Tailbone Pain (Coccydynia): Causes, Symptoms, and Treatment

Tailbone pain (coccydynia) is a common symptom that may be associated with muscle tension, myofascial pain syndrome, fascial dysfunction, coccyx displacement, or inflammation of the sacrococcygeal joint. Less commonly, the cause of pain is pelvic organ diseases, soft tissue inflammation, or neuralgia of nearby nerves.
The pain may be acute or chronic, worsening with sitting, standing up, movement, and physical activity. In this article, we will discuss the main causes of tailbone pain, how to distinguish muscle pain from other types of pain, what an MRI may show, and what methods are used for prevention and treatment.
Where Is the Coccyx Located?
Anatomy of the Coccyx and Pelvis
Eduard Konkin
Specialty: General Medicine
Experience: 8+ years
Article author
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Anatomy of the Coccyx: Where Is It Located?

The coccyx (from Latin coccyx or os coccygis — the coccygeal bone) is the lowest and smallest part of the spine, consisting of 4–5 (rarely 3–6) fused coccygeal vertebrae. The total length in an adult is only 3.5–6 cm. The coccyx is a vestigial tail — a remnant of a tail — therefore, it has almost no function in humans. The coccyx is not involved in the act of sitting, as sitting is performed on the ischial tuberosities of the pelvic bones.
The coccyx is attached to the lower surface of the sacrum via the sacrococcygeal joint and is held in place by the sacrococcygeal ligaments (anterior and posterior). Normally, the sacrococcygeal angle is obtuse (about 150 degrees) — meaning it is tilted slightly forward.
There is almost no movement in this joint, except during childbirth in women.
The muscles and ligaments of the pelvic floor attach to the anterior surface of the coccyx. These muscles are involved in the formation and function of the genitourinary system and the distal parts of the intestine.
Anatomy of the Coccyx
Anatomy of the Coccyx and Sacrum
The coccyx itself and the sacrococcygeal joint typically do not cause pain. However, since muscles and ligaments attach there, soft tissue pain may be mistakenly attributed to the coccyx and called coccydynia.

Why Does the Coccyx Hurt?

Pain in the sacrococcygeal and intergluteal region is a typical symptom of various conditions and can be caused by different factors:
  • From traumatic and trophic damage (pressure ulcers)
  • To muscle, intestinal, and functional disorders
The nature of the pain can also vary and be mixed:
  • From inflammatory and infectious
  • To neuropathic, myofascial, vascular, and organ-related (pelvic organ diseases)
In terms of duration and intensity:
  • Constant or intermittent (alternating)
  • Minor or severe
  • May depend or not depend on body position and activity
All these factors help indicate the cause and type of pain in the lower spine.
However, it is important to understand that the coccyx itself is extremely rarely the true source of pain in this area.

Main Causes of Tailbone Pain

Causes can be divided into groups and nosologies (diseases):
1. Traumatic pain
2. Vascular and intestinal tailbone pain
3. Neuropathic pain of the coccygeal plexus
4. Joint pain
5. Pain from coccyx displacement or angulation (dislocation)
6. Inflammation of subcutaneous fat (including paraproctitis)
7. Degenerative-dystrophic changes in the sacrococcygeal region
8. Spinal diseases of the sacrococcygeal region
9. Coccygeal cysts (pilonidal cyst)
10. Tailbone pain due to pelvic organ disease (including PID)
11. Muscular and fascial (myofascial) tailbone pain — pain from trigger points in the muscles
Diagnosis and Types of Tailbone Pain
Pain Symptoms in Myofascial Pain Syndrome
Sometimes the pain will be isolated — arising from a single condition — while in other cases it may be combined (complex) — meaning it occurs due to several causes at once.
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Traumatic Tailbone Pain

This category includes pain caused by external impact and trauma: a blow, fall, car accident, or wound.
The distinguishing features of this pathology are: pain appears immediately after the impact — that is, it develops instantly. It is also accompanied by signs of aseptic inflammation (without microorganisms).
On the skin, there may be redness, swelling, and an increase in temperature at the site of injury.
The severity of pain depends on the force of the external impact and the damage to soft tissues and bony structures.
There may be bruises, cracks, fractures of the coccyx and sacrum, tears and ruptures of the sacrococcygeal ligaments, displacement and pathological angulation of the coccyx. A characteristic feature is pain reduction with cold application (ice or a cooling compress).
If pain in the coccyx area appears after trauma or a fall, you should apply cold and go to a trauma center to have a pelvic X-ray to assess the extent of the damage.

