Let’s dispense with all the bad puns and get down to business. Not only does bum pain suck, it can take on many forms and significantly affect your day-to-day functioning.
“If the pain is showing up in the glute muscle area, it can be perceived as tightness or stiffness, shooting pains, cramping or a nagging ache,” Amanda Shipley, a pelvic physical therapist based in Georgia, tells HuffPost.
“Anus, rectum or tailbone-area pain, meanwhile, can be felt as an itching, burning, searing pain or spasm that varies from mild to intense.”
Besides the discomfort and inconvenience of the physical pain, which can affect your ability to do important activities, such as standing, walking and exercising, it can be embarrassing and stressful to have to deal with the symptoms as well.
“The pelvic floor and genital region is such a taboo area to talk about and acknowledge in our society,” Shipley says. “This adds to the unnecessary shame we might feel when we need help in this area.”
In non-emergency situations, a physical therapy evaluation can help determine the root cause of your gluteal pain and whether symptoms need to be addressed through a physiotherapist or doctor. Fortunately, once you have the right treatment plan and health care professionals in place, bum pain conditions are highly treatable.
So what might be causing your rear to act up? Below are some of the most likely culprits, according to experts.
1. Gluteal amnesia
Street name: dead bum syndrome, or DBS. “We experience DBS most commonly by prolonged sitting,” says Dallas Reynolds, a physical therapist at ATI Physical Therapy in Illinois. “When we sit for long periods of time, our hip flexors get tight, and glute muscles get weak and sleepy.”
This can cause pesky symptoms like soreness or numbness in your backside, along with hip pain and stiffness – symptoms you’ll most likely notice when trying to stand up after a lengthy sitting session.
One of the best ways to turn things around is to surround yourself with opportunities to sit for shorter lengths of time and switch up where you sit, both of which keep the muscles in your buttocks and lower back engaged.
You might do this by investing in a standing desk, setting a timer to remind yourself to get up and stretch every hour and sprinkling in to-do list tasks that require movement throughout your day instead of batching them together.
Reynolds also recommended establishing an exercise routine you can perform to stretch your hip flexors and activate your glute muscles to keep them healthy and strong. (Try these moves, courtesy of the Cleveland Clinic.)
“If after making these changes in your daily routine you see no change or your symptoms begin to worsen, you should check in with your doctor for a consult,” Reynolds says.
2. Sciatica
The sciatic nerve runs from your lower back, down through your buttocks and all the way to your feet.
“Sciatica is a term used to describe a radiating pain that runs along the path of the sciatic nerve and can be felt in the lower back, glute area and legs,” Reynolds said. “Sciatic pain is felt when the sciatic nerve becomes irritated or inflamed, often from disc or spine issues, along with muscular dysfunction in the glute area.”
The pain that strikes can range anywhere from a mild ache to excruciating pain. It can also resemble a jolt or electric shock. Usually only one side of your body is affected, and things like coughing, sneezing and sitting for prolonged periods can make symptoms worse, according to the Mayo Clinic. You might experience numbness, tingling or muscle weakness, too, because of reduced nerve function.
“Nerve glide exercises are an effective way to mobilize the nerve and its ability to move more freely,” Reynolds says. “This will reduce irritation and should be performed often throughout the day.”
Mild sciatica usually goes away over time. “Check in with your doctor if you see no change or symptoms begin to worsen over time,” Reynolds says. “You should also seek medical attention immediately if you experience increased or sudden loss of leg strength or difficulty walking.”
3. Piriformis Syndrome
Piriformis syndrome is a condition in which the piriformis muscle (located behind your gluteus maximus) can become tight and irritated. “This can cause pain in the glute area and sciatica-type symptoms,” Reynolds says. “Sciatica isn’t always related to piriformis syndrome, but often piriformis syndrome can result in sciatica.”
The piriformis muscle sits over the top of the sciatic nerve, so if the muscle becomes irritated, it can press down on the sciatic nerve and cause glute pain, along with radiating pain down the leg. “You might also find symptoms worsen with prolonged sitting,” Reynolds says.
Getting into a stretching routine that helps reduce compression on the sciatic nerve can be a helpful pain relief strategy, as can the previously mentioned nerve glide exercises. You can also talk to your doctor about medications that can address inflammation and nerve-based symptoms. And if these changes don’t make a difference or symptoms get worse, you know the drill.
4. Bursitis
Bursitis in the hip is when the bursa sac – the fluid sac that reduces friction between the moving part of our joints – becomes inflamed. Though bursitis may be caused by trauma, infection or sustained pressure on the bursa, it’s most commonly associated with overuse or repetitive or strenuous activity.
“What’s usually happening is certain muscles of the hip are tight and others are weak,” Reynolds says. “This imbalance causes more pressure and friction on the bursa than what it’s built for and results in irritation and inflammation.” The result? Pain surrounding the bursa, often including the gluteal muscles in the area.
Along with pain in the glute area, you may experience warmth, tenderness and swelling, “mostly on the outside, bony part of the hip,” Reynolds says.
The best first step to relieving this particular brand of bum pain is stopping or modifying the activity that’s causing the bursitis and focusing on pain management and inflammation reduction, such as applying ice or popping an NSAID pain reliever. (Always check with your doctor before beginning any new medication, Reynolds says.)
As the pain starts to subside, slowly reintroduce activities and gauge the body’s response. “This could include starting with a walking routine with the addition of a light stretching and strengthening routine,” Reynolds says. “The focus here would be to address recovery from the current bursitis episode and prevent future episodes.”
