Tailbone Pain

Coccygodynia, Coccydynia

Dear patient,

find out more about possible treatment options here. Of course, this does not replace a personal discussion with the doctor. Therefore, after reading, you can still ask specific questions about what is unclear or important to you.

Coccygodynia or tailbone painis pain in the area of ​​the coccyx (coccyx, coccyx). Anatomically, the lower end of the spine is formed by the tailbone and follows the sacrum. It consists of 2 to 5 vertebrae, usually fused together. If you look at the history of development, the tailbone corresponds to the bony remainder of the animal’s original tail. The melted vertebrae are more or less firmly connected to one another via so-called synostoses. In some people, the tailbone can bend up to 20 degrees when sitting, which returns to normal when standing.

In the meantime, the number of patients I treat is steadily increasing, so that even Bavarian television broadcast a contribution to clarify the situation. Look for yourself: link


Coccygodynia occurs primarily while sitting, women are more often affected than men. The causes are usually unclear and can be of a wide variety of types, the most common being described by the affected patients:

• History of a fall with a bruise in the buttocks area
• In women, onset of pain after a long, difficult delivery
• Repeated, prolonged sitting on especially hard surfaces

However, congenital anatomical misalignments and irritations in the area of ​​the muscle attachments or constipation can also play a role. As a rule, the causes result in unspecific irritation of the periosteum and thus the origin of the pain.
Before starting treatment with us, neurological or rectal causes for the pain should be clarified, as it is important to rule out other causes for the pain described.


A diagnosis is made on the one hand by describing the patient’s complaints and on the other hand by a clinical examination of the affected region. The coccyx can also be palpated through the rectum and any excessive mobility can be determined. Despite the different tailbone shapes, it makes sense to carry out an X-ray diagnosis. In the lateral x-ray, misalignments can often be seen. As a gold standard functional x-rays in standing and sitting position should be made. I recently published a ne classification for that:

Conservative treatment

The treatment of newly developed coccygodynia should always be conservative at first.
In addition to anti-inflammatory drugs, relief should be provided while sitting with a seat cushion in the form of a ring. Sitting for long periods of time should generally be avoided. If the complaint lasts longer than 6 weeks, we also recommend physiotherapy in the sense of pelvic floor exercises. Chirotherapeutic or osteopathic mobilization can also be helpful in the case of subluxations of the coccyx.
If the pain lasts longer than 3 months and there is a risk of chronification, we recommend infiltrating the affected area with local anesthetics and triamcinolone to block the nerves (ganglion impar). This is supposed to calm down and provide lasting relief from the pain. Procedures such as blockages by cold (cryodenervation) or heat (thermodenervation) are also described.

Operative treatment

If the symptoms show no significant improvement despite one year of consistent conservative therapy and if the clinical and radiological findings with positive test infiltration give a rounded picture, surgical removal of the coccyx (coccygectomy) is advisable. While the operation is still very controversial in older literature, since the pain has often been described as psychogenic, more recent studies show good results in more than 80% of patients if the indication and patient selection are correct.


In a coccygectomy (surgical removal of the tailbone), the movable part of the tailbone is removed through a small incision and the nerves are obliterated. The main dangers are wound healing disorders and infections. Intestinal injuries can also occur. Sometimes the success does not appear until a few months after the operation.
Surgical scar with Y-shaped skin incision to avoid infection.

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