If you’ve ever had a pinched nerve in your buttocks, you know exactly how it feels: painful. It could be a relatively mild, achy type of pain, like a muscle cramp. But it could also be a sharp, shooting pain that makes you wince.
It might be localized to your buttocks, but the pain may also shoot down your legs or into your hips and groin. Either way, the nerve won’t let you forget that something’s not right.
A doctor can examine you to confirm the most likely cause and rule out other causes of that lingering pain. Once your doctor determines which nerve is under pressure, you can learn how to manage the pain and go about your normal activities of daily life.
Most common cause
The most likely culprit for that nerve pain in your buttocks and legs — along with numbness, tingling or even weakness — is a condition called sciatica. You may develop this pain when part of the sciatic nerve near your spinal canal is pinched.
The most common cause of sciatica is a herniated disc, which is also called a slipped disc. Your spine comprises a series of individual bones called vertebrae.
A rubbery pad called a disc sits between every set of vertebrae. If some of the jelly-like filling of one of those discs pushes through a rip in the outer covering, it’s called a herniated disc.
It can put pressure on nearby nerves and cause weakness, tingling, and pain. If the herniated disc is low enough, it can lead to pain in your buttocks that can shoot down your legs, too.
The chances of experiencing a herniated disc increase as you age, as the discs tend to break down, or degenerate, over time.
A few other conditions can cause sciatica. Here are the most common:
- Spinal stenosis. This is when your spinal canal gradually narrows, putting pressure on the spinal cord and nerve roots inside. A number of conditions can cause spinal stenosis, but the most common is osteoarthritis.
- Piriformis syndrome. You have a muscle that runs from your lower spine to the top of your femur, which is the large bone in your thigh. If this piriformis muscle pushes down on your sciatic nerve, which traces a path from your spinal cord down your buttocks and the back of each leg, it can cause pain and numbness.
- Spondylolisthesis. The name of this condition is a mouthful, and the condition it describes is pretty intense, too. A stress fracture to one of the vertebrae causes it to slip out of its position in the spine. It can press on the sciatic nerve or another nerve at a different level of the spine and cause serious pain.
- Deep gluteal syndrome (DGS). Deep pain in the buttocks can be the result of what’s called entrapment of the sciatic nerve in the gluteal space. Your muscles, blood vessels, and skin are pushing on your nerves and causing severe pain, as well as possibly some tingling or numbness.
How to identify
You may not be able to tell for certain if the pain in your buttocks is originating in your hip or in your lower back. As it turns out, a nerve that’s gotten pinched in your hip might cause pain in your groin or your leg. So the pain you’re experiencing in your buttocks could have started somewhere else.
An examination by a doctor is the best way to determine where the pain is coming from. Your doctor may also take imaging tests, such as an MRI scan, to determine which nerve is being pressed.
You and a friend might both have sciatica and the associated nerve pain, but you might experience the pain in completely different ways. Some common symptoms include:
- tingling, or a “pins and needles” sensation
- numbness in your buttocks that may run down the back of your legs
- weakness in your legs
- a deep pain in your buttocks
- pain that radiates down your legs
Some people find that their pain gets worse when they sit, especially for long periods of time. Walking or other types of exercise can exacerbate the pain, too.
You’re probably eager to find some relief from the pain that your pinched nerve has been causing you, as well as improve mobility. The most common first-line treatments include:
- Heat and ice. If you’ve ever experienced a sports-related injury, you’ve probably applied ice or heat to knock out the pain that resulted. Ice tends to help swelling and inflammation, so it may be more effective when the pain is sharp. Once that initial pain ebbs a bit, you can try applying a heat pack to relax the muscles and perhaps reduce the compression upon the nerve that’s causing the pain.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter pain relievers, like ibuprofen (Advil), naproxen (Aleve), and aspirin can relieve moderate pain.
- Muscle relaxants. Your doctor might consider prescribing a drug that relaxes your muscles, like cyclobenzaprine.
- Physical therapy. Physical therapy is another commonly recommended therapy for people experiencing sciatic nerve pain. A physical therapist will work with you to learn certain exercises that decrease the pressure on the nerve, which should reduce the pain.
If these treatments don’t seem to help you manage your pain effectively, your doctor might propose that you consider one of these options:
- Spinal injections. An epidural steroid injection can address the inflammation of the nerve and the pain that it’s causing you. Your doctor will inject a corticosteroid or a pain medication into the area around your spinal cord. The anti-inflammatory effects of the steroid will begin working with a couple of days. The injection is more invasive than an oral medication, but they’re considered safe and effective, and side effects are pretty rare.
- Surgery. If your symptoms are progressing, and nothing else is working, it might be time to consider a surgical treatment. The type of surgery will depend on your specific situation, but a couple of common types of surgery include microdiscectomy, which removes fragments of a disc that’s herniated, and laminectomy, which removes part of the lamina bone that covers the spinal cord, and tissue that may be pushing down on your sciatic nerve.
Complementary therapies are another possibility. Consider whether one of these options might be right for you:
- Yoga. If you’re looking for a nonmedical, noninvasive way to address your sciatic nerve pain, you might unroll a yoga mat and ease yourself into child’s pose. A 2017 study found that yoga and physical therapy were able to help reduce chronic back pain, and some participants even needed less pain medication. Try a few poses at a home to see if they provide some relief for you.
- Acupuncture. Experts sometimes suggest giving acupuncture a try, along with stretching exercises and other treatments, to see if it will relieve some pain for you. A recent literature review noted that acupuncture is often used for the purpose of pain relief for a variety of conditions and could be helpful for treating this kind of pain, although more research is needed.
- Massage. You can massage the painful areas yourself, or you can seek a professional massage therapist. There are benefits to both deep tissue and soft tissue massage. Some research suggests that deep tissue massage helps with lower back pain and can be a good option for people who don’t want to take NSAIDs, or experience unpleasant side effects from them.
When to see a doctor
Pain is your body’s signal to you that something is wrong. Don’t ignore a nagging pain or an intense pain in your buttocks. If the pain is getting worse, or you’re having trouble controlling your legs and feet or even your bowels, make the call to your doctor.
Or if you’re unable to go about the activities that you do on a daily basis, call your doctor. Some type of treatment should be able to help reduce the pain.
The bottom line
You don’t need to take this pain in your rear end sitting down. But you do need to find out what’s causing it so you can address it. Sciatica is a very common cause of pain in the buttocks. But there are other potential causes of buttock pain, so you might want to see your doctor to rule out other causes.
For example, bursitis often gets confused for sciatica. Your doctor will be able to examine you and find out if that’s what you’re experiencing. Then, you can figure out the treatments that will be the most appropriate for you.