Buttock pain is a very common condition and is found to be ranging from 50% when it comes to corroborated numbers to 95% for reported numbers. The biggest condition that contributes to buttock pain is piriformis syndrome, which makes a total of 17.2% of patients among the overall patients with lower back pain. Buttock pain (1) is sometimes confused with back pain, especially in conditions like sciatica where the pain radiates from the lower spine towards the leg. Buttocks are one of the highest ignored parts of the body, but a pain experienced in the buttocks can reflect deeper health conditions and must be looked into further.
Anatomical Features of Buttocks
Buttocks are muscles called Gluteus Maximus in anatomy and are lined by several blood vessels and nerves that enable their movement and functions. It is a quadrangular-shaped muscle and is the largest of the three muscles that lie in this area. This muscle gives the exact shape to the hip, the other two being the Gluteus Minimus and Gluteus Medius. All of these muscles are together called “Glutes” or simply gluteal muscles. (2) Other muscles in this area include the piriformis muscle, femoral square, iliopsoas muscle, obturator internus muscle, upper and lower twins, hamstring muscle, and the small buttocks which can all contribute to the Buttock Pain.
Causes of Buttock Pain
Not only minor injuries and strains but also infections in the body can cause pain in the buttocks. A deep gluteal syndrome is a general term for characterizing chronic pain such as lower back pain, leg pain, and hip pain. The other most common causes are as follows:
Buttock Injury and Strained Muscles
Simple injuries can cause bruising in the buttock area where the blood vessels can get damaged. This will cause the blood to ooze out of the vessels onto the muscles making the skin look purplish-pink. Strenuous exercise and weightlift procedures can cause the buttock muscles to strain. Excessive stretching of the muscle can cause wear and tear of the muscle and result in muscle straining. (3) This bruising, bleeding, and strained muscle is often accompanied by swelling and lumping of the area.
Damaged Sciatic Nerve
Sciatica is a common condition with a prevalence of 13% – 40% in the general population. This involves the damage to the sciatic nerve and the patient suffers from extremely sharp and tingling pain moving from the lower back, hip, and thigh. (4) The cause of sciatica can be either nerve degeneration, a fall, or injury. Usually, elderly people, who are above the age of 40 are affected by this health condition.
Bursitis as a cause of buttock pain
Bursa is a fluid-filled sac found around the bones in our body. The role of these sacs is to protect the bones from severe injury by serving as a cushion. When a bursa is damaged or inflamed, there is a high chance of affected hip joint, elbow joint, and knee joints. The resulting pain usually starts from the lower back, towards the hip, and ends in the back of the thigh. The ischial bursa is located in the buttocks. Sitting on hard surfaces for a long period can cause this condition. (5)
Disc Herniation of the Vertebral Column
The vertebral column has several vertebrae, each of which is small bones joined by a fluid-filled pad to allow the bending of the spine without risk of fracture and spinal injury. These pads are called disks. In case of severe injuries, these discs can slip from their place or the outer coverage can get damaged, letting the gel-like material flow out. This can press on the nerves and cause buttock pain due to herniated disc. (6)
Spinal stenosis usually occurs in the lumbar spine which can also be a cause of buttock pain. It involves the narrowing of the spine and can compress the spinal nerves resulting in severe pain and impairment of the lower limb movements.
Degeneration of Discs
This is a condition observed with age. Hormonal imbalances and poor diet can also contribute to disk degeneration. Once you grow old, there is a high chance of disk degeneration and also subsequent bone and joint damage. It can result in low back pain, hip muscles, and thigh, causing numbness in the lower limbs and difficulty in walking. Patients of osteoarthritis can also cause disk degeneration.
Piriformis Syndrome as a cause of buttock pain
Piriformis is a muscle that initiates from the lower back and then runs down towards the upper thigh. This muscle is also innervated by the sciatic nerve. If damage to this nerve occurs due to severe injury, there is a chance of developing inflammation in the piriformis muscle. Overuse of piriformis muscle can cause piriformis syndrome as well. (7)
Sacroiliac Joint Dysfunction
The sacrum is the bone that joins with the base of the spine. (8) The sacroiliac joint when becomes inflamed can result in shooting pain running down your buttock region and upper leg. This condition is often misdiagnosed as low back pain but the dysfunction of this joint, leg pain, and joint pain makes this condition a little different from the others.
Symptoms and Diagnosis of Buttock Pain
The location and type of pain may vary from condition to condition. Sometimes, the patient is not able to perform regular activities like walking running, and stretching which indicates healthcare attention due to buttock pain. The ultimate goal is pain relief, but the physician must go through a complete diagnosis for detecting the cause of buttock pain. (9) The physician generally starts with a physical exam followed by a radiological exam. For hard tissues like bone and joints, an x-ray is the basic diagnostic test, but as the soft tissues like muscles, ligaments, and nerves are involved in most of the related conditions, a CT scan is the best diagnostic technique to opt for.
