Pain in the buttocks
Pain in the buttocks occurs with soft tissue lesions, neurological disorders, diseases of the lumbar spine with neurological symptoms, pathologies of nearby joints. It can be pressing, aching, bursting, jerking, acute, dull, constant, periodic, short-term. Sometimes it is associated with physical activity, body position. Diseases that cause pain in the buttocks are diagnosed according to the survey, external examination, the results of additional studies: ultrasound, radiography, MRI, CT, etc. Before the diagnosis, rest is recommended, in some cases it is possible to take painkillers.
Why do buttocks hurt
Traumatic injuries
Local infectious processes
Joint diseases
Soft tissue pathologies
Neurological diseases
Other pathologies
Diagnostics
Treatment
Assistance at the pre-hospital stage
Conservative therapy
Surgical treatment
Prices for treatment
Why do buttocks hurt
Traumatic injuries
The most common traumatic cause of the symptom is a bruise. The injury occurs due to a fall on the buttocks, more often observed in winter. It is characterized by moderate pain, gradually subsiding within a few days, swelling, bruising. The movements are not disturbed or slightly disturbed.
With severe bruises, blows with a hard object on the buttock area, hematomas are formed. The pain is initially pressing and aching, later bursting, increases with continued bleeding into the hematoma cavity. During the examination, local dense edema is detected. In the future, the soreness decreases, a fluctuating formation is formed.
Local infectious processes
Superficial and deep pyoderma are often detected in the buttocks. This zone is a frequent localization of vulgar ektima. With superficial pyoderma, the pain is minor or moderate, combined with itching, burning. The buttock swells, flickens, bullous rash or pustules form on it. Purulent foci are opened with the formation of erosions, the pain becomes painful. It is possible to attach a secondary infection with the development of a severe purulent process.
From deep pyoderma on the buttocks, boils and carbuncles are most often found. Accompanied by rapidly increasing pain, which after 1-2 days becomes twitching, bursting, throbbing, deprives sleep. The degree of violation of the general condition depends on the size of the purulent focus. A limited dense swelling of a purplish hue with one or more rods in the center is determined. After the abscess matures, the rod is surrounded by a yellowish rim. Palpation is sharply painful, fluctuation is detected.
The buttock area is the most common localization of a postinjection abscess. The beginning of the purulent process may go unnoticed, because after the injection, a painful infiltrate is normally formed. A distinctive feature of an abscess at the initial stage is an increase, not a decrease in pain. Subsequently, the injection site turns red, swells, the pain becomes twitching, pulsating. It becomes impossible to sit on the buttock. Symptoms of intoxication, 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 with minor pressing pains. With suppuration, pain sensations become sharp, bursting, pulsating, disrupt night sleep, are accompanied by weakness, weakness, hyperthermia, symptoms of intoxication. Palpation reveals a sharp soreness.
Purulent bursitis develops when the mucous sac located between the gluteus maximus and the posterior surface of the large trochanter is infected. It is manifested by symptoms of a deep abscess: increasing pain, fever, deterioration of the general condition, restriction of movements. Due to the deep localization of the bag, it may be difficult to determine the type of abscess.
In bedridden patients, bedsores form on the buttock. The pain syndrome is noted already at the initial stages of the formation of a bedsore, but due to its insignificant severity it often goes unnoticed. There may be burning, itching, discomfort, increased local sensitivity.
Pain in the buttocks
Pain in the buttocks
Joint diseases
The symptom is often observed in arthritis of the hip joint. The disease develops gradually. At first, patients are concerned about dull aching pains in the buttock, groin area, on the outside of the joint. Subsequently, soreness becomes the cause of movement restriction, gait disorders, and the appearance of lameness. The pain increases after staying in a stationary position. The cause of painful sensations may be the following pathologies:
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 pains can be observed in various forms of seronegative spondyloarthritis, including against the background of Bekhterev’s disease, Reiter’s disease, Behcet syndrome, chronic intestinal diseases. Soreness in the upper-outer quadrant of the buttock is typical for inflammation of the sacroiliac joint. The features of the symptom are determined by the type of sacroiliitis:
Purulent. There are sharp, rapidly increasing pains in the buttock, abdomen and lower back, which increase with hip extension. Body temperature is elevated, the condition is serious.
Aseptic. It is detected in rheumatic diseases. It is accompanied by moderate or mild pain in the buttock, giving to the hip, increasing at rest, weakening during movements.
Tuberculous. Moderate soreness without a clear localization, stiffness, local hyperthermia is detected. Over time, a leaky abscess often forms on the thigh.
Soft tissue pathologies
Myalgia in the area of the gluteal muscles develop after a significant load, as a rule – during sports training. They have a pulling, sometimes burning character. They increase sharply at the beginning of movements, subside a little after warming up, light massage, a little warm-up. They persist for 2-3 days, gradually disappear.
Tendinitis of the biceps tendon is more often detected in runners. Accompanied by deep pain in the buttock, radiating from behind along the thigh. At first, the symptom bothers only with intense loads, subsequently occurs with any movements, sometimes observed at night. With enthesopathy of the sciatic tubercle, soreness is localized at the point of attachment of the muscle to the bone protrusion, initially weakly expressed, subsequently progressive.
Bursitis of the sciatic sac of the gluteus maximus is manifested by pain in the projection of the buttock, which increases when sitting on a hard surface, tilts anteriorly. Develops with repeated traumatization (falls on the buttocks, pressure and blows to the buttocks), is more often diagnosed in figure skaters, people engaged in equestrian sports.
