Buttock pain has a surprisingly long list of possible causes, ranging from a simple muscle strain to hemorrhoids to nerve compression. The key to narrowing it down is paying attention to exactly where it hurts, what the pain feels like, and what makes it worse. Most causes are treatable and not serious, but a few combinations of symptoms do warrant urgent attention.
Where the Pain Is Matters
The buttock is a layered region with muscles, nerves, joints, skin, and the anal canal all packed into a relatively small area. Pain deep in the muscle feels different from pain at the tailbone, which feels different from pain around the anus. Thinking about the specific location is the fastest way to start identifying what’s going on.
Deep, aching pain in the fleshy center of one cheek often points to a muscular or nerve issue. Pain right at the base of the spine, especially when sitting, suggests the tailbone. Pain during or after bowel movements usually involves the anal canal. And pain on the outer edge of the buttock near the hip joint can signal a tendon problem. Each of these patterns leads to a different set of causes.
Muscle and Nerve Pain in the Buttock
Piriformis Syndrome
The piriformis is a small, deep muscle that runs across the buttock from the base of the spine to the top of the thighbone. When it spasms, tightens, or becomes inflamed, it can compress the sciatic nerve that runs right next to it (or, in some people, directly through it). This causes pain that starts deep in the buttock and may radiate down the back of the thigh, though it rarely extends below the knee. Sitting for long periods, climbing stairs, or crossing your legs can all trigger or worsen it.
Piriformis syndrome is often confused with sciatica, but true sciatica originates from nerve compression in the lower spine, typically from a herniated disc, bone spur, or spinal stenosis. The giveaway is how far the pain travels. Sciatica frequently radiates all the way down through the calf and into the foot, following the full path of the sciatic nerve. Piriformis syndrome stays higher, concentrated in the buttock and upper leg.
Gluteal Tendinopathy
If your pain is more toward the outer side of the buttock near the hip, the tendons connecting your gluteal muscles to the top of the thighbone may be irritated. This condition, gluteal tendinopathy, causes moderate to severe pain that often starts at a bony prominence on the outside of the hip and can extend down the outer leg toward the knee. It tends to flare when you climb stairs, get out of bed in the morning, lie on the affected side, sit for a long time, or stand on one leg. The area may feel tender to the touch.
Tailbone Pain
Pain centered right at the bottom of the spine, at the small triangular bone called the coccyx, is known as coccydynia. It’s one of the most common reasons for buttock pain that gets worse with sitting. The coccyx can become bruised or even fractured from a fall, a hard landing, or prolonged pressure (like sitting on a hard surface for hours). Childbirth is another common trigger. The hallmark pattern is soreness that increases when you sit down and sharp pain when you transition from sitting to standing.
For tailbone pain, a cushion with a cutout at the back (U-shaped or wedge-shaped) can take pressure off the coccyx while sitting. Donut-shaped pillows work too, though they’re more commonly used for anal or perineal pain. Avoiding hard chairs and leaning slightly forward when seated can also reduce pressure on the area.
Pain Around the Anus
Hemorrhoids
Hemorrhoids are swollen blood vessels inside or just outside the anal canal. They’re extremely common and are the most likely cause if your primary symptom is bright red blood on toilet paper or in the bowl. Most hemorrhoids don’t actually cause significant pain. External hemorrhoids can ache or itch, and a thrombosed hemorrhoid (one with a blood clot inside it) can be intensely painful, but the internal variety is often painless aside from occasional bleeding and a feeling of pressure or fullness.
Anal Fissures
An anal fissure is a small tear in the lining of the anus, and it’s more likely than hemorrhoids to cause sharp, stinging pain, particularly during and after a bowel movement. Passing a hard or large stool is the most common cause. You may also notice a small amount of blood when you wipe. The pain can linger for minutes to hours after using the bathroom, sometimes with a burning quality that makes it hard to sit comfortably. Most fissures heal on their own within a few weeks with increased fiber intake and adequate hydration to keep stools soft.
Skin and Soft Tissue Infections
A pilonidal cyst forms near the tailbone at the top of the buttocks crease. It often starts as a small pit or dimple in the skin and can become infected, producing pain, redness, swelling, and pus or blood draining from the opening. Some people also notice an unpleasant odor. These cysts are more common in younger adults, people who sit for long periods, and those with coarser body hair. A mild case may resolve with warm compresses and antibiotics, but infected cysts often need to be drained.
A perianal abscess is a similar type of infection but forms closer to the anus itself. It feels like a painful, swollen lump near the anal opening, often warm to the touch. Abscesses generally need medical drainage and don’t resolve well on their own.
Pudendal Nerve Pain
If your buttock pain comes with burning, stabbing, or shooting sensations in the area between your sit bones, including the genitals, perineum, or rectum, the pudendal nerve may be involved. This nerve controls sensation and muscle function across the pelvic floor, including the sphincter muscles you use for urination and bowel movements. When it’s compressed or irritated, the pain is typically worse when sitting and improves when you stand or lie down.
Pudendal neuralgia can be tricky to diagnose because the symptoms overlap with many other conditions. A key clue is the relief pattern: if sitting is consistently the worst position and standing or sitting on a toilet seat (which removes pressure from the perineum) brings noticeable relief, nerve compression is worth investigating. Cushions with a central cutout can help by taking pressure off the pelvic floor. Physical therapy focused on relaxing and stretching the surrounding muscles is a common first-line treatment.
When Buttock Pain Needs Urgent Attention
Most buttock pain is uncomfortable but not dangerous. There is one scenario, however, that requires an emergency room visit. Cauda equina syndrome occurs when the bundle of nerves at the base of the spinal cord becomes severely compressed, usually by a large herniated disc. The warning signs include:
- Numbness or tingling in the backs of the legs, buttocks, inner thighs, or groin (sometimes described as “saddle” numbness because it affects the areas that would touch a saddle)
- New difficulty urinating or having bowel movements, including not being able to feel when you need to go
- Sudden leg weakness or difficulty walking
- New onset of urinary or fecal incontinence
This combination of symptoms, especially the bladder and bowel changes, is what separates cauda equina syndrome from ordinary back or buttock pain. It requires surgery within hours to prevent permanent nerve damage. If you have buttock pain alongside any of these neurological symptoms, don’t wait it out.
Narrowing Down Your Cause
A few questions can help you sort through the possibilities before (or instead of) a medical visit. Does the pain get worse specifically when sitting and improve when standing? That points toward the tailbone, piriformis, or pudendal nerve. Does it hurt during or right after bowel movements? Think hemorrhoids or fissure. Is it on the outer side near the hip and worse with stairs? Gluteal tendinopathy is likely. Is there a visible lump with redness or drainage near the tailbone crease? A pilonidal cyst. Does the pain shoot down the back of the leg past the knee? That pattern fits classic sciatica from a spinal cause rather than a local buttock problem.
For many of these conditions, the initial approach is the same: avoid prolonged sitting on hard surfaces, use an appropriate cushion, stay active without aggravating the pain, and give it a few weeks to improve. Pain that persists beyond two to three weeks, worsens progressively, or comes with any of the red-flag neurological symptoms described above is worth getting evaluated.