Coccydynia (Tailbone Pain)

Symptoms of tumors in the lower base of the spine include:

What are the symptoms of tailbone cancer?

Cancer in the tailbone, also known as the coccyx, may be a chordoma or a cancer that has spread from elsewhere in the body. Symptoms include pain, noticeable mass, and weakness or numbness in the lower back and legs.

Chordomas are a rare type of cancer that can grow anywhere along the spine. They account for only 3% of all bone tumors.

Chordomas are slow-growing, but they can be hard to treat. Cancers of the tailbone are either primary, known as chordoma, or secondary, meaning they have spread from elsewhere in the body.

People with chordoma require ongoing follow-up even after treatment because it often reoccurs. As the symptoms are not specific to the condition, up to 70% of people with chordoma receive a misdiagnosis.

This article will explain the symptoms of tailbone cancer, as well as the types of cancer that can occur in and around the tailbone. It will also detail the causes and treatment.

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The type and severity of symptoms will depend mainly on the tumor size. When the tumor is very small, there may not be any symptoms. As the tumor grows and puts pressure on the nerves and spine, it can start to cause symptoms.

Symptoms of tumors in the lower base of the spine include:

lower back pain
tenderness
tingling
weakness in the lower back and legs
issues with bladder and bowel function, including loss of control
palpable mass in the lower back

Since the symptoms usually occur gradually, they can be easy to miss. A person may not receive a chordoma diagnosis until the tumor is at an advanced stage, making it harder to treat.

The symptoms of a tumor that has spread from another type of cancer will be similar to those of a chordoma. Such a tumor will also press on nerves in the area, causing the same effects as a chordoma.

There are different types of cancer that may grow in and around the tailbone.

Chordoma: A chordoma is a type of tumor that may grow anywhere along the spine. It is most likely to grow around the skull base, known as a clival chordoma, and the tailbone area, which is a sacral tumor. Chordomas are rare, with only 1 in 1,000,000 people receiving a diagnosis each year.
Colorectal cancer: Colorectal cancer pain may occur in the tailbone, but it is rare for it to spread to the bones. Only about 3–7% of people with colorectal cancer will have it spread to the bones.

Other types of cancer are more likely to spread to the bones. Breast, prostate, lung, thyroid, and kidney cancers account for 80% of all skeletal metastases.

The underlying causes of tailbone cancers are unknown, as they tend to occur spontaneously. Some theories suggest that they can occur due to genetic abnormalities or chromosomal abnormalities, such as an abundance of the T gene on chromosome 6.

Often, cancer spreads from another site in the body. In about 70% of breast and prostate cancer cases where cancer has spread, tumors are found in the bones.

Treatment will depend on the exact type of cancer and the tumor size. For cancers of the tailbone, treatment may include:

Surgery: Surgery is the typical first treatment for a sacral chordoma. As they often spread into nearby tissues and grow around nerves, they can be difficult to remove, especially as they continue to grow. If the tumor cannot be completely removed, a surgeon may be able to cut out parts of it.
Radiation therapy: Radiation therapy can shrink any remaining tumor. Radiation can also help prevent the tumor from growing again. If surgery is not an option, radiation may be the primary treatment.
Immunotherapy: Certain immunotherapy drugs can be used to trigger the immune system to fight cancerous cells. These drugs are only used if surgery or radiation are not an option or not effective.

Chemotherapy does not tend to work well in the treatment of sacral chordoma. Doctors may use it as part of overall treatment if the tumor in the tailbone area has spread from another site.

The outlook for someone with a sacral chordoma depends on how much of the tumor is surgically removed. Sacral chordomas rarely spread to other areas in the body and often grow back in the same place. Even if doctors fully remove the tumor, research shows that it grows back in about half of patients within 15 years .

