Pain in the buttock often appears as a result of pinching of the sciatic nerve by the piriformis muscle - a group of muscle fibers that begin in the sacrum area inside the pelvis and are attached by the lower tendon end to the femur. This muscle is responsible for external rotation of the hip and foot. Piriformis syndrome often accompanies degenerative changes in the discs of the lumbosacral region with the formation of a picture of radiculitis.
Doctors at the Osteomed Clinic in St. Petersburg almost daily observe manifestations of piriformis muscle syndrome, since lumbar osteochondrosis is the most common spinal problem in patients, regardless of their gender or age. And although pain in the buttock itself is not dangerous, it signals other disorders that need immediate correction. Experienced specialists conduct examinations and advise patients on this matter after making an appointment in advance.
Checklist against illness
The first thing that will help determine the disease is the symptoms. Clarification is needed for pain in the back of the thigh: it is pulling in nature, shooting, is constant, occurs in some poses, increases/decreases with movement, and so on. In this case, it is important to understand whether the buttock or the back of the thigh underneath it hurts. This may be accompanied by:
- pain in the buttock when sitting;
- burning sensation in the thigh and buttock;
- painful sensations on the outer or inner side of the lower leg;
- pain and/or partial loss of sensation in the foot.
All these sensations can be observed only on one leg or on both legs at once. In the second case, it is important to note whether the intensity of the pain is the same.
When recording symptoms, it is necessary to note whether they are somehow related to postures during work and rest. For example, if you slept on your right side and you feel tolerable, but if you slept on your left, it’s difficult to even get up.
You should also note any unusual sensations. A feeling of heat in the feet and even sudden sweating of the feet will definitely interest a good neurologist or vertebrologist.
Why do my buttocks hurt?
Traumatic injuries
The most common traumatic cause of the development of the symptom is a bruise.
The injury occurs as a result of a fall on the buttocks and is more common in winter. It is characterized by moderate pain, gradually subsiding over several days, swelling, and bruising. Movements are not impaired or slightly impaired. With severe bruises or impacts with a hard object on the gluteal region, hematomas are formed. The pain is initially pressing and aching, later bursting, and increases with continued bleeding into the hematoma cavity. During the examination, local dense edema is detected. Subsequently, the pain decreases and a fluctuating formation forms.
Local infectious processes
In the buttock area, superficial and deep pyoderma are often detected. This area is a common localization of ecthyma vulgaris. With superficial pyoderma, the pain is insignificant or moderate, combined with itching and burning. The buttock swells, phlyctens, bullous rashes or pustules form on it. Purulent foci open with the formation of erosions, the pain becomes raw. A secondary infection may occur with the development of a severe purulent process.
Of the deep pyodermas on the buttocks, boils and carbuncles are most often found. They are accompanied by rapidly growing pain, which after 1-2 days becomes tugging, bursting, throbbing, and deprives sleep. The degree of disturbance of the general condition depends on the size of the purulent focus. A limited dense swelling of a purple hue with one or several rods in the center is determined. After the abscess has matured, the rod is surrounded by a yellowish rim. Palpation is sharply painful, fluctuation is detected.
The buttock area is the most common location for post-injection abscess. The onset of a purulent process may go unnoticed, since after an injection a painful infiltrate normally forms. A distinctive feature of an abscess at the initial stage is the intensification, rather than subsidence, of pain. Subsequently, the injection site turns red, swells, and the pain becomes twitching and pulsating. It becomes impossible to sit on the buttock. Symptoms of intoxication and general hyperthermia are revealed.
Pararectal dermoid cysts are sometimes localized in the buttock area. In the absence of infection, the disease is asymptomatic or manifests itself as minor pressing pain. When suppuration occurs, the pain becomes sharp, bursting, pulsating, disrupts night sleep, and is accompanied by weakness, fatigue, hyperthermia, and symptoms of intoxication. Palpation reveals sharp pain.