Vascular and Intestinal Tailbone Pain

Along the anterior surface of the coccyx lies the posterior wall of the rectum. When this area is affected, pain may appear in the anogenital region. This condition is classified as coccydynia and may be called anococcygeal pain syndrome.
Causes of tailbone pain originating from the rectum:
1. Internal hemorrhoids (vascular tailbone pain): When hemorrhoidal veins become stretched or thrombosed, a person may experience cutting, stabbing, and bursting pain. Complaints worsen with defecation or constipation. There may be a sensation of a foreign body or rectal fullness. This is usually accompanied by slight bleeding (bright red blood in the stool).
  • 2. Anal fissures and proctitis: The mucous membrane of the rectum is susceptible to damage and inflammation (including from hard stools), which will cause acute, stabbing pain radiating to the coccyx.
If tailbone pain is associated with the rectum, there will be defecation disorders: constipation, blood in the stool, possible spasm of the anal sphincter, itching, and burning. It is necessary to see a proctologist.

Neuropathic Tailbone Pain

Along the anterior (inner) surface of the coccyx pass the nerves that form the coccygeal nerve plexus. Nearby also pass branches of the sacral plexus and the pudendal nerves. They provide innervation to the anal sphincter, obturator and coccygeus muscles, levator ani muscle, and urethral sphincter.
Many authors note that compression of these nerves in the pelvic area is possible, which can also cause pain in the coccyx region.
Slightly higher lies the piriformis muscle, which can be affected by trigger points and cause compression not only of the sciatic nerve but also of the pudendal nerve. This can lead to neuropathy (neuropathic pain) and sensory disturbances in the perineal and intergluteal regions.
Additionally, frequent constipation and distension of the large intestine can compress nerve endings and cause pain in the sacral and coccygeal regions.
Neuropathic pain is always accompanied by impaired conduction function — there will be sensory changes and reduced control over the innervated organ.

Joint Pain in the Coccyx

True arthrosis of the sacrococcygeal joint is practically nonexistent in its pure form. Since the joint is immobile, it does not cause pain. However, the sacroiliac joints are also located in this area, and although unlikely, they can cause pain in the lower back region that may be classified as coccydynia.
When there are multiple trigger points in the muscles of the lower back and buttocks, the muscles exert excessive pressure on the joint, leading to functional blockage. This can cause pain.
Since the coccygeal joint is surrounded by ligaments — the sacrotuberous and sacrococcygeal ligaments — pain may also be caused by pathology of these ligaments. However, this is not fasciitis or tendinitis, but myofascial pain syndrome — a non-inflammatory condition.
To examine this joint, one can apply pressure and move the coccyx toward the perineum. This manipulation is likely to be painless

Pain from Coccyx Displacement or Angulation

There is a classification of coccyx angulation into 6 types according to Postacchini and Massobrio. The coccyx may be strongly flexed forward, deviated backward, or there may be lateral deviations. However, these are typically incidental findings on MRI or X-ray. Such angulation may have been present throughout life and caused no symptoms.
A digital rectal examination can be performed with a pincer grasp of the coccyx to try to move it. This test is usually painless.
However, after trauma, the joint surfaces may become displaced (coccyx subluxation or dislocation), which will cause pulling pain in the coccyx that worsens with sitting.
If displacement or angulation is found on imaging, it should be confirmed with pincer palpation and coccyx mobilization to reproduce the patient's pain complaints.

Coccygeal Cysts — Pilonidal Sinus

Pilonidal sinus (epithelial coccygeal tract) is an inflammation of the subcutaneous fat in the coccyx region associated with a developmental abnormality, though it may first appear in adulthood. A narrow canal forms in the subcutaneous tissue, into which bacterial flora can enter, leading to purulent inflammation.
This problem is particularly common in men, as they have more body hair where infections can accumulate and have increased sweating. An ingrown hair can also trigger the problem.
Visually, there will be redness of the area over the sacrum and coccyx, a hard lump will be palpable within the skin, and pus discharge may be observed. The pain can be severe and throbbing.
For this problem, you should see a colon proctologist or purulent surgeon to have the inflammatory focus opened or excised.

