Colloquialisms aside, pain in the buttock area is no laughing matter. From an anatomical perspective, this area is highly complex with several muscles, tendons and nerves in addition to the bones of the pelvis and hip joint, and other soft tissues. All of these structures can potentially trigger buttock pain that could interfere with your daily activities and fitness pursuits.
The hip is a leading site of osteoarthritis, or degenerative arthritis, which typically occurs due to age- or injury-related wear and tear. Buttock pain proves very common with hip osteoarthritis and is second only to groin pain, according to a study published in 2004 in the Annals of the Royal College of Surgeons of England. Osteoarthritis-related buttock pain characteristically develops gradually and manifests as achiness, which is typically accompanied by joint stiffness.
Herniated Lumbar Disc
A herniated disc in lumbar section of the spine -- located in the small of the back just above the buttocks -- can cause referred pain in the gluteal area. When a disc herniates, it might compress the nerve roots emerging from the spine at the affected level. Gluteal pain most often occurs with a disc herniation at the L4/5 level, meaning the disc between the fourth and fifth lumbar spine bones. The pain might radiate down the back of the thigh and be accompanied by low back pain.
Sacroiliac Joint Disorder
The sacroiliac joints, or SI joints, join the sacrum bone at the base of the spine to the hip bones. SI joint disorders typically cause low back and upper buttock pain that might radiate down the back of the thigh. Sitting for long periods, bending forward and shifting body weight from one leg to the other -- such as when climbing stairs or using an elliptical trainer -- typically aggravate SI joint pain. Several SI joint disorders can provoke buttock and low back pain, including traumatic injury, arthritis and ligament strain. Pregnancy increase the risk for SI joint pain due to hormone-related loosening of the joint ligaments.
Muscle or Tendon Injury
The buttock area contains 8 muscles -- the glutes and the deep gluteal muscles -- as well as the tendinous attachments of the hamstring muscles of the thigh. A strain injury involving any of these muscles or tendons can trigger buttock pain. High hamstring tendon problems usually develop gradually and cause pain in the lower buttock area over the sit bone, or ischial tuberosity. Muscle strains occur more acutely. The specific location of the pain depends on the site of the strain injury.
The hip contains 4 bursae, fluid-filled sacs that cushion friction points. Bursitis refers to inflammation of one or more of these sacs. Inflammation of the gluteal or ischial bursa can cause pain in the buttock area. With gluteal bursitis, pain occurs in the upper outer buttock on the affected side. With ischial bursitis, pain occurs over the sit bone and might radiate down the back of the thigh.
Coccydynia refers to tailbone, or coccyx, pain. Tailbone pain and tenderness most frequently occurs due to traumatic injury, such as a backward fall. Coccyx pain can also occur after a vaginal delivery, particularly if the labor was long or difficult. Other causes of coccydynia include prolonged sitting on hard surfaces, arthritis and abnormalities of the joint that joins the coccyx and sacrum. Tailbone pain is aggravated by sitting, standing up and possibly moving the bowels.
Deep Gluteal Syndrome
Deep gluteal syndrome is an uncommon condition that causes buttock pain due to compression of the sciatic nerve in the gluteal area before it enters the pelvis. Sciatic nerve compression with deep gluteal syndrome can be caused by any of several structures, including the gluteal, upper hamstring or piriformis muscles, a blood vessel malformation or a tumor. In addition to buttock pain, symptoms might include numbness, burning or tingling in the gluteal area and possibly down the back of the thigh.
Next Steps and Precautions
See your doctor if you experience buttock pain that seems unrelated to muscle soreness to determine the cause and best treatment options. Seek medical care right away if your buttock pain is related to a traumatic injury or is accompanied by difficulty walking or bearing weight, or leg weakness.
- Annals of the Royal College of Surgeons of England: Hip Osteoarthritis: Where is the Pain?
- BMC Musculoskeletal Disorders: Which Level Is Responsible for Gluteal Pain in Lumbar Disc Hernia?
- Sports Health: Posterior Hip Pain in an Athletic Population -- Differential Diagnosis and Treatment Options
- Sports-Health: Chronic High (Proximal) Hamstring Tendinopathy
- Atlas of Uncommon Pain Syndromes, 3rd Edition; Steven D. Waldman
- The Ochsner Journal: Coccydynia: An Overview of the Anatomy, Etiology, and Treatment of Coccyx Pain
- Journal of Hip Preservation Surgery: Deep Gluteal Syndrome
- American Family Physician: Evaluation of the Patient with Hip Pain