The 3 major muscles of buttocks are known as Gluteus Maximus, Gluteus Medius and Gluteus Minimus. The gluteal muscles lie over posterior or back portion of the pelvic bone. Buttock is also often referred as gluteus. Pain in the butt is also known as gluteal pain or buttock pain. The Gluteus Maximus is the outermost muscle close to skin and Gluteus Minimus is innermost muscle that lies over back portion of pelvic bone and outer portion of sacrum. All three gluteal muscles help to extend, abduct (bring legs close to each other) and rotate the lower leg. Injuries and diseases of one of the three gluteus muscles cause gluteal pain or pain in the butt. The gluteal pain or pain in the butt is also observed in individual suffering with diseases or injuries of skin, subcutaneous tissue, nerves as well as pelvic bone.
Severe gluteal pain or pain in the butt in young obese and immunocompromised individual often is caused by skin disease like furuncles and carbuncles. The infection of skin and subcutaneous tissue over gluteal area in debilitating elderly and diabetic patient often causes rapid spread of infection in to deeper tissue resulting in cellulitis. Cellulitis spreads into deeper tissue like muscles and bone if not treated by appropriate antibiotics. Gluteal pain or pain in the butt caused by infection of subcutaneous tissue and muscles may result in clustered septic disease. Septic conditions over gluteal area spread as tiny abscesses, often seen among those living in crowded quarters with relatively poor hygiene. The gluteal skin and subcutaneous infection is mostly caused by bacteria known as Methicillin-resistant Staphylococcus aureus (MRSA).
What Can Cause Gluteal Pain or Pain in the Butt?
Gluteal Pain or Pain in the Butt Caused by Skin Abnormalities or Diseases
Gluteal pain or pain in the butt is very common due to furuncles. Furuncles are common on the buttocks. They are uncomfortable and may be painful when closely attached to underlying structures (e.g., on the nose, ear, or fingers). Appearance of a furuncle is a nodule or pustule that discharges necrotic tissue and sanguineous pus. Furuncle may be accompanied by fever and prostration.
Gluteal Pain or Pain in the Butt Caused Due to Carbuncle–
Carbuncle is formed by cluster of several hair follicle infections. Infection is caused by staphylococcal bacteria and causes high to low grade fever. The infection spreads to deeper tissue and causes scarring. The hair follicle infection spreads in deeper tissue and become abscess. The skin looks red and purulent. The abscess forms a lump and often shows oozing of pus. Carbuncle is a very painful disease and pain spreads in wide area. The infection is frequently associated with fever.
Gluteal Pain or pain in the butt can also be caused due to Impetigo. This condition is mostly observed in children and older patient who may be using diapers. The infection is caused by streptococcus pyogenes and staphylococcus aureus. The skin looks red and yellow because of pus within the blisters. Blister frequently ruptures and exposes underlying skin. The red skin is extremely painful at rest and when touched. In most patient the infection is spread to adjacent lymph node. The spread of infection causes lymph node enlargement. Enlarged lymph node is extremely painful and tender to touch during examination.
The decubitus ulcer is formed because of continuous pressure over the dependent skin resulting in decreased blood supply and tissue oxygenation of skin and subcutaneous tissue. The decubitus ulcer is also known as bed sore. Decubitus ulcer can cause severe burning pain in the gluteal region. Gluteal Pain or pain in the butt caused due to decubitus ulcer is observed in patients suffering with dehydration, paraplegia and prolonged lying on bed following surgery. The decubitus ulcer is also observed in patients suffering with debilitating diseases or multiple fractures. Gluteal blood supply is also compromised in older patient and patient using wheel chair, resulting in decubitus ulcer over gluteal muscles or around the buttocks.
Dermatomyositis is a disease of skin and muscles. Dermatomyositis of gluteal muscles causes severe pain over the buttocks and lower back. Gluteal pain or pain the butt caused due to dermatomyositis becomes severe while attempting to change the position from lying down to sitting or sitting to standing posture. Patients frequently feel severe pain in the glutes in the morning and would find themselves unable to get out of the bed without pain medications. The examination of dermatomyositis over the gluteal muscles or the buttock muscle reveals purple and red gluteal skin. The rash is often associated with muscle weakness. The muscles affected are gluteal and back muscles.
