Butt pain has a surprisingly wide range of causes, from sitting too long to a muscle strain to a problem near the anus. What you should do about it depends almost entirely on where the pain is and what it feels like. Most causes are treatable at home, but a few need prompt medical attention. Here’s how to sort it out.
Pinpoint Where It Hurts
The buttock region includes deep muscles, the tailbone, the sciatic nerve, the skin surface, and the anal area. Pain in each zone points to different problems and different solutions. Before trying any remedy, spend a moment narrowing down the location.
If the pain is deep in the fleshy part of your buttock and gets worse when you sit or walk, you’re likely dealing with a muscular or nerve issue. If it’s right at the tailbone when you sit down, that’s a different category. And if the pain is around or inside the anus, especially during or after a bowel movement, the cause is almost certainly something in the anal canal itself. Each of these has a distinct path to relief.
Anal and Perianal Pain
Pain around the anus is one of the most common reasons people search for help with butt pain, and two conditions account for the majority of cases: hemorrhoids and anal fissures.
Thrombosed external hemorrhoids feel like a hard, painful lump right at the anal opening. Anal fissures, which are small tears in the lining of the anal canal, cause sharp, stinging pain during bowel movements that can linger for hours afterward. Both conditions respond well to the same basic home care routine:
- Sitz baths: Sit in a few inches of warm water for 10 to 15 minutes, two or three times a day. This relaxes the muscles around the anus and improves blood flow to the area.
- Fiber supplements and stool softeners: Adults need 22 to 34 grams of fiber per day, depending on age and sex. Getting enough fiber keeps stools soft so you’re not straining, which is the single biggest factor in healing and preventing both hemorrhoids and fissures.
- Topical numbing cream: Over-the-counter lidocaine gel applied to the area can take the edge off while you heal.
Most acute fissures and hemorrhoid flare-ups improve within a few weeks with this routine. If your pain persists beyond four to six weeks, or if you notice pus, blood, or a foul-smelling discharge, you may be dealing with something else, like an abscess, a fistula, or a pilonidal cyst, all of which typically need medical treatment.
Pilonidal Cysts
A pilonidal cyst forms near the top of the buttocks crease, not at the anus itself. When infected, it creates a painful, swollen lump that may leak pus or blood. You’ll sometimes see a small pit in the skin at the crease. Infected pilonidal cysts usually need to be drained by a doctor through a small incision, and some require surgery. Warm compresses can help with discomfort while you wait for an appointment, but this one rarely resolves on its own once it’s infected.
Deep Buttock and Muscle Pain
If the pain sits deep in the fleshy part of your buttock, two common culprits are piriformis syndrome and gluteal tendinopathy.
Piriformis syndrome happens when the piriformis muscle, which sits deep in your buttock near the hip joint, tightens or spasms and compresses the sciatic nerve running beneath it. The pain usually stays in the buttock and upper thigh, rarely extending below the knee. It tends to get worse with activities that stretch or contract that muscle, like sitting cross-legged, climbing stairs, or long drives. This is different from true sciatica caused by a spinal problem, which typically starts in the lower back, radiates down the full length of the leg, and may come with numbness, weakness, or tingling.
Gluteal tendinopathy is pain at the outer hip and buttock caused by irritation of the tendons that attach your gluteal muscles to the hip bone. It’s especially common in people who sit for long periods or who suddenly increase their activity level. About 7 out of 10 cases improve within 8 weeks with targeted exercises and activity modifications.
Exercises That Help
A progressive exercise routine is the most effective treatment for both piriformis syndrome and gluteal tendinopathy. Start gently and increase the challenge over several weeks:
- Weeks 1 to 3: Lie on your back with a pillow under your knees and a belt looped just above them. Gently press your legs apart against the belt, hold for 5 seconds, and repeat 5 to 10 times. Do this two to three times a day. You can also add double-leg bridges: lying on your back with knees bent, squeeze your glutes and lift your hips off the floor.
- Weeks 4 to 6: Progress to single-leg bridges and squats with a resistance band around your knees. Do these every other day.
Some people feel significant improvement in just a few weeks by avoiding aggravating positions and doing gentle exercises. Others need several months of consistent work. Even without any intervention, about half of gluteal tendinopathy cases resolve within a year.
Tailbone Pain
Pain centered on the tailbone, called coccydynia, typically flares when you sit on hard surfaces and eases when you stand. It can start after a fall, after childbirth, or from prolonged sitting with no obvious trigger. The tailbone itself may be slightly unstable, and the surrounding pelvic floor muscles often tighten in response, making the pain worse.
The most immediate relief comes from a cushion designed to take pressure off the tailbone. Wedge-shaped cushions with a cutout in the back outperform donut-shaped cushions. Research shows people prefer wedge designs nearly five times more often, and for good reason: the wedge shifts your weight forward and keeps your spine aligned, while donut cushions can actually encourage slouching. When you sit on one, your tailbone should hover in the cutout without touching anything, with your sitting bones and thighs carrying your weight instead.
Pair the cushion with a chair that supports your lower back, use a footrest if the cushion raises your seat height, and take breaks every 30 minutes to stand and move. Pelvic floor physical therapy can also help by releasing the muscle tension that often accompanies tailbone pain.
Nerve-Related Pain
Pudendal neuralgia causes burning, aching, or shooting pain that you feel in the buttocks, the area between your legs, and sometimes the genitals or rectum. The hallmark feature is that it gets significantly worse when you sit and improves when you stand or lie down. Think of all the areas that would touch a bicycle seat: that’s the territory of the pudendal nerve.
Management focuses on reducing pressure on the nerve. A cushion with a center cutout helps by offloading the pelvic floor. Physical therapy targeting the pelvic floor muscles is a core part of treatment, and a therapist may also recommend a TENS unit, which uses mild electrical pulses to reduce nerve pain. Keeping your bowel movements soft with adequate fiber prevents straining, which can further irritate the nerve. Some people also benefit from prescription medications that calm nerve signaling.
Simple Fixes for Sitting-Related Pain
If your butt hurts mainly after long stretches of sitting and you don’t have any of the specific conditions above, the cause may simply be sustained pressure on the gluteal muscles and the nerves beneath them. This is sometimes called “dead butt syndrome,” and it’s exactly what it sounds like: your glute muscles essentially stop firing properly because they’ve been compressed for too long.
The fix is straightforward. Aim to work at least 20 minutes of standing or walking into every hour. Set an alarm to remind yourself to get up and stretch every 30 minutes. When you do sit, alternate between sitting and standing positions if you have access to an adjustable desk. Even a short walk to the kitchen and back can reset the muscles and restore blood flow.
When Butt Pain Is an Emergency
Most butt pain is a nuisance, not a crisis. But one rare condition, cauda equina syndrome, requires emergency care. It happens when the bundle of nerves at the base of the spinal cord gets severely compressed, usually by a large herniated disc. The red flags are unmistakable and involve more than just pain:
- Saddle numbness: Loss of sensation in the area that would sit on a saddle, including the buttocks, genitals, and inner thighs.
- Bladder problems: Inability to feel when your bladder is full, or sudden urinary incontinence. Urinary retention is the most common symptom.
- Bowel incontinence: Loss of control over bowel function.
- Leg weakness: Sudden weakness or heaviness in one or both legs.
If you experience any combination of these symptoms alongside butt or back pain, this is a surgical emergency. Delays in treatment can lead to permanent nerve damage.