Purulent bursitis develops when the mucous bursa located between the gluteus maximus muscle and the posterior surface of the greater trochanter becomes infected. It manifests itself as symptoms of a deep abscess: increasing pain, increased temperature, deterioration of general condition, limitation of movements. Due to the deep localization of the bursa, it may be difficult to determine the type of abscess.
In bedridden patients, bedsores form on the buttocks. Pain syndrome is noted already in the initial stages of bedsore formation, but due to its insignificant severity, it often goes unnoticed. Possible burning, itching, discomfort, increased local sensitivity.
Buttock pain
Joint diseases
The symptom is often observed with arthritis of the hip joint. The disease develops gradually. Initially, patients are bothered by dull aching pain in the buttock, groin area, and on the outside of the joint. Subsequently, pain becomes the cause of limited movements, gait disturbances, and the appearance of lameness. The pain intensifies after being in a stationary position. The following pathologies may be the cause of pain:
- Specific infections
: tuberculosis, brucellosis, syphilis, gonorrhea. - Secondary aseptic arthritis
: Crohn's disease, SLE, psoriasis. - Reactive arthritis:
after urogenital (mycoplasmosis, ureaplasmosis, chlamydia) and intestinal (yersiniosis, dysentery, salmonellosis) infections.
Dull, transient pain can be observed in various forms of seronegative spondyloarthritis, including ankylosing spondylitis, Reiter's disease, Behçet's syndrome, and chronic intestinal diseases. Soreness in the upper outer quadrant of the buttock is typical of inflammation of the sacroiliac joint. Features of the symptom are determined by the type of sacroiliitis:
- Purulent
. There are sharp, rapidly growing pains in the buttock, abdomen and lower back, intensifying with hip extension. The body temperature is elevated, the condition is serious. - Aseptic
. Identified in rheumatic diseases. Accompanied by moderate or mild pain in the buttock, radiating to the thigh, worsening at rest, weakening during movement. - Tuberculous
. Moderate pain without clear localization, stiffness, and local hyperthermia are detected. Over time, a leaky abscess often forms on the thigh.
Soft tissue pathologies
Myalgia in the gluteal muscle area develops after significant exercise, usually during sports training. They have a tugging, sometimes burning character. They sharply intensify at the beginning of movements, subside a little after warming up, a light massage, or a short warm-up. They persist for 2-3 days and gradually disappear.
Biceps tendonitis is more common in runners. Accompanied by deep pain in the buttock, radiating down the back of the thigh. At first, the symptom bothers you only during intense exercise; later it occurs with any movement, and is sometimes observed at night. With enthesopathy of the ischial tuberosity, pain is localized at the point of attachment of the muscle to the bony protrusion, initially mild, and subsequently progressive.
Bursitis of the ischial bursa of the gluteus maximus muscle is manifested by pain in the projection of the buttock, which intensifies when sitting on a hard surface or bending forward. It develops with repeated trauma (falls on the buttocks, pressure and blows to the buttocks), and is more often diagnosed in figure skaters and people involved in equestrian sports.
Neurological diseases
Pain in the buttock is typical of radicular syndrome, which is observed in a number of spinal diseases. It has an aching, burning, baking, shooting character, depends on the position of the body, is combined with paresthesia, in severe cases - with paresis, hyporeflexia, and sensory disturbances. Detected in the following diseases:
- Degenerative
: lumbar osteochondrosis, disc hernias and protrusions, spondyloarthrosis, spondylosis. - Developmental anomalies
: sacralization, lumbarization. - Injuries
: conditions after fractures of the lumbar vertebrae, traumatic spondylolisthesis. - Tumors
: primary and metastatic neoplasms.
The cause of radicular syndrome can also be infectious processes: tuberculosis, syphilis, spinal osteomyelitis, spinal meningitis. In addition, burning, shooting, pulling, cerebral, baking pain in the buttock, radiating along the back surface of the limb, is found in such neurological pathologies as:
- sciatic nerve neuropathy;
- lumbosacral plexitis;
- gluteal muscle syndrome.
Other pathologies
Other diseases associated with pain in the gluteal region include:
- Positional compression syndrome.
