Pelvic pain
Tailbone Pain (Coccydynia) and Chronic Pelvic Pain
Tailbone pain when sitting, or chronic pelvic and perineal pain? Gulf Coast Pain & Spine in Houston explains causes, ganglion impar blocks and team care.
Coccydynia is pain in the tailbone (coccyx) that is worst when sitting and when rising from a chair, usually after a fall, childbirth or prolonged sitting. Chronic pelvic and perineal pain is pain between the hips, in the rectum, genitals or perineum lasting more than 6 months, often with a nerve or muscle component after gynecologic, urologic or colorectal causes have been addressed. Gulf Coast Pain & Spine treats both with targeted care that includes the ganglion impar block, a small sympathetic nerve block at the tip of the tailbone, alongside pelvic floor physical therapy and coordination with your gynecologist, urologist or colorectal surgeon.
Key facts
| What it is | Coccydynia: pain from the tailbone and its joints, ligaments and the tissue around it. Chronic pelvic pain: persistent pain in the pelvis or perineum after organ-specific causes have been treated or excluded |
|---|---|
| Most common causes | Coccydynia: a fall onto the buttocks, childbirth, repetitive sitting strain, an unstable or hooked coccyx, obesity or rapid weight loss; idiopathic in about a third. Pelvic pain: pelvic floor muscle spasm, pudendal neuralgia, endometriosis, interstitial cystitis, chronic prostatitis, post-surgical nerve injury |
| Typical course | About 90 percent of coccydynia improves within weeks to months with conservative care; chronic pelvic pain tends to persist without a coordinated plan |
| See a specialist when | Tailbone pain has lasted more than 8 weeks despite a cushion and anti-inflammatories, or pelvic pain persists after your gynecologist, urologist or gastroenterologist has completed evaluation |
| Treatments we offer | Ganglion impar block (test and treatment), coccygeal and sacrococcygeal joint injections, pelvic floor PT referral, medication management, and, for confirmed cases, radiofrequency ablation of the ganglion impar |
When to get emergency care
Go to an emergency room or call 911 if you have:
- New loss of bowel or bladder control, or numbness in the groin, inner thighs or around the anus (saddle numbness)
- Tailbone or pelvic pain with fever, chills, or a warm, swollen area over the tailbone (abscess or infection)
- Rectal bleeding, blood in the urine, or unexplained weight loss with pelvic pain
- Severe pelvic pain with vaginal bleeding during pregnancy, or sudden severe one-sided pelvic pain with faintness
- Tailbone pain after a major fall or accident with inability to stand or walk, or bruising spreading over the buttocks
- Pain that wakes you at night and is steadily worsening, especially with a history of cancer
Tailbone or pelvic pain in someone with a history of cancer, or that started without any injury and is progressing, needs imaging before any injection.
What coccydynia and chronic pelvic pain are
The coccyx is the small curved bone of three to five fused segments at the bottom of the spine. It anchors pelvic floor muscles and ligaments and bears weight when you sit, especially leaning back. Pain from it, coccydynia, is about five times more common in women, partly because the female coccyx sits farther back and is exposed during childbirth. It is one of the more misunderstood pains in medicine because X-rays are often read as normal and the pain is dismissed, yet most cases have a mechanical cause that responds to treatment.
Chronic pelvic pain is pain below the navel and between the hips, in the perineum, rectum, or genitals, lasting 6 months or longer. It affects roughly 1 in 7 women and a smaller number of men. It often begins with an organ problem (endometriosis, bladder pain syndrome, prostatitis, a surgery) and then persists because the pelvic floor muscles go into protective spasm and the pelvic nerves, including the pudendal nerve and the sympathetic nerves that run to the ganglion impar, become sensitized. By the time a pain clinic is involved, the organ-level causes have usually been treated and what remains is muscle and nerve pain. Gulf Coast Pain & Spine treats coccydynia and chronic pelvic pain in Houston, Webster and Pearland (opening November 2026).