Degenerative-Dystrophic Changes in the Sacrococcygeal Region

There is an opinion that pain in the lower back is caused by morphological (structural) changes in the spine. With age, the height of the intervertebral discs decreases, the vertebral bodies may become deformed, and bone spurs (osteophytes) grow. This is collectively called spinal osteochondrosis.
However, if we take the adult population, this storage disease (diseases ending in "-osis" are storage diseases) occurs in everyone to varying degrees. But pain is far from universal. There are also episodes of exacerbation and remission — when there is no pain, but "osteochondrosis" does not disappear.
Spinal osteochondrosis — of the sacrococcygeal region in particular — is a natural process of involution (aging). But this is a physiological process and is not accompanied by pain.
The source of tailbone pain should be sought not in MRI images or the spine itself, but in the soft tissues that surround the vertebrae and discs.
Degenerative changes in the coccyx and the entire spine are a physiological process of aging — just as wrinkles and ptosis appear on the face, and the skin of the body becomes saggy and loose. Therefore, osteochondrosis does not cause tailbone pain.
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Spinal Diseases of the Sacrococcygeal Region

However, some spinal diseases can indeed cause pain in the coccyx area during certain stages of the disease.
Herniated intervertebral discs in the lumbar spine at the L4-L5 and L5-S1 levels can involve exiting nerves and cause neuropathic pain in the coccyx area.
The mechanism of spinal disc herniation is as follows: first, a deep back muscle disease (myalgia) develops; the muscles compress the vertebrae and mechanically push out a herniation or disc protrusion. The herniation stretches the surrounding spinal ligaments, and swelling forms in that area. Inflammation begins, the acidity in the inflamed area increases (acidosis), and this inflamed area involves the nerve, causing neuropathic pain in the coccyx as well.
However, this pain will occur only during the acute phase of nerve inflammation, which does not last long, and the main pain will be in the lower buttock and then, in a "striped pants" pattern, into the thigh and lower leg. These are unilateral complaints — that is, they go into one limb, not down the center of the torso and pelvis.
Based on MRI results, spinal and sacrococcygeal diseases are almost always found. It is necessary to perform a clinical diagnosis and correlate the MRI findings with the patient's complaints.

Tailbone Pain Due to Pelvic Organ Disease

Pain in the anogenital region can often radiate from inflammatory and non-inflammatory diseases of the pelvic organs in both men and women. Common nosologies (those that occur in both sexes) include:
1. Urethritis — inflammation of the urethra. In rare cases, it may manifest as heaviness and itching in the perineal region and be classified as coccydynia.
2. Cystitis — inflammation of the bladder wall. When the bladder fills, its wall shifts backward and stretches, which can cause pain radiating to the coccyx.
Diseases of the genitourinary system will be accompanied by urination disorders — pain during urination, weak stream, and possible atypical discharge from the urethra.

Tailbone Pain Without Obvious Cause

Situations occur where examinations are performed, an X-ray of the coccygeal region is taken, a visual examination is done — and no obvious or apparent cause of the pain is found. That is, structurally the coccyx and spine are normal, there is no swelling or signs of inflammation, and superficial palpation and tapping are also painless.
Then the complaints are attributed to: hidden or old trauma, psychological, psychogenic, or phantom pain. And here we come to the most common and important cause of tailbone pain — which is usually overlooked and not diagnosed — myofascial pain syndrome of the coccygeal region.

Muscular and Fascial (Myofascial) Tailbone Pain

Myofascial pain is almost always overlooked as a possible source of pain in the spine and joints — including the intergluteal fold.
Myofascial pain syndrome (or chronic trigger point muscle disease) is a primary, independent disease of muscle tissue and fascia. Painful tightness and nodules form in the muscles, which restrict range of motion and cause acute and chronic pain that can last from a few hours to many years. These nodules in the muscles are called myofascial trigger points, and they can masquerade as diseases of the spine, coccyx, and sacrum.
Trigger points in the coccygeal region appear due to prolonged sitting, awkward movements, muscle overload, exposure to cold, and other factors.
About 50% of all tailbone pain is caused by myofascial pain syndrome (MPS) of the muscles, and another 30% consists of two conditions simultaneously: one of the above-mentioned pathologies plus muscle pathology.

