Tailbone pain can make surprisingly simple things — sitting at your desk, driving, exercising or even opening your bowels — uncomfortable.
Coccydynia is the term used to describe pain arising from or around the coccyx, commonly known as the tailbone. The coccyx sits at the very bottom of the spine and has connections with muscles and ligaments of the pelvis, including parts of the pelvic floor.
Tailbone pain can develop following an injury, pregnancy or childbirth, prolonged pressure through the area or sometimes without an obvious cause.
Understanding what triggers your pain and whether the coccyx, pelvic floor or surrounding structures may be contributing can help guide management.
Coccydynia & Tailbone Pain: Why Does My Tailbone Hurt?
The coccyx is the small section of bone located at the very bottom of the spine, below the sacrum.
Although it is small, several muscles and ligaments attach around the coccyx, including structures associated with the pelvic floor.
The coccyx also moves slightly, particularly during activities such as sitting and bowel movements.
Because of these connections, coccyx pain can sometimes occur alongside pelvic floor symptoms.
Where Is the Coccyx?
Coccydynia is commonly experienced as pain or tenderness directly around the tailbone.
You may notice:
Pain when sitting
Pain after sitting for a long time
Pain when moving from sitting to standing
Tenderness directly over the coccyx
Pain when leaning backwards while sitting
Pain during or after bowel movements
Pain during some exercises
Pelvic floor discomfort or tension
Pain during sex for some people
Symptoms can range from a dull ache to sharp or more intense pain.
What Does Coccydynia Feel Like?
Sitting places pressure through the coccyx and surrounding tissues.
If the coccyx or nearby structures are irritated or sensitive, prolonged sitting — particularly on a hard surface or in certain positions — can increase symptoms.
You may notice yourself shifting your weight forward or onto one side to avoid pressure through the tailbone.
However, repeatedly sitting asymmetrically can sometimes create discomfort elsewhere, so simply avoiding one side isn't necessarily a long-term solution.
Why Does My Tailbone Hurt When I Sit?
Moving from sitting to standing changes the load through the pelvis and coccyx.
The coccyx normally has a small amount of movement, and the muscles and connective tissues attached around it also change tension as you move.
For people with coccydynia, this transition can sometimes reproduce a brief sharp or pulling sensation around the tailbone.
Why Does My Tailbone Hurt When I Stand Up From Sitting?
Yes.
Landing directly onto your bottom can bruise or injure the coccyx and surrounding tissues.
Some injuries settle relatively quickly, while others can result in symptoms that persist beyond the expected healing period.
If you've experienced significant trauma and have ongoing or severe coccyx pain, medical assessment or imaging may sometimes be appropriate to investigate fracture or other injury.
Can a Fall Cause Tailbone Pain?
Can Pregnancy Cause Tailbone Pain?
Pregnancy changes the loads placed through the pelvis and can influence posture, movement and the muscles surrounding the coccyx.
Some people develop coccyx pain during pregnancy even without a previous tailbone injury.
Management during pregnancy may involve modifying aggravating positions, addressing surrounding musculoskeletal factors and maintaining comfortable movement where appropriate.
The coccyx sits immediately behind the birth canal and naturally moves to help create space during vaginal birth.
In some cases, significant pressure during childbirth may irritate or injure the coccyx and surrounding tissues.
Postpartum tailbone pain may be more noticeable when:
Sitting to feed your baby
Getting in and out of chairs
Driving
Opening your bowels
Returning to exercise
If tailbone pain persists after birth, a postpartum pelvic health assessment may be useful.
Can Childbirth Injure the Coccyx?
Can the Pelvic Floor Cause Tailbone Pain?
The pelvic floor and coccyx are anatomically connected, so pelvic floor dysfunction can contribute to coccyx pain in some people.
Several pelvic floor muscles and connective tissues attach around the coccyx.
If these muscles are overactive, tender or having difficulty relaxing, they may contribute to pain or increased sensitivity around the tailbone.
However, not all coccyx pain is caused by a tight pelvic floor. The coccyx itself, surrounding joints, ligaments, previous injury and other musculoskeletal factors may also be relevant.
It can sometimes work in the other direction too.
When an area is painful, surrounding muscles may increase their activity as a protective response.
Someone experiencing persistent coccyx pain may therefore develop pelvic floor guarding or tension over time.
