Tailbone Pain in Pregnancy: The Essential Guide

Tailbone pain is a real pain in the… well, you know what. And tailbone pain in pregnancy is even more of a “bum”mer (pun intended). Let’s discuss why you might be hurting and what you can do about it. That way you can actually enjoy your time binge-watching snuggled up next to your love, instead of shifting uncomfortably like the world’s wiggliest woman. 

WHY DOES THE TAILBONE EVEN MATTER?! 

When having tailbone pain, a lot of my patients just wish they could get rid of it. And while there are surgeries that do just this, they shouldn’t be entered into lightly. And that’s because the tailbone actually does have a part to play in our function, including:

• Anchoring the end of the spinal cord 
• Part of the weight-bearing structure for sitting (along with the ischial tuberosities
• Assisting in walking  
  • Glute max attaches here and is necessary for walking
  • Pelvic floor muscles attach here and provide an anchor for low back and hip joints
• Supporting pelvic organs (via pelvic floor muscles – PFM)
• Giving birth
  • Expansion of the pelvic outlet through relaxation of the attached pelvic floor muscles
• Bowel function
  • Plays a role in both continence and elimination (keeping poo in and allowing it out)
• Sexual function
  • Affecting orgasm due to its connection to PFM 

WHAT TAILBONE PAIN FEELS LIKE

More often than not, women with tailbone pain come to me expressing sharp pain when sitting. But there are other ways it can manifest, like

• Pain with defecation or after
  • Especially with constipation or a history of constipation
• Headaches
  • Because the tailbone acts as an attachment point for the neurological system 
• Pain moving from sitting to stand
  • This is probably the second most common complaint I hear after pain with sitting
• Achy, crampy, general pelvic pain
• Referred pain 
  • Into the low back, SI joint, butt, groin, hips, perineum (like where you sit on a bicycle – if you don’t know much about your anatomy “down-there,” check out this post)
• Pain with sex
• Pain with coughing
  • Probably due to changes in pressure in the pelvic floor (Prolapse also has to do with pressure. You can read more about prolapse in this post)

WHY TAILBONE PAIN IN PREGNANCY (& OTHERWISE) HAPPENS 

Like many things in this world, there is not just one answer to why people get tailbone pain. Risk factors include increased time sitting, being female (because of the angle of our sacrum and coccyx/tailbone), and obesity. 

However, obesity isn’t a risk factor in itself. Instead, it is the sitting mechanics of people with more weight. And this is one reason why many women get more tailbone pain in pregnancy. 

Let’s look over a few reasons below. 

• Sacral sitting

  • The growing belly – and breasts! – change the way many women sit and stand. Their center of gravity moves and more weight is on the front of the body. They end up sitting more on their sacrum instead of the ischial tuberosities (the bony parts that stick out of the bottom of your butt while you’re sitting). Sitting more on the sacrum can create imbalances in the muscles that attach to it. 

• More sitting in general 

  • Less energy during pregnancy may mean more sitting in general (or if you’re stuck at home for long periods of time….) 

• Stretched (or too tight) muscles  

  • The tailbone attaches to A LOT of tissues, including many of the hip and pelvic floor muscles. These are stretched as the pregnancy progresses and sometimes remain in a lengthened position even after pregnancy. More commonly, this stretching can have a sort of rebound effect. In this case, the pelvic floor may get overly tight in an attempt to create a feeling of strength and stability. 

• Constipation

  • Hormonal changes, including rising progesterone, can cause constipation, and lead to pressure on the tailbone.

• Emotions

  • Some women experience more anxiety, fear, and stress during pregnancy. If you’ve ever seen a dog tuck its tail between its legs, we can do the same thing when facing these emotions. 

• Referred pain

  • Tailbone pain can also actually be coming from somewhere else in the body. Most commonly the pelvic floor muscles or the glutes, though others could be involved like the muscles that rotate the hips (ex: piriformis, obturator internus, gemelli), or adductor magnus (on the inner thighs). Other issues could be in the low back. 

• Inflammation

  • Direct trauma from falls, sports injuries, abuse, after giving birth, or repetitive strain from activities like horseback riding, cycling, or rowing. Or this could be chronic inflammation in the body from diet or another disease. 

• Scar adhesions

  • From episiotomies, hysterectomy, or endometriosis resulting in a less mobile tailbone

• Other  

  • Leg length discrepancy, bone spur, tumor, or normal variations of the sciatic nerve

In the end, most tailbone pain in pregnancy or after comes from a change in the mobility or position of the tailbone. The question is why and what can we do about it?

