DEAR MAYO CLINIC:

I'm 71 and have been experiencing mild pain in one of my buttocks for the past three months. It's uncomfortable to sit at times. What would cause this? What can I do for some relief?

ANSWER:

This type of pain can have a variety of causes. Simple self-care techniques may be all you need to relieve the discomfort. But if pain persists, make an appointment with your doctor to have your condition evaluated and develop a treatment plan.

The most common causes for the pain you describe are these. First, the source could be arthritis affecting the joints of your spine, particularly the joints between the vertebrae (facet joints) or those that connect your lower spine and pelvis (sacroiliac joints). Second, hip joint disorders are a common cause of buttock pain but are often overlooked. Third, your pain could be the result of a soft tissue condition, such as problems in the muscles of your buttock or hip regions, their tendons (tendonitis) or bursa (bursitis).

A fracture of your sacrum -- the bony structure at the base of the spine -- could also be the problem. This is a type of stress fracture and can occur without significant injury. A sacral fracture is of particular concern for people in your age group, especially women, because it could be a sign of osteoporosis.

A less common possible explanation of the pain is a spinal disk that's causing a pinched nerve. Very rarely, buttock pain may be caused by a serious condition, such as a tumor, cancer, infection, rectal disorder, neurologic disorder or a severe rheumatologic problem.

Before you pursue a medical evaluation, however, try the following techniques at home. Take over-the-counter pain medications, and use a hot pack or a cold pack. Or alternate heat and ice on the area, 15 to 20 minutes at a time, several times a day. Try gentle daily stretches for your legs, hips and buttocks. To relieve pressure, use a cushion when you're sitting.

If after two weeks there's no improvement, or if new symptoms develop, see your doctor. An evaluation will include a review of your medical history and a physical exam. Your doctor may inquire about your overall health and current symptoms, as well as any additional signs or symptoms that could point to a more serious underlying disorder. Those may include unexplained weight loss, fever, chills or night sweats, among others. Tell your doctor if you've recently had a significant injury or if you have a history of cancer.

A spinal X-ray may be necessary to determine if a fracture or other spinal instability is to blame. Other imaging tests -- an MRI or bone scan -- may also be needed. If you have a sacral fracture, your doctor should investigate for a possible diagnosis of osteoporosis.

Treatment depends on the underlying cause. Generally, though, pain control and physical therapy to strengthen muscles in the back and buttock region help in most situations. As a rule, the emphasis of treatment is on a return to normal activities, as much as possible. From there, treatment decisions are often based on how much the pain interferes with daily functioning. If discomfort causes you difficulty in performing normal activities, or otherwise limits your quality of life, treatment will likely be more aggressive than if the pain is a nuisance that doesn't have a large impact on your daily routines. Surgery is rarely needed to treat buttock pain.

Try the self-care steps outlined above. If that's not enough, see your doctor. Your primary care physician can offer medications and refer you to physical therapy, if needed. If your doctor feels further evaluation is necessary, you may be referred to a physical medicine and rehabilitation physician or a pain medicine physician who specializes in spine care.

-- Randy Shelerud, M.D., Spine Center, Mayo Clinic, Rochester, Minn.

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