Tailbone (anat. coccyx) pain can have different underlying causes. When seated nugging pain centered at the very bottom of your spine right above your buttocks can happen sponateously or after a fall and fractured tailbone. It can be associated with an infection or tumor as well.

The patient has sustained a fall on his buttocks. Nothing serious seemed to have happend right away. Nevertheless the pain at his tailbone hasn't subsided. Six months later, it is still hurting especially when sitting for a longer period of time. A newly purchased and softer office chair hasn't help as well. Even at home on the couch or in his favorite easy chair he cannot relax without permanent tailbone pain.  To ease the pain he has to shift his weight from one side to the other of his buttocks. The situation is a substantial handycap.  After seeing his family physician he has tried different pain medications (NSARs), a sitting pillows, and has tried repeated  local injections without relieve. He still cannot sit without pain and his patients has come to an end. What else to do about it?

First, the underlying cause of the tailbone pain should be identified. A thorough physical examination at a doctors office usually will be followed by x-rays and/or MRI studies (Fig. A, B) of the coccyx, sacrum, and pelvis. Bony structures and surrounding soft tissues can be looked at in detail.

The patient doesn't have a infection or tumor. His bloodwork and other results form the lab came back negative. Nevertheless he has  an abnormal "bend forward", mobile end of his tailbone. On rectal exam his coccyx has not healed can be moved back and forth provoking the same typical painful sensation when sitting. The MRI shows the remnants of two marked degenerated interverteberal discs at this particular location (Fig. B).

The surgical treatment is called coccygectomy. Surgery can carry risks, thus it should be considered only if all other treatment has failed. For this patient the last two vertebrae and adjacend discs have been removed (Fig. C) while preserving other surrounding tissues (Fig. D). 14 days later the pain has subsided and his wound has healed. It some instances it can take a longer time before the pain goes away.