Pempigoid is a skin disorder often seen in patients suffering with autoimmune disease. The gluteal lesion causes severe pain and muscle spasm of gluteal muscles when lesion is touched or pressed. The lesion is not contagious. The disease is chronic and needs continuous on going treatment. The lesion often causes extremely severe burning blisters and itching around the gluteal region or around the buttocks. Gluteal pain due to pempigoid become severe and restricts movements if the blister ruptures and inflamed skin is exposed. The friction caused by cloth or pressure over Pempigoid lesion on the buttocks causes severe excruciating gluteal pain or pain in the butt. Inadequate and delayed treatment causes scarring and disfiguring skin.
Gluteal Pain or Pain in the Butt Caused by Abnormalities or Diseases of Subcutaneous Tissue
The subcutaneous tissue contains sweat gland, fat cells, sebaceous gland, hair follicle, fascia, blood vessels and nerve endings. Fascia within gluteal subcutaneous tissue is formed by thin band of collagen fibers. Fascia stabilizes subcutaneous tissue by binding soft tissues like sweat glands, hair follicles, blood vessels and nerves. The infection of gluteal soft tissue spreads within subcutaneous tissue and fascia that results in widespread severe gluteal pain or pain the butt. The bacterial infection resulting in severe inflammation spreads through fascia and adjacent subcutaneous tissue. Such infection results in destruction of gluteal subcutaneous tissue and forms necrosis if not treated promptly.1 Subcutaneous tissue necrosis causes severe intense gluteal pain which often does not respond to anti-inflammatory pain medications. The condition associated with necrosis of subcutaneous tissue is known as necrotizing fasciitis or hemolytic streptococcal gangrene. Bacteria known as Clostridia Myonecrosis cause the most damaging bacterial infection resulting in severe tissue damage and gluteal pain or pain in the butt. The infection caused by Clostrodial Myonecrosis eventually results in formation of gas. The gas spreads rapidly through subcutaneous and deeper tissue in patients who have lower immunity. This condition is often seen in patients suffering with cancer, alcoholism, HIV infection and diabetes mellitus.
Gluteal pain or pain in the butt due to Gluteal cellulitis is a serious condition caused by spread of bacterial infection within gluteal skin and subcutaneous tissue. Gluteal cellulitis causes severe gluteal pain. Intensity of gluteal pain is increased several fold when area of cellulitis is pressed or squeezed. Staphylococcus or Streptococcus bacteria cause infection. The delay of appropriate antibiotic therapy results in spread of the infection within the skin and subcutaneous tissue. The gluteal subcutaneous infection following skin abrasion, laceration and ulcer often results in cellulitis. Patient frequently suffers with high fever and severe gluteal pain. The excruciating gluteal pain is observed over the skin covering cellulitis. The skin becomes purple and warm. Symptoms and signs include redness, tenderness, swelling, and warmth of the affected area. Cellulitis is contagious and patient should be kept in isolation. The disease is aggressively treated with antibiotics.
Sebaceous Gland Infection
Gluteal Pain or pain in the butt can also be caused due to sebaceous gland infection. Infection of sebaceous gland results in enlarged cystic sebaceous gland. Sebaceous gland lies underneath the skin within the layer of dermis. Sebaceous gland secretes oily or waxy matter. The sebaceous gland becomes enlarged when channel of sebaceous gland is blocked or infected. The continuous secretion of sebaceous substance within the inflamed gland causes painful cystic swelling of the gland. The swollen infected gland adheres to hair follicle within subcutaneous tissue. Infected sebaceous cyst causes red and tender bump under the skin. Bump over the skin feels warm and painful. In advanced cases cheesy foul smelling material drains from cyst. Gluteal pain or buttock pain caused due to sebaceous gland infection is treated with surgical excision of cystic gland.
Gluteal Pain or Pain in the Butt Caused by Muscle Abnormalities or Muscle Injuries
Gluteus Muscle Spasm
Fall or blunt trauma of the gluteal area frequently triggers muscle spasm of gluteal muscle. The muscle spasm of Gluteal muscles causes severe gluteal pain or buttock pain. Gluteal pain intensity increases when individual makes an attempt to stand from sitting position. Patient suffering with prolonged illnesses often suffers with wastage of gluteal muscles. The weak gluteal muscles goes in to severe spasm during internal or external rotation of lower leg resulting in severe gluteal pain or pain in the butt. Long-distance runners often suffer with gluteal muscle spam and severe gluteal pain. The muscle spasm is also observed in individual when muscle is lacerated during contact sport or automobile accident.
