Tailbone Pain (Coccydynia) Without Fracture: Patient Information
Start with conservative treatment including a specialized cushion, NSAIDs, ice therapy, and activity modification—this approach successfully resolves symptoms in 90% of cases. 1
Understanding Your Condition
Coccydynia is pain in your tailbone area that typically worsens when sitting or transitioning from sitting to standing. 2 The pain is located in the midline below your sacrum and above your anus. 2 Even without a fracture, the pain can result from inflammation of surrounding tissues, abnormal tailbone movement (hypermobility), or specific tailbone shapes that increase stress on the area. 3
First-Line Conservative Treatment (Start Here)
Cushions and Seating Modifications
- Use a specialized cushion with a cutout or wedge design to reduce direct pressure on your tailbone when sitting. 1
- Avoid prolonged sitting—take frequent breaks to stand and walk. 2
Medications
- Take NSAIDs (like ibuprofen or naproxen) for pain relief and to reduce inflammation. 2
- These can be used orally or as topical preparations. 2
Ice Therapy
- Apply ice through a wet towel for 10-minute periods to reduce pain and swelling. 2
- Repeat several times daily as needed. 2
Activity Modification
- Reduce activities that worsen your pain, but avoid complete rest to prevent muscle weakness. 1
- Avoid activities that put direct pressure on the tailbone. 2
Physical Therapy (If Initial Measures Don't Help)
Pelvic floor physical therapy is highly effective and should be considered if symptoms persist beyond 2-3 weeks of conservative care. 2, 1
- Stretching exercises for the pelvic floor muscles 2
- Manual manipulation and massage techniques 1
- Gentle range-of-motion exercises 1
Advanced Treatment Options (For Persistent Pain)
If conservative treatment fails after 6-8 weeks, consider:
Injections
- Local steroid injections into the coccygeal area can provide significant relief. 1
- Ganglion impar nerve blocks may be performed for refractory cases. 3
Other Interventional Options
- Transcutaneous electrical nerve stimulation (TENS) 1
- Radiofrequency treatment 3
- Extracorporeal shock wave therapy 3
Surgery (Last Resort)
- Surgical removal of the tailbone (coccygectomy) is reserved for cases that fail all conservative measures and typically has high success rates for pain reduction. 1, 4
- This is only considered after exhausting all other options, as 90% of cases resolve without surgery. 1
Treatment Timeline
- Weeks 1-6: Conservative measures (cushion, NSAIDs, ice, activity modification)
- Weeks 6-12: Add physical therapy if no improvement 5
- After 3 months: Consider injections or other interventional treatments if conservative care fails 1
- After 6+ months: Surgical consultation may be appropriate for truly refractory cases 4
Important Warnings
- Seek immediate evaluation if pain becomes constant at rest, or if you develop numbness, increasing swelling, or redness, as these may indicate infection or nerve compression. 6
- Most cases resolve with conservative treatment—patience and consistent adherence to the treatment plan are essential. 1
- A multidisciplinary approach combining physical therapy, ergonomic adaptations, medications, and possibly injections provides the greatest chance of success. 1
What to Expect
Most patients respond to conservative treatment within 6-8 weeks, and many cases resolve without any medical treatment at all. 1 The key is starting with simple measures and only progressing to more invasive options if symptoms persist despite appropriate conservative care.