At a glance
Tailbone pain is a surprisingly common complaint among people dealing with anal fissures. At first glance, the connection might not be obvious — the fissure is in the anal canal, and the tailbone is a separate structure. But the two are connected through the pelvic floor muscles, shared posture patterns, and referred pain pathways.
This guide explains why tailbone pain occurs alongside fissures and what tends to help.
The connection
Several mechanisms explain why people with anal fissures often experience coccyx (tailbone) discomfort:
Pelvic floor tension
Chronic fissure pain causes the pelvic floor muscles to tense up — a protective guarding response. These muscles attach to and surround the coccyx. When they are chronically tight, they pull on the coccyx and create pain at its attachment points.
Changed sitting habits
People with fissures often change how they sit — shifting weight, perching on one side, avoiding placing pressure on the perineum. These altered sitting positions can put unusual stress on the coccyx.
Prolonged sphincter spasm
The internal sphincter spasm that defines chronic fissure does not happen in isolation. The surrounding pelvic floor muscles often join in, creating a widespread tension pattern that includes the area around the tailbone.
Referred pain
Pain from the anal canal and lower pelvic floor can refer to the coccyx area. The nerves serving these areas overlap, which means irritation in one area can be felt in another.
What people describe
People with fissure-related tailbone pain commonly report:
- Aching or soreness in the tailbone area that developed alongside or shortly after their fissure symptoms
- Worse with sitting — particularly on hard surfaces or for long periods
- Some relief with standing or lying down
- The pain being separate from the fissure pain — they can distinguish the sharp fissure pain from the dull tailbone ache
- Improvement when the fissure improves — as the fissure heals and spasm reduces, the tailbone pain tends to follow
What helps
Addressing the fissure
The most effective approach to fissure-related tailbone pain is treating the underlying fissure. As the fissure heals and the sphincter spasm resolves, the pelvic floor tension that drives the tailbone pain tends to release.
Sitting support
- Coccyx cushion — a cushion with a cut-out or channel at the back that takes pressure off the tailbone. Many people with fissures use these already and find they help with both the fissure discomfort and the tailbone pain.
- Regular position changes — avoiding sitting in the same position for extended periods
- Sitting on softer surfaces where possible
Gentle stretching
Stretches that target the pelvic floor and hip area can help reduce the chronic tension contributing to tailbone pain:
- Child’s pose
- Happy baby pose
- Gentle hip circles
- Piriformis stretches
- Deep breathing combined with conscious pelvic floor relaxation
Warm baths
Sitz baths serve double duty — they soothe the fissure and help relax the pelvic floor muscles that contribute to tailbone pain.
Pelvic floor physiotherapy
For tailbone pain that persists even as the fissure improves, pelvic floor physiotherapy can address the tension patterns directly. A physiotherapist who specialises in the pelvic floor can assess whether chronic muscle tension is the primary driver and provide targeted treatment.
When to mention it to your clinician
Tailbone pain alongside a fissure is common and usually benign. However, mention it to your clinician if:
- The tailbone pain is severe or getting worse independently of the fissure
- You experience numbness, tingling, or weakness in the legs or perineum
- The pain does not improve as the fissure heals
- You have a history of tailbone injury or other conditions affecting the coccyx
- The pain is affecting your ability to work or carry out daily activities