5. Haemorrhoids
Haemorrhoids are swollen blood vessels that form on the anus and rectum, according to the US National Institute of Diabetes and Digestive and Kidney Diseases. There are two types: internal and external, with external usually the culprit for haemorrhoid-related bum pain.
“External haemorrhoids are very obvious – they can easily be seen and felt on the outside of the anus,” says Dr Stephanie Pannell, a colorectal surgeon and assistant professor of surgery at the University of Toledo. “They’re usually painful for a few days and slowly resolve over the next week or two.”
Haemorrhoids usually go away on their own, but, in the meantime, over-the-counter haemorrhoid creams can offer relief. So does sitting in a tub of warm water.
Internal haemorrhoids are usually caused by spending too much time on the toilet, whether from diarrhoea or constipation, so they can be more of a long-term issue. “If they’re bleeding, you should be evaluated by a physician,” Pannell says. “Any type of rectal bleeding needs to be seen by a physician.”
6. Anal fissures
Anal fissures are small tears in the tissues surrounding the anus. They usually happen as a result of passing a large, hardened stool and overstretching the anal opening.
“Patients describe anal fissures as feeling severe pain with bowel movements and possibly seeing small streaks of blood on the toilet paper,” Pannell says.
To top it off, the anal sphincter will contract once the skin is irritated on the outside. “This is an involuntary muscle, so even with bowel movements, the muscle will not relax,” Pannell says. “It makes the tear larger and bowel movements very painful.”
Anal fissures typically heal on their own and don’t require treatment. Things like upping your fibre and water intake and using stool softeners can be helpful in preventing them – but if yours won’t quit or they happen frequently, treatment is best done by your doctor, who can also make sure they’re not caused by an underlying condition, such as Crohn’s disease.
7. Anal abscesses
“Anal abscesses are very painful and usually present as a hard, sometimes red, tender area around the anus,” Pannell says. Fever is another common symptom. Rectal bleeding and trouble peeing – such as trouble initiating a urinary stream or painful urination — may also be present, according to the American Society of Colon & Rectal Surgeons, or ASCRS.
In most cases, treatment of an anal abscess involves surgical drainage. Your doctor will make an incision to drain the infection, with the end goal to ease the pressure and let the tissue heal. This can either be done at your doctor’s office or in an operating room if the infection is more severe.
8. Levator Ani Syndrome
Levator ani are the deep pelvic floor muscles, with levator ani syndrome referring to when these muscles are too tight and poorly coordinated (you have difficulty with things like contracting and relaxing them).
You might experience episodic pain and pressure in the rectum, lower spine or tailbone that lasts for hours or days. The pain usually feels dull or achy and may feel worse when sitting or lying down, according to the ASCRS.
“Immediate relief can be found with NSAIDs or more natural options like arnica montana and by applying heat or ice to the area,” Shipley says. “However, this pain can come on very suddenly, and if you’re on a call or in a meeting, you can’t always grab an ice pack to sit on.”
A pelvic physical therapist can do a thorough evaluation to determine the root cause of the pain (levator ani syndrome is considered a diagnosis of exclusion) to help alleviate your symptoms. Massage with a combination of heat and muscle relaxants has been shown to be effective in reducing symptoms in up to 90% of patients, according to the ASCRS.
9. Proctalgia Fugax
“Proctalgia fugax is just a fancy term that means sharp, painful spasms in the anus and rectum,” Shipley says. It may be diagnosed after a careful history and a thorough examination has been performed to rule out more serious causes of rectal pain.
Muscle relaxants may provide some relief from the intermittent discomfort, but ultimately treatment by a pelvic physical therapist is best to help alleviate your current pain and teach you how to minimise future flare-ups.
10. Menstruation
Some people who menstruate experience severe cramps that can cause pain in the rectum.
“When the uterus contracts to expel menstrual tissue, it can cause adjacent nerves to activate and cause pain in what most consider unusual areas,” says Dr Jennifer Roelands, an OB-GYN in Missouri. (This can happen with sex as well, she added: “Irritating the pelvic floor can cause spasms of these nerves, leading to severe pain in the pelvis, including the rectum, a condition called vaginismus.”)
There’s also endometriosis, a condition in which tissue that normally lines the uterus (the same tissue that sheds during your period) grows outside of it — any tissue growth that happens behind the uterus can often cause rectal pain, Roelands said.
Endo pain is often accompanied by bloating, moodiness, irregular periods, infertility and sometimes digestive issues.
“If you have butt pain that seems associated with the same time in your cycle, get evaluated by a doctor for endometriosis,” Roelands said. “There are a variety of natural, prescription and surgical treatments available, but a proper exam and diagnosis need to happen first.”
11. Fibroids
Uterine fibroids are masses that grow in the wall of the uterus. They can be as small as a grain of rice or as large as a grapefruit, with larger fibroids causing bum pain by pressing on the rectum or pelvic nerves.
“Associated symptoms include heavy, painful — and sometimes irregular —periods,” Roelands said. “Treatment is often surgical but requires an exam, ultrasound and discussion of the right treatment options with your doctor.”
Does colorectal cancer cause bum pain?
“Colon and rectal cancer are usually asymptomatic until the disease is advanced,” Pannell said. “Bleeding may be the first sign, which is why all rectal bleeding should be seen and discussed with your physician.”