Pelvic, Buttock, and Tailbone Pain

Pain in the buttock and pelvis can come from the muscles and nerves there directly, or be referred from the hip or back. Because so many structures overlap in this region — and because several causes are frequently overlooked — it's an area where a pain specialist's careful evaluation genuinely helps.

Muscle-based buttock pain

Myofascial pain and trigger points. Spasm in the buttock muscles can cause severe pain. Often the problem is a tender "knot" — a trigger point — that acts like a persistent muscle cramp, present around the clock. It may arise from the muscle itself or as the body's reaction to injury elsewhere. Treatment combines stretching, electrical stimulation, medications, and trigger-point injections, and results can be dramatic. (See our page on how trigger points work.)

Piriformis syndrome. A fall onto the buttock, a twisting injury while carrying weight, or a significant leg-length difference can injure the piriformis muscle deep in the center of the buttock — which matters because the sciatic nerve runs right beside it. The result is buttock pain plus leg pain that convincingly mimics disc sciatica. Treatment targets the cause: correcting a leg-length difference, stretching, and a targeted piriformis injection. (Covered in more depth on our low back and sciatica page.)

Ischiogluteal bursitis ("weaver's bottom"). A modern, sedentary-job ailment — inflammation of the bursa over the sit-bone. It's typically worse at night, and sufferers often prefer a hard chair. It can be hard to distinguish from sciatica or piriformis syndrome, and responds to a local cortisone injection.

Tailbone (coccyx) pain

The coccyx is the small bone at the very base of the spine. A slip, fall, or direct blow can fracture or sprain it — though about half of patients have no memory of a specific injury. The hallmark is pain when sitting on hard surfaces, and tenderness when the tailbone is moved on exam. Local injection and massage are often helpful.

Rectal and lower pelvic pain

Most rectal pain comes from common problems — hemorrhoids, fissures, proctitis, infection — that belong with a gastroenterologist, and cancer must always be excluded first. A pain specialist is consulted when those have been ruled out. One frequently overlooked cause is proctalgia fugax — spasm of the muscles around the rectum, which is surprisingly common. Treatment can include stool softeners, oral and topical medications, stretching, and numbing injections.

Bladder-related pelvic pain, including interstitial cystitis (pain above the pubic area that's worst when the bladder is full and eases with emptying), is diagnosed and managed primarily by a urologist; pain specialists contribute with certain nerve blocks and medications when needed.

Female pelvic pain

Pelvic pain has many causes, and the chronic-pain specialist typically becomes involved when the problem has evaded gynecological diagnosis or treatment, or when pain persists after gynecological surgery — which can be severe and disabling. A commonly overlooked contributor is spasm of the pelvic floor muscles. We can help with a range of tools: medications, nerve blocks, electrical stimulation, biofeedback, and counseling support, working alongside your gynecologist.

If pelvic, buttock, or tailbone pain has gone undiagnosed or untreated, call Newport Pain Management at (949) 759-8400.