This is why it can be useful to assess the coccyx and pelvic floor together where symptoms suggest both may be involved.
Can Tailbone Pain Cause a Tight Pelvic Floor?
Opening your bowels involves movement and relaxation of the pelvic floor and changes in pressure through the pelvis.
Because pelvic floor muscles and ligaments attach around the coccyx, bowel movements can sometimes reproduce tailbone pain.
Constipation and repeated straining may also aggravate symptoms.
If you're experiencing both difficult bowel movements and coccyx pain, addressing your bowel function may form an important part of management.
Why Does My Tailbone Hurt When I Poo?
Can Coccydynia Cause Pain During Sex?
For some people, yes.
The coccyx, pelvic floor and surrounding tissues are closely connected. Certain positions or increased pelvic floor muscle activity may reproduce symptoms.
However, pain during sex can have many possible causes, so it shouldn't automatically be attributed to the coccyx.
Is Tailbone Pain the Same as Pudendal Neuralgia?
No.
Both conditions can cause pain around the pelvic or perineal region and may be aggravated by sitting, but they involve different structures.
Coccydynia primarily describes pain arising from or around the coccyx.
Pudendal neuralgia involves pain within the distribution of the pudendal nerve and may produce burning, shooting, tingling or altered sensation around the genital, perineal or rectal region.
Because symptoms can sometimes overlap, assessment is useful when the source of sitting pain isn't clear.
Not always.
Imaging may sometimes identify a fracture, changes in coccyx position or other structural findings, but people can experience significant coccyx pain without a clear abnormality on imaging.
In some circumstances, dynamic X-rays taken in sitting and standing may provide information about coccyx movement that isn't visible on a standard X-ray.
Whether imaging is appropriate depends on your history, symptoms and clinical findings.
Will Coccydynia Show Up on an X-Ray or MRI?
A pressure-relieving cushion can sometimes make sitting more comfortable while symptoms are irritated.
A coccyx cut-out or wedge-style cushion may help reduce direct pressure through the tailbone.
I'd generally avoid telling everyone they need a traditional doughnut cushion, as this isn't necessarily the most appropriate option for coccyx pain.
A cushion can help with symptom management, but if pain is persistent, it's still worth investigating why the area remains sensitive.
Should I Use a Cushion for Tailbone Pain?
Management depends on what's contributing to your symptoms.
Depending on your presentation, this may involve:
Modifying aggravating sitting positions
Temporary use of an appropriate cushion
Pelvic floor assessment where relevant
Pelvic floor relaxation and coordination
Hands-on treatment of surrounding musculoskeletal structures where appropriate
Exercise and rehabilitation
Bowel management if constipation or straining is contributing
Gradually increasing sitting tolerance
Pain education and self-management
Medical management where required
Persistent or complex cases may require collaboration with your GP, pain specialist or other healthcare professionals.
How Is Coccydynia Treated?
Not necessarily.
An external musculoskeletal assessment can provide useful information about the coccyx, pelvis, hips and surrounding structures.
For some people, an internal pelvic floor assessment may provide additional information about muscles attaching around the coccyx.
However, this should only be considered when clinically relevant and performed with your informed consent.
You can decline or stop an internal assessment at any time.
Do I Need an Internal Pelvic Floor Assessment for Tailbone Pain?
Seek medical assessment if your coccyx pain follows significant trauma, is severe or progressively worsening, or occurs alongside other concerning symptoms.
Medical review is particularly important for unexplained pain associated with:
New bladder or bowel dysfunction
Saddle or genital numbness
Significant neurological symptoms
Fever or feeling unwell
Unexplained weight loss
Night pain that is persistent or unusual
Significant trauma
Persistent coccyx pain that isn't improving is also worth discussing with a healthcare professional.
When Should I See a Doctor About Tailbone Pain?
Tailbone Pain & Pelvic Health Care in Healesville
At Yarra Valley Women's Health, our pelvic health osteopaths can assess the pelvic floor and musculoskeletal factors that may contribute to coccyx and tailbone pain.
Management is individualised according to your symptoms and may include pelvic floor care, osteopathic treatment, exercise rehabilitation, bowel strategies and education.
Our goal is to give you the knowledge and strategies to understand your symptoms and feel more confident returning to comfortable movement and everyday activities.