What Causes Lower Back Pain Just Above The Buttocks?

Lower back pain is incredibly common, and it’s one of the primary reasons for missed work days. However, lower back pain above the buttocks isn’t as typical. We’re going to look at the causes of this issue in this article.

What are common causes of lower back pain just above the buttocks?

Sciatica

As much as 40% of the population will suffer from sciatica during their lifetimes.¹ 

Sciatica describes pain specifically affecting the sciatic nerve. The sciatic nerve is one of the longest nerves in the body, running from the lower back to the feet. It can be compressed, irritated, or pinched at any point along this path, causing symptoms. 

These may include: 

• Leg pain that extends to the foot or toes

• Numbness or tingling in the leg or foot

• Trouble sleeping

• Tightness in the buttocks or hip area

Sciatica is a symptom of another condition, not a condition in itself. 

If you’re wondering how to relieve sciatica and lower back pain, you’re not alone; it is a common problem that leaves many people continuously suffering from aggravating symptoms.

Core-strengthening exercises, staying active, hot and cold packs, and gentle stretching can be beneficial in managing sciatica. Sciatica can be worse when inactive, so cutting down on time spent sitting down is important. However, it can also worsen when you spend too much time standing, so you need a careful balance of rest and activity.

Doctors know how to treat sciatic nerve pain in the lower back, so it’s best to visit your healthcare provider if your symptoms affect your day-to-day life.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can be helpful, and your doctor may recommend muscle relaxants, corticosteroids (either oral or injected), and physical therapy. If the pain persists beyond 6-8 weeks, your doctor may order an MRI to get to the bottom of your sciatica symptoms.

If you have any of these symptoms, seek immediate medical attention:

• You can’t control your bowels or bladder

• Sudden, intense pain in your leg, lower back with numbness or muscle weakness in your leg

• The pain follows a severe injury, such as a fall from a height or car accident

Sacroiliitis

Sacroiliitis affects 10-25% of people with lower back pain.² It’s the inflammation of the sacroiliac joint, the connection between the spine and pelvis, one of the largest joints in the body.

If you have sacroiliitis, you may experience lower back pain just above the buttocks, pain in the hips, buttocks, thighs, or even elsewhere in the body (referred pain). You may also experience more pain after sitting or standing for a while or when twisting and bending.

A traumatic injury, a leg length discrepancy (one leg shorter than the other), ankylosing spondylitis, an infection in the joint, or pregnancy can be some of the many causes of sacroiliitis.

To diagnose sacroiliitis, your doctor will examine your joint to see where the pain is coming from. They may also order blood tests and imaging tests such as an x-ray and MRI to determine the cause. 

In most cases, sacroiliitis resolves on its own with rest, applying heat and cold packs, changing your sleep position, and taking pain medications. Your doctor may also suggest a steroid injection into the nerve to reduce the pain. If muscle imbalances or weaknesses cause the condition, your doctor may recommend physiotherapy. However, there are some instances in which surgery may be necessary, but this is always a last resort. 

Muscle spasm

Muscle spasms (short cramps) are very common, and dehydration, trapped nerves, heavy lifting, fatigue, overuse, stress, or conditions like fibromyalgia and multiple sclerosis can cause them. If you have a muscle spasm once in a while, it’s likely not something you need to worry about.

However, if you have them regularly, it’s worth further investigation, especially if you experience them alongside any of these symptoms:

• Muscle weakness

• Pins-and-needles

• Pain in the head, neck, or back

• Skin numbness

• Tremors

• Double vision

• Sleep issues

• Slow movements

• Poor coordination

• Paralysis

Neurological issues often cause these symptoms, so your doctor will conduct tests to determine the cause. They may order blood tests to rule things out, an MRI, and lumbar puncture, among other tests.

Coccydynia

Coccydynia is a common condition affecting the coccyx (tailbone), though it’s usually mild. Women are five times more likely to be affected than men, and it can be triggered by childbirth.³ Other triggers include trauma, poor posture, being under/overweight, and prolonged strain on the coccyx. Less common causes include arthritis, cancer, and infection. In many cases, doctors cannot identify a cause.

