Tailbone pain when sitting and standing up: causes, relief

Pain in the coccyx (the tailbone, the last bone of the spine) is called coccydynia. It typically hurts while sitting and, above all, as you stand up. It often starts after a fall onto your bottom, after childbirth or after long hours of sitting, although sometimes there's no clear cause. Most cases improve within weeks or a few months with simple changes to how you sit.

Why it hurts more when you stand up

When you sit, some of your weight rests on the coccyx, which bends slightly forwards. When you stand, the pelvic floor and buttock muscles pull it back into place: if the joint between the sacrum and coccyx is irritated or moves more than it should, that change is the most painful moment.

Causes

A fall onto your bottom, even months ago.
Childbirth, especially if it was difficult or assisted.
Long hours of sitting, especially on hard surfaces or leaning back.
Cycling, rowing or horse riding, from repeated pressure.
Rapid weight changes: both excess weight and rapid weight loss change how you rest when sitting.
No obvious cause, in some cases.

It's considerably more common in women, because of the shape of the pelvis and childbirth.

What you can do

When sitting

Use a cut-out or wedge cushion (with the gap at the back), so the coccyx doesn't take weight.
Lean slightly forwards and spread your weight over your thighs, not backwards.
Avoid soft, low sofas where you sink back.
Get up every 30-45 minutes.

When standing up

Lean your trunk forwards and push up with your arms before standing.

Also

Heat or ice on the area for 15-20 minutes, whichever helps more.
Avoid constipation, because straining on the toilet can hurt too.
Gentle stretches for the buttocks and hips.

How long it takes to improve

Many people improve within a few weeks with the cushion and posture changes. If it lasts more than two or three months, it's worth an assessment: there are other options, such as injections prescribed by a doctor, and surgery is kept for very specific cases that don't respond to anything else.

How we treat it at the clinic

We assess the pelvis, lower back and surrounding muscles, because the coccyx is often overloaded by how you sit and by tension in the buttocks and pelvic floor. We combine gentle manual techniques with exercises and specific advice for sitting at work and at home. If the pain started after a hard fall, we rule out a fracture first.

When to see a doctor

Pain after a hard fall, with a lot of pain when the area is touched (possible fracture).
A lump, redness, heat or discharge at the top of the buttock crease (it may be an infected pilonidal cyst).
Fever, unexplained weight loss or a history of cancer.
Pain that doesn't change with position and wakes you at night.
Changes in bladder or bowel habits, or numbness around the genitals.

Frequently asked questions

Why does my tailbone hurt when I sit and stand up? Because when you sit the coccyx bears weight, and when you stand the muscles pull on it. If the area is irritated, the move from sitting to standing hurts most.

Does tailbone pain go away on its own? In many cases yes, within weeks or a few months, especially if you change how you sit.

Does a cushion with a hole help? It does, especially one with a cut-out at the back or a U shape, which leaves the coccyx unsupported. A donut-shaped cushion doesn't always work as well.

Can I exercise? Yes. Walking and swimming usually go well. At first, avoid cycling, rowing and sit-ups on a hard surface.

Do I need an X-ray? After a hard fall, yes. X-rays taken sitting and standing can show whether the coccyx moves more than normal.