What is tailbone pain when sitting?

The tailbone is the lowest part of the spine. It is surrounded by a thin periosteum and supplied by a fine network of nerves, which can make it very sensitive to pain.

A variety of different causes can trigger tailbone pain, which is often mainly caused by sitting. Long and frequent sitting is the main risk factor for the development of the symptoms, also known as coccygodynia. The pain is often stabbing, but can also be felt as pulling or dull, pressing.

To relieve tailbone pain when sitting, a seat ring helps in many cases, which can be supplemented with painkillers if necessary.

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The most common causes of tailbone pain when sitting

Tailbone pain when sitting can have many different causes, with several factors often acting together and no specific trigger can be identified.

Long and frequent sitting: By far the most common cause of tailbone pain is long and frequent sitting itself. Office workers in particular, but also schoolchildren or students, often sit many hours a day, which on the one hand can trigger and on the other hand maintain the tailbone pain. With hard, immobile chairs in particular, there is a high risk of so-called microtraumas, i.e. tiny, invisible injuries in the tissue. Paradoxically, however, frequent sitting on soft surfaces such as a sofa can also lead to tailbone pain. In English there is therefore the slang term “televison bottom”, which means something like “TV rear”.

Incorrect posture: Incorrect posture can also cause tailbone pain. This is because the tailbone is a kind of extension of the spine. In addition to the tailbone, there are many other structures in the sitting posture, such as the muscles in the lower back, involved. Correspondingly, incorrect loading quickly affects the entire back, including the coccyx. This also includes tension in the pelvic floor, as well as irritation or pinching of nerves.

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Inflammation: This includes inflammation of the periosteum of the coccyx itself, but also of other surrounding structures, such as muscles of the lower back and buttocks. Joint inflammation, i.e. arthritis, can also lead to tailbone pain when sitting. This is the so-called sacroiliac joint, i.e. the joint between the sacrum and the iliac bone. This is heavily stressed, among other things, when sitting and can thus lead to pain that radiates into the tailbone.

Fall with landing on the tailbone: An injury such as a fall on the buttocks can result in a contusion or compression of the tailbone. In rare cases, severe injuries can lead to a dislocation or even a fracture of the coccyx. This tailbone pain is mostly noticeable when sitting, as pressure is exerted on the tip of the tailbone while sitting. They usually last for a few days, but the pain can also come back later. Repeated falls can also lead to chronic pain, which is particularly noticeable when sitting. The reason for this is that the coccyx is stressed especially when sitting.

Are you more interested in this topic? For more information, see: Tailbone fracture

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Other causes of tailbone pain when sitting

There are other causes where the pain does not come from the tailbone itself.

Lumbar spine damage: Damage to the lumbar spine such as irritation to a nerve root can be perceived as tailbone pain when sitting.

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Coccyx fistula: A coccyx fistula, which originates from an inflamed hair root mostly in the gluteal fold, can also be responsible for the symptoms.

Diseases of internal organs: In addition, diseases of internal organs such as the uterus in women can be perceived as tailbone pain when sitting. Also during and after pregnancy, pain in this area is often due to the pressure that the child exerts on the bones from within.

Psychological causes: Even without a physical cause, tailbone pain can be caused by a psychological disorder, for example. Only in extremely rare cases is a threatening cause such as cancer underlying the symptoms.

Are you interested in this topic? Read more on the topic: Coccyx pain- these are the causes

Diagnosis of tailbone pain when sitting

In order to make a diagnosis of tailbone pain while sitting, the doctor will first ask a few specific questions. Among other things, he would like to know exactly where the pain is, when it occurs and how long it lasts. He will also ask about previous injuries, concomitant illnesses and any medication taken. Questions about work and everyday life, especially with regard to frequent sitting as a possible cause of the complaints, are also often asked.

The next important step in making the diagnosis is the targeted physical examination. By looking, pressing or tapping, the doctor can assess whether the pain really originates from the tailbone or whether there is another source of pain such as the lumbar spine. Pressing the tailbone end with your finger can be informative.

