What’s the difference between lower back pain, tailbone pain, and pain in your buttocks? Anatomically speaking, all three are connected – yet they are wholly separate, and pain in any of the three areas can mean very different things. The tailbone is a real bone, and as the name implies, it is, in fact, an evolutionary remnant of our lost fifth limb. If you’ve ever sat down on the edge of something a little too fast or slid down a rail and felt an electric pain run up your back from between your buttocks, you’ve felt tailbone pain.
This little remnant of our evolutionary blueprint is so ingrained in the human body that the average human embryo grows a little tail when no more than a month old. As we mature in the womb, the tail becomes absorbed into the rest of our body. It then becomes the coccyx, the bottom capstone of the human spine.
Understanding the Function of Your Coccyx
The coccyx, or tailbone, is named after its shape – reminiscent of the beak of a cuckoo bird – and it has an actual function, despite being no more than an inch long in most adult humans. It forms the middle leg of a tripod that allows us to sit more easily alongside the bottom two parts of the hip, called the ischium. Imagine the hip as a triangle without a bottom line at the human spine’s base.
This is where the coccyx helps provide balance. It is also attached to multiple different muscles in the hips and buttocks. When we’re born, the coccyx and spine are mostly cartilaginous and separated. It only becomes bone as we age and finally solidifies with the sacrum into one articulate bone after puberty. In general, we don’t sit on our hips and coccyx. We mostly sit on the muscle and fat of the buttocks, composed of multiple gluteal muscles.
But these bones provide the structure for the modern human being’s seat. Like many other parts of the human body, however, the coccyx can feel tremendous pain – often at its strongest when sitting down or defecating. Sometimes, this happens because of the bone’s direct impact and surrounding nerve endings. Sometimes, it’s because of a different condition, including infection, tissue growth, or irritated ligaments. Tailbone pain is also called coccydynia, or coccygodynia.
Tailbone Pain Symptoms vs. Lower Back Pain
One dead giveaway for tailbone pain is that the base of your spine hurts, between the buttocks, rather than your lower back. Tailbone-specific pain does not tend to radiate, meaning you aren’t likely to feel pain throughout the rest of the pelvis, front of the hips, or up your back. You may also associate lower back pain with pain running down one leg (unilateral pain or sciatic pain) or pain in your other extremities.
Another sign that your pain originates in the tailbone rather than the lower back is that your pain becomes more intense when you load the tailbone, for example, by sitting down. Increased pain during menstruation, bowel movements, and sexual intercourse is also a sign of a bruised, injured, or aching tailbone. Tailbone pain is often related to physical trauma or injury, but it can become chronic or may be related to chronic health problems. Chronic tailbone pain must be consistent for at least three months before doctors consider it chronic pain.
Have I Hurt My Tailbone? Common Tailbone Pain Causes
The only surefire way to tell that your tailbone is the culprit behind your pain and not another part of your hips or spine is to consult a medical professional and receive both physical and imaging tests. For the most part, women are more likely to injure their tailbone than men – at a rate of five to one -because pregnancy and labor strain the ligaments of the tailbone. Sometimes, this strain can lead to injury, or the ligaments loosen enough to make injury in the area more likely. Aging is another factor – an increased risk of osteoarthritis also means an increased risk of tailbone pain.
In the majority of cases, tailbone pain is not very serious. If you’ve fallen off some steps or a ladder onto your buttocks, for example, you may have bruised your tailbone, which may take a few days to heal. Should the pain not go away, it may be because you’ve fractured your tailbone or suffered a more serious injury. If your pain is severe or lasts more than a few days, it is essential to see a doctor. Not all tailbone pain occurs after an injury or pregnancy. Tailbone pain can also result from an infection or, in some rare cases, a tumor pressing on the nerves around the bone.
Treating an Injured Tailbone
Your doctor will recommend a different, individualized treatment plan depending on whether you have chronic or acute pain and the origin of your coccydynia. For example, in most cases, a little physical rest, some anti-inflammatory pain meds, and perhaps a unique pillow to keep pressure off the area when sitting may be enough to mediate the pain until the area heals. In other, more severe cases, your doctor may recommend stronger medication or a coccygeal nerve block, cutting off all pain signals from the area to the brain via an injected analgesic drug.
Lying on your belly with a heated pad on your tailbone can help relieve pain, as does adjusting your posture. Try to lean forward with your torso as you sit down, bend your back against the backrest of your chair or sofa and keep your feet flat on the ground and away from you. If you sit a lot at work, your doctor may recommend a standing desk or a supportive pillow. In addition to medication and local injections, your doctor may recommend a massage or even transcutaneous nerve stimulation applied to the area around your tailbone. This treatment method sends electric signals into your body, targeting the nerves around the tailbone and temporarily interfering with pain signals.