Causes of Buttock Pain and Treatment Options

Buttock pain can have several causes, including injuries, overuse conditions, and nerve compression. Because buttock pain can significantly impact your ability to sit, stand, or walk, it is important to determine the underlying cause, receive appropriate treatment, and prevent your condition from getting worse.

This article will discuss common causes of buttock pain, how it is diagnosed, treatment options, and when to see a healthcare provider.

Causes of Buttock Pain

Different causes of buttock pain can produce varied symptoms, including shooting, burning, numbness, tingling, or aching sensations. Some causes of buttock pain will come on suddenly while others can develop gradually over time.

Osteoarthritis

Osteoarthritis, also called degenerative joint disease, is a condition that causes pain, stiffness, and inflammation of joints from the breakdown of cartilage. Osteoarthritis tends to develop slowly due to the wear and tear that accompanies aging, but can also develop quickly after an injury. 

Osteoarthritis can affect any joint, including the hip. Osteoarthritis of the hip can cause a dull, aching pain in the groin, side of the hip, or back of the buttocks that can make walking difficult. 

Sciatica

Sciatica is a general term that refers to compression of the sciatic nerve, the largest nerve in the body that runs from the lumbar spine of the lower back down the back of the leg. Compression of the sciatic nerve can cause pain, tingling, numbness, and weakness in the buttock, back of the thigh, and/or below the knee.

Sciatica nerve compression can result from a variety of different causes, including bulging or herniated discs, spinal stenosis, direct nerve injury, or muscle tightness.

Piriformis Syndrome

Piriformis syndrome is a condition characterized by an overly tight piriformis muscle in the back of the hip. Because the piriformis muscle most commonly overlays the sciatic nerve, tightness of the piriformis can cause compression of the sciatic nerve, resulting in buttock pain that radiates down the leg.

Symptoms of piriformis syndrome present or significantly worsen when sitting for extended periods due to constant pressure on the piriformis muscle.

Sacroiliac Joint Dysfunction

The sacroiliac joint is the joint that forms between your sacrum and both sides of your pelvis at the base of your spine. While very little movement occurs in the sacroiliac joints compared to other joints of the body, the sacroiliac joints can become stressed or shifted out of normal alignment from pregnancy and childbirth, injury to the spine or pelvis, muscle imbalances, or uneven leg lengths.

Sacroiliac joint dysfunction causes deep joint pain directly at the sacroiliac joint pain at the upper portion of the buttocks. Standing, walking, and climbing stairs all tend to worsen sacroiliac joint pain.

Hamstring Tendonitis

Tendonitis refers to inflammation of a tendon, connective tissue that attaches muscles to bones, from overuse of the associated muscle without proper rest. Hamstring tendonitis can occur from overuse of the hamstring muscles in the back of the thigh, which commonly occurs with long-distance running, repetitive weight lifting, and field-based sports. 

The hamstring tendons attach to the ischial tuberosities of the pelvis, the hard bony prominences that you can feel at the bottom of your buttocks when you sit. With hamstring tendonitis, pain can develop at these bony areas and deep at the bottom of your buttocks.

Trochanteric Bursitis 

Bursae are small, fluid-filled sacs that lay in between tendons and bones to decrease friction and irritation at tendons from rubbing over bones. With repeated contraction or overuse of the muscles associated with the tendons, the underlying bursae can become inflamed and irritated, resulting in bursitis.

Trochanteric bursitis occurs at the side of the hip where the femur (thigh bone) joins with the hip. Symptoms of trochanteric bursitis include pain, tenderness, swelling, and muscle weakness at the side of the hip and/or buttocks.

Coccydynia

Coccydynia, or coccyx (tailbone) pain, often results from a fall on your buttocks and landing directly on your tailbone. Injuring your tailbone can cause a tailbone fracture or bruise to the connective tissue around your tailbone, causing significant pain and discomfort, especially when sitting.

Hemorrhoids

Hemorrhoids result from swollen and inflamed blood vessels around the rectum, causing pain, burning, itchiness, and sometimes bleeding during bowel movements. Hemorrhoids are often caused by straining during bowel movements, chronic constipation or diarrhea, or pregnancy.

Other Causes

Some other conditions can also lead to pain in the buttocks, including:

• Pilonidal cyst
• Muscle strain
• Degenerative disc disease

When to See a Healthcare Provider

If your buttock pain persists longer than a week, especially if you did not injure your hip or leg, contact your healthcare provider. 

The presence of certain signs and symptoms should also prompt you to schedule a visit to see a healthcare provider. These include:

• Your pain significantly impacts your ability to walk, stand, or sit for extended periods.
• You cannot move your hip without causing pain.
• You experience burning, numbness, tingling, or weakness in your hip or leg.
• You have pain and/or difficulty passing bowel movements.
• You have unusual symptoms such as fever, fatigue, or unexplained weight loss. 

