Explore the causes of tailbone pain during pregnancy and effective relief strategies.

Tailbone pain during pregnancy is extremely common. Postural changes, weight gain, pressure and tension on the pelvic floor during to the weight of the growing baby, and increased ligament laxity all contribute to reasons you may have tailbone pain start in pregnancy.

The tailbone sits on the base of the spine and the pelvic floor muscles attach directly to it. The tailbone position is somewhat controlled by the position of the sacrum and sacroiliac joint (SIJ) and therefore tailbone pain and SIJ pain can go hand in hand.

When does tailbone pain start during pregnancy?

Tailbone pain starts during pregnancy typically around the second trimester. This is because weight gain and postural changes begin to become prevalent. 

If left untreated throughout pregnancy, typically the tailbone pain will get worse. This is due to progressive weight gain, postural changes, walking or gait changes, pelvic floor tension, and laxity in the pelvic ligaments increase as you progress through pregnancy.

Will tailbone pain during pregnancy go away once I have the baby?

Unfortunately, if left untreated, research shows that tailbone pain as well as low back pain does not necessarily go away after you deliver the baby. The pelvic floor muscles tense in response to tailbone pain. Therefore as the tailbone pain progresses, the pelvic floor tension typically gets worse. 

Delivering the baby does not take away the tension that has developed in the pelvic floor muscles. In addition, there is a lot of sitting down that comes with postpartum recovery and caring for a new baby. Therefore, tailbone pain can actually get worse postpartum.

The pelvic floor muscles and tailbone pain.

The pelvic floor muscles directly attach to the tip of the tailbone. Therefore, tension or tightness in the pelvic floor muscles can result in pulling and therefore pain to the tip of the tailbone.

In fact the tension that occurs in the pelvic floor as a result of tailbone pain can make vaginal deliveries more complicated because these muscles need to relax during vaginal deliveries. 

Things that provide relief from tailbone pain during pregnancy include:

Postural changes, especially changes and modifications to sitting posture. Try to aim to sit on a soft, yet firm surface. You will notice that chairs that are too soft cause you to round your lower back and put too much pressure through your tailbone, yet will also find that hard surfaces are equally as uncomfortable.

When sitting, aim to sit on your sit bones (the bones at the bottom of your butt) as opposed to rounding your back and sitting directly on your tailbone.

Exercises to decrease tension and pulling on the pelvic floor muscles. These exercises are typically child’s pose, happy baby, and puppy pose. We usually like to tell patients to try to avoid holding any tension in the anus or back of the butt. Keeping those muscles relaxed will take pressure off the tailbone by decreasing the tension in the pelvic floor

Use a tailbone cutout pillow to help off load the pressure through the tailbone. There are tons of tailbone pillows. The biggest mistake we see is that patients often are using them backwards. The little cutout in the cushion is for the tailbone and therefore needs to be in the back of the seat, not the front.

Internal tailbone adjustments or mobilizations with someone trained in this technique (typically this is a pelvic floor physical therapist). Often times patients will need manual release to the pelvic floor muscles to help decrease the pull on the tip of the tailbone, in addition to internal tailbone adjustments.

During internal tailbone adjustments, a pelvic floor physical therapist performs tailbone mobilizations internally through the rectum. To learn more about internal tailbone adjustments, click here.

Tailbone pain during pregnancy can be excruciating. If you are experiencing tailbone pain during pregnancy, please reach out to an internal pelvic floor physical therapist. Waiting to see if the pain will go away is not supported in the research and can actually make the tailbone pain worse. Through treatment, relief for tailbone pain during pregnancy is possible.