Buttock pain is a prevalent issue that can significantly hinder daily activities such as sitting, walking, or exercising. While initial discomfort may seem minor, persistent pain can compromise mobility and overall quality of life. Understanding the underlying causes of buttock pain is crucial for effective treatment and prevention.
Anatomy of the Buttocks
The buttocks are composed of interconnected muscles, nerves, bones, and connective tissues that work synergistically to support body movement and stability. Irritation, inflammation, or injury to any of these components can result in pain. Buttock pain can manifest as sharp, dull, aching, or radiating sensations, with intensity ranging from mild to severe.
Buttock pain can stem from various sources, including musculoskeletal issues like muscle strain, nerve compression, or underlying health conditions like infections or tumors. Even minor injuries or imbalances in the buttocks, which comprise essential muscles, nerves, and joints supporting movement and posture, can trigger discomfort.
Common Causes of Buttock Pain
Several factors can contribute to buttock pain, including:
1. Muscle Strain
The gluteal muscles, including the gluteus maximus, medius, and minimus, are crucial for hip movement, balance, and posture. Muscle strain in the buttocks occurs when these muscles are overstretched or torn due to sudden movements, heavy lifting, or overuse during intense physical activity.
Read also: Myofascial Pain Syndrome Relief
2. Sciatica
Sciatica is a condition that arises when the sciatic nerve, the longest nerve in the body, becomes compressed or irritated. This nerve extends from the lower back through the buttocks and down each leg, and any compression can cause pain to radiate along this path. Sciatica pain is a common type of nerve pain. Excess weight is also one of the most common causes of sciatic pain.
3. Piriformis Syndrome
Piriformis syndrome occurs when the piriformis muscle, a small, pear-shaped muscle located deep in the buttocks, becomes tight, irritated, or inflamed. People who sit for extended periods, runners, and those with poor hip flexibility are more susceptible to developing this condition. Piriformis syndrome is pain and numbness in your buttocks and down the back of your leg. It occurs when the piriformis muscle in the buttocks presses on the sciatic nerve.
4. Bursitis
Bursitis develops when one of the small, fluid-filled sacs known as bursae, which cushion joints, becomes inflamed. This inflammation often results from overuse, injury, or prolonged pressure. Ischial bursitis, near the “sit bones,” and trochanteric bursitis, near the outer hip, are two primary types of bursitis that can affect the buttocks.
5. Herniated Disc
A herniated disc occurs when the soft, gel-like center of a spinal disc pushes through its outer layer, exerting pressure on nearby nerves. When a herniated disc occurs in the lower back, it can compress the nerves that travel through the buttocks and down the legs.
6. Sacroiliac (SI) Joint Dysfunction
The sacroiliac (SI) joints connect the base of the spine (sacrum) to the pelvis, playing a vital role in absorbing shock and stabilizing the body during movement.
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7. Muscle Imbalances
Muscle imbalances occur when specific muscles become stronger or tighter than their opposing muscles, leading to uneven tension and strain on the body.
8. Hamstring Injuries
The hamstrings are a group of muscles on the back of the thigh that play a crucial role in walking, running, and bending the knee.
9. Pelvic Fracture
A pelvic fracture involves a break in one or more of the bones that constitute the pelvis, often resulting from high-impact trauma, such as a car accident or a severe fall. Stress fractures may also occur in athletes or older adults with osteoporosis.
10. Hip Labral Tear
The hip labrum is a ring of cartilage that surrounds the hip socket, providing stability and cushioning for the joint. A tear in this cartilage can cause pain that radiates into the buttocks, especially during hip movements.
11. Myofascial Pain Syndrome
Myofascial pain syndrome is a chronic pain disorder caused by trigger points or sensitive “knots” of tight muscle fibers that can develop after injury or muscle overuse. In the buttocks, these trigger points are often found in the gluteal muscles, and they can radiate pain to other areas like the hips, lower back, or legs.
Read also: Sciatic Nerve Pain Relief Through Massage
12. Spinal Stenosis
Spinal stenosis occurs when the spaces within the spine narrow, putting pressure on the nerves that exit the spinal cord. This condition is more common in older adults and often affects the lower back.
13. Deep Gluteal Syndrome
Deep gluteal syndrome occurs when the sciatic nerve becomes compressed by muscles or other anatomical structures within the gluteal region.
14. Tumors
Although rare, tumors or abnormal growths in the pelvis, spine, or soft tissues of the buttocks can cause pain. These growths, which may be noncancerous or cancerous, press on nearby nerves, muscles, or bones.
15. Infections
Infections, such as abscesses or bone infections, can develop in the soft tissues, bones, or joints of the buttocks. These infections may result from open wounds, surgery, or the spread of bacteria from another part of the body. Symptoms include swelling, warmth, redness, and intense pain in the buttocks.