Neurological diseases
Pain in the buttock is typical for radicular syndrome, which is observed in a number of diseases of the spine. It has a nagging, burning, baking, shooting character, depends on the position of the body, is combined with paresthesia, in severe cases – with paresis, hyporeflexia, sensitivity disorders. It is detected in the following diseases:
Degenerative: lumbar osteochondrosis, hernias and protrusions of the disc, spondyloarthrosis, spondylosis.
Anomalies of development: sacralization, lumbalization.
Injuries: conditions after fractures of the lumbar vertebrae, traumatic spondylolisthesis.
Tumors: primary and metastatic neoplasms.
The root syndrome can also be caused by infectious processes: tuberculosis, syphilis, osteomyelitis of the spine, spinal meningitis. In addition, burning, shooting, pulling, cerebellar, baking pains in the buttock, giving off along the back surface of the limb, are found in such neurological pathologies as:
sciatic nerve neuropathy;
lumbosacral plexitis;
gluteal muscle syndrome.
Other pathologies
Other diseases accompanied by pain in the gluteal region include:
Positional compression syndrome. Occurs during prolonged sleep in an uncomfortable position in a state of drug or alcohol intoxication. It can cause the development of acute kidney injury, a threat to life due to a significant array of damaged gluteal muscles.
Chronic pelvic pain syndrome (SHTB). Painful sensations in the buttock are of an irradiating nature, observed in many diseases of the female genital organs: oophoritis, adnexitis, salpingitis, endometritis, fibroids, ovarian cyst. Sometimes they are diagnosed with urological pathologies, gastrointestinal diseases: cystitis, urolithiasis, colitis.
Lerish syndrome. At first, the pain in the buttocks is insignificant, pulling. Subsequently, intense pain syndrome bothers while walking, causes intermittent lameness. In the final stages, soreness is noted even at rest.
Derkum’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 zone can be found in hysteria, depression, some diseases accompanied by senestopathies, sensory hallucinations.
Diagnostics
The initial examination is carried out by an orthopedic traumatologist. Depending on the features of the pathology, the patient may be redirected to a neurologist, rheumatologist, surgeon, and other specialists. The diagnostic action plan includes the following procedures:
Survey, physical examination. The doctor finds out when and under what circumstances the pain appeared, how they changed over time, what external circumstances are provoked. During an external examination, a specialist evaluates the patient’s position, mobility of the spine and hip joint, reveals a zone of soreness, swelling, hyperemia, and other symptoms.
Neurological examination. It is necessary for diseases of the spine, neurological pathologies. It includes the study of coordination of movements, muscle strength, reflexes, surface and deep sensitivity.
Sonography. Ultrasound of soft tissues is performed for deep hematomas, abscesses, diseases of soft tissue structures. With Lerish syndrome, ultrasound of the abdominal aorta is prescribed, with diseases of the female genital and urinary system – ultrasound of the genitals, ultrasound of the kidneys, bladder.
Radiography. Pictures of the hip joint, lumbar spine or sacrum are performed for arthritis, sacroiliitis, spinal lesions. Radiographs show signs of inflammatory, degenerative, tumor processes, and the consequences of injuries.
Other visualization methods. If the ultrasound is not informative enough, patients are referred for MRI, which allows a detailed assessment of the condition of soft tissues. With ambiguous radiography results, CT is prescribed for a detailed study of solid structures.
Functional techniques. To study nerve conduction, muscle condition, evoked potentials, electroneuromyography, electromyography are studied.
Laboratory tests. Analyzes are performed to identify signs of the inflammatory process, determine the pathogen, and study tissue morphology.
Physical examination
Physical examination
Treatment
Assistance at the pre-hospital stage
Patients with buttock pain are provided with rest. In case of severe pain, an anesthetic is given. With diagnosed spinal diseases and neurological diseases, the use of warming and anti-inflammatory ointments is effective. Intense pain, violation of the general condition, hyperthermia are the reason for immediate treatment to a specialist.
Conservative therapy
Conservative treatment includes medication and non-drug therapy. Patients can be assigned:
Protective mode. Bed rest or load restriction is recommended. Sometimes the use of additional devices is shown: walkers, crutches, canes.
NSAIDs. They are used for rheumatic and degenerative processes. They are used in the form of tablets, injections, topical agents: gels, ointments, creams.
Antibiotics. They are necessary for infectious diseases. Treatment of specific infections is carried out according to special protocols. In case of nonspecific infections, broad-spectrum drugs are prescribed, after determining the sensitivity of the pathogen, correction of antibiotic therapy is performed.
Physiotherapy. To reduce pain, stimulate resorption, activate blood circulation, accelerate healing or improve nerve conduction, directions are given for electrophoresis, laser therapy, UHF, electrical stimulation. According to the indications, exercise therapy, massage, kinesiotaping, acupuncture, manual therapy are used.
Surgical treatment
Taking into account the peculiarities of the disease , the following surgical interventions are performed:
Traumatic injuries: opening of a hematoma.
Local infections: autopsy, drainage of a boil, carbuncle, abscess.
Joint pathologies: arthroscopy, arthrotomy, arthroplasty, arthrodesis.
Neurological diseases: discectomy, nucleoplasty, laminectomy, vertebroplasty, corporectomy.
SHTB: myomectomy, removal of ovarian cyst, oophorectomy, adnexectomy, cystolithotripsy.
Lerish syndrome: aorto-femoral bypass surgery, lumbar sympathectomy, reconstructive surgery.
In the postoperative period, bandages are performed, antibiotic therapy and painkillers are prescribed. Subsequently, rehabilitation measures are carried out.