Occurs when sleeping for a long time in an uncomfortable position while under the influence of drugs or alcohol. It can cause the development of acute renal failure, which is life-threatening due to a significant array of damaged gluteal muscles. - Chronic pelvic pain syndrome (CPPS)
. Painful sensations in the buttock are radiating in nature and are observed in many diseases of the female genital organs: oophoritis, adnexitis, salpingitis, endometritis, myoma, ovarian cyst. Sometimes they are diagnosed with urological pathologies and gastrointestinal diseases: cystitis, urolithiasis, colitis. - Leriche's syndrome.
At first, the pain in the buttocks is minor, nagging. Subsequently, intense pain occurs during walking and causes intermittent claudication. In the final stages, pain is noted even at rest. - Dercum's disease.
Along with the buttocks, stabbing, burning or aching pain appears in the hips, shoulders, and abdomen. Multiple lipomas are detected. - Mental disorders
. Soreness in the gluteal area can be detected in hysteria, depression, certain diseases accompanied by senestopathies, sensory hallucinations.
The investigation is being conducted by a vertebrologist
The first and most important part of the diagnosis is interviewing the patient. For example, if a patient told the doctor: “My buttock hurts when I sit,” then the sciatic nerve is probably to blame. If the patient has not had injuries to the hip, pelvis, coccyx area, or unsuccessful intramuscular injections, the doctor will suggest sciatica - pinching of the sciatic nerve somewhere between the 4th lumbar vertebra and the sore spot. The most common culprit is a spasm of the piriformis muscle, through which this nerve passes. But it happens that problems are associated with the 5th lumbar or the first three sacral vertebrae, the hip joint, tumors, or even changes in the pelvic area during pregnancy (including early stages). The same diagnostic algorithms are available for pinched other nerves.
The doctor then examines the patient. He determines which muscles are tight, how the patient reacts when certain points are pressed, and conducts standard neurological tests. Next, an examination is scheduled. Depending on the results of the survey and examination, the following may be prescribed:
- x-ray in two projections;
- computed tomography (CT);
- magnetic resonance imaging (MRI).
Usually they start with an x-ray. A CT scan will be needed if there is a suspicion of a fracture, and an MRI will be needed if it is necessary to exclude herniated discs or changes in soft tissues. Additional studies - blood tests, electrocardiogram, ultrasound and others - are prescribed if the doctor suspects non-neurological causes of pain or wants to make sure there are no contraindications to certain prescriptions.
Lower back pain radiating to the leg
The pain effect occurs in the sacrum and throughout the back, with pain in the right hip joint or left hip joint. The reasons for these sensations may be:
- pathologies of the musculoskeletal system - osteoporosis, vertebral hernia, trauma, the presence of osteophytes, inflammation of cartilage tissue and muscles, pinching of the sciatic nerve;
- diseases not associated with a disorder in the structure of the spine - improper blood circulation, spinal cord tumors, meningitis, osteoarthritis of the hip joint;
- proximal neuropathy of the asymmetric type - formed against the background of diabetes mellitus or due to the accumulation of blood behind the wall of the abdominal cavity, accompanied by pain in the hip joint on the right and muscle atrophy;
- sciatica – characterized by pain spreading throughout the lower limb.
Pain in the hip joint of the right or left leg is not the only possible scenario. In some pathologies, pain affects other areas of the body, for example:
- Lower back pain radiating to the leg - complete analysis, causes, treatment and prevention
- if the pain syndrome affects the sacrum, we can talk about the development of an inflammatory process in this section and nearby areas;
- damage to the radicular part of the spinal cord is accompanied by pain in the lower back that does not extend to the legs;
- pinching of the sciatic nerve is characterized by the localization of pain in the lower back, then it descends to the buttocks and limbs.
Four ways to help
Let's figure out how to treat pain in the buttock that radiates to the leg if it is determined that the disease is associated with the spine or muscles. There are several ways to help such patients.