Myofascial Pain in the Coccyx Area

Trigger points can appear in the central part of the muscle (belly) and at the muscle attachments to bones — i.e., tendinous and ligamentous triggers. Several muscles attach to the anterior surface of the sacrum and coccyx, and these muscles will cause pain in the coccyx.
Additionally, affected muscles, like internal organs, can produce referred pain. Sometimes pain from a trigger point can radiate up to 30–40 cm from the source.
Typical signs of myofascial tailbone pain:
  • Dull and aching pain without precise localization or borders
  • Chronic muscle pain in the pelvic region
  • Worsens after physical activity and subsides at rest
  • Exacerbated by exposure to cold and relieved by warming
  • May shoot into the coccyx and cause spasm of the anal sphincter
  • Sensation of a "stake in the coccyx" and that it is contracting
  • No other obvious causes of damage or pain

Which Muscles Cause Tailbone Pain

The muscles that cause coccydynia can be divided into 2 groups: those in close proximity and those at a significant distance that produce referred pain.
Muscles of the first group (local):
  • Bulbospongiosus muscle
  • Ischiocavernosus muscle
  • Pubococcygeus muscle
  • Iliococcygeus muscle
  • Levator ani muscle
  • Coccygeus muscle
  • Internal obturator muscle
Muscle-Related Tailbone Pain
Pain Symptoms in Myofascial Pain Syndrome
Muscles that can refer pain to the coccyx:
  • Gluteus maximus
  • Piriformis muscle
  • Quadratus lumborum
  • Multifidus muscles
  • Adductor longus and adductor magnus
  • Pectineus muscle
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Why Do Trigger Points Form Around the Coccyx?

Trigger points that cause pain in the coccyx area form due to the following reasons:
  • Load-related: during prolonged static muscle tension — for example, during prolonged sitting at office work.
  • Mechanical: a single awkward movement and muscle overload — lifting something heavy, slipping.
  • Traumatic: formation of trigger points after a bruise or fall, or after immobilization.
  • Trophic: during prolonged sitting or compression of the gluteal muscles by a belt, capillary circulation is disrupted and muscle tissue experiences hypoxia.
  • Physical: exposure to cold temperatures — "the lower back was blown" or general hypothermia.
  • Neurogenic: when a nerve is damaged, nodules appear in the muscles that this nerve innervates.
  • Psycho-emotional: the level of stress hormones rises, muscles become excessively tense and become damaged.
  • Nutritional (deficiency): muscles require many nutrients; with deficiency, muscles cannot produce enough energy.
Trigger points appear due to a combination of causes, not just one. To effectively treat pain, these factors must be taken into account

How to Distinguish Muscle Pain from Other Causes

Myofascial tailbone pain has no signs of inflammation — that is, there is no skin redness, swelling of the subcutaneous fat, or localized increase in temperature.
There are also no signs of pelvic organ involvement: stool and urine are normal, and there is no pathological discharge. Superficial comparative palpation is painless, as are tapping and percussion on the coccyx. There are no neurological abnormalities: no changes in sensation or paresthesias.

Why an MRI of the Coccyx Does Not Always Show the Cause of Pain

When performing an MRI or CT of the sacrococcygeal region, two situations can be distinguished:
  1. Changes and deviations from the norm are present (usually corresponding to the patient's age) — or they are completely absent.
  2. If changes are present, this does not mean that the symptoms in the coccyx are caused by them. We have already discussed spinal osteochondrosis.
Не редко бывает, что изменений на снимках нет, и специалисты называют это функциональной кокцигодинией. Обычно в таких ситуациях источником боли будет именно миофасциальный синдром копчиковой области.

Where and How the Coccyx Hurts

Tailbone pain can be described according to various criteria that help determine the exact cause or combination of causes (nosologies):
  • By character: stabbing, cutting, shooting, piercing — or conversely — pressing, aching, bursting, pulsating, constricting
  • By duration: from acute (short-term) to chronic (pain present for years)
  • By onset: instantaneous (appears suddenly) or gradually increasing
  • By intensity: from mild discomfort to severe
  • By continuity: intermittent or persistent (constant)
A detailed description of the nature and conditions of tailbone pain helps the doctor order the necessary examinations and make the correct diagnosis.

Tailbone Pain When Sitting and Standing Up

During prolonged sitting, intra-abdominal pressure may increase, which can impair venous outflow from the rectal venous plexus. This can lead to hemorrhoids, which will add coccyx pain to muscle pain.
Additionally, the gluteal and piriformis muscles are in a compressed state, which promotes the formation of trigger points in this area and can cause tension muscle pain.
The gluteal muscle, in turn, can involve the coccygeus muscle, where painful tightness will also form.
The multifidus muscles of the back become overloaded, leading to referred pain and coccydynia.
When standing up, the hips extend and the gluteal muscles contract, which can irritate trigger points in these muscles, causing pain.
If tailbone pain appears or worsens while sitting or standing up, it is essential to check the muscles of this area for the presence of tight nodules.

