A hard fall on your tailbone can result in a bruise, a fracture, or a dislocation of the coccyx, the small triangular bone at the very bottom of your spine. A bruise typically heals in about 4 weeks, while a fracture can take 8 to 12 weeks. The severity depends on the force of the impact and the surface you landed on, but even a “minor” tailbone injury can cause surprising amounts of pain because the coccyx bears a portion of your body weight every time you sit down.
Bruise, Fracture, or Dislocation
Slipping and falling backward onto a hard surface is the most common cause of coccyx injuries. The impact can do one of three things: bruise the bone and surrounding tissue, crack the bone itself, or push the coccyx out of its normal alignment at one of the small joints between its segments.
A bruise is the mildest outcome. The bone stays intact, but the tissue around it swells and becomes tender. A fracture means one or more of the small coccygeal segments has cracked. A dislocation means the bone has shifted out of position, sometimes subluxating backward when you sit and sliding back into place when you stand. You can’t reliably tell the difference between these injuries based on pain alone. A bruise can hurt intensely, and a hairline fracture can feel deceptively mild at first.
What the Pain Feels Like
The hallmark of a tailbone injury is pain that gets worse when you sit, especially on hard surfaces. Standing up from a seated position often produces a sharp spike of pain. Leaning back in a chair puts direct pressure on the coccyx, which makes it worse than sitting upright or leaning slightly forward.
Bowel movements can also become painful. The coccyx sits just behind the rectum, so any straining or pressure in that area pushes against the injured bone. Constipation after a tailbone injury is common, partly because of the pain itself and partly because people instinctively avoid bearing down. Eating high-fiber foods and staying hydrated can help keep things moving without excessive straining.
Some people also notice pain during activities they wouldn’t expect: transitioning from sitting to standing, climbing stairs, or even coughing and sneezing. Sexual intercourse can be painful as well, since the pelvic floor muscles attach directly to the coccyx.
How Doctors Diagnose It
A physical exam is the starting point. Your doctor will press along the lower spine to locate the tenderness and may perform a rectal exam to feel the coccyx from the inside, checking for abnormal movement or displacement. This part is uncomfortable but gives the clearest hands-on assessment of whether the bone has shifted.
Imaging typically starts with X-rays. For suspected instability, the gold standard is a dynamic X-ray: one taken while you’re standing and another while you’re sitting. Comparing the two reveals how much the coccyx moves under load. Normal movement is between 5 and 25 degrees of flexion. More than 25 degrees is considered hypermobile, and more than 35 degrees of posterior subluxation is classified as significant hypermobility. If the coccyx displaces backward when sitting and snaps back when standing, that’s a full luxation. An MRI or CT scan may follow if the X-rays are inconclusive or if your doctor suspects soft tissue damage.
Managing Pain at Home
Most tailbone injuries heal without surgery. The first few days call for ice, applied for 15 to 20 minutes at a time through a cloth to reduce swelling. Over-the-counter anti-inflammatory pain relievers help with both pain and inflammation during the acute phase.
The single most helpful change is how you sit. A cushion with a cutout at the back allows the tailbone to hover over open space instead of pressing against a hard surface. Wedge-shaped cushions with a triangular cutout at the rear edge tend to work better than donut-shaped ones. Among patients who tried both, they were roughly five times more likely to prefer the wedge. The slight forward tilt of a wedge cushion also shifts your weight onto your thighs and away from the coccyx. If you spend long hours at a desk, this one adjustment can make a meaningful difference in daily pain levels.
Leaning forward slightly when you sit, rather than reclining, reduces direct pressure on the coccyx. Standing up by shifting your weight forward onto your feet before rising, rather than pushing straight up, can also help you avoid that sharp jolt of pain.
The Pelvic Floor Connection
Several pelvic floor muscles, ligaments, and connective tissues attach directly to the coccyx. A hard fall can disrupt these structures in ways that outlast the bone injury itself. Overactive pelvic floor muscles can pull on the coccyx and create persistent, sharp pain. Weak or underactive muscles fail to stabilize the pelvis properly, placing extra stress on the tailbone. Many people unconsciously change their posture after the injury, sitting lopsided or clenching their pelvic floor, which creates new muscle imbalances that keep the pain going.
Pelvic floor physical therapy is one of the most effective treatments for tailbone pain that lingers beyond the expected healing window. A therapist can identify whether muscles around the coccyx are too tight, too weak, or poorly coordinated, then design a program to address the specific imbalance. This is especially relevant if your pain persists past the 8 to 12 week mark despite the bone having healed.
When Pain Becomes Chronic
Most people recover fully with time and conservative care. But for a subset, the pain becomes chronic, lasting months or even years. This is called coccydynia, and it can develop from an injury that never fully healed, from ongoing instability at a coccygeal joint, or from pelvic floor dysfunction that started with the original fall.
When conservative treatments plateau, doctors may recommend a nerve block targeting the ganglion impar, a cluster of nerve fibers near the base of the spine that relays pain signals from the coccyx region. In a study of 83 patients who received these blocks, about 88% of procedures produced an immediate reduction in pain of more than 50%. However, the relief was often temporary. At one-month follow-up, 41% of patients reported lasting improvement, and about 23% were significantly better long term. Roughly half reported no lasting change. These blocks can be repeated and are sometimes combined with other approaches.
Surgical removal of the coccyx, called a coccygectomy, is reserved for cases where conservative treatment and injections have failed. Surgeons may remove just the damaged segments or the entire coccyx, depending on where the problem is localized. It is considered a last resort, typically after at least several months of nonsurgical management.
Red Flags That Need Prompt Attention
Most tailbone falls, however painful, are not emergencies. But certain symptoms after a fall signal something more serious. Sudden numbness, tingling, or weakness in one or both legs suggests possible nerve involvement. Loss of bowel or bladder control, or numbness in the groin area (sometimes called saddle anesthesia), can indicate pressure on the nerves at the base of the spinal cord. A sudden increase in pain or swelling days after the injury, or prolonged constipation you can’t resolve, also warrants a call to your doctor. These symptoms are uncommon after a simple fall, but they require prompt evaluation to rule out nerve damage or other complications.