- Drug therapy is usually used in the early stages and includes the prescription of vitamins, microelements, medications that relieve muscle spasms, and anti-inflammatory and painkillers. Unfortunately, ointments, tablets and injections most often cannot cure a patient, but in the first stages they help relieve an acute condition.
- Physiotherapy - the use of electromagnetic fields (magnetotherapy) and weak currents (electrophoresis) are considered the main methods, although other procedures are also possible. Their goal is to relax muscles and relieve inflammation.
- Massage, manual therapy and osteopathy are the three main methods of treatment. This is not only about relaxing muscles and restoring blood flow. With the help of these methods, it is possible to correct your posture, and this reduces the likelihood of relapse of the disease.
- Movement treatment: physical therapy, special rehabilitation complexes on suspension systems help consolidate the result and give the back and abdominal muscles the strength necessary to keep the spine in the correct position.
There is no universal treatment for pain in the buttock that radiates to the leg. The doctor prescribes treatment individually. Good news for pregnant women who often suffer from back pain: there are effective ways to treat their spine and joints for them too.
Diagnosis of the causes of lumboischialgia
When pain in the lower back radiates to the leg and buttock, you need to consult a chiropractor or neurologist. Our center’s specialists use an integrated approach to diagnosis and treatment, so they can quickly make the correct diagnosis. Diagnosis begins with a survey of the patient, during which the nature of the complaints, as well as the characteristics of work and rest, are clarified. The doctor must carefully examine the patient, palpating the spine, as well as conducting special functional and neurological tests. This allows you to get a complete picture of the patient’s condition, detect signs of neurological deficit and assess the extent of damage.
In order to establish the exact cause of lower back pain radiating to the leg and buttocks, instrumental diagnostic methods are prescribed. They almost always start with assessing the condition of the bones, intervertebral discs, ligaments and muscles of the spine. For this purpose the following are assigned:
- X-ray;
- CT;
- MRI.
The most complete and accurate picture of the state of the soft tissue structures of the spine is provided by magnetic resonance imaging. The method involves conducting a study of the body using powerful magnetic fields that do not have a negative effect on the human body. Therefore, it has practically no contraindications, with the exception of the presence of metal foreign bodies or implants in the body. If there are any, the patient is referred to a CT scan or x-ray. But only MRI allows one to determine the size of protrusions and intervertebral hernias with millimeter accuracy and detect the slightest degenerative-dystrophic changes in the discs, as well as signs of compression of nerve structures.
In our clinic you can also learn in more detail about the composition of your body and the state of the vascular system, which is involved in the blood supply to internal organs, musculoskeletal muscles, and the brain. Our experienced doctors will explain the data obtained to you in detail. Bioimpendansometry calculates the ratio of fat, muscle, bone and skeletal mass, total fluid in the body, and basal metabolic rate. The intensity of recommended physical activity depends on the state of muscle mass. Metabolic processes, in turn, affect the body's ability to recover. Based on the indicators of active cell mass, one can judge the level of physical activity and nutritional balance. This simple and quick test helps us identify disturbances in the endocrine system and take the necessary measures. In addition, it is also very important for us to know the condition of blood vessels for the prevention of diseases such as heart attacks, hypertension, heart failure, diabetes and much more. Angioscan allows you to determine such important indicators as the biological age of blood vessels, their stiffness, stress index (which indicates heart rate), and blood oxygen saturation. Such screening will be useful for men and women over 30, athletes, those undergoing long-term and severe treatment, as well as everyone who monitors their health.
In this case, body composition analysis gives us information that adipose tissue predominates in the body, and the bone-muscle component is in relative deficiency. These data will help the rehabilitation doctor competently draw up a physical activity plan, taking into account the individual characteristics of the patient.
If during the examinations no abnormalities in the condition of the spine are found, the patient is referred for consultation to a proctologist, gynecologist or urologist, since pain in the lower back radiating to the leg and buttock can be accompanied by proctitis, paraproctitis, prostatitis, adnexitis, uterine prolapse, prostate adenoma and other similar diseases.