Buttock Pain After Rapid Weight Loss: "Ozempic Butt"
If you’ve been using Ozempic (semaglutide) or a similar GLP-1 agonist medication and lost a significant amount of weight, you may have noticed other unexpected changes in your body - especially in your buttocks. Some people describe their once-fuller glutes as looking deflated, saggy, or flat after weight loss, a phenomenon that is known as "Ozempic butt."
Ozempic butt is an informal term for a loss of volume, firmness, or shape in the buttocks after significant weight loss on Ozempic or similar GLP-1 receptor agonist medications. This class of drugs, originally designed for managing type 2 diabetes, is now widely used for weight loss because the medications curb appetite, slow digestion, and promote weight loss. While losing weight can have many health benefits, it often leads to changes in body composition, including reductions in both fat and muscle mass - which is what contributes to the appearance of Ozempic butt.
Unlike natural age-related muscle loss or weight fluctuations from diet and exercise, Ozempic butt is primarily driven by rapid fat loss without sufficient muscle preservation. The buttocks naturally store fat. When this fat diminishes quickly (without maintaining muscle), it can lead to a flatter, deflated, or sagging appearance. In some cases, loose skin may also develop, especially in people who have lost a significant amount of weight. While this change in the appearance of the glutes can be frustrating, it’s important to note that the underlying cause is often a combination of fat and muscle loss. It’s not just about the loss of fat but also the lack of muscle tone to maintain glute shape.
Causes of Ozempic Butt
Several factors contribute to the development of Ozempic butt, including:
- Rapid fat loss: The buttocks naturally store a significant amount of fat. When someone loses weight quickly, the fat in this area can shrink rapidly, which can lead to a deflated, sagging, or flattened appearance.
- Loss of fat where you naturally store more fat: Everyone stores fat a little differently - some people carry more fat in their abdomen; others in their face, buttocks, or other areas. If you naturally store more fat in your glutes, you may notice a more pronounced change in their shape and fullness compared to someone who carries more weight elsewhere.
- Muscle loss: Any time you lose weight, you lose both fat and muscle. But the faster the weight comes off, the more muscle you’re going to lose - especially if you’re not eating enough calories or doing enough strength training. Gluteal muscles (gluteus maximus, medius, and minimus) play a key role in the shape and function of your buttocks. When these muscles shrink, your butt may appear smaller, softer, or less lifted.
- Loose skin: The ability of skin to bounce back after weight loss depends on factors such as collagen, elastin, hydration, and genetics. If weight loss is too rapid, the skin doesn’t have time to adjust. This can create loose or sagging skin on your buttocks, making them appear deflated.
- Age-related changes: Some people naturally lose collagen, elastin, and muscle mass as they get older, which can make the effects of rapid weight loss more pronounced. Older individuals may also find that their skin becomes thinner and less resilient, making it harder to adapt to changes in body composition.
Treatments for Ozempic Butt
If you’re already seeing signs of Ozempic butt - such as sagging, volume loss, or a flatter appearance - there are several approaches to address it. Here are a few effective and sustainable solutions that focus on strengthening your muscles and improving overall fitness.
- Strength training: Resistance exercises can help rebuild lost volume in your glutes. It’s one of the best ways to restore both appearance and function after significant or rapid weight loss.
- Work with a physical therapist: If pain is limiting you from working on strengthening your glutes, a physical therapist can help create a personalized plan to reduce pain and safely work toward your goals. They can assess muscle imbalances, recommend targeted movements, and ensure you're engaging the right muscles effectively. This is especially helpful if rapid weight loss has led to decreased muscle function, postural changes, or joint discomfort. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.
- Eat a protein-rich diet: Protein is essential for muscle repair and growth, making it a key part of restoring volume in your buttocks. Foods like lean meats, fish, eggs, dairy, tofu, legumes, and protein shakes can help provide the necessary building blocks for muscle recovery. Aim to spread protein intake throughout the day to support consistent muscle growth. Combining protein with strength training enhances your ability to regain muscle mass in areas affected by weight loss.
- Hydrate: Water supports protein metabolism, nutrient absorption, and circulation, all of which contribute to muscle repair and growth. Proper hydration can also help maintain skin and muscle firmness, which may improve the appearance of sagging after weight loss. Aim to drink at least half your body weight in ounces of water each day to keep your muscles and tissues healthy.
There are also more expensive options such as cosmetic treatments for Ozempic butt, like dermal fillers, fat transfer (BBL), or skin-tightening procedures. These can restore volume to your glutes but they don’t address the underlying muscle loss that contributes to changes in shape and firmness. A more sustainable and health-focused approach involves strength training, nutrition, and hydration to rebuild muscle and support overall body composition.
How to Avoid Ozempic Butt
If you're currently taking a GLP-1 agonist medication, there are steps you can take to minimize the risk of developing Ozempic butt.
- Incorporate strength training early: Incorporating strength training from the start of your weight loss journey can help maintain and even build muscle mass in your glutes.
- Move your body: While focusing on glute exercises is important, overall body movement - such as walking, cycling, or swimming - helps promote balanced muscle preservation.