Causes
Coccydynia:
- A fall onto the buttocks (the most common trigger), which can bruise, sprain or fracture the coccyx or the joint between the sacrum and coccyx
- Childbirth, particularly a long labor, a large baby or forceps delivery
- Repetitive strain from prolonged sitting on hard surfaces, cycling or rowing
- An unstable coccyx that flexes too much or dislocates when sitting, or a rigid, sharply hooked coccyx with a bony spur at its tip that presses into the skin
- Rapid weight loss, which removes the cushioning fat pad, or obesity, which changes sitting mechanics
- Rarely, infection, a pilonidal cyst, or a tumor (chordoma), which is why persistent, unexplained pain gets imaging
Chronic pelvic and perineal pain (often more than one at once):
- Pelvic floor muscle dysfunction (levator ani spasm), the most common driver of persistent pain, causing deep aching, pain with sitting, intercourse or bowel movements
- Pudendal neuralgia: burning or sharp pain in the perineum, genitals or rectum, worse sitting and eased by sitting on a toilet seat; often after cycling, childbirth or pelvic surgery
- Gynecologic: endometriosis, adhesions, pelvic congestion, vulvodynia
- Urologic: interstitial cystitis / bladder pain syndrome, chronic prostatitis / chronic pelvic pain syndrome in men
- Colorectal: proctalgia, anal fissure, post-hemorrhoidectomy pain
- Post-surgical nerve injury after hernia repair, hysterectomy, cesarean or mesh procedures (ilioinguinal, genitofemoral, pudendal nerves)
Symptoms, and how they differ from look-alikes
Coccydynia is localized: you can point to it with one finger at the very bottom of the spine. It is worst when sitting, especially on hard surfaces or leaning back, and there is often a sharp jolt when rising from sitting. Bowel movements and intercourse can hurt. Standing and walking are usually fine. This distinguishes it from low back pain (higher, broader, worse with bending), sacroiliac joint pain (off to one side over the dimple of the buttock, worse with standing on one leg and climbing stairs), and sciatica (travels down the leg). Pilonidal cysts sit over the tailbone in the skin and produce swelling, redness or drainage rather than deep bone pain.
Chronic pelvic pain is described as deep, aching, burning or pressure in the perineum, rectum, vagina or scrotum. Clues to a nerve or muscle cause: pain that is worse with sitting and better standing or lying, pain that improves sitting on a toilet seat (classic for pudendal neuralgia), tenderness of the pelvic floor muscles on exam, and normal findings from the gynecologist, urologist or colorectal surgeon. A pain that is cyclical with periods points to endometriosis; pain with bladder filling relieved by emptying points to the bladder; blood, discharge or fever point to an organ problem that needs its specialist first.
How we diagnose it
Coccydynia is diagnosed by exam: pressing directly on the coccyx reproduces the pain, and a gentle internal examination can assess whether the coccyx is unusually mobile or has a spur. Sitting and standing lateral X-rays of the coccyx (dynamic films) are the most useful imaging: they show whether the coccyx flexes or subluxes more than 25 degrees on sitting, which predicts who benefits from an injection or, rarely, surgery. MRI is ordered when there is a history of cancer, night pain, fever, or no injury to explain the pain, to exclude tumor, infection or a stress fracture. A local anesthetic injection at the sacrococcygeal joint that removes the pain confirms the coccyx as the source.
Chronic pelvic pain requires that the organ specialists have finished their evaluation; we ask for their notes, imaging and any procedure reports. Our exam maps the painful area, tests the pelvic floor muscles for tenderness and spasm, tests the pudendal nerve territory for altered sensation, and checks the hips, sacroiliac joints and lumbar spine, which commonly refer pain to the pelvis. A diagnostic ganglion impar block or, for suspected pudendal neuralgia, a pudendal nerve block, is used as a test: relief during the anesthetic period confirms the target for further treatment.
Treatment options, in order
Most coccydynia settles with conservative care within a few months; the plan escalates only when it does not. Chronic pelvic pain almost always needs a team: pelvic floor physical therapy, the relevant organ specialist, and pain management working together.
- Conservative care for coccydynia
A wedge or U-shaped cushion that unloads the tailbone (not a doughnut, which increases pressure on it), sitting upright rather than slouched, limiting sitting time, NSAIDs for 2 to 4 weeks, warm baths, stool softeners if bowel movements hurt. About 90 percent improve with these measures over 8 to 12 weeks.
- Pelvic floor physical therapy
For both conditions. Therapists trained in pelvic health release the levator ani and coccygeus muscles, mobilize the coccyx internally, and retrain breathing and bowel habits. It is the single most effective treatment for pelvic floor pain and is often the missing piece. Learn more →
- Medication
For nerve-type pelvic pain: gabapentin, pregabalin, duloxetine or a low-dose tricyclic. Muscle relaxants or vaginal or rectal diazepam suppositories for pelvic floor spasm are prescribed by the pelvic specialist. Opioids are not effective for chronic pelvic pain and are not part of the plan. Learn more →
- Sacrococcygeal joint or coccygeal injection
Local anesthetic and steroid injected at the joint between the sacrum and coccyx, or around the coccyx tip, under X-ray guidance. Takes about 10 minutes; relief typically starts within days and lasts weeks to months. Repeated up to about 3 times a year.
