Buttock pain

The buttocks are located below the lower back and are formed from subcutaneous fat superimposed on large muscles. These muscles are called the gluteus maximus, the gluteous medius and the gluteus minimus muscles and are located in both the left and right buttock. The gluteus maximus muscles are the largest in the human body. 

The buttock muscles are responsible for achieving the upright posture when the body is bent at the waist, maintaining the body in the upright posture by keeping the hip joints extended, and helping to propel the body forward when walking or running. When you are seated, the buttocks bear the weight of your upper body and take the weight off your feet. 

Buttock pain is a common complaint within the population and it afflicts both the athletic and those that are not. You may feel pain in buttocks when walking or buttock pain when sitting for long periods. You may also feel localised pain in the right buttock cheek or pain in the left buttock cheek.  

Healthcare professionals often find the complaint difficult to diagnose because there are a wide variety of causes. Diagnostic tests, such as CT scans and blood tests, are not particularly good at discovering the cause of pain in the buttocks and should not be seen as a substitute for professional medical advice from a specialist orthopaedic spine or hip surgeon. 

There are many reasons why you might be experiencing buttock pain. It can be the result of trauma from an injury, a pulled muscle or damage to the sciatic nerve. These are the most common causes:

The hip joint as the cause of buttock pain

The two main causes of hip and buttock pain that arise from the hip joint are age-related changes, known as hip osteoarthritis, and a hip labral tear. The pain may be more pronounced when you are lying on your side.

In most cases these conditions will be characterised by pain in the buttock and groin region. Sometimes the pain may be in the outer or front thigh. However, in some cases, normally when there is a significant defect towards the back of the hip joint, these two conditions can result in buttock pain in isolation.

If the hip joint is suspected to be the cause of buttock pain, x-rays from specialist angles and an MRI scan, possibly with contrast dye injected in to the hip joint (MR arthrogram) may be requested.

Spinal causes of buttock pain

The joints and soft tissue structures (ligaments and joint capsules) of the lower spine may all refer pain in to the buttock region. You may be feeling lower back and buttock pain or there may be pain in top of buttocks.

This referred pain is due to the body’s central nervous system being unable, in some cases, to distinguish the exact location of the problem and can occur with all musculoskeletal tissues, such as a spinal stenosis which is the result of a herniated disc.

The second way that a lower spinal problem can cause buttock pain is when there is irritation or compression of the sciatic nerve which runs through the buttock. In these cases, there may be associated pins and needles, tingling or further pain throughout the affected leg.

With suspected spinal causes of buttock pain a consultant orthopaedic specialist will often request an MRI scan to help to confirm the exact tissue responsible.

Muscular and tendinous causes of buttock pain

Buttock pain can arise from the muscles and tendons of this region, such as pain in the buttocks and legs. This can be due to the gluteal muscles or the uppermost tendon of the hamstring muscles, which attach to the sitting bones of the pelvis.

Typically, if these structures are the cause, then the pain will be aggravated with prolonged sitting, or active tasks when the muscles and tendons are placed under load such as sports activity or climbing stairs when you may feel a sharp pain in the buttock.

Diagnostic scans for muscular and tendon causes of buttock pain often only demonstrate normal changes to these structures with age. Therefore, an orthopaedic specialist may only in specific circumstances request an ultrasound scan.

Other causes of buttock pain

Several other rare causes of buttock pain exist. Some of these causes will be related to medical problems inflaming the soft tissue around the pelvic area (autoimmune diseases).

A further diagnosis which often poses difficulty for clinicians is a condition known as piriformis syndrome. The piriformis is a deep gluteal muscle which runs from the pelvis to the outer hip bone.

As it passes through the middle of the gluteal region this muscle runs in close proximity to the sciatic nerve. Anatomical variants exist among the population but sometimes the nerve passes to one side of the muscle but in others the nerve can pierce the central portion of the piriformis muscle.

In these cases, the sciatic nerve can become irritated by the muscle causing familiar buttock pain which may run down the back of the thigh and calf. It is thought that this condition may be triggered by unaccustomed hip movements or exercises which may lead to tightness or enlargement of the piriformis muscle.

Piriformis syndrome is not reliably diagnosed by scans and as such, under normal circumstances a specialist will refer on to a physiotherapist for treatment.

The symptoms will vary depending on the location of the pain in the buttocks. The most common symptoms are:

• Bruising
• Restricted range of motion
• Ambulatory difficulties, when you find it difficult to walk
• Shooting pain in the lower back
• Muscle weakness
• Snapping or popping sensation
• Swelling of the buttocks

Buttock pain treatments are dependent on the underlying causes. Due to the difficulty in diagnosing the cause of buttock pain, a consultation with a specialist orthopaedic spine or hip surgeon can be helpful as the first step.  

In your private consultation, you will be able to discuss your symptoms with a consultant, who will provide a detailed provisional diagnosis as well as any relevant diagnostic scans before a follow up appointment is arranged to discuss the best onward treatment plan. 

An initial consultation for buttock pain will involve enquiring whether the pain arose from an injury or related to a particular task.  

The consultant will also locate the specific site of the buttock pain and will determine if there are any associated symptoms such as other areas of pain, pins and needles or tingling. A full medical screening will also be taken at the initial consultation. 

To confirm possible sources of buttock pain, the consultant will examine specific tissues around the spine and hips with certain physical examination tests. 

Once the cause of the pain has been identified then a treatment plan can be initiated for the condition. 

If you are in pain, over-the-counter pain medication may be of help. Ibuprofen, for example, is a non-steroidal anti-inflammatory (NSAID), which can help to reduce swelling or inflammation linked to the arthritis. 

Physical therapy may also help improve the range of motion and to strengthen the muscles surrounding the affected area. Strengthening exercises can relieve buttock pain caused by tight and inflamed muscles.  

Techniques to correcting posture can also reduce pain associated with poor posture. 

There are some circumstances when you may require surgery, such as when your range of motion has been reduced or you are experiencing long-term chronic pain. Surgery can also sometimes help to manage the related arthritis in a joint.