Buttock pain

Is this cause for concern?

You might not have paid much attention to your buttocks, given that they’re behind you. But you will notice if they start to hurt. Your buttocks are mainly composed of fat and gluteal muscle, but they can be prone to injury and disease.

A number of conditions can cause pain in the buttocks, from minor muscle strains to infections. Most of these conditions aren’t serious, but some warrant a visit to your doctor.

Call for an appointment if the pain doesn’t go away, it gets worse, or you also have symptoms like these:

• numbness or weakness in your leg
• trouble controlling your bowels or bladder
• a sore that doesn’t heal
• sharp or shooting pain
• a fever of 104°F (40°C) or higher
• pain that only happens when you’re walking and limits your movement

Here are some of the conditions that can cause pain in your buttocks, as well as tips to help you figure out which one you might have.

1. Bruising

Bruising is a common cause of buttock pain. The black-and-blue color of a bruise is caused by blood from damaged blood vessels pooling under the skin. 

You can get a bruise if you’re injured in the buttocks — for example, if you fall while rollerblading or get hit while playing a contact sport like football. Often, you’ll notice a swollen lump and tenderness in the bruised area. 

Your buttocks are made up of three muscles: the gluteus maximus, gluteus medius, and gluteus minimus. You can strain one of these muscles if you stretch it so much that it tears.

This can cause:

• swelling
• tenderness
• stiffness and trouble moving the affected muscle

Common causes of muscle strains are exercising too much, not warming up before you exercise, or moving suddenly or in an awkward way.

3. Sciatica

Sciatica isn’t a condition, but a symptom. It’s a sharp or burning pain that radiates down your sciatic nerve, which runs from your lower back through your buttocks and down each leg.

You can also have numbness or tingling in the affected leg. 

Sciatica is often caused by a herniated disk or narrowing of parts of the spine that then presses on the sciatic nerve. You’re more likely to get sciatica in your 40s and 50s, because the conditions that cause it become more common with age.

Although studies vary on how many people get the condition, some researchers estimate that as many as 40 percent of people have experienced sciatica.

4. Bursitis

Bursitis is a common condition in which the fluid-filled sacs called bursae that cushion the bones become inflamed. Areas like the shoulder, hip, elbow, and knee are most often affected.

You also have a bursa — called the ischial bursa — in your buttocks. Bursitis that affects the ischial bursa is called ischial bursitis.

Symptoms include:

• pain when you sit or lie down
• pain that radiates down the back of your thigh
• swelling and redness

You can develop bursitis in the ischial bursa if you injure the bursa or sit for a long time on hard surfaces. This type of bursitis is sometimes called “weaver’s bottom” or “tailor’s seat” after the professions that commonly cause it. 

5. Herniated disk

Each of the bones in your spine is separated and cushioned by small pads filled with a jelly-like material. These are called disks. A disk can become herniated if its outer layer tears, letting some of the inner material slip out. A herniated disk can press on nearby nerves, causing pain, numbness, and weakness.

If the affected disk is in your lower back (lumbar spine), you’ll likely feel the pain in your buttocks. The pain can also radiate down your leg. Other symptoms include:

• numbness
• tingling
• weakness

You’re more likely to get a herniated disk as you get older, because disks degenerate with age. Other risks include obesity and working in a job where you lift or pull heavy objects.

As you get older, the disks in your back can wear down. As the disks shrink, you lose the cushioning that keeps the bones of your spine from rubbing against each other.

Degeneration of disks in the lower back can cause pain in the buttocks and thighs. The pain may get worse when you sit, bend, or lift something. Walking or other movement can relieve it. You might also have numbness and tingling in your legs.

7. Piriformis syndrome

The piriformis is a muscle that runs down your lower back to the top of your thigh. You also have a nerve that runs from your lower spine through your buttocks to the back of your thigh, called the sciatic nerve.

Injuries or overuse can inflame the piriformis muscle to the point where it presses on the sciatic nerve. This pressure can cause a type of pain called sciatica that runs from your buttocks down the back of your leg.

The pain may get worse when you walk upstairs, run, or sit. You might also have numbness or tingling. 

Piriformis syndrome is often misdiagnosed as other types of back pain. About 6 percent of people who are diagnosed with low back pain actually have piriformis syndrome.

8. Pilonidal cyst

A cyst is a hollow sac that can form in different parts of your body. Cysts often contain fluid, but a pilonidal cyst contains tiny pieces of hair and skin. These cysts form at the cleft between the buttocks. You can get one of these cysts if a hair grows into your skin (ingrown hair).

Along with the pain, you may notice:

• reddened skin
• pus or blood draining from the opening
• a foul smell

Pilonidal cysts are more common in men than women, and in people who sit for long periods of time. You can also get them from friction — for example, while riding a bike.

9. Perirectal abscess

A perirectal abscess (also called a perianal abscess) is a pus-filled cavity that forms in a gland near the anus, the opening through which stool leaves your body. The abscess is caused by a bacterial infection.

This type of abscess is common in babies. Adults are more likely to get an infection if they have diarrhea, constipation, or another problem with bowel movements.

Some people have an abnormal connection between the inside of their anus and their skin. This is called a fistula. Bacteria can get trapped in this connection and cause an abscess to form.

10. Sacroiliac joint dysfunction

Your sacroiliac joint connects the sacrum — the triangular bone at the base of your spine — to your pelvic bone. When this joint becomes inflamed, it can cause pain in your lower back that may radiate down your buttock to your upper leg.

Activities like walking, running, or climbing stairs can aggravate the pain, but there are options for relief. 

Sacroiliac joint pain is often misdiagnosed as another type of low back pain. About 10 to 25 percent of people with low back pain have a problem with their sacroiliac joint.

11. Arthritis

Arthritis is a disease that causes pain and stiffness in your joints. There are about 100 different types of arthritis, which together affect more than 54 million Americans.

Some types are caused by a gradual wearing down of the joints with age and activity. Others are due to an immune system attack on the joints.

Arthritis in the hip joint can cause pain that radiates to the buttocks. The pain and stiffness may be worse in the morning, and gradually improve as you move the joint. Medication and physical therapy can help with pain management.

12. Vascular disease

The aorta is the main blood vessel from the heart. It splits into two smaller vessels called the iliac arteries that then continue to get smaller and bring blood to the legs. A blockage in these blood vessels from atherosclerosis can cause buttock pain.

The pain occurs when walking and can be achy in nature. It may force you to stop walking, after which the pain goes away. There can also be weakness and hair loss in the lower legs.

What treatment options are available?

To treat pain in your buttocks, you should see your primary care provider, a rheumatologist, or an orthopedic specialist. Your doctor will tailor your treatment to the cause of your pain.

Your doctor may recommend:

• corticosteroid injections to bring down inflammation
• physical therapy to help strengthen the muscles around the injury and improve range of motion in the affected area
• a procedure to drain a cyst or abscess
• surgery to repair a damaged disk or replace a worn-down joint

Home remedies can help relieve your symptoms until a treatment plan is in place.

When to see your doctor

If the pain hasn’t improved in a few days or it’s getting worse, see your doctor. They’ll perform a physical exam and possibly take imaging tests, such as X-rays, to look for the cause of the pain.

Once your doctor knows what’s behind your buttocks pain, they’ll work with you on a treatment plan suited to your needs.