- Ganglion impar block
The ganglion impar is a small nerve junction in front of the tip of the tailbone that carries pain signals from the coccyx, rectum, perineum and genitals. Under X-ray guidance, a needle is passed through the sacrococcygeal joint and local anesthetic with or without steroid is placed at the ganglion. This is both a test (relief during the anesthetic confirms the source) and a treatment; relief in responders typically lasts weeks to several months and the block can be repeated. The procedure-specific risk is injury to the rectum, which is uncommon with image guidance. Learn more →
- Radiofrequency ablation or pulsed radiofrequency of the ganglion impar
For patients whose pain returns after a clearly positive ganglion impar block, radiofrequency treatment of the ganglion can extend relief to 6 months or longer. Evidence is from case series rather than large trials; coverage varies by insurer. Learn more →
- Neuromodulation or surgery
For refractory cases, dorsal root ganglion or sacral nerve stimulation is considered, and for a proven unstable or spurred coccyx with failed conservative care, referral for coccygectomy; both are last steps.
What you can do now
- Get a wedge cushion with the cutout at the back, and take it everywhere (car, office, restaurants). Doughnut cushions make tailbone pain worse.
- Sit forward and stand often. Lean slightly forward on your sit bones; stand for a minute every 20 to 30 minutes.
- Avoid constipation and straining: fiber, fluids, a footstool for the toilet.
- Ask about pelvic floor physical therapy early; your PCP or gynecologist can refer, and it helps both conditions.
- Bring your specialist records. For pelvic pain, the gynecology, urology or GI notes and any imaging or scope reports shorten the first visit considerably.
- Keep a two-week log of pain with sitting, standing and bowel movements.
New patients can start at new patient information; physicians can use the referral page.
Frequently asked questions
My X-ray was normal. Why does my tailbone still hurt?
Standard X-rays are taken lying down and miss the most common problem, a coccyx that moves too much or dislocates when you sit. Sitting-versus-standing lateral X-rays show this. Bruised ligaments and joint irritation also do not show on X-ray. A normal film does not mean the pain is not from the coccyx.
What is a ganglion impar block and does it hurt?
It is an injection of local anesthetic, sometimes with steroid, at a small nerve cluster in front of the tailbone tip that carries pain from the coccyx and perineum. Under X-ray guidance, it takes about 10 to 15 minutes with local numbing and, if you prefer, light sedation. Most patients describe pressure rather than sharp pain. It is a test and a treatment: relief during the numbing phase confirms the source, and in responders it can last weeks to months.
How long does tailbone pain last after a fall?
A bruised coccyx typically improves over 2 to 4 weeks; a sprain or fracture over 8 to 12 weeks. Pain beyond 8 weeks despite a cushion and anti-inflammatories is the point to see a specialist, since injections work best before the pain has been present for a year or more.
Can the tailbone be removed?
Coccygectomy is reserved for the small number of patients with proven coccygeal instability or a spur, who have failed at least 6 months of conservative care and injections. In patients who meet those criteria, success rates in surgical series are reasonably high, but wound complications are common because of the location, so it is a last step, done by a spine or orthopedic surgeon.
Do you treat endometriosis or interstitial cystitis?
Not directly. Those conditions are managed by gynecology and urology. We treat the nerve and muscle pain that often persists after those conditions have been addressed, and we coordinate with your specialist so that both parts of the problem are covered.
Is pudendal neuralgia the same as pelvic floor dysfunction?
They overlap but are different. Pudendal neuralgia is irritation of the pudendal nerve, causing burning pain in the perineum and genitals that is worse sitting and better on a toilet seat. Pelvic floor dysfunction is spasm of the muscles the nerve passes through, and can compress the nerve. Pelvic floor physical therapy treats both; a pudendal nerve block helps sort out how much is nerve.
Will insurance cover a ganglion impar block?
Medicare and most commercial plans cover ganglion impar blocks for coccydynia and perineal pain when conservative treatment is documented. Radiofrequency treatment of the ganglion impar is reviewed case by case. The practice accepts most commercial plans, Medicare and workers' compensation; it does not accept Medicaid.
Sources
- Coccydynia: An Overview of the Anatomy, Etiology, and Treatment of Coccyx Pain (opens in new tab) — Lirette LS et al., Ochsner Journal 2014 (PubMed)
- Chronic Pelvic Pain (FAQ) (opens in new tab) — American College of Obstetricians and Gynecologists
- Chronic Pelvic Pain: ACOG Practice Bulletin No. 218 (opens in new tab) — American College of Obstetricians and Gynecologists (PubMed)
- Tailbone (Coccyx) Injury (opens in new tab) — American Academy of Family Physicians, familydoctor.org
Request an appointment
Call (832) 916-2075 or request an appointment online. New patients are welcome; the team confirms insurance and referral requirements before scheduling.