Tailbone pain, known as coccydynia, is a persistent and often debilitating discomfort localized in the coccyx region at the base of the spine. This pain is typically exacerbated by prolonged sitting, leaning back while seated, or the transition from sitting to standing. Given that the coccyx serves as an anchor for several ligaments, tendons, and muscles of the pelvic floor, pain in this area can significantly impact daily life. Successfully managing this condition starts with understanding the progression of care and knowing which medical professional to consult.
Starting the Diagnostic Journey
The first step in addressing tailbone pain should be a visit to your Primary Care Provider (PCP), General Practitioner (GP), or Family Medicine physician. These doctors serve as the necessary entry point for a comprehensive initial assessment and can rule out other potential causes of pain in the lower back and pelvic area. The initial physical examination will often include palpation of the coccyx to pinpoint the exact location of the tenderness, which is a classic diagnostic sign of coccydynia.
Your PCP will likely recommend initial conservative management. This foundational treatment involves using pressure-reduction cushions, such as specialized cut-out or wedge-shaped pillows, to offload the coccyx while sitting. They may also suggest over-the-counter anti-inflammatory medications, such as Ibuprofen, to reduce local swelling and pain. If the pain is persistent and does not begin to resolve within several weeks to a few months, the PCP acts as the gatekeeper for referral to specialized care.
Specialists for Conservative and Interventional Treatment
For pain that becomes chronic or refractory, referral to a specialist who focuses on non-surgical treatments is the next appropriate step. Two types of physicians excel in this area: Physical Medicine and Rehabilitation (PM&R) specialists, also called physiatrists, and Pain Management specialists. Physiatrists focus on restoring function and quality of life through physical therapies and non-surgical means.
A physiatrist will often prescribe specialized physical therapy, particularly pelvic floor physical therapy, which is highly effective in treating coccydynia. Since the coccyx is an attachment point for various pelvic floor muscles, spasms in these structures can contribute to the pain. The therapy focuses on relaxation techniques, stretching, and manual therapy. This may include intrarectal manipulation to directly address muscle tension or joint restriction around the tailbone.
If pain persists despite several months of physical therapy and conservative measures, an interventional approach becomes necessary. This is typically managed by a Pain Management specialist, often an Anesthesiologist or a PM&R physician with specialized training. These specialists use targeted injections to diagnose and treat the source of the pain. The most common procedure is a coccygeal injection, which delivers a combination of local anesthetic and corticosteroid directly into the joint or surrounding tissue to reduce inflammation.
A more advanced technique is the ganglion impar block, which targets a cluster of nerves located just in front of the sacrococcygeal junction that transmits pain signals from the coccyx. This nerve block is performed using imaging guidance, such as fluoroscopy or ultrasound, to ensure precise needle placement. Interventional treatments are designed to provide significant, localized relief and can delay or entirely prevent the need for surgical intervention.
When Surgical Consultation Is Necessary
Surgical consultation is reserved for a small subset of patients whose severe, chronic coccydynia has failed to respond to at least six to twelve months of comprehensive conservative and interventional management. The specialists involved at this stage are typically Orthopedic Surgeons, particularly those specializing in spine or pelvic conditions, or Neurosurgeons. The surgical procedure considered is a coccygectomy, which involves the partial or complete removal of the tailbone.
Before proceeding, the surgeon will assess the structural cause of the pain. This often utilizes dynamic X-rays to check for abnormal mobility or instability of the coccyx. Other reasons for surgical consideration include a non-healing fracture or a fixed dislocation. While generally considered a last resort due to potential complications, coccygectomy can provide substantial pain relief for carefully selected patients with intractable pain.