Painful, Small, Hard Lump at End, On, Near & Below Tailbone: Causes, Treatments

Evolutionary biology tells us that we can trace our roots to apes. But if that is correct, where did our tails go? Apparently, humans have a small, multi-segmented bone located just above the buttocks at the bottom of the spine. This small structure is known as the tailbone, or coccyx. It is supposed to explain what remains of our “tails.” The tailbone has other important functions, however. Quite a number of tendons are attached to it, not to mention that it keeps us stable when sitting.

A painful lump on the tailbone is commonly referred to as a pilonidal cyst. Swelling and pain in the tailbone area can also be caused by injury or trauma.

Painful lump on tailbone; pilonidal cyst

In earlier days, it was thought that pilonidal cysts form during embryonic development. The theory went out of fashion in favor of injuries and trauma as the most probable causes. Today, most experts agree that these cysts result from accumulation of hair, skin debris and dirt in a pilonidal sinus (a small tunnel or hole in the skin) in the tailbone area.

Cysts are not supposed to be painful. Pain occurs when the cyst gets infected to form a pilonidal abscess, which is intolerably painful.


It is not clear what causes pilonidal cysts. The most widely agreed theory suggests that loose hairs penetrate the skin and, together with skin debris and dirt, collect to form a cystic lump. It is also suggested that ingrown hairs might the biggest contributing factor. The reason as to why hairs are mostly mentioned is because doctors often find hair follicles after operating on the cyst.

Risk factors

  • Being male
  • Previous pilonidal cyst infection
  • Young age
  • Excess weight and obesity
  • Hereditary factors
  • Body hair, especially on the tailbone area
  • Occupations such as long distance driving

Men, especially in their 20s, tend to develop these cysts more often. People who have been previously infected are more prone to a subsequent infection. This is thought to be caused by formation of scar tissue during the healing process. Bacteria can invade a scar tissue more easily. If you have a dimple or thick hair around the tailbone, you have higher chances of developing a pilonidal cyst.


Symptoms of a pilonidal cyst mostly occur when it has been infected. Ordinarily, you might not even realize that the cyst is there. The symptoms include:

  • Pain in the lower back near tailbone
  • Swelling above tailbone
  • Tenderness and redness at base of tailbone
  • Pus and sometimes blood discharge
  • Foul smell
  • Fever

Pain is usually intolerable when sitting. Pus and bloody discharge indicate a broken pilonidal cyst. See your doctor if this happens. The infection can spread to other parts of the body once the cyst has broken open.

Diagnosis and treatment for a lump under skin near tailbone


Your doctor will most likely start by performing a physical exam. Most pilonidal cysts appear as a lump under the skin near the tailbone. Pain, swelling and pus are signs of infection.

It will be helpful if you can prepare a short list of the symptoms you have been experiencing when preparing for an appointment. Your doctor will probably ask you some questions regarding the symptoms, your medical history and lifestyle.

Severe infections may call for a biopsy.


Drainage is the most common and effective treatment option. Your doctor will make a small incision and drain the cyst. The wound will be dressed and left open. The dressing will have to be removed after about 3 weeks. If the cyst recurs, it will be removed all together and more extensively.

Depending on what type of surgery you are receiving, the wound can be closed after the operation. The problem with this method is that recurring cysts are harder to remove.


Prevention measures include losing weight, avoiding a sedentary lifestyle and keeping bacteria out of the tailbone area. You can also try keeping the area shaved. Talk with your doctor on how to take care of the wound during the recovery period.

Home remedies

Some home remedies may help with a pilonidal cyst. But before we discuss them, it is important to note that your doctor may advise against such methods, especially after surgery. Make sure to consult before use.

Apply raw garlic to the sore lump above the tailbone. Garlic is known to fight infections and may reduce bacteria accumulation around the area. Don’t use garlic on open wounds since it can be quite irritating.

Rub an essential oil such as lavender oil or tea tree oil all around the tailbone area. Essential oils soothe irritated skin, reduce pain and may also fight bacteria. You can also use essential oils for a swollen lump in calf muscle. Carrier oils such as coconut oil and olive oil are commonly used with essential oils.

Try sitting in warm bath water up to the hips. This is also known as a sitz bath. Traditionally, sitz baths are used to clean the area between the rectum and genitals. It is said to relieve itchiness and pain such as caused by a sore lump on butt cheek caused by inflamed hair follicles or a skin condition such as eczema or psoriasis.

Try massaging the swollen area in circular motions. Massage improves blood circulation and reduces pain as well as swelling. Massage can also help with a painful lump on finger joint after injury.

Learn about the RICE protocol. It is quite effective when recovering from an injury especially in the lower extremities.

Pain and sore lump below tail bone

Sometimes, pain or a sore lump below tail bone can be caused by injury. For example, falling on a hard surface can bruise or fracture the tailbone. The resulting pain usually gets worse when sitting or leaning back on a chair.

Being overweight can also contribute to pain and swelling of the tailbone. This is because quite a number of ligaments and tendons are attached to the bone. Sometimes, the pain can be caused by old age. It is also common for women to experience pain and discomfort in the tailbone area when pregnant.

If the pain is not accompanied by a lump or swelling, it is likely that it will go away on its own. It is however advisable to check with your doctor for confirmation.

Treatment for pain and sore lump in tailbone area

If you have been involved in an accident, such as a fall for example, your doctor may decide to go for surgery. Surgery is only necessary if there is need to get rid of the entire tailbone or a part of the tailbone.

In most cases, OTC medications are prescribed to relieve pain. This allows enough time for the tailbone to recover.

At home, try sitting on a plastic bag in which some ice packs are wrapped. This eases pain and reduces swelling. Ice treatment can also be used for a hard lump on shin bone due to a swollen lymph node.

You can also try massage or a warm compress. The most important thing is to ensure that no unnecessary pressure is exerted on the tailbone area. For example, you can try taking a walk rather than sitting for long in your office or home. Ask your doctor about physical therapies designed to help with tailbone pain and swelling.

When to see a doctor

Most people get concerned about a lump in the tailbone area when it starts to hurt or swells. Pain and swelling indicate either an infection or some form of injury. The former is more serious. See your doctor ff the lump is accompanied by the symptoms of an infected pilonidal cysts listed above. As for injuries, see your doctor if the pain is intolerable or doesn’t respond to home treatments.

There are other topics such as different types of breast lumps, where does testicular lump appear, causes of lump in stomach above belly button and so on that you can find quite helpful. The truth is that your doctor is the only one who can correctly diagnose a lump but you have the responsibility of discovering its presence and reporting it to your doctor.