccyx also makes it susceptible to injury during a difficult childbirth, especially one requiring use of instruments.
A broken or bruised coccyx will usually heal on its own. Physical therapy, exercises, and a special cushion can all help ease the pain and speed recovery.
See your doctor if pain is severe, or if you have trouble with bowel movements or urination. Surgery is needed in fewer than 10 percent of cases.
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