Symptoms include:

• Tenderness or aching just above the buttocks

• Pain which may: 

• • Be worse when sitting down or standing for prolonged periods, having sex, or going to the toilet

  • Be dull and achy most of the time, with occasional sharp pains

  • Make it difficult to do everyday tasks like bending and driving

  • Affect the hips, buttocks, and back

• Sciatica

Treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs), a donut cushion to ease the tension on the coccyx while sitting, avoiding prolonged sitting, and applying hot and cold packs.

If the pain hasn’t resolved within eight weeks, you may benefit from physiotherapy, stretching, massages, or a steroid injection. Rarely, you may require surgery to manipulate the coccyx if all other treatment options have failed. The coccyx may need to be removed in incredibly rare cases, which is called a coccygectomy.

Lumbar spinal stenosis

While spinal stenosis is rare in those under 50, degenerative spinal changes are evident in up to 95% of people aged 50. Spinal stenosis is most common in the over 60s, with 21% having lumbar spinal stenosis (LSS).⁴

A 2013 study found that while LSS can be congenital (present from birth), most cases developed throughout the participants’ lives.⁵

These symptoms are associated with LSS:

• Lower back pain

• Pain in the buttocks or thighs

• Numbness and/or pain in the thighs down to the calves, shins, and feet, especially after standing for a while

• The intensity of numbness and/or pain increases after walking for a while, but resting relieves these symptoms.

• Bending forward reduces numbness and/or pain.

As with most back pain, doctors will recommend nonsteroidal anti-inflammatory drugs (NSAIDs) for dealing with day-to-day pain. Physical therapy and exercise are important for slowing down the effects of spinal stenosis. Your doctor may recommend an epidural corticosteroid as these have performed well in some studies for LSS.

Surgery is another option for treating LSS, with a 45-72% long-term success rate, depending on the end goal (ability to work, leg/back pain.)⁶

Two such surgeries are laminotomies and laminectomies. The lamina is an arch of bone that protects your spinal canal. Only part of the lamina is removed with a laminotomy, whereas a laminectomy is an almost total removal. Staying active is a large part of recovery and success after these operations. 

What are less common causes?

Herniated disk 

A herniated disk affects up to 2% of the population every year. Most patients’ symptoms resolve within 12 weeks without any specific treatment.⁷

A herniated disk is a condition in which an intervertebral disk’s soft, gel-like center pushes through a tear in its surrounding outer ring of cartilage. The disk provides cushioning for the surrounding vertebrae, so when it slips, this can cause back pain.

The pain from a herniated disk often radiates down the back of the leg (sciatica). The most common herniated lumbar disk symptom is lower back pain that worsens with sitting or standing for long periods.

Other symptoms may include:

• Numbness or tingling in the legs or feet

• Pain that radiates down one or both legs

• Pain that worsens at night or with activity

• Pain that’s relieved by rest or bending forward

Typically, herniated disks are treated conservatively with rest, ice or heat, exercise, medication, or physical therapy. 85% of herniated disk patients recover without surgery, so this will not be the first treatment offered. However, your healthcare provider will consider it if you:

• Are struggling to carry out your daily activities

• Are in severe pain

• Have numbness or weakness

• Can’t control your bladder or bowels

A discectomy is the most common surgery where your surgeon removes the disk entirely or partially. They make an incision in your back under a general anesthetic, and they will attempt a microdiscectomy: this reduces recovery time. 

As with lumbar spinal stenosis, a laminectomy or laminotomy is another option.

A spinal fusion may be necessary, where a surgeon fuses two or more vertebrae. This surgery stabilizes the affected vertebrae permanently, reducing movement and compression of nearby nerves. They may use bone from another part of your body (often the hip), donor bone, or artificial bone, securing it with screws or connecting rods.