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In most cases, a medical consultation and physical examination are sufficient to make a diagnosis, initiate mostly symptom-oriented therapy and make recommendations. Further diagnostic measures such as imaging are only useful in a few cases. A normal X-ray is usually taken first if, for example, there is a suspicion that the tailbone may be broken. Computed tomography (CT) or magnetic resonance imaging (MRI) is only indicated in exceptional cases in the case of tailbone pain while sitting.

Are you interested in this topic? You can learn more about this in the following article: MRI or CT - what's the difference?

Which doctor treats this?

There are several doctors who can treat tailbone pain while sitting. This depends on the underlying cause. If there is any uncertainty about a possible trigger, a family doctor can be seen first. In many cases, for example after a fall or if there is additional tension, it makes sense to see an orthopedic surgeon.
If pain during intercourse or other gynecological symptoms occur in addition to tailbone pain when sitting, a gynecologist should be consulted. If you experience pain during bowel movements at the same time, it may be useful to consult an internist.

Therapy of tailbone pain when sitting

The therapy for tailbone pain while sitting depends on the underlying cause. Various pain medications are available for acute pain relief. Often, simple pain relievers such as ibuprofen, diclofenac or aspirin are enough to reduce the pain. They usually work well, but due to side effects, they are by no means suitable for taking over a long period of time. If the pain is more severe, medication can also be injected directly into the tailbone area. These include light anesthetics or cortisone.

Furthermore, the application of heat, e.g. In the form of a hot water bottle, hip baths, cherry stone pillows, or cold, in the form of cool packs, also help. Acute inflammatory diseases such as coccyx fistula are an exception.

In addition, the sitting position should be avoided if possible to relieve the tailbone. A seat cushion or a seat ring that is open to the rear, which reduces the stress on the tailbone, can also be useful in many cases. Aids of this kind are available from medical supply stores.

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Since the tailbone pain is often caused by tension or injuries when sitting, it is advisable in many cases to seek physiotherapy treatment. Various exercises to relieve the coccyx can be learned. Some people also experience improvement in tailbone pain while sitting through alternative procedures such as acupuncture.

A completely different treatment option comes into play if mental health problems could be partly or entirely responsible for the pain. In such a situation one should not be afraid to seek and receive help. Contact person and mediator can be the family doctor, for example.

Read more on the topic: Treatment of tailbone pain

What is a tailbone seat ring?

Depending on the type and cause of the tailbone pain when sitting, a special mat can also be helpful when sitting. These include the coccyx seat ring, as well as special seat cushions or seat wedges. These are available in different degrees of hardness and can be individually adapted to the shape of the tailbone and buttocks.
They are available, for example, in a medical supply store or an orthopedic accessory facility. The coccyx seat ring is open to the rear and thus relieves the coccyx when sitting.

Can a cortisone injection help?

A cortisone injection can be particularly helpful for chronic pain. Cortisone is injected into the painful area together with an anesthetic. The whole thing happens under the control of the injection site with an X-ray machine to make sure that no structures can be injured. This leads to a significant improvement in tailbone pain when sitting for many people. However, since this treatment also entails certain risks, it should be carefully weighed beforehand whether another therapy option might also bring improvement.

Further information on the subject can be found at: Cortisone injection - areas of application and side effects

Duration of tailbone pain

The duration of tailbone pain while sitting depends largely on the cause and if something is done to correct the pain.

If the pain has arisen from excessive sitting, an improvement can usually be achieved within a few days by more movement and less time sitting or by using the tailbone ring. If nothing is changed in the sitting behavior, but only the pain is treated with medication, the tailbone pain can become chronic. Therefore one should pay attention to a better sitting behavior.

In the case of poor posture, a tailbone ring can improve the symptoms. However, if the bad posture persists for several years, for example, the duration is usually correspondingly longer.

If the pain is caused by a bruise, such as a fall, it usually lasts a few days. However, if more serious injuries such as If a fracture of the tailbone occurs, the duration of tailbone pain while sitting is considerably prolonged and can last from several weeks to a few months.

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Concomitant symptoms

Tailbone pain when sitting usually has a pulling, stabbing or burning character and is localized at the lowest end of the spine at the level of the buttocks. In some cases the symptoms are not limited to the coccyx region, but radiate to the anal area, the groin region or the hip.

The pain can either only occur when sitting or be aggravated by this body position or during other activities, such as climbing stairs, having sexual intercourse, or defecating.

