Cushions for Piles and Tailbone Pain

Understanding the problems

### Piles (haemorrhoids)

Piles are enlarged blood vessels inside or around the lower rectum and anus. Causes include straining with constipation, long sitting on the toilet, low-fibre diet, pregnancy in younger people, obesity and ageing of the supporting tissues. Symptoms include itching, a lump, discomfort on sitting, and bright red blood on the toilet paper or in the bowl. Many cases settle with simple measures; some need treatment.

### Tailbone pain (coccydynia)

The coccyx is the small bone at the end of the spine. Pain can follow a fall onto the bottom, a long period of sitting on a hard surface, weight loss that reduces padding, arthritis or sometimes no clear cause. It is typically worse on sitting, leaning back, rising from a chair and during bowel movements. It usually improves over weeks to months.

### Other causes of a sore bottom

Pressure sores from long sitting, skin infections, fissures (small tears), abscesses, bowel problems and, rarely, tumours can all cause pain in this region. That is why persistent or unexplained pain should be checked.

What a cushion can and cannot do

A cushion can:

• reduce direct pressure on the tailbone or the sensitive area;
• spread weight onto the thighs and the sit bones;
• improve comfort during sitting; and
• allow a person to sit for longer periods while the condition settles.

It cannot treat piles or heal a coccyx injury. It needs to be combined with the right habits and, where needed, medical care.

Types of cushion

### Coccyx (wedge or U-shaped cut-out) cushions

A wedge-shaped cushion with a U-shaped or keyhole cut-out at the back, designed so that the tailbone hangs free while the thighs and sit bones take the weight. Often made of firm memory foam or gel-foam. This is the most commonly recommended design for tailbone pain, and it is better than a full ring cushion.

### Wedge cushions

A simple wedge, thicker at the back, that tilts the pelvis forward and reduces tailbone loading. They are used by some people with coccydynia, sometimes without a cut-out.

### Ring and donut cushions

A circular cushion with a central hole. Many people find them comfortable for short periods, but they can concentrate pressure around the edge, restrict blood flow and increase swelling of piles. They are not recommended for people at risk of pressure sores. See ring and donut cushions.

### Gel and gel-foam cushions

Spread pressure and stay cool. A flat gel cushion helps comfort; a gel cushion with a cut-out suits tailbone pain. See gel cushions for pressure relief.

### Air cushions

Used mostly for pressure sore prevention; not usually needed for tailbone pain.

### Standard firm foam cushions

A firm, flat cushion, 5 to 8 cm thick, can improve comfort on hard seats. Avoid very soft foam that lets the tailbone sink into the seat.

Choosing a cushion

• Match the problem. A cut-out or wedge for tailbone pain; a soft, supportive flat or gel cushion for piles, used for short periods; not a ring for pressure sores.
• Firmness. Medium-firm and supportive.
• Size. Fits the seat and the person; the cut-out should sit under the tailbone, not under the thighs.
• Cover. Breathable and washable, with a non-slip base. In hot weather, choose a mesh or gel surface.
• Weight limit. Check.
• Try it. If possible, try for a few minutes before buying.

Place the cushion with the open end towards the back of the chair and sit well back so that the tailbone is over the cut-out.

Sitting habits that help

• Sit upright or lean slightly forward rather than slumping back onto the tailbone.
• Avoid hard, narrow seats. Choose a well-padded chair; see choosing a chair for an older person.
• Shift position every 20 to 30 minutes; stand, walk and stretch.
• Do not sit for long periods; see sitting for long hours.
• Lean forward when standing up and avoid sudden drops into the seat.
• Avoid prolonged sitting on the toilet. Do not read or use the phone.
• Use a footstool when on the toilet to ease straining, with the knees above the hips.
• Keep the bottom clean and dry, using gentle washing and patting dry, not harsh wipes.

Dealing with piles: the foundation

For piles, habits matter more than cushions.

• Prevent constipation. More fibre from vegetables, fruit, pulses and whole grains; fluids; regular walking. See constipation in older adults and high-fibre foods for seniors.
• Consider a fibre supplement such as psyllium husk, if the doctor agrees; see psyllium husk: how to take it and who should be careful.
• Do not strain. Allow time, but do not sit on the toilet for more than a few minutes.
• Respond to the urge, rather than delaying.
• Warm baths can soothe (a sitz bath for ten minutes), with care about slipping; see bathroom safety checklist for seniors.
• Creams and suppositories from a pharmacist or doctor for short-term relief; follow the label and ask a doctor if symptoms last more than a week.
• Avoid long use of steroid creams and harsh remedies.
• Maintain a healthy weight.
• Review medicines that cause constipation, such as some painkillers, iron tablets and certain blood pressure and antidepressant medicines, with the doctor, not stopping them yourself.

Dealing with tailbone pain

• Rest and avoid aggravating positions for the first days after a fall.
• Use a suitable cushion, as above.
• Heat or cold: a warm pack, with a barrier, can relax muscles; see hot packs and older skin. Cold may help after an injury.
• Painkillers as advised by a doctor; see painkillers and older adults.
• Gentle stretches and physiotherapy for pelvic floor and hip muscles.
• Avoid long drives and hard seats.
• See a doctor if pain persists beyond a few weeks, or follows a fall in someone with osteoporosis, in case of a fracture; see osteoporosis at home.

Warning signs: see a doctor

Seek medical help promptly for:

• rectal bleeding, especially dark or mixed with stool, or any bleeding in an older person for the first time, since cancer must be excluded;
• a change in bowel habit lasting more than a few weeks;
• unexplained weight loss, tiredness or anaemia;
• a hard, painful lump or severe pain, particularly with fever (possible abscess or thrombosed pile);
• numbness around the groin or buttocks, leg weakness or loss of bladder or bowel control (an emergency);
• tailbone pain after a fall with severe pain or inability to sit;
• pain that wakes you at night; or
• skin that is red, broken, black or blistered over the tailbone (a pressure sore); see pressure ulcers: stages, wound care and prevention.

Never assume bleeding is "just piles" in an older adult without a doctor's check.

Care of the cushion

Wash or wipe the cover regularly, especially if there is any bleeding or discharge. Air the cushion; avoid sharing it. Replace when it flattens or loses shape.

When to ask a professional

See a doctor, or a surgeon for persistent piles, for assessment and treatment options such as rubber band ligation. A physiotherapist can help with tailbone pain, posture and pelvic floor exercises. A nurse or occupational therapist can advise on cushions. Our care advisors can arrange a nurse visit and recommend equipment.