Features of the treatment of pain of different types
Treatment methods are selected depending on the established diagnosis. To temporarily relieve pain, you can take a painkiller. It will only act for a short time. Since the cause is not eliminated, the unpleasant sensations return again.
Most often, for diseases of the articular system, doctors prescribe conservative therapy. Medications are prescribed - steroidal or non-steroidal anti-inflammatory drugs, vasodilators, chondroprotectors, vitamin complexes. Additionally, physiotherapeutic procedures are prescribed.
If the disease is at an advanced stage of development, conservative therapy may be ineffective. In such a situation, doctors consider the advisability of surgical intervention. For bursitis, removal of fluid from the periarticular bursa is indicated. For infectious diseases, in addition to basic therapy, antibacterial drugs are prescribed.
Diagnosis and treatment of pain in the butt
The treatment process for pain in the buttocks depends entirely on the nature of the pathology. The patient needs to see a proctologist and attend an initial consultation. The doctor will examine the affected organ and perform palpation. If purulent discharge, bleeding and infectious processes are detected, then we suggest performing an operation to remove anal fissures.
For pain in the butt resulting from an injury, the patient is prescribed painkillers and warming ointments that can relieve swelling. Non-steroidal medications relieve pain and promote rapid healing of soft tissues.
For boils, patients are prescribed Vishnevsky ointment and ichthyol ointment. In untreated cases, medical workers use massages, warm compresses, and physical therapy.
After consulting a doctor, the patient begins to engage in physical therapy. Improves muscle tone and strengthens. Doctors at the private clinic “KDS Clinic” have developed a special gymnastic system that will relax injured muscles and reduce pain.
Prevention measures
In order to reduce the likelihood of acute pain in the buttock and leg, you need to take care of your spine. This concern is realized in a system of prohibitions and recommendations.
The prohibitions consist of observing the following rules:
- do not overload your spine by carrying heavy objects and uncomfortable body movements;
- avoid prolonged hypothermia, especially in the legs and lower back;
- do not wait for acute pain to appear, take action if you feel discomfort in the lower back, buttocks and back of the legs;
- Avoid salty, spicy and fatty foods.
Following these rules will reduce the risk of lumbago, radiculitis, osteochondrosis, sciatica and other unpleasant diseases accompanied by acute pain and decreased mobility.
For those who have repeatedly suffered from these diseases, there is one more piece of advice - take chondroprotectors not only during an attack, but periodically, for example, once a year or, if necessary, more often. This will constantly maintain the integrity of the cartilage tissue in the joints and spine. As a result, you will further reduce the risk of unpleasant symptoms.
Treatment
If your tailbone and left buttock hurt, or the pain spreads more widely, you should consult a doctor. Treatment is selected individually, based on the patient’s complaints and diagnostic results. Pain syndrome in the area of the coccyx and buttocks is usually treated with conservative methods; if necessary and in extreme cases, surgical intervention is prescribed. Conservative treatment is aimed at relieving pain, eliminating the causes of pain and consolidating the result. Various methods are used for this.
Pain relief
Pain relief is carried out by prescribing non-steroidal anti-inflammatory and analgesic drugs, as well as using novocaine blockades in painful areas. Anti-inflammatory drugs can be microenemas, suppositories and tablets. A special approach to treatment is selected for pregnant women.
Physiotherapy
Physiotherapeutic procedures include various procedures: mud therapy, ultrasound, electrotherapy, laser therapy, UHF, darsonvalization, etc. For each patient, the number and type of methods are selected individually and adjusted if necessary to achieve the best result.
Physical therapy methods
Exercises for pain of varying intensity and nature in the tailbone and buttocks, or exercise therapy, are prescribed to strengthen the muscle corset and health in general. The number and type of exercises are also determined individually. Exercises can be performed by coming to classes in groups or at home, but having previously received all the necessary instructions and checked the correctness of their implementation with a specialist. Any actions that will put stress on the spine are excluded from physical activity - running, jumping, fast walking, lifting weights, etc.
