Butt pain has a surprisingly long list of possible causes, ranging from something as simple as sitting too long on a hard chair to nerve compression, muscle strain, or a skin condition near the tailbone. The location, timing, and quality of the pain are the best clues to figuring out what’s going on. Here’s a breakdown of the most common causes and how to tell them apart.
Pain That Gets Worse With Sitting
If your pain flares up the longer you sit and eases when you stand or walk, two conditions top the list: tailbone pain and sitting bone bursitis.
Tailbone pain (called coccydynia) is typically caused by a direct hit to the tailbone, like falling onto a hard surface, or by repetitive pressure from prolonged sitting. Childbirth is another common cause. The pain is localized right at the base of the spine, and pressing on the tailbone from the outside usually reproduces it. Some people develop this pain without any obvious injury at all. It tends to be worst when you first sit down or when you shift from sitting to standing.
Sitting bone bursitis is a different kind of sitting pain. Your “sitting bones” are the bony points at the bottom of your pelvis, and a small fluid-filled cushion (a bursa) sits between each one and the muscle above it. When that cushion gets inflamed, you feel a low-grade, pinpoint ache deep in the buttock that gets worse with sitting, especially on hard surfaces. People in jobs that involve heavy vibration, like operating tractors or road equipment, are more prone to it. The pain can also radiate into the upper back of the thigh and make it hard to climb stairs or get up from a chair. Avoiding hard seats and reducing the activity that triggered it are usually the first steps toward relief.
Pain That Shoots Down Your Leg
When buttock pain doesn’t stay in the buttock, it’s often related to the sciatic nerve, the thick nerve that runs from your lower back through your glutes and down each leg. Two conditions compress this nerve in different places.
Piriformis syndrome starts in a small muscle deep inside the buttock. When the piriformis muscle tightens or spasms, it can squeeze the sciatic nerve right where it passes through. The result is pain concentrated in the buttock that may radiate partway down the leg. It tends to flare with prolonged sitting, crossing your legs, or climbing stairs. The key feature is muscle tightness or a deep ache in the glute itself.
Sciatica, by contrast, usually originates in the lower spine, where a herniated disc or bone spur presses on the nerve root. The pain is often sharper and travels further down the leg, sometimes all the way to the foot. Numbness, tingling, or weakness in the leg are more pronounced with sciatica than with piriformis syndrome. Bending or twisting the back tends to make it worse, whereas piriformis pain is more aggravated by specific leg movements.
A simple way to start telling them apart: if the pain is mostly in your buttock and worsens with hip movement, think piriformis. If the pain starts in your lower back and shoots well below the knee, sciatica is more likely.
Sharp Pain During or After a Bowel Movement
Pain that hits right when you’re on the toilet points toward the anal area rather than the muscles or bones of the buttock.
Anal fissures are small tears in the lining of the anus, most often caused by straining to pass hard stool. The pain is sharp, tearing, or burning, and it’s worst during a bowel movement but can linger for minutes to hours afterward. You’ll often notice bright red blood on the toilet paper. About 90% of fissures cause pain, which sets them apart from hemorrhoids, where pain is less consistent. Some people find that fissure pain radiates into the buttocks, upper thighs, or lower back, which can make it confusing if you’re not sure where the pain is coming from.
Hemorrhoids are swollen blood vessels in or around the anus. They can cause itching, bleeding, and a feeling of pressure. External hemorrhoids are more likely to hurt, and that pain can be constant rather than coming in episodes. Both fissures and hemorrhoids are linked to straining, and both cause rectal bleeding, but fissures produce a more distinct, sharp pain tied to bowel movements while hemorrhoid discomfort tends to be duller and more persistent.
Sudden, Intense Spasms That Vanish Quickly
Some people experience a sudden, sharp, cramp-like pain deep in the rectum or lower buttock that lasts anywhere from a few seconds to several minutes and then disappears completely. This is called proctalgia fugax. Between episodes, there’s no pain at all.
Common triggers include stress, constipation, bowel movements, sexual activity, and menstruation, though episodes can strike without any obvious cause. The pain can be startling in its intensity, but it’s a functional muscle spasm rather than a sign of structural damage. If episodes are infrequent and short-lived, they’re generally harmless. People who have frequent or prolonged episodes may benefit from treatments aimed at relaxing the pelvic floor muscles.
A Painful Lump Near the Tailbone
A pilonidal cyst is a pocket in the skin near the top of the buttocks crease, close to the tailbone. It usually contains trapped hair and skin debris. Many people have one without knowing it, but when it becomes infected, it turns into an abscess that’s hard to ignore.
Signs of an infected pilonidal cyst include a visible pit or swelling near the tailbone crease, redness, tenderness, and pus or blood draining from the skin. There may be a noticeable odor. Pilonidal cysts are more common in younger adults, people who sit for long periods, and those with coarse or abundant body hair. An infected cyst typically needs to be drained by a healthcare provider and sometimes requires a minor surgical procedure to prevent it from coming back.
How Doctors Figure Out the Cause
Because so many structures live in and around the buttock, pinpointing the source of pain often starts with a few specific physical tests. Your doctor may watch you walk to check for an abnormal gait or pelvic drop, which can signal hip or joint problems. A test called the FABER (where your leg is positioned in a figure-four shape while lying down) helps distinguish between sacroiliac joint issues, hip problems, and spine-related pain. Other positioning tests flex and rotate the hip to check for labral tears or impingement, with some having sensitivities above 85% for detecting internal hip problems.
For tailbone pain, diagnosis is more straightforward: pressing on the coccyx from outside typically reproduces the pain. In some cases, X-rays taken while sitting and standing can reveal whether the tailbone moves excessively under pressure. MRI may be used when the cause isn’t clear or when more serious conditions need to be ruled out.
For anal symptoms, a visual exam and medical history are usually enough to identify fissures or hemorrhoids.
When Butt Pain Is an Emergency
Most causes of buttock pain are manageable and not dangerous. There is one rare exception worth knowing about. Cauda equina syndrome occurs when the bundle of nerves at the base of the spinal cord becomes severely compressed, and it requires immediate emergency care. The red flags to watch for are: loss of sensation in the area that would contact a saddle (the groin, inner thighs, buttocks, and genitals), sudden inability to feel the urge to urinate or a bladder that feels overfull without the normal signal, and loss of bowel or bladder control. If any combination of these symptoms appears alongside buttock or leg pain, get to an emergency room without delay. This condition can cause permanent nerve damage if not treated within hours.