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Causes of Tailbone Pain and Treatment Options

Tailbone pain (coccydynia) can occur after trauma to the tailbone (a.k.a. coccyx) or another compromising issue, such as vaginal childbirth or degenerative joint changes.

It is one of the most uncomfortable sensations and can be disabling, considering it tends to occur when sitting, standing for a long period of time, and rising from a seated position. Pain during bowel movements and sex are also quite common. Discomfort can range from faint, throbbing pain to sharp pain that radiates up and/or down.


Causes

There are multiple potential causes for tailbone pain, with some more common than others.

Common Causes

The most common cause of tailbone pain is trauma, including both direct, forceful trauma and repetitive trauma to the coccyx. But there are other possibilities to consider.

  1. Trauma: Tailbone pain may be due to a fall backward on your bottom or another sort of trauma to your coccyx that inflames the ligaments in the tailbone area. The severity of the injury can range from a bruise to a fractureof the coccyx. Rarely, dislocation of the sacrococcygeal joint, which is located between the top of your sacrum and the base of your coccyx, may occur as a result of trauma and cause coccydynia. In addition, activities, like horseback riding or cycling, can increase the risk of tailbone pain due to repetitive pressure or friction on the coccyx for long periods of time. Likewise, simply sitting on a hard surface during a long car ride or airline flight may cause tailbone pain. Since the coccyx is the insertion site for many muscles and ligaments, any trauma resulting in a strain to the pelvic floor muscles or inflammation of the ligaments in the tailbone area may lead to coccydynia as well.

  2. Vaginal Childbirth: Vaginal childbirth, especially if the delivery is difficult and forceps are used, can cause tailbone pain due to the pressure placed on the top of the coccyx from the baby's head. Typically, tailbone pain from childbirth is a result of a bone bruise or ligament strain, although sometimes the coccyx does fracture.

  3. Degenerative Joint Disease: As with bones and joints in other parts of the body, wear and tear from aging or repetitive motions can cause degenerative joint disease of the coccyx, also known as osteoarthritis.

  4. Unique Coccyx Morphology: As mentioned above, there is variability in the number of coccygeal bones a person has; more bones mean more opportunity for issues. In addition, some people have a bone spur or spicule (a bony growth) located on the lowest tip of the coccyx. This growth can irritate the coccyx area when a person sits; specifically, it can pinch the skin and the fatty tissue between the spur and the chair. Besides a bony growth, some experts report scoliotic deformity as a potential cause of coccydynia.

  5. Nerve Pain: A bundle of nerves called the ganglion impar is located in front of the upper part of the coccyx. Overactivity or irritation of these nerves may cause chronic coccyx pain.

  6. Pelvic Floor Muscle Spasms: Since the tailbone serves as the attachment site for a deep layer of pelvic floor muscles (called levator ani), muscle spasms and irritation can cause a dull, aching pain, often felt in the coccyx and higher up in the rectum.

Rare Causes

Though less common, these other causes of tailbone pain may be considered by your doctor.

  1. Cancer: In rare instances, a malignant tumor that has metastasized to the tailbone (for example, cancer from the prostate, ovaries, cervix, or colon) may be the source of tailbone pain. Also rarely, a primary bone cancer called a chordoma may arise on the coccyx or within the coccygeal region.

  2. Infection: An infection located in the tailbone area, such as a pilonidal cyst, can cause swelling and pain over the coccyx, along with redness, warmth, and drainage of a thick, whitish fluid (pus). An infection of the actual coccyx bones, called osteomyelitis, may also rarely cause coccydynia. Often, a person will have a history of a deep sacrococcygeal decubitus ulcer and have signs of an infection like fever, as well as warmth and redness along the coccyx.

When to See a Chiropractor/ Doctor

If your tailbone pain is severe and debilitating—for instance, you are not able to go to work or care for your children or home—be sure to see your chiropractor/ doctor.

Other symptoms of tailbone pain that warrant seeing a chiropractor/ doctor include:

  1. Persistent pain, despite conservative measures

  2. A lump or mass on your tailbone

  3. A fever or redness, warmth, swelling, or drainage of an area near or on your tailbone

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