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Christensen, T., et al. (2018). Systematic review: Incidence, risk factors, survival and treatment of bone metastases from colorectal cancer.
https://www.sciencedirect.com/science/article/pii/S2212137418302653
Radaelli, S., et al. (2016). Sacral chordoma: Long-term outcome of a large series of patients surgically treated at two reference centers.
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Raeke, M. (2017). Q&A: Chordoma, a one in a million bone cancer.
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Schmid-Alliana, A., et al. (2018). Understanding the progression of bone metastases to identify novel therapeutic targets.
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Wang, X., et al. (2023). Immunotherapy as a promising option for the treatment of advanced chordoma: A systematic review.
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Zhao, C., et al. (2022). A chronicle review of new techniques that facilitate the understanding and development of optimal individualized therapeutic strategies for chordoma.
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Zhao, F., et al. (2022). A correlation analysis of sacrococcygeal chordoma imaging and clinical characteristics with the prognostic factors.
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Coccydynia (Tailbone Pain)

Tailbone pain (coccydynia) can make everyday tasks uncomfortable at best, and unbearable at worst. The coccyx, a small triangular bone at the bottom of the spinal column, can get bruised and even fractured. Sitting increases pain while walking relieves it. Using at-home remedies and changing behaviors such as sitting too long make the biggest differences.

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Overview

What is tailbone pain (coccydynia)?

Tailbone pain, called “coccydynia,” is pain in and around the small triangular bone at the very bottom of your spinal column, above the cleft of your buttocks.

The term “coccyx” comes from the Greek word for “cuckoo” as it resembles a bird’s beak with the tip pointed down. “Dynia” means “pain,” and so “coccydynia” literally means “pain of the coccyx.” And because the bone corresponds to the location of an animal’s tail, it’s called the “tailbone.”

What is the tailbone/coccyx?

Your coccyx is made up of three to five fused vertebrae (bones). It lies beneath the sacrum, a bone structure at the base of your spine. Several tendons, muscles and ligaments connect to it. Both the coccyx and the ischial tuberosities (two bones that make up the bottom of your pelvis) bear your weight when you sit down. Two-thirds of adults have a coccyx that curves a bit instead of pointing straight down, but one that is curved too far is abnormal and, therefore, painful.

Why does my tailbone hurt?

Tailbone pain ranges from a dull ache to a fierce stab. It can last for weeks, months or sometimes longer. There are three types of events that cause tailbone pain:

External Trauma: A bruised, broken or dislocated coccyx caused by a fall.
Internal Trauma: Trauma caused by a difficult childbirth or from sitting on a narrow or hard surface for too long.
Others: Infection, abscess and tumors.

Is tailbone pain (coccydynia) permanent?

No. Tailbone pain is rarely lifelong.

How common is tailbone pain (coccydynia)?

Tailbone pain is common.

Women are five times more likely than men to develop coccydynia. Adults and adolescents get it more often than children. Obese persons are three times more susceptible than those at the ideal weight according to the BMI (Body Mass Index) scale. You’re also more vulnerable if you lose weight too quickly.

Symptoms and Causes

What causes tailbone pain (coccydynia)?

Falling

Who hasn’t fallen backwards onto their behind? Maybe your feet slipped out from under you on the ice. Maybe you fell off a ladder. Or, maybe you were leaning too far back in your office chair and took a tumble. If you take a really bad fall you can bruise, break (fracture) or dislocate (knock out of place) your tailbone (coccyx).

Repetitive Strain Injury (RSI)

Sports like bicycling and rowing require you to lean back and forth and stretch your spine. Too much of that repeated motion can strain the tissues around your coccyx.

Pregnancy/Childbirth

During the third trimester of pregnancy, a woman’s body secretes hormones that soften the area between the sacrum and the coccyx. This enables the coccyx to move as necessary during childbirth. This is a natural process but, unfortunately, such movement may stretch the muscles and ligaments around the coccyx too far, causing additional pain. Such a strain on those soft tissues keeps them from supporting your coccyx at the correct angle.

Obesity

Extra weight applies additional pressure to the coccyx. This can cause the coccyx to lean backward. Your tailbone will hurt if it is out of position.

Underweight

If you don’t have enough fat in your buttocks to prevent your coccyx from rubbing against the muscles, ligaments and tendons, that can cause. The rubbing inflames the soft tissues.