If nerve irritation is the cause of the symptoms, abnormal sensations such as tingling or numbness of the buttocks can also occur. If an inflammatory reaction, for example due to a coccyx fistula, is the cause of tailbone pain in the back, accompanying symptoms are usually redness and swelling. Itching can also occur. If the tailbone is broken, you may notice an abnormal mobility of the bony structures when you sit down, which is usually particularly painful.

Tailbone pain when standing up

Often, tailbone pain is exacerbated when sitting up when you get up. This can be explained by the fact that when changing the body position from sitting to standing the whole spine is moved. Many people sit with little body tension and only straighten their backs when they stand up. Since the tailbone is the lowest end of the spine, all forces and movements act on this part of the body when you stand up.

Coccyx pain that already exists while sitting is often intensified at first. However, standing up and walking or standing is the most important measure for tailbone pain, which is most pronounced while sitting. In most cases, too long and frequent sitting is the main cause of the discomfort or sitting at least encourages and maintains the tailbone pain.

Anyone who suffers from tailbone pain should therefore sit as little as possible or at least get up regularly. Even if getting up can increase the pain in the short term, it often leads to an improvement in the symptoms in the long term or at least prevents further deterioration.

Tailbone pain when defecating

Sitting tailbone pain is often related to bowel movements, and two different aspects can be distinguished. On the one hand, the cause of pain can be constipation, which many older people in particular suffer from. When defecating, the very hard stool must pass through the rectum, which is located in front of the tailbone. Pressure can be exerted on the pain-sensitive end of the spine, which leads to the development of pain. On the other hand, even with normal bowel movements, tailbone pain can intensify. If there is already irritation of the tailbone from another cause, bowel movements may be the trigger for the pain. The symptoms are also favored by the sitting position when defecating.

Tailbone pain after a fall

After a fall on the buttocks, severe tailbone pain often occurs while sitting. In most cases there is only a bruise and rarely a fracture of the coccyx. However, since pressure is exerted on the pain-sensitive lower end of the spine when sitting, the symptoms often arise here. Sitting should therefore be avoided as much as possible. Unlike most other causes of pain, heat should not be applied. Relief, however, is provided by temporarily cooling the coccyx region.

Tailbone Pain During Pregnancy

Tailbone pain when sitting is common during pregnancy, but most of the time there is no dangerous cause.

The pain usually arises from the fact that the growing child pushes the uterus against the coccyx from the inside. Typically, the symptoms are greatest when lying down, but the tailbone pain can also be very severe when sitting.

The pregnant woman should then not spend too much time sitting, but rather be on her feet a lot. If this is not possible or becomes too strenuous, you can remedy the situation by lying on your side. If you have severe or recurring tailbone pain while sitting, you should consult your gynecologist or family doctor.

For more information, we recommend our website to: Tailbone pregnancy

Tailbone pain after childbirth

After giving birth, many women experience tailbone pain while sitting. The reason is that the tailbone is heavily stressed by the delivery. The child exerts a lot of pressure from within. The risk of tailbone pain after childbirth is increased, especially in very large babies and women with a narrow pelvis. A long and complex labor process can also be the cause of the symptoms after delivery. However, since it is usually only a strong irritation of the bones and ligaments and there is usually no injury, the pain will subside after a few days. If possible, the woman should not sit on hard surfaces in the time after the birth.

How can I prevent tailbone pain while sitting?

In most cases, tailbone pain that occurs while sitting is not a disease that can be specifically treated. What can be done is usually only symptom-oriented therapy to alleviate the symptoms and avoid the circumstances that trigger the symptoms. Since frequent and long sitting is usually the cause of the complaints, attempts should be made to reduce the amount of time spent sitting in everyday life. If you have to sit a lot for work, you should get up as often as possible. Ideally, part of the work can be done while standing. At best, the seating should be flexible and not too hard. It is best not to spend leisure time sitting, but rather in motion.

Prognosis of tailbone pain when sitting

The prognosis of tailbone pain while sitting depends on the underlying cause and treatment options. If the cause is acute and treatable, the prognosis is usually relatively good. However, in many cases it is complicated because the pain is often chronic, i.e. it has existed for a long time. Therefore, the various treatment options should be fully exploited to improve the prognosis.


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