Why do I have a pain in the butt?

Butt pain commonly arises from the sacroiliac joint (SI joint).  This pain is called sacroiliitis.   SI joint pain maybe felt under your jean pocket.    SI joint may cause back, buttock and leg pain. The pain is worse sitting especially on the butt cheek and with activity.

Causes of SI joint pain include arthritis (degenerative sacroiliitis), separation or weakness of the joint (SI joint disruption or laxity), abnormal joint from birth (sacral dysgenesis), inflammation and swelling (ankylosing spondylitis, Reiter’s syndrome or inflammatory bowel disease (IBD)), break or fracture, infection, bone disease and tumor.

The sacroiliac joint is the located between the spine (sacrum)  and the hips (ilium).  It is a large joint held together by strong muscles and ligaments.

SI joint pain can be difficult to diagnose and often is associated with spinal disease.  SI joint pain can be diagnosed by careful history, physical examination and diagnostic injections.  A needle is placed into the joint under x-ray or CT scan and steroid and pain medicine is injected.   Pain relief confirms the diagnosis of SI joint pain.

People may benefit from physical therapy, anti-inflammatory medicine and steroid injections. Patients who fail conservative treatment may consider fusion surgery.   Fusion surgery “fuses” the sacrum to the ilium to prevent pain.  This is done by surgically placed implants.  Many  people will have coexisting spinal disease requiring spinal surgery.


Dr. Spivak is a neurosurgeon who is fellowship trained in minimally invasive spinal surgery (MISS).  He treats a variety of disorders of the neck, back and SI joints. For more information on spine or SI joint treatment please call 908-452-5612 or click schedule-an-appointment.

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