Sitting

Just this simple act can increase coccyx pain, especially if you’re sitting on a hard or narrow surface. Do your best to get up often, stretch and take a short walk. Better yet, find yourself a softer, more comfortable place to sit or use a cushioned seat.

Cancer

Only in rare cases is tailbone pain a sign of cancer. It is extremely unlikely.

What are the symptoms of tailbone pain (coccydynia)?

The symptoms of coccydynia include:
Achy or piercing pain in the tailbone.
More severe pain when changing from sitting to standing up.
More severe pain when sitting for long periods of time.
Pain during bowel movements.
Pain during sex.

Other related symptoms that may occur with coccydynia include:

Depression.
Anxiety.
Poor sleep.
Painful buttocks.
Back pain.

Is tailbone pain (coccydynia) a sign of pregnancy?

As the fetus grows, its weight does put pressure on your pelvic space, causing pain in that general area.

Can tailbone pain (coccydynia) cause rectal pain?

Yes, chronic coccydynia is one of the causes of rectal pain.

Does menstruation cause tailbone pain (coccydynia)?

Tailbone pain is typically worse when a woman is menstruating.

Diagnosis and Tests

How is coccydynia (tailbone pain) diagnosed?

First, after getting your general medical history, your healthcare provider will ask you about any recent traumas including a fall or childbirth. Next he/she will do a visual examination of the area checking for an obvious fracture, deformity, mass or an abscess (infection).

What tests are used to diagnose tailbone pain (coccydynia)?

To check for a fracture:

To check for inflammation and chordoma (a rare type of cancerous tumor of the spine):

Management and Treatment

How is coccydynia (tailbone pain) treated?

Most people recover without undergoing any sort of treatment. Of those who do require treatment, 90% just need to use at-home remedies.

At-home remedies for tailbone pain (coccydynia) include:

Taking a NSAID like ibuprofen to reduce pain and swelling.
Decreasing sitting time. Lean forward if you have to sit.
Taking a hot bath to relax muscles and ease pain.
Using a wedge-shaped gel cushion or coccygeal cushion (a “donut” pillow) when sitting.
Taking stool softeners to reduce pain during bowel movements.
Stretching and strengthening the muscles of your lower back and pelvis.
Applying hot or cold packs to your lower back. Apply for no longer than 20 to 30 minutes, several times a day.
Wearing loose-fitting clothing.

Outpatient treatments for tailbone pain (coccydynia) include:

Blocking the nerve supply of the area — a Coccygeal nerve block — using numbing medications and steroids to decrease the inflammation.
Massage therapy (usually only provides temporary relief).
Stretching exercises and posture improvement guided by a physical therapist.
Acupuncture.
TENS (transcutaneous electrical nerve stimulation).

Surgical options include:

Partial coccygectomy (removal of part of the coccyx — extremely rare).
Total coccygectomy (removal of the entire coccyx — extremely rare).

Recovery time from a coccygectomy can take a few months — maybe a year. Unfortunately, there’s no guarantee that the pain will go away even if the bone is gone. Again, this procedure is rare.

Other symptoms that could occur along with coccydynia, such as depression, anxiety and sciatica, should also be addressed and treated as well.

How is tailbone pain (coccydynia) treated when a woman is pregnant?

When you are pregnant, it’s normal to have tailbone pain. Pain comes from sitting for long periods of time, but can also occur when standing and walking. This is because the growing fetus is putting pressure on the bone. Physical therapists recommend you lie on your side when you sleep and sit on a coccyx cushion. Both will help relieve some of the pain by taking pressure off of your coccyx.

Does walking help tailbone pain (coccydynia)?

Yes. Standing up and walking around decreases pressure on your coccyx, reducing pain.

How should I sleep with tailbone pain (coccydynia)?

Sitting, driving, bending and sleep are all affected by tailbone pain. In severe cases it can vastly decrease your quality of life. Lie on your side to reduce tailbone pain.

Can a chiropractor help with tailbone pain (coccydynia)?

Yes. A chiropractor can help correct the misalignment of a coccyx that leans too far forward or back.