Gluteus Muscle Tear
Torn gluteus muscle can cause severe gluteal pain or pain in the butt. The sudden twist and turn of lower leg during contact sports often causes gluteal muscle tear. Patient is often incapacitated and unable to walk or change position from sitting to standing or lying down to sitting. The skin over the gluteus muscle tear is often discolored and looks purple red. Patient’s ambulation and activities are restricted for 4 to 6 weeks. Patient often need walker to walk.
Gluteus Maximus Syndrome
The trauma or injury of gluteus Maximus muscle causes selective gluteal pain triggered in Gluteus Maximus muscle. The muscle is attached to coccyx. The spasm of muscles often causes pain referred to lower sacrum and coccyx. Patient suffering from gluteal pain due to gluteus maximus syndrome is unable to maintain sitting position and also unable to stand from sitting position. The symptoms are mostly observed on one side.
Gluteal Pain Caused Due to Piriformis Syndrome
The pain associated with piriformis syndrome is caused by irritation of sciatic nerve.2 Sciatic nerve passes through the piriformis muscles. The spasm, twist or injury of piriformis muscles causes sciatic nerve pinch. The pain caused by irritation or injury of sciatic nerve within piriformis muscles is known as Piriformis syndrome. Pain caused by piriformis syndrome is spread over buttocks, perineum and back of the lower leg.
Hamstring Muscle Pain
Hamstring muscles are spread over back of the upper thigh and lower gluteal area. Hamstring muscle pain is caused by muscle spasm, muscle sprain and muscle tear. Gluteal pain caused due to hamstring muscle pain is excruciating and restricts patient’s activities. In few cases patient is unable to walk or even step forward. Pain is observed over back of upper thigh and lower gluteal area. The painful area is tender and pain becomes severe following examination of the muscles.
Gluteal Pain or Pain in the Butt Caused by Never Abnormalities or Nerve Injury
Lumbar Radicular Pain
Gluteal pain or pain in the butt can be caused due to lumbar radicular pain. Radicular pain caused by irritation of third, fourth and fifth lumbar nerve spreads over gluteal area and lower leg. The irritation of lumbar nerve L4/L 5 by disc herniation causes severe pain over gluteal area.3
Gluteal Pain Caused Due to Facet Pain
Irritation of the medial branch of posterior spinal nerve of lower facet joint causes facet pain.4 Facet pain of lower 3rd to 5th lumbar vertebra is spread over gluteal area and back of upper thigh. The pain is increased when back is bent backward and while sitting as well as walking.
The group of lower lumbar and upper sacral nerve forms sacral plexus.5 One of the major bundle of nerves of sacral plexus is known as sciatic nerve. Irritation or injury of lower lumbar nerve, upper sacral nerve or sacral plexus causes sciatica pain. Sciatica pain is also frequently seen following irritation or injury of sciatic nerve. Sciatica pain is always observed over lower gluteal area and back of the lower leg. The nerves of sacral plexus are frequently irritated within spinal canal or vertebral column because of disc bulge, herniation or foraminal stenosis. Sciatic nerve outside spinal canal may be injured following work or auto injury. The partial laceration or complete transaction of sciatic nerve causes severe gluteal pain or pain over buttocks and lower leg.
Gluteal Pain Caused by Pelvis Bone Abnormalities or Injuries
Fracture of Ilium and Sacrum
Pelvis girdle is formed by four bones known as pubic, ischium, ilium and sacrum. Fracture or injury of Ilium and Sacrum causes severe gluteal pain or pain in the butt spread over gluteal area either left or right side depending on side of the injury. Pain is often severe and increased during sitting and lying down.
Sacroiliac Joint Dislocation or Injury
A person may experience gluteal pain due to sacroiliac joint dislocation or injury. Sacroiliac joint is formed by approximation or fusion of sacrum and ilium. Sacroiliac joint inflammation, injury, dislocation or fracture causes severe pain, which is spread over buttocks and back upper thigh. Pain is increased with extension and rotation of lower leg.
Gluteal Pain or Pain in the Butt Caused by Hip Joint Abnormalities or Injuries
Hip Joint Arthritis
Hip joint inflammation is caused by osteoarthritis, rheumatoid arthritis, psoriatic arthritis, or septic arthritis. The pain caused by hip arthritis spreads over groin and gluteal area. The gluteal pain is spread over middle of gluteal muscles and spreads to upper thigh. Gluteal pain often becomes severe during lying down and change of position from sitting to standing. Gluteal pain become intolerable when patient is going up and down the staircase. Pain restricts activities and ambulation of the patient.