Spinal cord cancer

While back pain can be an early symptom of a spinal cord tumor, these are extremely rare. The chance of developing a malignant brain or spinal cord tumor in your lifetime is less than 1%, with survival rates depending on the type of cancer.⁸

Symptoms of a spinal cord tumor include:

• Constant pain in the back, which gets worse and may radiate out to other places

• Pain that feels like a burning or tingling as the nerve is compressed

• Numbness, weakness, loss of sensation, or a lack of coordination in the arms and/or legs, typically on both sides of the body

• Muscle weakness or stiffness

• Decreased skin sensitivity to temperature

• Bladder or bowel problems

• Sexual dysfunction

To diagnose a spinal cord tumor, your doctor will order a series of tests, which may include blood tests, a biopsy, a lumbar puncture, and/or a contrast dye MRI.

If you’re diagnosed with a malignant tumor, you will have a specialized team working on your case to ensure you get the best care possible. Treatment will depend on the location and severity of the tumor⁹. Your team may recommend multiple treatments.

Surgery 

This is the first approach for treatment as this enables surgeons to remove as much of the tumor as possible. As treatment options depend on the type of cancer, they will also take a sample of the tumor to determine the required follow-up treatment.

Steroids 

They help reduce swelling and may be given before or after surgery or during or after radiotherapy.

Radiation therapy 

Radiation therapy uses repeated doses of high-energy beams such as x-rays or protons to shrink or prevent the tumor from growing. It can treat inoperable tumors or cells left over after surgery.

Radiosurgery 

This is typically a one-time treatment using multiple precise radiation beams aimed at the tumor from several angles. It hinders a tumor’s ability to grow, and doctors may use it in inoperable cases or after radiation therapy.

Chemotherapy

This uses powerful drugs to kill cancer cells and stop them from spreading or multiplying. The drugs are given orally, intravenously, or through a catheter.

Targeted therapy 

This type of treatment uses drugs to target specific proteins and genes involved in cancer growth, reducing the production of cancer cells.

Clinical trials 

Clinical trials can offer new drugs or treatments that aren’t otherwise available to the public. These treatments and medicines may be in the early, experimental stages or further down the line with promising studies. 

How is lower back pain just above the buttocks treated?

The first course of action is medication to reduce inflammation and pain, so anti-inflammatory drugs can make it easier to carry out your daily tasks. Heat and cold therapy can help, whether heat or cold packs or a hot bath. Taking a break from any vigorous activity is important, but you need to stay as active as possible, as too much time resting can exacerbate some conditions.

If your pain hasn’t eased after these treatments and lasts more than a couple of weeks, speak to your doctor as they can refer you to the right specialist.

Your doctor may recommend physical therapy, including core-strengthening exercises, stretching, and massage. Surgery may be necessary if other treatments are not effective.

When should you see a healthcare professional?

If you have any of these red flag symptoms alongside your back pain, you should immediately seek medical care:

• An inability to control your bowels or bladder or to urinate

• Sudden, intense pain in your legs or lower back with numbness or muscle weakness in your legs

• The pain follows a severe injury, such as a fall from a height or car accident

• Difficulting walking, using your lower body muscles, or paralysis

• Loss of feeling in your lower body

• Tingling or numbness in your genitals or buttocks

• Pain that is severe enough to prevent sleep

If your pain doesn’t ease within a couple of weeks of gentler activity and pain relief, make an appointment to speak to your doctor. They will be able to get to the bottom of your symptoms and start appropriate treatment. 

The lowdown

While lower back pain just above the buttocks can be a hassle to deal with, something as simple as a muscle strain or common conditions like sciatica or muscle spasms can cause it.

Less vigorous activity and basic home care can reduce the pain from these conditions. If you have lingering pain after a couple of weeks, speak to your doctor. They will advise you of the next steps in diagnosis and treatment.

You should present any red flag symptoms to a doctor as soon as possible; these symptoms can indicate issues that need immediate attention.

If you’re concerned about any symptoms or you’re worried you may have spinal cord cancer, get checked out as soon as you can. While it’s a rare type of cancer and your back pain probably has a more common, benign cause, it’s worth speaking to a doctor for your peace of mind.