Pain from the lower back and sciatica
The lower back often refers pain into the buttock. When a disc or narrowing irritates a nerve root, pain can travel down the back of the leg, sometimes with tingling, numbness or weakness, and is often worse with sitting, bending or coughing.
Sacroiliac joint pain
The sacroiliac (SI) joints connect the base of the spine to the pelvis. SI joint pain is felt low in the buttock, near the dimple, usually on one side, and may spread to the groin or thigh. It is common in pregnancy, after falls and in people with inflammatory arthritis.
See SI joint stretches.
Gluteal tendinopathy and bursitis
The gluteal tendons attach to the outer hip bone. Gluteal tendinopathy causes pain on the outer hip and buttock, worse lying on that side, climbing stairs, standing on one leg and crossing the legs. It is most common in women over 40.
See hip bursitis and hip pain while sleeping.
Hamstring tendinopathy and the sitting bone
Pain deep in the lower buttock at the sitting bone (ischial tuberosity), worse with sitting on hard surfaces, running uphill, lunges and bending forward, often comes from the hamstring tendon attachment. It is common in runners.
See sore bum bones and hamstring tendonitis.
Piriformis syndrome
The piriformis muscle runs deep in the buttock close to the sciatic nerve. Piriformis syndrome describes deep buttock pain, sometimes with sciatica-like symptoms, worse with sitting and climbing stairs. It is diagnosed after other causes are considered.
See piriformis syndrome.
Other causes
- Gluteal muscle strain after sport or lifting.
- Coccyx (tailbone) pain, felt at the base of the spine when sitting.
- Hip joint problems, usually felt in the groin but sometimes the buttock.
- Bruising after a fall.
- Rarely, infections, circulation problems or tumours.
How the source is found
A physiotherapist or doctor asks where exactly the pain is, what makes it worse and whether there are nerve symptoms, then examines the back, hips, SI joints and tendons with specific tests. Imaging is not usually needed, but ultrasound or MRI may help when symptoms persist.
What helps
- Reduce, but do not stop, aggravating activities.
- Sit on a cushion and change position often.
- Use heat to relax tight muscles.
- Sleep with a pillow between the knees.
- Take simple painkillers if appropriate.
- Keep walking within comfort.
Exercises for buttock pain
- Glute bridges: lift the hips from lying on your back.
- Side-lying leg lifts or isometric hip abduction for gluteal tendinopathy.
- Hamstring isometrics pressing the heel into the floor.
- Clamshells with a band.
- Gentle piriformis stretch if it eases symptoms.
- Walking and gradual return to running.
Avoid deep stretching of irritated tendons, which can make tendinopathy worse. See hip mobility exercises.
Managing sitting pain
Many types of buttock pain worsen with sitting. Use a supportive cushion, avoid very low or hard seats, keep the hips slightly higher than the knees, avoid crossing your legs and stand up every 30 minutes. For coccyx pain, a wedge or cut-out cushion can help.
Buttock pain in runners and active people
Runners commonly develop buttock pain from hamstring tendinopathy, gluteal tendinopathy or referred pain from the lower back. A sudden increase in mileage, more hill running, speed work or a change in shoes often comes before symptoms. Reducing volume and hills for a few weeks while keeping some running, and adding strength work for the hamstrings and glutes twice a week, usually allows a gradual return.
Track pain during and the day after running: pain up to about 3 out of 10 that settles by the next morning is generally acceptable while you rebuild.
Buttock pain in pregnancy
Pelvic girdle pain is common in pregnancy and can be felt in the buttocks, over the sacroiliac joints and at the front of the pelvis. Keeping the knees together when getting in and out of the car or bed, avoiding standing on one leg, taking stairs one at a time and specific physiotherapy help. A pelvic support belt suits some women.
When to seek urgent help
- Loss of bladder or bowel control or difficulty passing urine.
- Numbness around the genitals, buttocks or inner thighs.
- Weakness in the legs.
- Fever, unexplained weight loss or night pain.
- Severe pain after a fall, especially in older adults.
Key points to remember
- Buttock pain often comes from the lower back, SI joint, gluteal tendons or hamstring.
- Pain down the leg with tingling suggests sciatica.
- Targeted strengthening and activity changes help most people.
- Bladder or bowel changes and saddle numbness are an emergency.
Questions about buttock pain
These answers are general information and do not replace an examination or individual medical advice.
Why does my buttock hurt when I sit?
Hamstring tendinopathy, piriformis syndrome, sciatica and coccyx pain commonly worsen with sitting.
Is buttock pain sciatica?
Sometimes. Sciatica usually spreads down the leg below the knee, often with tingling.
Can a tight piriformis cause buttock pain?
It can contribute, though other causes should be considered first.
What exercises help buttock pain?
Glute bridges, side-lying leg lifts, clamshells and walking help many people.
How long does buttock pain last?
Many cases improve within weeks; tendon problems can take a few months.
Should I stretch a painful buttock?
Gentle stretches may help some causes, but deep stretching can irritate tendons.
When is buttock pain serious?
With bladder or bowel changes, saddle numbness, leg weakness, fever or night pain.
Can sleeping position cause buttock pain?
Lying on the painful side can aggravate gluteal tendinopathy; a pillow between the knees helps.
Does buttock pain need an MRI?
Usually not; it is reserved for persistent symptoms or warning signs.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.