Medically reviewed guide · Last updated: 28 October 2026 · Reading time: approx. 10 min

Tailbone Pain: When Sitting Hurts

The most common causes compared

The causes in detail

The tailbone (coccyx) is the lowest end of the spine: three to five small, fused vertebrae to which ligaments, pelvic floor muscles and the gluteal muscle are attached. When you sit, it carries part of your weight. This article covers pain right there. If the pain pulls more in the lower back or radiates into the leg, the article on back pain will help; if it shot in suddenly when you bent over, the one on lumbago.

A fall onto the buttocks: bruise, fracture or dislocation

The most common clearly identifiable trigger is a fall onto your bottom, for example on black ice, on the stairs or during sport. The tailbone can be bruised, cracked or displaced in its joint with the sacrum. Typical signs are severe pain when sitting and standing up, and sometimes when opening your bowels. Even a fracture almost always heals without surgery, so X-rays often change little about the treatment. The symptoms can nevertheless last for weeks to months. First step: take the pressure off when sitting, use a cushion with a cut-out and, if needed, painkillers for a short time.

Long periods of sitting and overuse

If you sit a lot, especially leaning back or on a hard surface, you put constant strain on the tailbone. Cycling with an unsuitable saddle, rowing or horse riding can also irritate it. The pain is then more of a dull ache that starts after a while of sitting and eases when walking or standing. Here, posture, sitting breaks and the right cushion often make a clear difference on their own.

Pregnancy and childbirth

During pregnancy, hormones loosen the ligaments in the pelvis so that the baby can later pass through the birth canal. During birth, the tailbone moves backwards — in the process it can be compressed, displaced or, less commonly, broken, especially with a difficult birth or a vacuum or forceps delivery. Tailbone pain after childbirth usually improves within a few weeks. If it persists for months, a targeted examination is worthwhile, possibly together with pelvic floor physiotherapy.

Overly mobile tailbone

In some people, the tailbone tilts too far forwards or backwards when they sit down, or slips slightly in its joint (instability, subluxation). This does not show on a normal X-ray taken lying down, but only when images taken sitting and standing are compared (dynamic X-rays). Excess weight encourages this form, because the pelvis rolls differently when sitting and the tailbone carries more load. In very slim people or after major weight loss, on the other hand, the protective padding is often missing.

Pilonidal sinus: inflammation in the cleft between the buttocks

A pilonidal sinus does not affect the bone but the skin above it: in the cleft between the buttocks, broken-off hairs bore into the skin and trigger chronic inflammation with small channels. Typical signs are small pits in the skin, a painful, red swelling above the tailbone and sometimes a discharge of pus or blood. Mainly young men with thick body hair are affected, often after a lot of sitting. An abscess usually has to be opened surgically; according to the current guideline, the sinus itself is treated surgically if it causes symptoms, with the smallest possible, tissue-sparing procedures preferred today.

Radiating pain: back, pelvic floor and rectum

Pain in the tailbone area does not always come from the tailbone itself. The lumbar spine, a herniated disc or irritation of the sacroiliac joints can radiate pain there — inflammatory back pain that is worst at night and in the morning and improves with movement fits ankylosing spondylitis. A tense pelvic floor causes dull pain and pressure deep in the pelvis. Conditions of the rectum such as haemorrhoids, a tear at the anus or an abscess cause pain mainly during and after opening the bowels. In women, cycle-dependent pain deep in the pelvis can also point to endometriosis; more on this under pelvic pain.

Rare, serious causes

Rarely, a tumour of the sacrum or tailbone, secondary growths from cancer or a bone infection is behind it. In older people with osteoporosis, even a minor fall can cause an insufficiency fracture of the sacrum, which makes itself felt as deep pain in the buttocks or lower back. Clues to such causes are pain that is severe even at rest and at night, unintended weight loss, fever or known cancer.

Self-tests: first clues at home

These tests do not replace a diagnosis; they only point you in a direction. With numbness in the genital area, bladder or bowel problems or weakness in the legs: do not test, go to the emergency department immediately.

• The standing-up test: notice when it hurts most. A brief, stabbing pain at the very moment you stand up after sitting for a while is very typical of the tailbone itself.
• The lean-forward test: sit upright and then lean forward slightly, or shift your weight onto one buttock. If the pain eases noticeably, the pressure is being taken off the tailbone — another clue pointing to coccydynia.
• The pressure point search: can you feel the pain precisely at the tip of the tailbone? Then the bone is probably the source. If it is more the skin in the cleft between the buttocks above it that is swollen or red, or there are small pits there, this points to a pilonidal sinus.
• The radiation check: does the pain pull into the buttock and leg, does it get worse when you cough or bend over, or is there tingling in the leg? Then the lumbar spine is more likely to be involved.
• The toilet log: pain when opening your bowels can come from the tailbone, but also from the rectum. Note down whether you have to strain, whether there is blood on the paper and whether the pain persists afterwards.
• The medication timeline: are you taking medicines that can cause constipation — such as strong painkillers, iron or certain antidepressants — or have you been taking cortisone for a long time? Note down the start date and dose.

