If you were a rough-and-tumble child, you probably had a fall or two that landed you squarely on your tailbone, causing bruising and pain that lasted for several days. But if you experience tailbone pain as an adult that is unrelated to trauma, it could signal pelvic floor dysfunction. In many cases, pelvic floor physical therapy can help correct the underlying cause of tailbone pain and restore pain-free movement.

About Your Tailbone

Your tailbone is not really a single bone. It is made up of 3-5 vertebral segments at the very end of your sacral spine that may or may not be fused together, depending on your unique anatomy. Your tailbone is joined to your sacral spine via the sacrococcygeal joint.

Medically called the coccyx (or sometimes coccydynia, or coccygodynia), your tailbone has a limited range of motion that allows it to curve when you’re sitting down, and to give way during childbirth. Because the coccyx is well innervated, it can be quite painful when injured.

The coccyx serves multiple functions in your pelvic region:

● Serves as an attachment for multiple pelvic muscles and ligaments

● Provides support for the pelvic floor

● Assists in bowel control

● Facilitates childbirth

An injured coccyx can cause hypertonicity of the pelvic floor muscles, leading to bowel and urinary issues and pain during intercourse.

Symptoms and Causes of Tailbone Pain

Medical doctors are often baffled by chronic non-traumatic tailbone pain. Rather than admit that they don’t know what is causing your pain, they may brush it off as unimportant or tell you it will go away on its own. But chronic pain in any part of your body is not normal — it is there to signal that something is not right.

Tailbone pain symptoms include:

● Tailbone pain when sitting down and getting up

● Tailbone pain after sitting for an extended period of time

● Tailbone pain that gets worse when lying down

Common causes of tailbone pain include:

● Trauma from a fall or a blunt force

● Repetitive strain injury from cycling or rowing

● Pressure and trauma from pregnancy and childbirth

● Obesity

● Sedentary lifestyle with too much sitting

● Poor posture when sitting

● Being underweight, with too little fatty padding in your buttocks

According to research, women are five times more likely to suffer from tailbone pain than men, and obese people are three times more likely to have coccyx pain than people who maintain a healthy weight.

One study of 127 women with pelvic pain found that nearly 50 percent of them also had tailbone pain. The women with coccyx pain reported higher levels of pelvic pain, greater pelvic floor dysfunction and were found to have significantly more abnormalities during a pelvic physical exam.

Tailbone Pain Treatment Options

Eliminating tailbone pain can be difficult due to the location of the coccyx and its involvement in everyday movement and sitting.

Common treatments for chronic tailbone pain include:

● Anti-inflammatory pain medications (NSAIDs)

● Using a donut- or U-shaped cushion when sitting

● Ice packs and heat pads

● Dietary changes to avoid straining on the toilet

● Weight loss and increased physical activity

● Improved posture when sitting

● Pelvic floor physical therapy

While exercising with tailbone pain may seem counterintuitive, regular physical exercise like daily walking helps to tone the muscles of the pelvic floor and promote healthy spinal alignment and function. Start slow, and gradually increase your pace and distance. If you sit at a computer during the day, take frequent breaks to walk around, and consider using a standing desk or bar-height counter while you work.

About Pelvic Floor Physical Therapy

The primary target of pelvic floor physical therapy is to relax overly tight pelvic floor muscles. In addition to contributing to tailbone pain, tight pelvic floor muscles can cause pain during sexual intercourse, constipation, difficulty urinating and pelvic pain.

In a recent study of 124 patients with tailbone pain, 72% of those treated with pelvic floor physical therapy reported significant relief from tailbone pain symptoms.

References:

Mabrouk, Ahmed, Almothenna Alloush, and Patrick Foye. “Coccyx Pain.” StatPearls [Internet] (2020).

Neville, Cynthia E., et al. “Association of Coccygodynia with Pelvic Floor Symptoms in Women with Pelvic Pain.” PM&R (2021).

Scott, Kelly M., et al. “The treatment of chronic coccydynia and post coccygectomy pain with pelvic floor physical therapy.” PM&R 9.4 (2017): 367-376.