Pain with Bending and Movement

When bending or moving, some muscles contract (shorten) while their antagonists relax and lengthen. Muscle fibers with tight nodules respond poorly to changes in muscle length and become irritated, causing pain.
However, after a few minutes and a couple of cycles of full-range movements, the pain decreases — because blood flow removes pain mediators from the nerve endings.
The sensation of a "stake in the coccyx" appears when isometric muscle tension changes to isotonic tension — that is, muscles transition from a state of constant tension at a fixed length to dynamic work.
This is characteristic of myofascial tailbone pain.

Tailbone Pain in Women

Gynecological diseases can cause and complement muscle pain in the coccyx, which is referred to as pseudococcydynia. Typical female causes:
  • Endometriosis: hormone-dependent overgrowth of the uterus, especially when localized on the posterior wall of the uterus, which can also spread to the rectum
  • Uterine fibroids: a benign neoplasm of the myometrium that, as it grows, can compress the coccygeal nerve plexus
  • Ovarian cysts (functional and organic): can cause pain in the lower abdomen, but can also displace other organs and cause pain in the anorectal region
  • Adhesive process (adhesive disease): after surgical interventions and inflammatory diseases of the pelvic organs, adhesions may remain, which restrict organ mobility and cause pain with bending, movement, and sexual intercourse
Women are recommended to undergo a gynecological smear for flora and PCR testing to rule out infections, especially in the presence of discharge.

After Childbirth

As the fetus passes through the birth canal during delivery, the fetus exerts pressure on the coccyx, bending it backward, which can lead to hypermobility, dislocation, and subsequent pain.
Sometimes a surgical incision of the perineum (episiotomy) is performed to prevent spontaneous tears and complications after childbirth. The incision is sutured after the placenta is delivered, but adhesions may remain after this procedure.

During Pregnancy

The hormonal background of a woman's body changes during pregnancy and adapts for childbirth. The natural birth canal must significantly widen to allow the fetus to pass through, so connective tissue (ligaments, tendons, and fascia) must become more elastic and softer. The hormones responsible for this include:
  • Relaxin: makes collagen fibers soft, which weakens ligaments
  • Progesterone: relaxes smooth muscles and the ligamentous apparatus
  • Estrogens: alter collagen synthesis, loosening the tissue
Additionally, the growing fetus inside the uterus shifts internal organs — elevating the liver, pressing the intestines toward the spine — which can lead to adhesive disease and coccyx pain.
Coccydynia in women can appear after pregnancy and childbirth, but part of the pain may be caused by fascial shortening, muscle damage, and trigger points in scar tissue.

Tailbone Pain in Men

Pain in the anogenital region in men can be caused by the following diseases of the prostate gland and reproductive system:
  • Prostatitis — congestive or bacterial inflammation of the prostate, which can radiate to the sacrum and coccyx
  • Prostate adenoma (BPH, benign prostatic hyperplasia) — the prostate enlarges, obstructing urine flow, and can also compress the coccygeal plexus and nerve ganglion
  • Prostate cancer (carcinoma) — may be asymptomatic in the early stages, then progress
  • Varicocele and pelvic vein varicosities — lead to impaired venous outflow, bursting pain in the pelvis and coccyx
In such conditions, there will be sexual dysfunction — decreased libido, erectile and ejaculatory disorders, dyspareunia (pain during sexual intercourse).
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Connection with Pelvic Muscles

However, the above-mentioned conditions can cause reflex spasms and overstrain of the pelvic muscles, and over time trigger points will form. A sedentary lifestyle also leads to spastic pain in the perineal and coccygeal regions.
Chronic stress can cause the "tail-tucking" reflex — the pelvic muscles involuntarily contract, intensifying the pain syndrome.

When to See a Doctor Immediately

There are situations or "red flags" in which you need to seek qualified medical help immediately:
  • Severe pain after trauma — there may be a fracture or crack
  • Trauma with sensory and motor disturbances — possible damage to motor and sensory nerves
  • Pelvic organ dysfunction — inability to use the toilet, or urinary/fecal incontinence
  • "Stabbing" penetrating pain — a sign of "acute abdomen" and surgical pathology
  • Blood in the stool (fresh or dark) — signs of intestinal bleeding
  • Signs of purulent inflammation — swelling and redness with a palpable focus
  • Uncontrollable pain — pain that does not go away or subside even with analgesics and NSAIDs
  • Persistent high fever, pallor, unexplained weight loss
Depending on the severity of the condition, you need to either call an ambulance or see a doctor as soon as possible.

