Coccydynia — pain at the tailbone, characteristically worse on sitting and when standing up from sitting — is disproportionately disabling for such a small structure. It affects work, driving, meals and social life, because sitting is unavoidable.
It is also frequently dismissed. Patients are commonly told to buy a cushion and wait, sometimes for years. Cushions help, but they are symptom management, not treatment.
The reason it is often mistreated is that the coccyx is not an isolated bone. The pelvic floor muscles attach directly to it, as do the anococcygeal ligament and the gluteus maximus. Coccyx pain is therefore usually as much a muscular problem as a bony one — and the muscular component responds well to treatment that almost nobody offers.
Common causes
Childbirth
The coccyx moves backwards during delivery and can be bruised, sprained or occasionally fractured. A common cause, and one that is frequently written off as ordinary postnatal soreness for far too long.
A fall onto the tailbone
Direct trauma, sometimes years earlier. Symptoms can persist long after any bony injury has healed, because the surrounding muscles remain protectively overactive.
Prolonged sitting
Particularly on hard surfaces or in a slumped posture, which loads the coccyx directly. A common contributor in desk-based and driving occupations.
Pelvic floor overactivity
Because the pelvic floor attaches to the coccyx, sustained muscle tension pulls on it continuously. Often the primary driver rather than a secondary effect.
Hypermobility or hypomobility
The coccyx normally has a small amount of movement. Too much or too little can both be painful, and they need different management.
After surgery
Pelvic, rectal or spinal surgery can leave scarring and altered mechanics around the coccyx.
Constipation and straining
Repeated straining loads the pelvic floor and coccyx directly. Frequently a maintaining factor. See constipation physiotherapy.
No clear cause
Common, and it does not prevent effective treatment — assessment identifies what is currently maintaining the pain regardless of how it started.
How it is treated
Assessment
How the pain behaves, what provokes and eases it, how it started, and — with your consent — assessment of coccyx position and mobility, and of the pelvic floor muscles attaching to it. Mobility assessment is what distinguishes a hypermobile from a stiff coccyx, and they need opposite treatment.
Internal coccyx mobilisation
The most effective manual treatment for coccydynia, performed via the rectum, allowing direct assessment and mobilisation of the coccyx and the muscles attaching to it. It is entirely optional and explained fully first — but it is worth knowing it exists, because most patients are never offered it.
Pelvic floor release
Downtraining and trigger point release of the levator ani and coccygeus, which pull directly on the coccyx when overactive. Frequently produces more improvement than treating the bone itself.
External manual therapy
Treatment of the gluteals, hip rotators, sacrum and lumbar spine, plus scar work where relevant. A genuine alternative if you would prefer not to have internal treatment.
Sitting management
The right cushion — a wedge or coccyx cut-out rather than a ring, which can worsen symptoms — plus sitting posture, position changes and standing breaks. Practical, and it makes daily life bearable while treatment progresses.
Bowel management
Reducing straining removes a significant repeated load on the coccyx. Positioning, defaecation mechanics and stool consistency are all addressed.
Graded return to sitting
Progressively rebuilding sitting tolerance rather than avoiding sitting indefinitely, which tends to entrench sensitivity.
Why so many people are told nothing can be done
Coccydynia falls between specialities. It is not clearly an orthopaedic problem, not clearly a spinal one, and not clearly a colorectal one — so patients are often given a cushion and discharged.
It also sits in the small group of conditions requiring internal assessment for accurate diagnosis, and comparatively few clinicians are trained to perform it. Without that, the pelvic floor contribution is invisible, and treating the coccyx as an isolated bone frequently fails.
The practical consequence is that many people have had coccyx pain for years having never received any treatment beyond analgesia and a cushion. That is not because the condition is untreatable — it is because the treatment that works is rarely offered.
See your GP for: coccyx pain following significant trauma, pain with fever or swelling, pain with unexplained weight loss, bleeding from the rectum, or a lump or skin change over the area. These need medical assessment first.
What to expect
Coccydynia responds well to conservative treatment for the substantial majority of people. Improvement typically develops over six to twelve weeks, with sitting tolerance usually the first thing to change.
Longstanding pain takes longer, particularly where the nervous system has become sensitised over years, but duration alone is not a barrier — patients with pain lasting many years frequently improve markedly once the pelvic floor contribution is finally addressed.
Where conservative treatment does not achieve enough, injections and, rarely, coccygectomy exist as options via a specialist. Having completed proper physiotherapy strengthens that pathway, because conservative treatment is expected first.
Frequently Asked Questions
What causes coccyx pain?
The most common causes are childbirth, a fall directly onto the tailbone, and prolonged sitting — particularly on hard surfaces or in a slumped posture. Pelvic floor muscle overactivity is also a frequent driver, because those muscles attach directly to the coccyx and pull on it when they are held tight. In many cases no single cause is identifiable, which does not prevent effective treatment.
How long does coccydynia last?
With appropriate treatment, most people improve substantially within six to twelve weeks, with sitting tolerance usually improving first. Longstanding coccyx pain takes longer, but duration is not a barrier — patients with pain lasting years frequently improve considerably once the pelvic floor contribution is addressed, which is often the element that was previously missed.
What sort of cushion should I use?
A wedge cushion or one with a coccyx cut-out at the back, which offloads the tailbone directly. Ring or doughnut cushions are commonly bought but can concentrate pressure around the coccyx and make symptoms worse. Cushions manage symptoms rather than treating the cause, so they work best alongside active treatment rather than instead of it.
Do I need an internal examination for coccyx pain?
It is not compulsory, but it is the most accurate way to assess coccyx position and mobility and the pelvic floor muscles attaching to it, and internal mobilisation is the most effective manual treatment for coccydynia. It is explained fully beforehand, entirely optional, and can be stopped at any point. External treatment of the gluteals, hips, sacrum and lumbar spine is a genuine alternative.
Can coccyx pain after childbirth be treated?
Yes, and it should be. The coccyx moves backwards during delivery and can be bruised, sprained or occasionally fractured, and pelvic floor muscles attaching to it are frequently overactive afterwards. Coccyx pain after birth is often dismissed as ordinary postnatal soreness for far too long, when it responds well to targeted treatment.
Will I need surgery?
Very rarely. Coccydynia responds to conservative treatment for the substantial majority of people. Where it does not, injections are usually the next step, and coccygectomy — surgical removal of the coccyx — is reserved for a small number of cases after conservative treatment has been properly tried. Completing physiotherapy first is expected before those options are considered.
Clinically reviewed by Jency Sudha, Consultant Pelvic Health Physiotherapist & Biofeedback Specialist — last updated 26 July 2026
The information on this page is for general guidance and does not replace individual clinical assessment. If your symptoms are new, worsening, or accompanied by bleeding, fever or severe pain, contact your GP or NHS 111.
A Cushion Is Not a Treatment
Coccyx pain usually involves the pelvic floor — and that component responds well to treatment that is rarely offered.
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