Prevention

How can I reduce my risk of tailbone pain (coccydynia)?

You can reduce your risk of tailbone pain by:

Avoiding falling. Keep your floors and pathways free of loose objects, debris and cords. Make sure all stairs are well lit and include rails. Don’t walk while looking at your cellphone.
Avoiding activities that worsen symptoms such as cycling and sitting for long periods of time.

Outlook / Prognosis

What can I expect if I have tailbone pain (coccydynia)?

Dull pain, hard pain, stabbing pain, and any other amount and severity of pain in between. Your pain will be worse when you sit and stand up, and also when you have a bowel movement and have sexual intercourse.

How long will I have tailbone pain (coccydynia)?

Only a few days or weeks, typically. Less time if you use your at-home remedies.

When can I go back to work/school?

Tailbone pain is uncomfortable but it shouldn’t keep you from your daily activities. If it does, contact your healthcare provider and make an appointment right away.

What is the outlook for tailbone pain (coccydynia)?

Tailbone pain is not something you just have to live with. Follow the at-home remedy recommendations and check with your healthcare provider about outpatient options.

Living With

How do I take care of myself?

Don’t sit for long periods of time without standing up, take a short walk or do a couple quick stretches. If you love to ride your bike, cut back for now. Lie on your side when you sleep. Spend more time on your feet! Use the at-home remedies and stay in contact with your healthcare provider.

When should I see my healthcare provider?

See your healthcare provider if your severe tailbone pain does not improve within a few weeks. Also see him/her if your at-home remedies don’t work.

What questions should I ask my doctor?

What’s the cause of my tailbone pain?
How long do you think it will take for my pain to go away?
What over-the-counter medications do you recommend?
What type/brand of donut cushion do you recommend?
Which at-home remedies do you recommend?
Do you think I need surgery?
What else can I do to decrease my pain?
Is there a chiropractor you recommend?
What other medical professionals could help with my tailbone pain?

A note from Cleveland Clinic

Tailbone pain is uncomfortable but temporary. Keep vigilant. Take your medications as prescribed, apply your ice packs, take hot baths, get a donut (the cushion and, well, you might as well get the chocolate glazed one as well) and spend more time on your feet and keep those feet moving. Don’t let your coccydynia get unbearable before you contact your healthcare provider!

Last reviewed by a Cleveland Clinic medical professional on 07/06/2020.

References

NHS: Acute Services Division. Information About Coccydynia. (https://www.nhsggc.org.uk/media/255476/information-about-coccydynia.pdf) Accessed 7/1/2020.
Salar O, Mustaq F, Ahmed M. Defecation pain and coccydynia due to an anteverted coccyx: a case report. (https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-6-175) J Med Case Rep. 2012 Jul; 6:175. Accessed 7/1/2020.
American Physical Therapy Association. PT in Motion. What to Expect When They’re Expecting: PT’s Who Treat Patients During and After Pregnancy. (http://www.apta.org/ptinmotion/2017/12/feature/whattoexpect/) Accessed 7/1/2020.
GARD: Genetic and Rare Diseases Information Center. Coccydynia. (https://rarediseases.info.nih.gov/diseases/5168/coccygodynia) Accessed 7/1/2020.
Emerson SS, Speece AJ. Manipulation of the coccyx with anesthesia for the management of coccydynia. J Am Osteopath Assoc. 2012 Dec;112:805-807. Accessed 7/1/2020.
Patel R, Appannagari A, Whang PG. Coccydynia. (https://link.springer.com/article/10.1007/s12178-008-9028-1) Curr Rev Musculoskelet Med. 2008 Dec;1(3-4):223-226. Accessed 7/1/2020.
Smallwood-Lirette L, Chaiban G, Tolba R. Coccydynia: An overview of the anatomy, etiology, and treatment of coccyx pain. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963058/) Ochsner J. 2014 Spring; 14(1):84-87. Accessed 7/1/2020.
NHS. Coccydynia. (http://www.nhs.uk/Conditions/coccydinia/Pages/Introduction.aspx) Accessed 7/1/2020.

Coccydynia (Tailbone Pain)