Most people understand why their tailbone can hurt after a hard fall on their backside, but what about tailbone pain that seems to come out of nowhere and never goes away? This is more common than you might think and can be related to pelvic floor problems. Tight muscles, sitting posture and a history of injuries in the area can all play a role.
How do I know if I have coccyx pain?
The tailbone, or coccyx, is the bottom of the bone column that includes your spine and sacrum. It is a small, roughly triangular bone that attaches to your sacrum at a small joint called the sacrococcygeal joint.
You can feel the tip of your own tailbone as you press along the bone that runs along the top part of your buttocks and feel where it ends – usually a few inches above the anus. If this area hurts, you officially have coccydynia!
Pain in the coccyx area usually manifests itself in two ways. Sometimes the pain is concentrated around the tip of the bone, where it feels like there is a single sharp tender point that hurts when it comes into contact with a surface (such as a hard chair). Other people have more pain around the sacrococcygeal joint, which is higher up and feels more widespread. This second type of pain is often most severe when standing up after sitting for a while, moving the joint slightly. You may experience both!
What causes tailbone pain?
Coccyx pain can affect people of all ages and all genders. Common causes The main causes of tailbone pain are trauma (including a fall or childbirth), prolonged sitting on a hard surface, and tension in the pelvic floor muscles.
Fall or injury
If you fall on your butt, you can sprain the joint or even break the bone. Depending on how you land, the tailbone may be bent too far forward or backward, or pushed off center to the left or right.
If your pain started with a hard fall or other type of physical trauma, and/or if it persists after six to eight weeks and does not respond to conservative treatment, it is best to have imaging (such as an X-ray) performed to help identify the cause and a treatment plan.
Pregnancy or postpartum
Coccyx injuries can also occur during a vaginal birth if your baby’s head presses hard enough (and/or fast enough) against the bone as it comes through the birth canal. During pregnancy, body shape and posture changes can make the tailbone more mobile and sensitive.
The entire pelvic area tends to be sore immediately after delivery, so it can be difficult to determine whether it is the tailbone or something else. If the pain is severe and persistent after a few weeks postpartum and seems further back than the vagina, make an appointment with a pelvic floor physiotherapist who can help assess and support your recovery.
Sitting for long periods of time
Painful tailbone from sitting? You are not alone; it is a common cause of tailbone pain. Because the tip of the bone is quite pointed and we don’t have much natural padding there, sometimes just the pressure of a surface on the bone can cause soft tissue injury. In this case, it is particularly important to try to sit on softer surfaces and avoid positions that place further pressure on this area.
If you sit in a more slouched position with your buttocks “tucked in,” there is more pressure on the tailbone. If you sit a little straighter, with the weight more on the sit bones, the pressure on the tailbone should decrease. Sometimes placing a small pillow on the small curve of the lower back can help maintain this position. Sitting upright in bed for long periods of time is a common cause of coccyx pain; it is very difficult to maintain a good posture in bed.
A physiotherapist can help you troubleshoot problems with your seating arrangement and sitting position to help you become more comfortable and avoid future problems!
Pelvic floor tension
The pelvic floor muscles are also directly connected to the tailbone. If these muscles are too tight, especially for long periods of time, they can pull the tailbone into a more tucked position or to one side and also cause pain. The gluteus maximus, or largest buttock muscle, is also connected to the coccyx, so if you train this muscle heavily you may also experience some discomfort in this area.
If you can poke around the muscles on either side of the tailbone and they feel tight and tender, that’s a surefire way to tell that your problem may be related to the pelvic floor.
Other signs of possible pelvic floor strain include:
- Pain with intercourse or other forms of penetration (inserting a tampon, getting a Pap smear)
- Pain or difficulty with bowel movements
- Frequency and urgency when urinating
- Pain in other nearby areas such as the sit bones, perineum, bladder, rectum, anus, vulva or testicles in AMAB people.
Healthcare providers who do not specialize in pelvic health are often less aware of this type of tailbone pain and may not offer appropriate treatment – in this case pelvic floor physiotherapy is usually the best choice!
What are the best treatments for tailbone pain relief?
From pillows to physical therapy, there are different ways to find relief depending on what’s causing the pain.
Adjust your sitting position
If sitting aggravates your tailbone, small changes can make a big difference. Sit up straight with your weight on your sit bones rather than under them, and try a pillow with a tailbone cutout for extra relief.
Stretching exercises at home
Do you think your tailbone pain is related to the pelvic floor? Try these stretches to help extend And relaxed the muscles attached to your tailbone.
Figure 4 Stretching
Try this stretch to stretch the hip and pelvic floor muscles attached to the tailbone! Cross one ankle over the opposite knee, then press the crossed knee away from you until you feel a stretch in your glutes. You can do this on your back (‘supine position’), sitting in a chair or standing.
Child’s pose with wide legs
With knees comfortably apart, bring hips back and relax your upper body toward the floor. Breathe deeply into your pelvis.
Happy baby
While lying on your back, grab your feet, knees, or the backs of your thighs and bring your knees toward your armpits until you feel a stretch between your legs and hips. Take a deep breath and try to relax your pelvic floor and glutes.
Pelvic floor physiotherapy
Pelvic floor physical therapy is one of the most effective treatments for tailbone pain, especially if the cause is muscle tension, a history of childbirth, or pain that has not responded to other treatments. Pelvic floor physical therapy can assess your posture, loosen tight muscles and… create a plan specifically tailored to your situation.
Frequently Asked Question: Should I use a donut pillow?
If you have broken your tailbone, you may be given an inflatable ‘donut’ cushion to sit on during your recovery. Although they can take pressure off the tailbone, they are generally not very comfortable to sit on and can make good posture difficult.
What is often more comfortable is a larger pillow that supports the entire pelvis, with a small recess in the coccyx area. Our doctors love and recommend these: Wedge seat cushion with coccyx recess And Tush Cush coccyx cushion.
Medical treatment for severe cases
Although conservative care is usually effective, other treatment options are available for severe cases. They may include medications to reduce muscle spasms, injections for nerve blocks, electrical shock wave therapy and, for the most persistent cases, surgery to remove part of the tailbone.
Pelvic floor therapy is often prescribed in addition to these more intensive treatments, to aid recovery and reduce risk factors that can cause pain to return (Scott et al. 2017).
Ready to find relief from your coccyx pain?
Coccyx pain is common, but it doesn’t have to be something you just have to live with. Whether your pain stems from an old injury, prolonged sitting or tension in the pelvic floor, Origin’s pelvic floor physiotherapists can help you find the cause and get you sitting and moving comfortably again. Plan your evaluation Today!
Sources
Blanco-Díaz et al. “Physiotherapy approaches for coccydynia: evaluation of effectiveness and clinical outcomes.” BMC Musculoskeletal Disorders, 26 (2025). https://doi.org/10.1186/s12891-025-08744-3.
Nathan, ST et al. “Coccydynia: A Review of Pathoanatomy, Etiology, Treatment, and Outcome.” The Journal of Bone and Joint Surgery. British volume vol. 92.12 (2010): 1622-7. doi:10.1302/0301-620X.92B12.25486
Scott et al. “The Treatment of Chronic Coccydynia and Postcoccygectomy Pain with Pelvic Floor Physiotherapy.” PM&R9 (2017). https://doi.org/10.1016/j.pmrj.2016.08.007.
Sidiq et al. “Effectiveness of physiotherapy interventions for coccydynia: a systematic review with a narrative synthesis.” Physiotherapy Archive15 (2025): 77 – 89. https://doi.org/10.33393/aop.2025.3233.
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