Buttock pain can arise from various issues, including injuries, overuse conditions, and nerve compression. Given that buttock pain can significantly affect your ability to sit, stand, or walk, it’s crucial to identify the underlying cause, receive appropriate treatment, and take steps to prevent the condition from worsening.

This article covers common causes of buttock pain, how it’s diagnosed, treatment options, and guidance on when to seek medical attention.

Causes of Buttock Pain

Buttock pain can manifest in different ways, such as shooting, burning, numbness, tingling, or aching sensations. The pain might develop suddenly or gradually over time.

• Osteoarthritis: Also known as degenerative joint disease, osteoarthritis involves joint pain, stiffness, and inflammation due to cartilage breakdown. It typically progresses slowly with aging but can also occur rapidly following an injury. When affecting the hip, it can cause a dull, aching pain in the groin, side of the hip, or back of the buttocks, which can make walking challenging.
• Sciatica: This term refers to compression of the sciatic nerve, which runs from the lower back down the back of the leg. Sciatic nerve compression can lead to pain, tingling, numbness, and weakness in the buttock, thigh, and/or lower leg. Causes include bulging or herniated discs, spinal stenosis, direct nerve injury, or muscle tightness.
• Herniated Discs: Discs are jelly-like pads that cushion the vertebrae. When the outer layer tears, the inner material leaks out, causing pain, weakness, and numbness. Herniated discs in the lumbar spine can lead to pain radiating from the back through the buttock and into the thigh, leg, or foot.
• Piriformis Syndrome: This condition involves an overly tight piriformis muscle, which is located in the back of the hip. The piriformis muscle can compress the sciatic nerve, leading to buttock pain that radiates down the leg. Symptoms often worsen with prolonged sitting due to pressure on the piriformis muscle.
• Sacroiliac Joint Dysfunction: The sacroiliac joint connects the sacrum to the pelvis. Although it has limited movement, it can become misaligned or stressed from pregnancy, spinal or pelvic injury, muscle imbalances, or uneven leg lengths. This dysfunction causes deep pain at the sacroiliac joint, which can worsen with standing, walking, or climbing stairs.
• Hamstring Tendonitis: Inflammation of the hamstring tendons, typically from overuse, can cause pain at the ischial tuberosities (the bony parts at the bottom of the buttocks) and deep in the buttock. Common in long-distance runners and athletes involved in repetitive weight lifting or sports.
• Trochanteric Bursitis: This condition involves inflammation of the bursa at the side of the hip where the femur meets the hip. Symptoms include pain, tenderness, swelling, and muscle weakness at the side of the hip and/or buttocks.
• Coccydynia: Pain in the tailbone (coccyx) often results from a fall or direct trauma to the buttocks, causing a fracture or bruise that leads to significant discomfort, especially when sitting.
• Hemorrhoids: Swollen blood vessels around the rectum can cause pain, burning, itchiness, and sometimes bleeding during bowel movements, often resulting from straining, chronic constipation or diarrhea, or pregnancy.

Other Potential Causes:

• Pilonidal cyst
• Muscle strain
• Degenerative disc disease

When to See a Healthcare Provider

If you experience persistent or unexplained buttock pain (not related to a recent hip or leg injury) that radiates into the leg, consult a healthcare provider. Consider scheduling an appointment if:

• The pain significantly impacts your ability to walk, stand, or sit.
• You experience pain when moving your hip.
• You have burning, numbness, tingling, or weakness in your hip or leg.
• You have pain or difficulty with bowel movements.
• You notice unusual symptoms like fever, fatigue, or unexplained weight loss.

Diagnosing Buttock Pain

A healthcare provider will start by conducting a physical exam and reviewing your medical history, including the onset and nature of your symptoms. Based on this, imaging tests may be recommended to identify the cause.

Medical History

During your appointment, you’ll discuss your medical history, including any existing conditions and details about your buttock pain. Be prepared to answer questions such as:

• Are there additional symptoms like tingling, numbness, or weakness?
• Has the pain worsened over time?
• Does the pain vary with different positions or activities?
• Have you had a recent injury or issues with bowel movements?
• Have you experienced symptoms like fever or unexplained weight loss?

Physical Examination

Your healthcare provider will inspect and palpate your buttocks, hips, and spine, and test your range of motion. They will check for signs of:

• Redness
• Swelling
• Tenderness
• Bruising
• Numbness
• Abnormal joint alignment

Imaging

Imaging tests help evaluate the structures in and around the spine, hip, and sacroiliac joints. X-rays may be performed first to check for arthritis or fractures. If tendon or ligament injury is suspected, an MRI may be used to identify sprains, tears, or other issues. An MRI can also reveal spinal problems like bulging discs or nerve compression.

Nerve Conduction Study

If nerve compression is suspected, a nerve conduction study may be conducted. Electrodes will be placed on your skin to measure nerve signal transmission, assessing for abnormal nerve function.

Treatment for Buttock Pain

Treatment depends on the cause and severity of the pain. Many cases can be managed with conservative methods, though surgery may be required for severe or chronic conditions.

Lifestyle Treatment Options

At-home methods to manage buttock pain include:

• Applying ice or heat
• Using topical pain-relief creams
• Gentle stretching of hip muscles
• Resting from activities that aggravate the pain
• Using a seat cushion to relieve pressure
• Making dietary changes for better bowel regularity

Medications

Medications may help manage pain, including over-the-counter NSAIDs or stronger prescription options. Steroid injections into the hip or spine can also be considered.

Physical Therapy

Physical therapy is beneficial for many causes of buttock pain. A physical therapist will design a personalized exercise program to stretch tight muscles and improve strength. They may also use manual treatments and modalities like heat, ice, or electrical stimulation.

Surgery

Surgery might be necessary for significant issues like spinal stenosis or herniated discs if conservative treatments fail. Surgical options include foraminotomy, laminectomy, and spinal fusion to address nerve compression and alleviate pain.

Preventing Buttock Pain

Preventing buttock pain involves addressing physical issues related to overuse or muscle imbalances. Regular exercise and strengthening of the glutes, hamstrings, and abdominals can help reduce injury risk. When starting a new exercise program, increase intensity gradually and consult your doctor to ensure you’re fit to exercise.

Summary

Buttock pain can stem from various causes such as osteoarthritis, sciatica, piriformis syndrome, sacroiliac joint dysfunction, hamstring tendonitis, trochanteric bursitis, coccydynia, and hemorrhoids. Most cases can be managed with at-home treatments, physical therapy, and medications. However, persistent or severe cases, particularly those related to spinal issues, may require surgical intervention. Preventing repetitive strain and correcting muscle imbalances can help avoid or lessen symptoms.