Tailbone Injury Overview
A coccyx injury results in pain and discomfort in the tailbone area (the condition is called coccydynia). These injuries may result in a bruise, dislocation, or fracture (break) of the coccyx. Although they may be slow to heal, the majority of coccyx injuries can be managed with cautious treatment.
The coccyx is the triangular bony structure located at the bottom of the vertebral column. It is composed of three to five bony segments held in place by joints and ligaments.
The majority of coccyx injuries occur in women, because the female pelvis is broader and the coccyx is more exposed.
Tailbone Injury Causes
Most tailbone injuries are caused by trauma to the coccyx area.
- A fall onto the tailbone in the seated position, usually against a hard surface, is the most common cause of coccyx injuries.
- A direct blow to the tailbone, such as those that occur during contact sports, can injure the coccyx.
- The coccyx can be injured or fractured during childbirth.
- Repetitive straining or friction against the coccyx (as happens in bicycling or rowing) can injure the coccyx.
- Sometimes, the cause of coccyx injuries is unknown.
- Less common causes of coccyx injuries include bone spurs, compression of nerve roots, injuries to other parts of the spine, local infections, and tumors.
Tailbone Injury Symptoms
- Severe localized pain and tenderness may be felt in the tailbone area.
- If the injury is traumatic, a bruise may be visible in this area.
- The pain is generally worse when sitting for prolonged periods of time, or with direct pressure to the tailbone area.
- Bowel movements and straining are often painful.
- Some women may experience pain during sexual intercourse.
When to Seek Medical Care
If you have the signs and symptoms of a coccyx injury or unexplained discomfort in the tailbone area, contact your doctor. It may be necessary for the doctor to decide if the injury is traumatic or if the pain is caused by other, more serious, problems.
Injuries to the region of the tailbone rarely require a visit to the emergency department. However, if you are concerned about your symptoms, it is wise to call a doctor or visit the nearest hospital’s emergency department.
Exams and Tests
The cause of a coccyx injury is largely determined based on a medical history and a physical exam. Occasionally, X-rays are taken.
- The entire vertebral column (spine) may be examined. A neurologic exam may be performed. A rectal exam may also be performed. For this exam, the doctor inserts a finger into your rectum to feel the area of the coccyx and determine if there is a dislocation or a fracture that can be felt and if direct pressure against the coccyx reproduces your pain.
- Rarely, if the cause of discomfort is unknown, a local anesthetic may be injected into the tailbone area to determine whether the origin of the pain is from the coccyx or another part of the vertebral column.
- X-rays may be taken to determine whether there is a fracture or dislocation. However, X-rays occasionally may not reveal these injuries. Some doctors recommend X-rays in both the standing and seated positions to better determine the presence of a fracture or dislocation.
Tailbone Injury Treatment
Tailbone injuries are often extremely painful, so home remedies aim to control pain and avoid further irritation to the area.
- Avoid sitting down for long periods of time. When seated, avoid sitting on hard surfaces and alternate sitting on each side of the buttocks. Also, lean forward and direct your weight away from the tailbone.
- For traumatic injuries, apply ice to the tailbone area for 15-20 minutes, four times a day, for the first few days after the injury.
- Take nonsteroidal anti-inflammatory drugs (NSAIDS) such as aspirin or ibuprofen to reduce pain and improve your ability to move around. Do not take NSAIDS if you have kidney disease, a history of gastrointestinal bleeding, or are also taking a blood thinner — such as Coumadin — without first talking with your doctor. In that case, it is safer to take acetaminophen, which helps lessen pain but does not reduce inflammation.
- You can purchase a “doughnut” cushion or pillow to sit on. This cushion has a hole in the middle to prevent the tailbone from contacting the flat surface.
- Eat foods high in fiber to soften stools and avoid constipation.
In addition to home care, a doctor may be able to provide further relief of pain with other medical and, rarely, surgical interventions.
- Stronger pain medications may be prescribed at the discretion of your doctor.
- Stool softeners may be prescribed to prevent constipation.
- Injections of local anesthetics into the tailbone are sometimes required for continuing pain.
- Rarely, the coccyx may be surgically removed.
Follow-up After a Tailbone Injury
Follow-up is recommended at the discretion of your doctor and depends on the severity of the injury and the progress you are making with medical treatment.
- Most people do not require follow-up if their coccyx injury is improving with medical treatment.
- People with chronic tailbone pain, for whom medical therapy has not worked, require more frequent follow-up and may be referred to other medical or surgical specialists.
Prevention of Tailbone Injuries
- Most tailbone injuries are accidental (such as a slip on ice) and therefore cannot be entirely avoided.
- Wear proper protective padding when participating in contact sports that can potentially lead to coccyx injuries.
- The prognosis for tailbone discomfort depends on many factors.
- The original cause of the problem (whether from a fall or other trauma, tumor, or infection)
- If traumatic, the severity of the injury (a bruise, fracture, or dislocation)
- Your ability to comply with medical treatment
- Your natural ability to recuperate and heal
- The majority of cases of traumatic coccyx injury get better within several weeks of the injury with proper medical treatment.
- A few people suffer from chronic discomfort despite proper medical treatment. This can be an extremely frustrating and debilitating problem.