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Health condition

Buttock pain, a symptom with many causes - and a clear way to work through them.

From gluteal tendinopathy and sciatica to vascular claudication and inflammatory back disease. A stepwise assessment finds the cause and points to the right treatment.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against NICE, BOA, BASS and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including deep gluteal syndrome, image-guided injections and vascular workup.

Key facts

Buttock pain at a glance.

The essentials, in plain English - the usual causes, the red-flag ones, and how UK clinicians work it up.

  • What it is

    A symptom, not a diagnosis - pain felt over one or both buttocks that can come from muscle, tendon, joint, nerve, spine or blood vessels.

  • Most common causes

    Gluteal tendinopathy, piriformis and deep gluteal syndrome, sacroiliac joint dysfunction and lumbar radiculopathy referred from the low back.

  • Sitting-related

    Coccydynia, ischial bursitis and pudendal neuralgia often flare with prolonged sitting on hard surfaces.

  • Walking-related

    Lumbar stenosis and vascular gluteal claudication both worsen with walking - the distinction matters and is testable.

  • Red flag causes

    Cancer, infection, cauda equina and critical limb ischaemia are uncommon but must be excluded early.

  • Foundation therapy

    A tailored physiotherapy programme, activity pacing and targeted injections resolve most musculoskeletal buttock pain.

Why this guide matters

A differential you can act on.

Buttock pain is common and, in most people, treatable. The three principles below shape the assessment on this page.

  • Location, character and triggers matter

    Where the pain sits, what makes it worse and how it radiates points quickly at the tissue and system involved - muscle, joint, nerve or vessel.

  • Red flags first, then targeted testing

    A short red flag screen filters out cauda equina, infection, cancer and critical ischaemia before deciding on imaging or bloods.

  • Treatment is cause-specific

    A piriformis release, a nerve root injection, revascularisation and a DMARD are very different treatments. Getting the diagnosis right saves months.

How the cause is worked out

From first appointment to a clear plan.

The steps a UK GP or specialist will normally follow, in order - so you know what to expect and why each step is done.

  1. 01

    Assessing

    Structured history and red flag screen

    Onset, site, radiation, aggravating factors and screen for weight loss, cancer, fever, neurology, bladder or bowel change and saddle anaesthesia.

  2. 02

    Assessing

    Focused examination

    Inspection, palpation, hip and spine range of motion, neurology, straight leg raise, FABER, FADIR, resisted hip abduction and prone hip extension.

  3. 03

    Assessing

    Vascular and inflammatory review

    Pulses and ankle-brachial pressure index if claudication is suspected. Morning stiffness and inflammatory back pain features flagged for rheumatology.

  4. 04

    Confirming

    Targeted imaging

    Plain X-ray for hip osteoarthritis, ankylosing spondylitis, Paget disease, fracture or bony tumour. MRI for radiculopathy, deep gluteal, labrum, infection or malignancy.

  5. 05

    Confirming

    Ultrasound and guided injection

    Ultrasound clarifies tendinopathy and bursitis and allows precise diagnostic and therapeutic injections in one visit.

  6. 06

    Referring

    Bloods when indicated

    FBC, CRP and ESR for infection or inflammation; HLA-B27 when spondyloarthritis is suspected; PSA or myeloma screen if bony metastasis is a concern.

  7. 07

    Referring

    Specialist onward referral

    Pain, neurology, rheumatology, vascular, orthopaedics, gynaecology, urology or colorectal depending on the working diagnosis.

Typical timeline: first visit to a working diagnosis in one to three weeks.

Symptoms

How buttock pain actually feels.

Different causes have different fingerprints. Recognising the pattern helps direct the assessment and the treatment plan.

  • Deep gluteal ache

    A dull, deep pain that worsens with sitting - suggests piriformis or deep gluteal syndrome.

  • Lateral hip and buttock pain

    Sharp pain over the greater trochanter radiating into the buttock - classic gluteal tendinopathy.

  • Pain radiating down the leg

    Sciatica-type pain past the knee suggests lumbar radiculopathy from an L5 or S1 nerve root.

  • Coccyx pain when sitting

    Pin-point pain at the tailbone, worse leaning back - coccydynia, often after a fall or childbirth.

  • Ischial pain when sitting

    Tender at the sitting bone with pain on running or driving - hamstring origin tendinopathy or ischial bursitis.

  • Buttock cramp when walking

    Cramping that stops you walking a set distance and eases with rest - consider vascular gluteal claudication.

  • Inflammatory back and buttock stiffness

    Alternating buttock pain and morning stiffness under 40 - screen for ankylosing spondylitis and other spondyloarthritis.

  • Red flag - saddle numbness or fever

    Saddle anaesthesia, bladder or bowel change, fever, night pain or unexplained weight loss - urgent assessment.

Treatment

How buttock pain is treated in the UK.

Cause-led care - physiotherapy and lifestyle for most, injections and surgery when needed, and specialist medical or vascular pathways when the cause demands it.

  • Structured physiotherapy

    A tailored programme of hip and core strengthening, glute activation and stretching underpins recovery from tendinopathy, piriformis and SI joint pain.

  • Activity modification and pacing

    Ergonomic changes, a donut cushion for coccydynia, standing breaks and graded return to sport prevent flares and support tissue healing.

  • Simple analgesia and NSAIDs

    Short courses of paracetamol and NSAIDs settle nociceptive pain; neuropathic agents such as gabapentin or amitriptyline help nerve-driven pain.

  • Image-guided injection

    Ultrasound or fluoroscopy-guided steroid, PRP, trigger point, SI joint or ganglion impar block - diagnostic and therapeutic in one visit.