Diagnosis of Tailbone Pain

Diagnosis should begin with a general (therapeutic) examination. A medical history is taken, including the history of the present illness. The conditions under which the pain appeared, how quickly the complaints developed, what makes it better, what makes it worse, what medications and treatments the patient has received, and so on, are clarified.
Associated complaints are also collected: changes in sensation, signs of inflammation, pelvic organ dysfunction, signs of fever, and so on.
Based on the complaints, a subsequent plan of confirmatory examinations is drawn up, since pain is a non-specific complaint.

Examinations by Specialists

After a general practitioner's examination and if symptoms are present, consultations with the following specialists may be ordered:
  • Gynecologist — to rule out or confirm diseases of the female reproductive organs
  • Coloproctologist (proctologist) — to assess the involvement of the distal parts of the intestine, especially in the presence of bloody discharge
  • Urologist — to assess the involvement of the male reproductive system
  • Traumatologist-orthopedist — checks the integrity of bony structures and spinal ligaments
  • Neurologist — when pain is accompanied by sensory disturbances and loss of strength in the lower limb
  • Osteopath — can theoretically assess the condition of the ligamentous apparatus and fascia in this area
  • Manual therapist — can perform joint diagnostics and assess their role in the pain syndrome

Musculoskeletal Examination

This is the most important type of examination for tailbone pain. The following should be performed:
  • Shift the skin fold (assess skin turgor) — this indirectly indicates the condition of the fascia
  • Perform deep and superficial palpation — the physician searches for tight muscle fibers that may contain trigger points. Palpation techniques are quite deep and painful, performed with longitudinal-transverse movements. The elasticity of the muscle tissue and the search for painful nodules are assessed.
  • Assess the range of passive movement in the muscles of the buttocks, lower back, and thighs. Affected muscles restrict the range of physiological motion. If movement is limited, this may be a sign of muscle pathology.
  • When trigger points are found, perform diagnostic dry needling with an acupuncture needle to elicit a local twitch response — this is a criterion for the presence of a trigger point.
  • Diagnostic kneading so that the patient feels their familiar tailbone pain when the myofascial trigger is pressed.
  • Joint mobilization — grasp the coccyx with fingers and move it in different directions to examine the joint. Also assess the sacroiliac joints with rhythmic pressure on the iliac bones.
  • If indicated, digital rectal examination of the pelvic floor muscles — using sliding movements to assess tenderness in the perineal muscles, pelvic floor, and pelvic wall muscles.

Imaging Diagnostics

The choice of imaging method depends on the complaints and the equipment available at the medical facility:
  • Radiography (X-ray) of the sacrococcygeal region: a primary examination, especially after trauma. Can show fractures, displacements, and dislocations. Performed in frontal and lateral projections.
  • CT (computed tomography): a more detailed examination of bony structures with high resolution. May be ordered if X-ray findings are insufficient. Does not show swelling or the condition of joints.
  • MRI (magnetic resonance imaging): performed in frontal, sagittal, and axial planes. Shows the condition of soft tissues, their size, the presence of free fluid, cavity filling, nerve condition, and the presence of cysts.
  • Ultrasound of the pelvic organs: can be used to examine for gynecological and urological diseases, as well as the presence of phlegmon (diffuse purulent inflammation) in the anogenital region.

Instrumental Diagnostics

  • Sigmoidoscopy: a visual examination of the rectal cavity using a rectoscope to a depth of 20–25 cm to check for polyps, fissures, neoplasms, and sources of bleeding.
  • Colonoscopy: a deeper examination of the large intestine — a flexible tube passes up to 1.5 meters through the body. May be ordered if, in addition to pain, there are stool disorders and for differential diagnosis. Also, for individuals over 40, it may be a preventative procedure.
  • Electroneuromyography (surface and needle): may be ordered in the presence of neurological complaints (including radicular syndrome and sciatic nerve entrapment) to assess nerve tissue conduction.

Laboratory Tests

Urine and blood tests are not the primary methods for establishing or clarifying the diagnosis of coccydynia, but they can help in understanding the nature of the symptoms. The following are performed:
  • Complete blood count with leukocyte formula — allows assessment of the presence of active inflammation based on blood cell composition (increased leukocyte count)
  • Urinalysis — to rule out urinary tract diseases
  • Prostate secretion analysis — if bacterial prostatitis is suspected
  • Fecal occult blood test — to assess intraintestinal pathologies
  • Smear for bacterial flora and PCR — to rule out sexually transmitted infections (STIs)
Each diagnostic method for tailbone pain must be correlated with clinical manifestations, and it is mandatory to perform muscle diagnostics to identify trigger points.

