Causes of coccydynia

The pain is typically focused at the bottom of the spine and becomes sharper when sitting down, leaning back, rising from a chair or pressing directly over the coccyx.

A backward fall may bruise the coccyx, strain nearby ligaments or occasionally cause fracture or displacement. Repeated loading from firm seats, cycling or prolonged sitting can irritate the local joints and soft tissues. Childbirth can also place substantial force through this area.

Some cases relate to excessive or reduced coccyx movement, pelvic floor tension or pain referred from nearby structures. Infection and a mass are uncommon considerations but become more relevant when pain is constant, occurs with fever, drainage, unexplained weight loss or is not influenced by position.

Limit long sitting spells, lean slightly forward rather than resting directly on the tailbone and try a coccyx cut-out cushion that supports the thighs and buttocks. Change position regularly. After a recent minor injury, a wrapped cool pack may ease local discomfort.

If symptoms persist or keep returning, a clinician can examine the coccyx, lower back, hips and pelvic floor. Physiotherapy may address posture, hip movement, pelvic floor overactivity and gradual return to activity. For selected persistent cases, a cortisone injection may be discussed after the pain source has been assessed.

Arrange prompt assessment for severe pain after a fall, inability to sit or walk comfortably, fever, redness, swelling, drainage near the cleft or pain that steadily worsens regardless of position. Persistent unexplained night pain or unintentional weight loss also deserves medical evaluation.

Seek emergency care if tailbone or back pain occurs with new loss of bladder or bowel control, numbness around the groin, marked leg weakness or loss of walking ability.

Ask whether the pain is arising from the coccyx or a nearby structure, whether imaging would change management and which sitting modifications suit your pattern. Clarify whether pelvic floor assessment is relevant and what improvement would be expected before considering an injection.