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Where is the coccyx located?
The coccyx is the small bony end located under the sacrum, at the back of the pelvis. Ligaments and muscles attach in this area. The pressure and pull around this area changes with sitting, standing, and certain movements.
The word coccydynia describes pain, not necessarily a fracture or displacement. Pain in the lower back, buttock or anal area may be felt nearby without having the same origin. Showing the area accurately and describing activities that are difficult helps the professional determine which examination is appropriate.
Understand the picture
Reduce pressure, maintain movement possibilities
Sacrum
It is located at the base of the spine.
Coccyx
The small end under the sacrum may become tender.
Seated support
The support and duration change the pressure felt.
Chapter sources [1]
What situations can trigger pain?
Discomfort is often felt when sitting, especially on a hard surface or for a prolonged period of time. Getting up, bending over or having a bowel movement can also be painful. Some people mainly feel a sore spot; others describe more diffuse pain around the end of the spine.
These symptoms alone do not establish the cause. Specify whether the pain started after a fall, childbirth, or unusual sitting. Also say if it exists apart from the pressure, if it wakes you up or if you have urinary, intestinal or genital symptoms. Information that is difficult to discuss can be important and can be discussed in a respectful setting.
Why can this area become painful?
A fall on the buttocks, the constraints of childbirth or repeated pressure can be associated with coccyx pain. Sometimes, no specific event is found. The shape and mobility of the area may vary, but variation alone does not demonstrate the cause of symptoms.
We should not conclude from pain that the coccyx is necessarily twisted or that it must be put back into place. The surrounding tissues, their sensitivity and the way pressure is distributed when sitting contribute to the assessment. A simple explanation can help, but excessive certainty can lead to inappropriate treatments. The professional must be able to distinguish what is observed from what remains a hypothesis.
Chapter sources [1]
What does the clinical assessment look for?
The professional asks you about the start, the sitting constraints, the treatments tried and the associated symptoms. The examination may concern the coccyx, lower back, pelvis and difficult movements. It must be explained. You can ask why an area is being examined and refuse or interrupt a maneuver.
An intimate examination is not automatically necessary for every coccyx pain. When a specialized assessment of the pelvic floor or anal region is considered, its purpose and your consent are essential. The images are not systematic; the doctor decides on their interest based on trauma, an unusual development or a specific question. A normal image does not erase real pain.
What signs require another priority?
Seek care promptly if you have fever, unusual swelling, discharge, or associated pain in your stomach or lower back. Significant pain after a fall, especially if walking becomes difficult, should be evaluated. Persistent pain that increases or is accompanied by a change in general condition also merits medical advice.
New difficulty urinating, loss of sensation between the legs, or significant weakness with back or leg symptoms may be an emergency. This is not a situation where you try a cushion or manipulation first. The warning signs guide specifies ways to help. After childbirth, a fever or significant bleeding is the responsibility of the medical team.
How to make sitting more bearable?
Try to vary the periods of sitting and periods of standing or walking. A cushion designed to reduce pressure on the tailbone may help some people. Its shape and placement should be judged on your actual comfort; an expensive product does not guarantee a better response.
Choose a situation to test the adaptation, for example a short period of work. Check for pain while sitting, getting up, and after. If the cushion creates further discomfort or increases pressure, change the installation. The objective is to distribute the load and find useful durations, not to maintain a rigid posture. Long journeys or meetings may need to be temporarily accommodated.
Chapter sources [1]
In everyday life
Prepare for a seated meeting
Plan
Choose a place that allows you to easily change positions.
Try
Use a comfortable support and a suitable duration.
Reassess
Compare how easily you get up and reaction after the meeting, then adjust.
Chapter sources [1]
Work, car, sleep and toilet trips
At work, bring necessary objects closer together and plan position changes compatible with your tasks. In the car, adjust the seat and take breaks when the journey is long. Avoid compensating by remaining constantly tense: an adaptation must allow you to relax the effort and continue an activity.
For sleeping, a side position can reduce direct pressure if it suits you. Pain during a bowel movement can lead to holding back, which sometimes complicates the situation. Ask the doctor or pharmacist for advice if constipation is causing discomfort; do not start internal maneuvers. Unusual anal pain, bleeding, or other changes should be evaluated in context.
What can care and physiotherapy offer?
Treatment depends on the assessment and may combine adaptation of the seat, gradual activity, pain management and rehabilitation. The physiotherapist can examine the useful movements and the constraints which maintain the discomfort. A referral to a professional trained in pelvic problems may be relevant when another difficulty is associated.
Pelvic floor exercises aren't always about contracting harder. They should not be offered automatically without assessing the problem. Medications, an injection or, rarely, a surgical option are discussed with the doctor and according to a precise indication. No treatment should promise to absolutely correct the shape of the coccyx or make all pain disappear.
Chapter sources [1]
How to find activity again without repeating the same irritation?
Keep to activities that do not cause significant aggravation, for example suitable walking. If cycling or other activity directly compresses the sensitive area, reduce it temporarily or choose an alternative. General hip movement can be tolerated, but is not a specific treatment for the tailbone.
Recovery is built with small experiments. You can increase a sitting period when the previous duration becomes easier, then check the reaction. Don't change the seat, cushion, duration and multiple exercises at the same time, otherwise it becomes difficult to understand what helps you. Persistent worsening requires adjustment and sometimes reassessment.
When to expect improvement and when to review the plan?
The duration varies. Pain after trauma or that has been present for a long time may take longer to progress. The improvement may first be seen in easier standing or better sitting tolerance. You don't need to wait for complete disappearance to recognize useful progress.
If the pain severely affects your activities, does not improve after a few weeks of appropriate measures or worsens, seek advice. A new evaluation can verify another cause, the relevance of the cushion, the dosage of activities or the interest of a specialist. Continuing the same technique indefinitely without clear benefit is not the only option.
Your questions
Should you buy a specific cushion?
A cushion that reduces pressure on the coccyx can be tried. The effect depends on its form, the seat and your reaction. There is no one obligatory purchase or one brand that suits everyone. A cushion should not delay an assessment in the presence of unusual signs.
Chapter sources [1]
Is pain after a fall necessarily a fracture?
No. Different tissues can become sore after a fall. Intensity, ability to walk and other signs guide the assessment. Do not try to determine the presence of a fracture alone by repeated pressure on the coccyx.
Should I contract the pelvic floor to relieve the pain?
Not without knowing if this corresponds to the problem. Needs vary and some people require a different approach. Ask for an assessment and, if necessary, specialist guidance. This page does not provide instructions for internal treatment or a routine contraction program.
Chapter sources [1]
Can I continue to work sitting down?
It depends on tolerance and planning possibilities. Shorter periods, position changes and appropriate support can help. If, despite this, you can no longer work normally, discuss adaptation and medical re-evaluation.
Chapter sources [1]
Sources and references
- [1] NHS — Tailbone pain
- [2] NHS — Pelvic pain
- [3] NHS — Hip pain in adults
- [4] NHS — Sciatica and urgent neurological symptoms
Text updated on
Medical review: awaiting Hasib Selimovic.