Coccyx pain (coccydynia): why it hurts and how to treat it
Coccyx pain — or coccydynia — typically flares up when sitting and disrupts daily life. The good news: in the vast majority of cases it is controlled without surgery. Assessment and treatment in Valencia.
Coccyx pain (also spelled tailbone pain), known medically as coccydynia, is pain at the very tip of the spine, right where the sacrum ends. It is highly recognisable: it appears or worsens when sitting, especially on hard surfaces, and eases when standing up. It is more common in women than in men and, although very bothersome, most cases resolve with well-planned conservative treatment.
What is coccydynia
The coccyx is the small bone, made up of several segments, that closes the spine at the bottom. Ligaments and pelvic floor muscles attach to it. When that area becomes inflamed, hypermobile or poorly aligned, coccydynia appears: pain that concentrates on a very precise point and is triggered by direct pressure when sitting.
Why it happens: causes of coccyx pain
Around 70% of cases have a traumatic origin. The most frequent causes are:
Fall onto the coccyx
A fall onto the buttocks or sitting down hard can bruise, sprain or, less often, fracture the coccyx.
Prolonged sitting
Sitting for long periods on hard surfaces (office, driving, cycling) overloads the area.
Childbirth
The passage of the baby can strain the coccyx and trigger pain in the postpartum period.
Repetitive microtrauma
Cycling, rowing or sustained-impact exercise can irritate the area progressively.
Hypermobility or poor alignment
A coccyx that is too mobile or deviated rubs and becomes inflamed when sitting.
Idiopathic
In some cases no clear trigger is identified; the work-up serves to rule out other causes.
How it shows up: symptoms
- Pain at the base of the spine, very localised, worse when sitting and when moving from sitting to standing.
- Discomfort or tenderness when touching the coccyx area.
- Pain that may radiate slightly toward the sacrum, the buttocks or the lower back.
- Increased discomfort with bowel movements or during intercourse in some cases.
- Characteristic relief when standing up or leaning forward while seated, offloading the coccyx.
When to seek help
Coccydynia is rarely an emergency, but an assessment is advisable if the pain does not settle within a few weeks, recurs or limits your daily life. Some situations do require prompt attention.
How it is diagnosed
History and examination
The exact point of pain and its relationship with posture are confirmed; often the diagnosis is clinical.
Dynamic X-rays
Comparing the coccyx standing and sitting shows whether it is hypermobile or deviates under load.
MRI
Useful to assess inflammation, rule out lesions and other causes of pain in the area.
Rule out other origins
It is important to distinguish coccydynia from low lumbar problems, the pelvic floor or other causes.
Treatment: start with the least invasive
The approach is stepwise: it always begins with conservative measures, which resolve most cases, and only moves up a step if the pain persists.
Offloading cushion
A wedge or donut cushion avoids resting on the coccyx and relieves from day one.
Postural habits
Avoid hard surfaces, do not stay seated for long stretches and correct your posture.
Physiotherapy
Manual therapy, pelvic floor work and specific techniques that help reduce inflammation.
Medication
Analgesics and anti-inflammatories prescribed for a limited time to control the flare-up.
Injections and ganglion impar block
When pain does not settle with the measures above, the next step is image-guided injections, without surgery. These are percutaneous (needle-based) procedures performed on an outpatient basis:
- Local injection with corticosteroid and anaesthetic into the sacrococcygeal joint, to reduce inflammation and break the pain cycle.
- Ganglion impar block: a technique targeting the small nerve ganglion located in front of the coccyx, responsible for transmitting pain from this area. Performed under radiological control, it is one of the most effective options in stubborn coccydynia.
These techniques control pain in many cases that did not respond to conservative treatment, avoiding the need for surgery.
And if nothing works: surgery
Coccyx surgery (coccygectomy, removal of the coccyx) is reserved for the very selected cases that do not improve after exhausting conservative treatment and injections, and in which the coccyx has been confirmed as the true source of pain. It is an uncommon option and always the last step: the vast majority of patients never need to reach it.
How Dr. Vilatela approaches it
As a spine surgeon, Dr. Antonio Vilatela treats coccydynia in a stepwise, conservative way: first confirm that the coccyx is the true source of pain, then control the inflammation with simple measures and, if needed, use guided injections before considering any surgery. If you are travelling to Valencia for treatment, see the information for international patients.
Frequently asked questions
Most coccydynia improves within weeks with conservative treatment. Some cases become chronic and need injections, but even then pain control is usually good.
Not necessarily. The most common finding is a bruise or a sprain, not a fracture. An assessment and, if appropriate, an X-ray will clarify it. In the meantime, an offloading cushion helps.
Yes. A wedge or donut cushion avoids resting directly on the coccyx and usually helps considerably. It is one of the first recommended measures.
Very unlikely. Surgery (coccygectomy) is reserved for exceptional cases that do not improve with anything else. The vast majority are controlled without operating.
Consultations are private. We do not work with Asisa or Adeslas; you are seen as a private patient so we can give your case the time and follow-up it needs.
Living with coccyx pain?
You do not have to put up with it. Dr. Antonio Vilatela reviews your case in private consultation in Valencia, confirms the source of the pain and proposes the least invasive treatment that resolves it.