- Eat healthy fats: Essential fatty acids, like those found in avocados, nuts, seeds, and olive oil, support skin elasticity and muscle recovery. Healthy fats also play a role in maintaining overall body composition and can help prevent excessive fat loss in certain areas.
- Try to lose weight gradually: Rapid weight loss increases the likelihood of losing both fat and muscle, leading to a more pronounced change in body shape. Slow, steady weight loss allows your body to adjust while minimizing muscle breakdown. If you’re taking a medication like Ozempic for weight loss specifically, talk to your doctor about your dose. They may be able to adjust your dose to help you lose weight more gradually.
Gluteal Compartment Syndrome
Gluteal Compartment Syndrome is a rare condition caused by excessive pressure within the gluteal compartments, which leads to a number of potentially serious sequelae, including rhabdomyolysis, nerve damage, renal failure, and death. As bariatric patients are heavy and during prolonged bariatric procedures lie in one position for extended periods of time, they are especially susceptible to developing this complication. It is therefore essential that bariatric surgeons are aware of this complication and how to minimise the chances of it occurring and how to diagnose it.
Symptoms of Gluteal Compartment Syndrome
Symptoms include painful movement of the hip, bruising, tense swelling of the buttocks, altered sensation, paraesthesia and palsy within the territory of the sciatic nerve. Clinical signs such as increased gluteal compartmental pressure to at least >30 mmHg (n = 14 mmHg), Myoglobulinuria (tea coloured urine) resulting in acute renal failure, third space fluid losses, causing hypotension, hyperkalaemia causing acidosis and multi organ failure may be present.
Diagnosis and Treatment of Gluteal Compartment Syndrome
The diagnosis of Gluteal comp syndrome is a clinical one but measuring Creatinine Kinase concentrations, the intra-compartmental pressure and MRI features help to confirm the diagnosis. The latter may demonstrate muscle oedema. In order to avoid permanent nerve and muscular damage, early diagnosis is of paramount importance. Fasciotomy should be carried out as soon as possible to release the pressure and all necrotic muscle excised. Renal failure, which may accompany this condition as a result of rhabdomyolysis, should be treated with forced diuresis and alkalinisation of the urine. Haemodialysis may be required in severe cases.
Prevention of Gluteal Compartment Syndrome
Various recommendations have been made for the prevention of this syndrome: Adequate intraoperative padding and positioning, limiting the duration of surgery, decubitus positioning every 2 h per-operatively, and avoiding operating on super obese high risk patients early in the learning curve or consider a shorter operation such as sleeve gastrectomy as the definitive procedure or a two stage procedure where a sleeve gastrectomy followed by a Gastric bypass. Other options would include weight loss pre-operatively using measures such as a strict low calorie diet, an intra-gasric balloon, Endobarrier or POSE procedure. Post operative measures such as systematic neuromuscular examination looking for signs of compartment syndrome and routine checking of CPK levels will help in early identification.
Other Considerations
Nerve Pain After Weight Loss or Gain
Weight changes-whether rapid loss or significant gain-can profoundly impact your nervous system. Each additional pound you gain imposes four additional pounds of force on your joints and spine. Weight fluctuations trigger metabolic changes that directly impact nerve health. Surprisingly, rapid or significant weight loss can also trigger nerve pain. Nutritional deficiency may induce the immune mechanisms of neuropathy, and multiple factors including nutritional and metabolic disturbances might be involved.
If you’re experiencing nerve pain after weight changes, proper medical evaluation is essential. Effective treatment requires addressing both the underlying weight issues and the nerve pain symptoms.
Coccyx Pain
Although a very small bone, the coccyx can contribute to very large amounts of pain. Many muscles and ligaments attach to the coccyx, making this anatomical structure of great interest to pelvic physical therapists. Most commonly trauma to the tailbone, such as a fall, childbirth, deliveries with use of forceps or a vacuum assisted delivery can all contribute to impairments. Pelvic physical therapy is a conservative treatment route one can take to improve their pain with sitting. Assessing sitting posture- the coccyx is a weight bearing bone when in sitting, however one’s posture can be impaired and causing more aggravation/ stress to the area.
Piriformis Syndrome vs. Sciatica
Although the conditions are sometimes related and both affect the sciatic nerve, they are different. A herniated disk or spinal stenosis can cause sciatica. The symptoms tend to affect the lower back and can travel down through the buttocks and leg. Piriformis syndrome only involves the piriformis muscle pressing on one area of the sciatic nerve in the buttock.
Prevention Strategies
While not all causes of buttock pain are preventable, many can be avoided by adopting healthy habits that support muscle strength, flexibility, and proper posture. Incorporate exercises that target gluteal strength and flexibility, such as bridges, squats, and hip stretches. Regularly stretch the hip flexors, hamstrings, and gluteal muscles. Avoid prolonged sitting or repetitive motions that strain the glutes. Use fall-prevention strategies, especially for older adults, and wear protective equipment for high-risk activities. Keep wounds clean and properly treated to prevent infection.