Treatment of Tailbone Pain

Treatment of coccydynia begins after identifying the types of pain and establishing a diagnosis. In most cases, this is conservative therapy; in rare cases, surgical treatment is considered.
Conservative treatment is divided into medication, physiotherapy, manual therapy, and massage. Medication treatment is divided into oral and injectable.
Since trigger point pain in this area is present and may be combined with other types of pain, we will begin with it.
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Trigger Point Massage

Massage is aimed at inactivating active and latent (dormant) trigger points in this area. Additional effects: improved tissue blood circulation, restoration of tissue mobility and glide over fascia, restoration of range of motion reserve.
Massage is performed using strong, deep stroking and kneading techniques. First, the muscle band within the muscle is palpated, then it is kneaded longitudinally and transversely. One anatomical segment can be treated per session. The criterion for effectiveness is restoration of tissue elasticity.
Transrectal massage (rectal approach) — can be used in both men and women if the main problems are in the perineal muscles and pelvic floor. The middle finger takes a small sector (1.5–2 hours on a clock face) and kneads the muscles through the rectal wall using sliding movements.

Dry Needling

Dry needling of trigger points is performed using an acupuncture needle. First, the painful band is localized by palpation, then it is held with a flat or pincer grip, and the tip of the needle is directed toward the center. When the needle hits the target and inactivates the trigger point, a local twitch response (muscle twitch) occurs, which is visually noticeable and felt by both the patient and the physician. Some muscles in this area are located deep, so it is important to choose the appropriate needle size.
10–12 needle insertions are recommended per session.
After 20–30 minutes, a dull, bursting sensation is felt at the treatment sites, which lasts 10–16 hours.
The following muscles are needled: gluteal muscles (medius, maximus, and minimus), piriformis muscle, adductor muscles of the thigh.

Exercises and Stretching

After kneading and needling, it is necessary to restore the range of motion in the affected muscles. Post-isometric relaxation is performed — one of the manual therapy methods for tailbone pain.
The muscle is first brought to pre-stretch, when the patient feels a restriction in further flexion or extension. Then the person inhales and provides slight counter-resistance — this is the tension phase. Then they exhale and completely relax — the physiological relaxation phase begins. The physician then stretches the affected muscles with external force, restoring mobility.
3–4 cycles are performed per muscle group. Then the patient independently performs several full-range movements within the new range of motion.

Drug Treatment

Medications are used according to indications and with specific goals:
  • NSAIDs (in tablets, ointments, and suppositories) — for severe pain. However, this is not a complete treatment, but only for analgesic purposes.
  • Muscle relaxants — a trigger point is a condition that differs from muscle spasm, although spasm may be present. Therefore, muscle relaxants are not the most effective method.
  • Laxatives — if the intestines are involved and there are dietary issues, laxatives may be used for more regular bowel emptying to avoid exacerbating coloproctological pain.
  • Ointments for tailbone pain — used in the absence of purulent inflammation to locally relieve pain.
  • B vitamins — prescribed when radiculopathies and nerve tissue damage are present.

Manual Therapy and Coccyx Manipulation

This method may be used after chronic coccygeal trauma or after childbirth. It can be performed externally or rectally — the physician holds the coccyx with two fingers on the anterior and posterior walls and aligns the position of the bone to correct pathological position and angulation of the coccyx.

When Surgery Is Required

Surgery can be divided into purulent, specific, and complete coccyx removal (coccygectomy).
  • For purulent diseases (pilonidal sinus, abscess, furuncle) — incision and drainage or radical (complete) excision are performed.
  • For diseases of internal organs — surgical treatment of those organs (uterus, prostate, ovaries, bladder).
  • For neoplasms or improperly healed fractures — complete removal of the coccyx (coccygectomy) may be considered. However, there are situations where pain persists even after surgery.

Choosing a Treatment Method for Tailbone Pain

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How to Relieve Tailbone Pain at Home

To relieve pain at home, you can use stretching and strengthening exercises, alternating these with rest, self-massage, heat therapy, and proper sitting posture during daily activities.
For acute pain, apply cold — you can use frozen products wrapped in a towel.
If the pain is muscular — which is more likely — cold may worsen the situation. Hot compresses on the buttocks are recommended. You can also take a hot shower and direct the spray onto the painful areas.