  • Lumbar spine care

    For radiculopathy or stenosis, physiotherapy, epidural steroid injection and, when indicated, decompressive surgery restore function.

  • Hip preservation surgery

    Hip arthroscopy for FAI or labral tears, gluteal tendon repair for tears, and deep gluteal release for refractory sciatic entrapment.

  • Vascular revascularisation

    Endovascular or open bypass for aortoiliac disease or Leriche syndrome - relieves gluteal claudication and prevents limb loss.

  • Disease-modifying therapy

    DMARDs and biologics for spondyloarthritis; oncology or fracture pathways for bony pathology; antibiotics or surgery for infection.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or specialist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Sciatica (lumbar radiculopathy): assessment and management (NG59, updated).

  • NICE. Low back pain and sciatica in over 16s (NG59).

  • British Orthopaedic Association (BOA). Standards for musculoskeletal care.

  • British Association of Spine Surgeons (BASS). Guidance on lumbar spine conditions.

  • Vascular Society of Great Britain and Ireland. Peripheral arterial disease guidance.

  • European League Against Rheumatism (EULAR). Recommendations for axial spondyloarthritis.

Red flags

When buttock pain needs urgent attention.

Most buttock pain is manageable in primary care. These are the situations that are not - and where same-day or urgent specialist review is warranted.

  • Cauda equina syndrome

    Saddle anaesthesia, new bladder or bowel dysfunction and bilateral leg weakness - a same-day surgical emergency.

  • Suspected malignancy

    Unexplained weight loss, night pain, history of cancer or a new palpable mass - urgent imaging and specialist referral.

  • Infection

    Fever, escalating pain, immunosuppression, IV drug use or a hot, tender area over the buttock - consider abscess, discitis or necrotising fasciitis.

  • Critical limb ischaemia

    Rest pain in the buttock or leg, ulcers or gangrene, absent pulses - urgent vascular assessment.

  • Leriche syndrome

    Buttock claudication with erectile dysfunction and absent femoral pulses - aortoiliac occlusive disease that needs revascularisation.

  • Progressive neurological deficit

    Worsening leg weakness, foot drop or sensory loss - urgent MRI and spinal opinion.

  • Fragility fracture

    Sudden severe pain after a low-energy fall in an older adult - image the pelvis, hip and sacrum promptly.

  • Inflammatory back and buttock pain

    Alternating buttock pain, morning stiffness over 30 minutes and age under 45 - refer for axial spondyloarthritis workup.

  • Post-injection sciatic nerve injury

    New foot drop or dense sciatic pain after an intramuscular injection - urgent neurology and orthopaedic review.

Living with it

A common problem, with a stepwise path back to function.

Four things make the biggest difference day to day - gentle movement, sitting strategy, hip and core strengthening, and knowing when to ask for a scan.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits kept up for weeks do more than a heroic session that leaves you sore for days.

  1. 01 Move

    Keep moving, gently

    Complete rest stiffens joints and deconditions the glutes. Short, frequent walks and graded loading beat prolonged bed rest.

  2. 02 Sitting

    Rethink how you sit

    A supportive chair, a donut or wedge cushion, standing breaks every 30 to 45 minutes and a laptop stand can offload the coccyx and ischium.

  3. 03 Strength

    Rebuild hip and core strength

    Glute medius, glute max and deep core work protect the SI joint, hip and lumbar spine - a physio-led programme pays off within weeks.

  4. 04 Escalate

    Ask for imaging if it does not settle

    If pain persists past 6 weeks, or if red flags appear, escalate to targeted imaging and specialist review rather than pushing through.

Frequently asked

Everything we get asked about buttock pain.

Quick answers on causes, red flags, imaging and the treatment path.

  • What causes pain deep in one buttock?

    The commonest culprits are gluteal tendinopathy, piriformis or deep gluteal syndrome, sacroiliac joint dysfunction and referred lumbar radiculopathy from an L5 or S1 nerve root. Hip labral tears, femoroacetabular impingement and ischial bursitis are also frequent. Careful history and examination, and often ultrasound or MRI, distinguish them.

  • How do I know if my buttock pain is sciatica?

    Sciatica describes pain that travels from the buttock down the back or side of the leg, often past the knee, and may include pins and needles, numbness or weakness. It usually stems from an irritated L5 or S1 nerve root. Persistent, severe or progressive symptoms deserve MRI and a spinal opinion.

  • When is buttock pain a medical emergency?

    Seek urgent care for saddle numbness, new bladder or bowel problems, fever with severe pain, a rapidly spreading hot swelling, foot drop, unexplained weight loss or rest pain with cold, pale legs. These may indicate cauda equina, infection, necrotising fasciitis, spinal cord compression, malignancy or critical limb ischaemia.

  • What is deep gluteal syndrome?

    It is entrapment or irritation of the sciatic nerve within the deep gluteal space, which includes the piriformis and other short external rotators. It causes deep buttock pain, sitting intolerance and sometimes leg symptoms. Diagnosis combines examination, MRI and diagnostic injection; treatment ranges from physiotherapy and injection to endoscopic release.

  • Can buttock pain come from a blood vessel problem?

    Yes. Aortoiliac atherosclerosis can cause gluteal claudication, cramping buttock pain that starts after a predictable walking distance and eases with rest. When combined with erectile dysfunction and absent femoral pulses, it is called Leriche syndrome and needs vascular assessment.

  • Do I need a scan for buttock pain?

    Not always. Most cases settle with a period of tailored physiotherapy and simple analgesia. Imaging is warranted early if there are red flags, if symptoms persist beyond 6 weeks, if there is significant neurology, or if a specific diagnosis such as FAI, labral tear, deep gluteal syndrome or spondyloarthritis is suspected.

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