Pain localized to the tailbone can be due to many causes. It is necessary to consult when the pain is severe or persists.

Tailbone pain, or coccygodynia, is pain felt in the region of the tailbone, this bone located at the end of the spine, at the buttocks.

Remember that the coccyx is made up of four (sometimes five) small vertebrae more or less fused together. They can be slightly mobile with respect to each other, thanks to the presence of joints and ligaments.

The pain may be continuous, but it is worse when sitting and when performing the movement to get up (or sit). It also intensifies when touched, whether by external or internal touch (rectal examination).

We generally distinguish:

• acute coccygodynia (lasting less than 8 weeks);
• let has chronic, persistent coccygodynia.

Admittedly, these pains are more frequent in women than in men.

Other pains in the lower back, related for example to the lumbar vertebrae, can be wrongly attributed to the coccyx. It is therefore necessary to consult to ascertain the source of the pain.

A painful tailbone is often examined for medical imaging. Let us quote:

• x-rays;
• dynamic x-rays (images taken as the patient leans forward to stand up);
• discographie coccygienne ;
• MRI;
• or even bone scintigraphy.

Tailbone pain is, to sum up, due to abnormal movement or displacement of the tailbone. The coccyx, placed in the prolongation of the sacrum, can be more or less curved inwards (like the end of a tail which “rebels” towards the front). The more it is aligned with the sacrum, the more the coccyx is protected from trauma, for example.

The causes of tailbone pain are diverse. The number one cause of tailbone pain is trauma:

• it can be caused by a fall on the buttocks;
• childbirth (the coccyx is moved by the passage of the baby);
• or repetitive strain injuries (for example in motorcyclists or cyclists who experience shocks while sitting).

The coccyx fracture can be seen on an x-ray (it can also be determined during a physical examination, after trauma). It can also be sacral fractures, which cause pain in the same area. These fractures heal within weeks, without treatment.

Other types of lesions may be involved, for example:

• a dislocation of the joint between the sacrum and the coccyx, or all or part of the movable portion of the coccyx itself. It represents 20 to 25% of cases of tailbone pain;
• a “coccygeal spine”, which is a small bony growth present at the tip of the coccyx (15% of cases of coccygodynia). The thorn can be felt on palpation: it exerts pressure in a sitting position and causes local inflammation;
• or even hypermobility, defined as abnormal flexion of the coccyx when sitting (angle of more than 25 to 30 °).

Often, no specific cause is found. This is called idiopathic occygodynia.

Note that certain factors have been associated with tailbone pain:

• overweight or obesity;
• the anatomy of the coccyx itself (certain “shapes” are more often associated with pain);
• more rarely, symptoms are due to a tumor, infection or inflammation of the sacrococcygeal joint.

Depending on the cause, the pain may subside on its own or on the contrary persist. As the movement of sitting down and getting up is particularly common (and difficult to avoid), tailbone pain is very troublesome in everyday life. It becomes difficult to drive, to work in a seated position, even to move … It is therefore imperative to consult a doctor to obtain relief from pain and appropriate management.

The management of coccygodynia depends on the diagnosis. It is generally multidisciplinary, and begins with advice on posture in a sitting position (modify the supports to avoid pain, or even use a hollow cushion to relieve pressure, especially after a fall).

In case of acute pain, related for example to a coccygeal spine, taking painkillers or anti-inflammatory drugs may be useful. Applying heat or cold to the painful area can also be beneficial.

In the event of a fracture, no orthosis or cast can be used. Physiotherapy (or physiotherapy) sessions may be necessary to regain mobility. The use of intranasal calcitonin has been shown to be effective in several studies.

Osteopathy sessions (manipulations) can sometimes be beneficial, in particular to restore mobility or replace the vertebrae after childbirth, for example. They are also effective if the problem is more in the lumbar region.

Finally, intradiscal injections of corticosteroids (prednisolone) and local anesthetic are sometimes effective. In very rare cases, removal of the coccyx (coccygectomy) by surgery may be considered, after failure of other treatments.