Coccydynia

Coccydynia is a type of lower back pain felt around the last bone at the base of the spine (known as the coccyx or tailbone).

The pain of coccydynia can range from mild to severe and is usually worse when:

sitting down – particularly if you are leaning backwards
moving from sitting to a standing position

Some people can only tolerate sitting in the same position for a few minutes before having to move to relieve the pain.

The pain in and around your coccyx can sometimes make it very difficult to carry out everyday activities, such as driving, bending over or sitting down.

It may seem odd, but sitting on a soft surface may be more painful than sitting on something hard. This is because sitting on a soft surface places most of your weight on your coccyx rather than on the hard bones below your pelvis.

Other symptoms

As well as pain in your coccyx, other symptoms of coccydynia may include:

backache
shooting pains down your legs
pain before or when you pass stools
pain during sex
painful buttocks and hips
in women: increased pain during your period

If you have coccydynia, the pain in your coccyx can also make it difficult to sleep comfortably at night. You may need to keep changing positions while lying in bed.

What causes coccydynia?

Coccydynia can occur when something damages the coccyx or surrounding area, such as:

the muscles and ligaments supporting the coccyx stretching out of place during childbirth
trauma to the coccyx, resulting from an accident
pulling the coccyx out of its normal position, either through poor posture or repeated activity, such as cycling or rowing

In around a third of cases of coccydynia, no obvious cause can be found, although age-related "wear and tear" may play a part.

Read more about the causes of coccydynia.

When to seek medical advice

See your GP if you have persistent lower back pain that lasts more than a few days.

While coccydynia is not usually a serious condition it is important your GP examines you in case there is a more serious and less common cause of your symptoms, such as a fracture.

In most cases, they can diagnose coccydynia based on your symptoms and a physical examination of your lower back and spine.

In some cases your GP may refer you for further tests, such as:

two X-rays (one sitting and one standing) – comparing the two images will help determine whether your coccyx is moving more than normal when you sit or stand
an MRI scan – to check for other conditions, such as a bone infection or bone cancer, which may be causing unexplained symptoms

X-rays can also be used to check if any of the bones that make up the coccyx have been fractured.

Treating coccydynia

Painkillers, such as ibuprofen, are the first step in trying to treat coccydynia and in most cases the pain will resolve within a few weeks.

If this fails, stronger treatment, such as steroid injections (corticosteroids) will be recommended.

In a minority of cases the pain can persist for more than three months, which is known as chronic coccydynia. Chronic coccydynia is unlikely to clear up by itself and will probably require a combination of treatments.

There are a number of things you can do yourself to help with the pain, including using specially designed cushions to support the coccyx.

Spinal manipulation techniques such as physiotherapy, osteopathy and chiropractic can also provide short-term relief from pain.

In a small number of cases surgery may be required to remove the coccyx (coccygectomy).

Read more about the treatment of coccydynia.

Who is affected

Coccydynia is uncommon. It is estimated around one in 100 cases of lower back pain are the result of coccydynia. Women are five times more likely to develop coccydynia than men due to the association with childbirth.

Older adults are more prone to coccydynia, but the condition can affect people of all ages, including children.

Pain: Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Physiotherapy: Physiotherapy is a treatment that uses physical movements, massage and exercise to relieve illness or injury.
Spine: The spine supports the skeleton, and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.