Treatment and Management
Muscle spasm causes pain that must be treated using pain medications and non-medicated ways.
Pain Medications
Anti-inflammatory drugs like ibuprofen work best for muscle spasms and deeper injuries. In case of mild muscle tears, over-the-counter medicines can work as well.
Other Therapies
In the case of piriformis syndrome, a piriformis stretch works very well. It is a physical therapy that stretches the piriformis muscle while lying on the back with legs straight. The range of motion allowed during buttock pain is assessed by physical therapists for a suitable recommendation of exercises. The treatment plan usually involves medicines as well as therapies combined for effective recovery. (10) If the condition is very severe and recovery is negligible, surgery is the last option suggested by orthopaedics.
Frequently Asked Questions
What does nerve pain feel like in the buttocks?
The nerve pain usually feels like a tingling sensation or a radiating pain that runs with the location of the nerve, usually from the lower back into the buttocks and down into the upper thigh.
How long can buttock pain last?
The buttock pain can last from days to weeks and even months, depending on the cause of buttock pain. For example, in the case of sciatic pain, the pain usually starts getting better in a period of four to six weeks.
Is buttock pain serious?
Buttock pains can be a mild condition that can heal on its own, and also be a problem that needs immediate medical attention. If the buttock pain is serious and consistent, you should get it clinically examined.
What causes severe pain in the buttocks?
Severe in the buttocks can be due to muscular spasms and compressed nerves. If there is a simple muscle tear, the mild pain will go away quickly, however, nerve-induced pain usually causes severe pain.
Is walking good for sciatica?
Interestingly, walking is a good way for relieving sciatic pain. Long-term sitting and staying in the same position worsen sciatica so walking is always preferred. This will not only help in reducing inflammation but also release endorphins that will ameliorate pain sensation.
What causes buttock pain sitting?
Vertebral herniation, degenerative discs, and sciatica are one of the few health conditions that can cause buttock pain while sitting. Minor injuries in the hip muscles can be a reason too, but you should visit your doctor if long-term sitting is aggravating the pain.
References
- Brukner, P. (1991). Buttock pain. Sports Medicine, Training and Rehabilitation, 2(3-4), 257–262. https://doi.org/10.1080/15438629109511924
- Schilling, J. F., & Wechsler, R. J. (1986). Computed tomographic anatomy of the buttock. Skeletal Radiology, 15(8), 613–618. https://doi.org/10.1007/bf00349854
- Vasudevan, J. M., Smuck, M., & Fredericson, M. (2012). Evaluation of the Athlete With Buttock Pain. Current Sports Medicine Reports, 11(1), 35–42. https://doi.org/10.1249/JSR.0b013e3182423d71
- E., K. (2021). Imaging of peripheral nerve causes of chronic buttock pain and sciatica. Clinical Radiology, 76(8). https://doi.org/10.1016/j.crad.2021.03.005
- Johnson, D. B., & Varacallo, M. (2020). Ischial Bursitis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482285/
- Kim, D.-S., Lee, J.-K., Jang, J.-W., Ko, B.-S., Lee, J.-H., & Kim, S.-H. (2010). Clinical Features and Treatments of Upper Lumbar Disc Herniations. Journal of Korean Neurosurgical Society, 48(2), 119. https://doi.org/10.3340/jkns.2010.48.2.119
- Kirschner, J. S., Foye, P. M., & Cole, J. L. (2009). Piriformis syndrome, diagnosis and treatment. Muscle & Nerve, 40(1), 10–18. https://doi.org/10.1002/mus.21318
- Slipman, C. W., Jackson, H. B., Lipetz, J. S., Chan, K. T., Lenrow, D., & Vresilovic, E. J. (2000). Sacroiliac joint pain referral zones. Archives of Physical Medicine and Rehabilitation, 81(3), 334–338. https://doi.org/10.1016/s0003-9993(00)90080-7
- Robinson, M. (2016). Clinical diagnosis and treatment of a patient with low back pain using the patient response model: A case report. Physiotherapy Theory and Practice, 32(4), 315–323. https://doi.org/10.3109/09593985.2016.1138175
- Kim, K., Isu, T., Chiba, Y., Iwamoto, N., Morimoto, D., & Isobe, M. (2016). Decompression of the gluteus medius muscle as a new treatment for buttock pain: technical note. European Spine Journal, 25(4), 1282–1288. https://doi.org/10.1007/s00586-016-4440-5