SOLUTIONS FOR TAILBONE PAIN IN PREGNANCY

I’ve treated a number of women with tailbone pain. And each of them is unique in exactly what helped the most. But the one thing that all of them had in common was a need to work on releasing – both their muscles, as well as their emotions. Because the tailbone is so tied to our stress response, I always make stress reduction a big part of any treatment plan. So keep that in mind as you work through what strategies sound best to you. 

• Change the way you sit 

  • Place something underneath you

    • • Sit on an airline neck pillow or boppy turned backward. Some women prefer something with more firmness, like with a wedge cushion
      • Place a rolled-up pillow, blanket, or towel behind your back. This can help minimize sacral sitting 
      • Sit on an exercise ball (just try to find one high enough so your hips can stay above your knees) 
      • Fold up two towels and place one under each cheek allowing the tailbone to rest untouched in the middle. But try not to stretch the area between the towels too much.

• • Sit less or change your position

    • • Set an alarm to remind yourself to move more often
      • Try sitting in different positions and on different surfaces. Most women prefer a softer surface, but this can lead to more sacral sitting for some. 

• Soft tissue release

  • Massage

    • • Try massaging or releasing some of the muscles that can refer pain to this area especially the glutes and adductors (the muscles on the inside of the thighs). You don’t have to do this super hard. You’re just trying to give the brain some info about this area and get it to pay attention to what you’re feeling. 

• • Using Tools

    • • Use a small ball to gently roll in the area in between the ischial tuberosities – kind of sitting on it. This is one way you can reach the pelvic floor to help release it externally. 
      • You can also get a “pelvi-wand” or the like to work on pelvic floor release (though I wouldn’t recommend this during pregnancy and would see a pelvic floor therapist to help teach you how to use it)  

• Stretching and exercise – focusing on releasing and relaxing

  • Happy baby

    • • This is one of my personal favorites and I give to most of my clients (though you may want to use some caution if you’ve had pubic symphysis pain). 
        • • Bonus, it’s great for preparing for giving birth

• • Wide-legged child’s pose

    • • Another great exercise that some people find more comfortable than “happy baby”
      • Depending on how big your belly is, this may not be comfortable

• • Cat/cow with focus on releasing

    • • This exercise has a lot of different names including cat/camel or cat/dog. Whatever you call it, the focus is on relaxing the bum and pelvic floor as you lower the trunk toward the floor

• • Figure-4 stretch
    

    • • My favorite stretch for the piriformis is the figure-4 stretch. 
      • Also, another great one to help open up the pelvis and prepare for labor if you’re pregnant 

• • Hip flexor stretch

    • • There are so many different ways to stretch but I personally like the ½ kneel to stretch hip flexors.

• Breathwork 

  • Diaphragmatic breathing

    • • Inhaling down deep into the pelvic floor, thinking about lengthening the PFM. One cue is to think about your pelvic floor like a flower blooming. 
        • • This is another great birth prep exercise, as your pelvic floor needs to be able to expand for its birth
          • This type of long, slow breathing can also help you feel more relaxed. As we said before, relaxation is key for working on tailbone pain. 

• Decrease constipation 

  • Hydration

    • • There aren’t any really good studies (that I’ve found) explicitly stating how much water you need to drink. But the common rule-of-thumb is ½ your body weight in ounces. So if you weigh 150 lbs, you would drink 75 ounces of water. 

• • Fiber intake

    • • The American Pregnancy Association recommends 25-30g of fiber a day (for reference, the American Heart Association recommends 20g/day for an average adult)

• • Learn how to poop

    • • First, get yourself in a good pooping posture – ideally knees above hips by using a stool. Many women also do better if they lean forward slightly, though the best toilet posture can be a little different for everyone. 
        • • • The Squatty Potty is the most well-known tool, but you can use a small trash can or step-stool, as well 

• • • • Remember the breathwork we talked about above? That’ll help with giving birth and with pooping.
        • • • The cues I like to use are big breath, big belly, slow blow. 
            • Essentially you want to take a breath in thinking about gently relaxing and expanding the pelvic floor.
            • Then maintain the mild pressure you’ve built up in your belly as you slowly exhale, thinking about gently pressing out the stool.
            • The slow exhale is probably the most challenging for people who are used to using a technique called the Valsalva, where you hold your breath for all your worth and push. But the slow exhale is better for managing pressure in the pelvic floor, which is part of what preventing prolapse is all about.
            • Don’t worry – this will probably take some practice, especially if you have a history of constipation. But it’s can dramatically change your toilet life (not to mention giving birth!) if you learn how to do this.
      • If you’re still having trouble, do a little dance moving your trunk. Yep, grooving on the toilet can help get things moving.