Warning signs: when not to wait

• Numbness or altered sensation in the genital, perineal and buttock area (“saddle anaesthesia”)
• New problems passing urine, urinary retention or loss of control over the bladder or bowels
• Weakness or paralysis in one or both legs
• Fever together with a hot, red, very painful swelling in the cleft between the buttocks or at the anus
• Severe pain after a fall if you have osteoporosis or have been on cortisone treatment for many years
• Pain at rest and at night, unintended weight loss or known cancer
• Blood in the stool or changed bowel habits over several weeks

The treatment pathway: step by step

Without warning signs, conservative treatment usually comes first — and that is enough for most people.

1. Relief in everyday life. Break up periods of sitting, sit upright or leaning slightly forward instead of leaning back, on a soft surface. A wedge cushion with a cut-out at the back usually takes the pressure off the tailbone better than a round ring cushion. Warmth can loosen tense muscles, and some people find cooling helpful in the first few days after a fall.
2. Keep your stools soft. Straining makes the pain worse. Fibre, drinking enough and, if needed, a mild laxative such as macrogol after consulting your doctor or pharmacist help if constipation plays a part.
3. Examination at the GP practice. If the pain does not improve after a few weeks: palpation of the tailbone, the cleft between the buttocks and the back, often also a rectal examination, which allows the tailbone to be assessed from the inside. Imaging makes sense mainly after falls, with warning signs or if an unstable tailbone is suspected.
4. Physiotherapy and manual treatment. Relaxation and training of the pelvic floor, stretching of the surrounding muscles and manual techniques — sometimes also from the inside via the rectum — can help. The evidence is limited, but many people benefit.
5. Injections and surgery as the last step. With stubborn symptoms, an injection of local anaesthetic and cortisone at the tailbone or at a nerve plexus in front of it can be tried. Surgical removal of the tailbone is only an option for selected patients after many months of unsuccessful treatment. Whether and when a procedure makes sense is always decided by the practice treating you, together with you.

The medication angle: bones, constipation and painkillers

Medicines rarely trigger tailbone pain directly, but they can encourage or intensify it. A look at your medication plan is particularly worthwhile if the pain started without a fall.

Medicines that cause constipation

Strong painkillers from the opioid group such as tramadol or oxycodone, iron preparations, some antidepressants and bladder weakness medicines with an anticholinergic effect make the stool hard. Straining on the toilet then intensifies the tailbone pain and encourages haemorrhoids and tears at the anus. With opioids, a laxative is therefore often prescribed alongside from the start.

Cortisone and osteoporosis

Long-term treatment with cortisone such as prednisolone is one of the most important causes of drug-induced osteoporosis. In that case, even minor falls can fracture the sacrum. New, deep pain in the buttock and sacral area while taking cortisone should therefore be assessed by a doctor. Which other active substances weaken the bones is explained in the guide Medicines and osteoporosis risk. Never stop cortisone abruptly after taking it for a long time — the practice plans the tapering.

Blood thinners and major weight loss

While taking blood thinners, a fall onto the buttocks can cause a large bruise that adds to the pressure. If you lose a lot of weight, for example with a weight-loss injection, you also lose padding on the buttocks — some people then feel the tailbone more clearly when sitting. This is no reason to question the treatment, but it is a reason to adjust what you sit on.

Painkillers: limited benefit, limited duration

Anti-inflammatory painkillers such as ibuprofen or naproxen can help in the first few days after a fall or during a flare-up of pain. Without medical advice, the package leaflet generally says: no longer than three to four days in a row. Together with blood thinners, the risk of bleeding rises, and caution is needed with kidney, stomach or heart problems. In pregnancy, ibuprofen and related medicines are off-limits in the last trimester and should only be taken before that after consulting your doctor — more on this in the guide Medicines during pregnancy. The painkiller comparison gives an overview; which treatment is right is always decided by the practice treating you.

How to prevent tailbone pain

• Sit upright, stand up often — do not sit leaning back on your tailbone, break up periods of sitting regularly and plan in some work standing up.
• The right surface — use a cushion with a cut-out on hard chairs, in the car and when travelling; when cycling, make sure your saddle is well adjusted.
• Avoid constipation — fibre, enough fluids and exercise keep the stool soft and spare the tailbone from straining.
• Prevent falls — non-slip shoes in winter, good lighting on stairs and balance training in older age lower the risk of falling onto your buttocks.
• Look after the cleft between the buttocks — if you are prone to a pilonidal sinus, hair removal in the cleft can help prevent it coming back; ask your surgical practice about this.

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