Hip Joint Fracture
Hip joint fracture is observed following fall from height and automobile accident. Hip Joint fracture causes severe pain all around the pelvis, groin, gluteal dermatome and leg. The posterior dislocation of hip joint causes hard swelling over buttocks or gluteal dermatome. The anterior dislocation causes abnormal swelling over groin and severe pain referred to buttocks. Gluteal pain caused by fracture of hip joint restricts activities associated with movements of leg on injured side.
Hip Joint Dislocation
Hip joint dislocation is often observed in individuals involved in contact sports like football, soccer and wrestling. Dislocation causes abnormal swelling either over the groin or buttocks depending on anterior or posterior dislocation. Patient is unable to move his lower extremity on injured side. Pain is severe over groin and buttocks. Any attempt to move leg results in severe gluteal pain or pain in the butt.
Gluteal Pain or Pain in the Butt Caused by Ligament Abnormalities or Injuries
Pelvic bones are connected and fused by band of several ligaments. Inflammatory disease or tear of pelvic ligaments causes mild to severe gluteal pain.
Inflammation of any one of the several pelvic ligaments listed below causes severe gluteal pain or pain in the butt. Gluteal pain caused due to ligamental inflammation does respond to anti-inflammatory medications and rest. The ligament inflammation and injury heals within 4 to 6 weeks. The rest helps to heal the injure ligament faster. The inflammation is triggered by abnormal twist or stretching of the ligament, which is frequently seen during contact sports, fall or automobile accident.
Ligamental tear of pelvic ligament causes severe gluteal pain and the pain increases with movements of the pelvic bone and lower extremity. Gluteal Pain caused due to ligamental tear may last for several weeks if healing is slow and incomplete. Mild to moderate pain does respond to anti-inflammatory medications but severe to very severe gluteal pain due to ligamental tear does not respond to NSAIDs. Most of the patients are treated with opioids and muscle relaxants.
List of Pelvic Ligaments-
- Posterior Sacroiliac Ligament- Posterior sacroiliac ligament binds sacrum and ilium bone on posterior side.
- Anterior Sacroiliac Ligament- Anterior sacroiliac ligament binds sacrum and ilium on anterior side.
- Ileo-Lumbar Ligament- Ileo-lumbar ligament binds ilium and lower lumbar vertebrae.
- Anterior Longitudinal Ligament- Thick band of fibrous tissue runs in front of lower lumbar vertebrae and sacrum.
- Sacro-Spinous Ligament- Binds sacrum and spinous process.
- Sacro-Tuberous Ligament- Binds ischial tuberosity and sacrum.
Gluteal Pain or Pain in the Butt Caused by Tendon Abnormalities or Tendon Injuries –
Gluteal pain is often caused by inflammation or tear of tendon attached to gluteal muscles. The opposite end of tendon of gluteal muscles is attached to pelvic or hipbone. The pain caused by gluteal tendon injury or inflammation is referred to gluteal area.
Tendon inflammation is known as tendonitis. Gluteal muscle tendonitis is divided as gluteus Maximus tendonitis, gluteal medius tendonitis and gluteal minimus tendonitis. Gluteal pain caused due to tendon inflammation is often seen in patients who are involved with repeated use of these muscles like individual participating in long distance bicycle ride or running.
Tendon tear is observed in individual who are involved in contact sports like football, wrestling and soccer. Tendon tear is extremely painful condition and may not get better if proper treatment is not offered during initial period following injury. The pain due to tendon tear is spread over gluteal area.
The three Gluteal muscles end in to tendon at both ends. Tendons are attached to the pelvic bone, sacrum and femur. Tendon dislocation is observed when tendon is detached from its attachment to the bones at either of the two ends or both the end. The pain is extremely severe and patient is unable to move since gluteal muscle contraction is unable to pull the pelvic and femur leg bones.
Bilateral gluteal ischemic necrosis mistaken for stage IV pressure wound: case report and discussion.
Brandon L. Hicks; Matthew Varacallo. , https://www.ncbi.nlm.nih.gov/books/NBK448172/
Possible pathogenic mechanism of gluteal pain in lumbar disc hernia. L4/5
Posterior Branches of Lumbar Spinal Nerves – part II: Lumbar Facet Syndrome – Pathomechanism, Symptomatology and Diagnostic Work-up.
Deep gluteal syndrome
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