• Posture and transfers

  • In sitting

    • • We talked about this earlier, but it’s important enough to mention again. Try to get out of sacral sitting. Not only will this help decrease the strain on your tailbone, but it’ll also help with giving birth. The sacrum needs to be able to move when your baby is coming down through the birth canal. And sitting on the sacrum can make it less mobile.  

• • Transferring more slowly and intentionally

    • • If you get pain when moving from sit-to-stand, this may help. When you go from sit to stand normally, are your glutes squeezed? Or are they relaxed? Whichever is true for you, try the opposite and see how it feels.

• Taping

  • This is a challenge to do to yourself, but if you have a willing helper, it’s worth a try. The article below outlines one of the techniques for helping with coccyx pain. It’s not specifically tailored to tailbone pain in pregnancy, but I still think it has value.
    • • https://www.coccyx.org/treatmen/taping.htm

• Icing or heating

  • Pretty self-explanatory. Place ice or heat (or alternate) along the tailbone. Leave on for 10-20 min. Obviously, if you start to feel too hot or cold remove the pack. And if you’re having any issues with sensitivity – either too sensitive or not really feeling much, you might want to skip this and talk to your healthcare provider.  

• Other treatments

  • Anti-inflammatory aids

    • • During pregnancy, NSAIDs aren’t recommended. But there are studies showing some natural alternatives may be as effective in pain reduction.
        • • Ginger in particular is a great option. One study looking at pain during the menstrual cycle reported “750–2000 mg ginger powder during the first 3–4 days cycle” was beneficial. While obviously not the same pain, ginger has been helpful in other areas including delayed onset muscle soreness, osteoarthritis, chronic low back pain, and migraine.  As such, we could make an educated guess it might help with tailbone pain in pregnancy too. 

• • Nerve blocks

    • • Likely not recommended in pregnancy, but some people have found nerve blocks for the nerves that go to the tailbone to be helpful. However, I think this should be something paired with a lifestyle change (changing postures for instance). 

• • Injections – steroid or botox into PFM

    • • Again, probably not recommended in pregnancy. But the effect of these injections may help some women. 

• • Manual to coccyx and/or muscles

    • • This, however, is totally feasible in pregnancy. Find a pelvic floor physio near you who can help with some release of the tissues. Or try the soft-tissue techniques described above. 

• • Coccyx removal

    • • IMO, this should be the last thing to try, because as we discussed above, the coccyx does have a purpose and play a role in the body’s function. 

• • Pulsed radiofrequency

    • • I don’t have any experience with this personally, but I’m all about educating people as to options. The basis for this treatment is to help with altering the way the body perceives the pain signals. Not sure how much evidence there is for this, but, again, nice to have options. 

• • Psychotherapy 

    • • This is underutilized in general, I think, particularly because tailbone pain and stress levels can be so correlated in my experience. Speaking as someone who has utilized therapy even when I wasn’t sure I needed it, it was SO worth it. 

THE TAIL-END 

Now that we’re at the “tail-end” (sorry, had to) of our article, what questions do you have about tailbone pain in pregnancy?

Mini-review: the tail-bone has a function, tailbone pain can arise from different areas of the body and may actually cause pain other than in the tailbone, pain, in general, comes from a change in the mobility or position of the tailbone, and there are A LOT of different ways to help. 

Wonder which of these I would choose first? Changing my sitting posture and breathwork. Plus, both are important for helping give birth so you’re doing double-duty.

If you want to learn more about alignment and breathing, head over here to check out my free e-book. 

 

Sources 

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• Patel R, Appannagari A, Whang PG. Coccydynia. Curr Rev Musculoskelet Med. 2008;1(3-4):223–226. doi:10.1007/s12178-008-9028-1
• Abdel-Aal NM, Elgohary HM, Soliman ES, Waked IS. Effects of kinesiotaping and exercise program on patients with obesity-induced coccydynia: a randomized, double-blinded, sham-controlled clinical trial. Clin Rehabil. 2020;34(4):471–479. doi:10.1177/0269215519897414
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