Self-Massage with Rollers and Balls

For prevention and treatment, you can use massage equipment: rollers (rubber and foam), trigger point massagers, massage cones. Starting position: on the floor, place the massage ball on the floor. Find the most painful spots and massage them, gradually adding your body weight. Spend 60–120 seconds on each point or area — ideally, the pain should decrease. Allow 15–25 minutes for the entire procedure for one anatomical segment (e.g., the buttocks).

Myofascial Release

This technique is similar in essence, but the range of motion is more extensive — one roll can cover 20–40 cm, whereas kneading has a much smaller range. Myofascial release also addresses fascial shortening. The procedure is quite painful, which is why people often do not achieve results or significant improvement. It is recommended to allocate sufficient time to these exercises until the first noticeable improvements appear.
Exercises for Tailbone Pain
Pain Symptoms in Myofascial Pain Syndrome

Stretching Exercises for the Coccyx Area

The muscles of the pelvic floor itself are difficult to stretch, but you can stretch the muscles of the functional unit — the synergists.
  • Piriformis muscle: Figure-four stretch — lying on your back, knees bent, feet on the floor. Bring one knee toward the floor, then the other, alternating sides, feeling tension and release in the gluteal area.
  • Gluteal muscles: Pigeon pose — from a quadruped position, bring one knee forward and lower onto the thigh, feeling a stretch in the outer portion of the gluteal muscles.
  • Multifidus muscles and lower back muscles: Spinal rounding while lying down — lying on your back, bring both knees toward your chest (knees bent) and tuck your chin to your chest. Feel the stretch in the sacral region.
  • Adductor muscles: Deep lateral squat (lunge) with leg abduction. Place your feet wide apart and lower into a squat toward one leg. In the other (straight) leg, you should feel a stretch in the inner thigh.

Proper Sitting Posture

When sitting (especially for long periods), pay attention to the position of your pelvis — avoid letting your pelvis tilt backward. It is also important to sit on your ischial tuberosities (sitting bones) so that the coccyx is not involved or overloaded. It is recommended to stand up and stretch every 45–60 minutes for 2–3 minutes.

Using a Cushion and Lumbar Support

If you sit on a hard or uncomfortable chair, you can use lumbar support. You can take a roll or cushion and place it under your lower back to create a natural curve (lordosis in the lumbar spine).
You can also use a footrest if the seat is too high and you have to stretch your legs to reach the floor.
Pay attention to the height of the chair or seat. There should not be an acute angle between your thighs and torso (if you sit too low and deep), as this can involve and overload the iliopsoas muscle.

Prevention of Tailbone Pain

  • For prevention, pay attention to these factors:
  • Nutrition: ensure your diet contains enough fiber so that your stool is regular.
  • Stress and emotional tension: the pelvic muscles tend to instinctively overstrain during stress and fear.
  • Physical activity: do warm-ups, stretch, take walks in the fresh air. If you sit for long periods, stand up and stretch, bend over. During long drives, take breaks.
  • Weather conditions: dress warmly so that your muscles do not become chilled.
  • Weight monitoring: keep an eye on your weight. If weight increases, it increases the load on muscles and metabolism, contributing to chronic pain.
  • Clothing: do not use tight underwear or tight belts — they can compress muscles and lead to stagnation.

Frequently Asked Questions (FAQ)

1. Why does the coccyx hurt without a fall or injury?
The most common causes are muscle pain that arises from chronic muscle overload during prolonged sitting.
2. Can tailbone pain be related to muscles?
Yes. The pain is often caused by myofascial trigger points (trigger point muscle disease). The affected muscles include the gluteal muscles, piriformis muscle, and pelvic floor muscles.
3. Why does the coccyx hurt when sitting?
This could certainly be spinal or inflammatory pain, but most often it is pain from muscle disease. However, different types of pain can also be combined — when several types of pain occur simultaneously.
4. What diseases can radiate pain to the coccyx?
These can be inflammatory, vascular, intestinal, gynecological, and urological diseases. But it is essential to check the muscles.
5. When should you see a doctor for tailbone pain?
If the pain is stabbing in nature, appeared after trauma, is accompanied by bleeding or signs of purulent inflammation, or if analgesics do not help.
6. How is tailbone pain treated?
Treatment depends on the nature of the pain. The following methods are used: manual therapy, trigger point massage, physiotherapy (shockwave therapy and ultrasound).

Sources and References

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