How Buttock Pain is Diagnosed

To diagnose the cause of your buttock pain, a healthcare provider will perform a physical exam and ask you about your medical history, including how and when your symptoms began.

Depending on the nature of your condition, your healthcare provider may recommend imaging tests to determine the underlying cause of your buttock pain. 

Medical History

During your visit with your healthcare provider, you will review your medical history. This will include going over any medical conditions you have and discussing how and when your buttock pain began. 

Your healthcare provider will also ask you questions about your condition, which may include:

• Are you experiencing any other symptoms besides pain, such as tingling, numbness, swelling, burning, or muscle weakness?
• Has the pain been getting worse over time?
• Does the pain occur or worsen with different positions, such as sitting, standing, or bending?
• Did you injure or previously injure your hip or back?
• Are you having any problems passing bowel movements?

Be sure to tell your healthcare provider if you recently had an infection or experience unusual symptoms like fever, fatigue, or unexplained weight loss as these factors may point to an atypical systemic condition causing your buttock pain.

Physical Examination

After reviewing your symptoms and medical history, your healthcare provider will perform a physical exam to look at your buttocks and surrounding areas, including your hips and spine. Your healthcare provider will inspect and touch your buttock and thigh muscles and move your hips and legs to see if your motion is restricted and/or painful. 

During your physical exam, your healthcare provider will look for signs of:

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

Imaging

Imaging methods may be used to examine the structures in and around your spine, hip, and sacroiliac joints to check for damage. X-rays are typically performed first to check for signs of arthritis or broken bones.

If an injury to a tendon or ligament is suspected, you may have an MRI (magnetic resonance imaging) performed to check for a sprain, tear, tendinitis, or bursitis. An MRI may also be used to examine your spine to check for irregularities, such as spinal stenosis, bulging or herniated discs, and nerve root compression. 

Nerve Conduction Study

A nerve conduction test may be performed to examine the functioning of your nerves if your healthcare provider suspects nerve compression or damage is causing your buttock pain. During this test, you will have electrodes applied to your skin while small electrical shocks are administered. This test will measure how fast your nerves transmit signals to assess abnormal nerve functioning.

How Buttock Pain is Treated

Treatment options for buttock pain will vary depending on the underlying cause and severity of your symptoms. Many causes of buttock pain can be managed conservatively with medication, physical therapy, and at-home treatments, although surgery may be needed for serious or chronic injuries.

Lifestyle Treatment Options

Simple at-home methods can be used to help manage buttock pain. These include:

• Ice or heat for pain relief
• Topical pain-relieving creams or gels
• Gentle stretching of your hip muscles
• Resting from aggravating activities such as running, vigorous exercise, or prolonged standing, sitting, or walking
• Using a specialized seat cushion to relieve pressure from your rectal/tailbone area 
• Dietary changes to improve your bowel movement regularity 

Medications

If needed, medications can be used to help reduce your pain levels. Pain medication can be taken by mouth, such as over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) or stronger prescription-strength opioids, or delivered through a steroid injection into your hip or spine.

Physical Therapy

Physical therapy is very important for treating many causes of buttock pain. A physical therapist will create an individualized exercise program for you to help stretch overly tight muscles and improve your strength to help correct muscle imbalances.

A physical therapist may also perform manual treatments and administer therapy that includes heat, ice, or electrical stimulation to help reduce your pain intensity. 

Surgery

Surgery may be an option for significant causes of buttock pain due to spinal problems such as spinal stenosis or herniated discs that cause ongoing pain and limit the ability to stand and walk comfortably. However, surgery may only be considered after trying other treatment methods for several weeks or months. 

Spinal surgical procedures that can help decrease nerve compression and buttock pain from spinal disorders include foraminotomies to enlarge the area around one of the bones in the spine, laminectomies to create space by removing bone spurs and tissue in the spine, and spinal fusions which permanently connect two or more vertebrae in the spine. 

Preventing Buttock Pain

Most causes of buttock pain are due to physical issues resulting from overuse, muscle imbalances, or joint problems that develop over time. Exercising regularly and strengthening muscle groups around your buttocks such as your glutes, hamstrings, and abdominals can help decrease the risk of injury. 

Whenever starting a new exercise program or an increase in physical activity, start slowly to allow your body to adjust to the increase in physical demands, and check with your doctor to make sure that you are healthy enough to exercise. 

Summary

Buttock pain can result from a variety of different causes, including osteoarthritis, sciatica, piriformis syndrome, sacroiliac joint dysfunction, hamstring tendonitis, trochanteric bursitis, coccydynia, and hemorrhoids. 

Most causes of buttock pain can be addressed with at-home treatments, physical therapy, and medication if needed. Some severe or ongoing causes of buttock pain resulting from spinal problems like spinal stenosis or herniated discs may require surgery if symptoms fail to improve with conservative treatment options. 

Limiting repetitive strain to your hips, correcting muscle imbalances, and resting from aggravating activities, especially if your buttocks are already hurting, can help prevent symptoms from developing or worsening.