It starts as a dull ache. Then, maybe a sharp sting when you stand up or a weird, deep throbbing while you’re just trying to watch a movie. You’re wondering why does the inside of my buttocks hurt, and honestly, it’s one of those things people are too embarrassed to talk about at dinner, but it’s incredibly common. We’re talking about that specific, deep-tissue discomfort—sometimes it feels like it’s in the bone, sometimes it feels like a pulled string running down your leg.
The anatomy back there is a mess of overlapping muscles, nerves, and ligaments. It's not just "the glutes." You’ve got the piriformis, the obturator internus, the pelvic floor muscles, and the sciatic nerve all fighting for real estate in a very tight space. When one thing goes wrong, everything feels like it’s on fire.
The Piriformis Problem and the Nerve Trap
Most people immediately jump to "sciatica" when their butt hurts. They aren’t entirely wrong, but the culprit is often the piriformis muscle. This tiny, pear-shaped muscle sits deep behind your gluteus maximus. Its main job is rotating your hip. The problem? The sciatic nerve runs right underneath it—or in about 15% of the population, right through it.
When this muscle spasms or gets tight from sitting too long at a desk, it crushes the nerve. This is Piriformis Syndrome. It doesn't just stay in the butt; it radiates. You might feel a numbness that creeps toward your hip or a tingling that makes you want to shake your leg out constantly. Dr. Aaron Horschig, a renowned physical therapist and author of The Squat Bible, often points out that this isn't usually a "weak" muscle issue, but a "stability" issue. Your body is tightening that muscle because it doesn't feel supported elsewhere.
If you spend eight hours a day in a standard office chair, you are essentially "smothering" these tissues. The blood flow drops. The nerves get grumpy. It’s a physical protest.
Is It Your Tailbone or Something Deeper?
Sometimes the pain is more central. If the ache feels like it’s right at the "crack" or deep inside near the base of your spine, you might be looking at Coccydynia. That’s a fancy word for tailbone inflammation. You don't have to fall on the ice to get this. Repetitive strain—like cycling for hours or sitting on hard stadium bleachers—can do it.
But let’s get a bit more clinical. Sometimes the "inside" pain is actually Levator Ani Syndrome. This involves spasms of the pelvic floor muscles. It feels like a dull, pressure-heavy ache deep inside the rectum or the pelvic floor, and it can be triggered by stress or even chronic constipation. It's frustrating because you can't exactly "stretch" it out like a hamstring. It requires a different approach, often involving pelvic floor physical therapy, which, yes, is a real and highly effective medical field.
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The SI Joint: The Great Mimicker
If the pain is off to one side, right where your dimples would be if you have them, it’s likely the Sacroiliac (SI) Joint. This joint connects your spine to your pelvis. It isn't supposed to move much. But if it moves too much (hypermobility) or too little (hypomobility), it creates a deep, gnawing pain in the inner buttock area.
- Pregnancy: A huge factor here. The hormone relaxin loosens ligaments, making the SI joint unstable.
- Uneven Gait: If you’ve ever had a knee or ankle injury, you might be walking slightly "off." That imbalance travels up the chain and hits the SI joint hard.
- Arthritis: Specifically, ankylosing spondylitis often starts right here.
It’s tricky because SI joint pain feels almost identical to a herniated disc. A doctor might use a "Provocation Test"—basically moving your leg in weird angles to see if they can trigger the specific pain—to tell the difference.
When to Actually Worry About Deep Buttock Pain
Most of the time, it’s a muscle knot (trigger point) or a grumpy nerve. But we have to be real. There are "red flags" that mean you shouldn't just be rolling around on a lacrosse ball in your living room.
If the pain is accompanied by saddle anesthesia—which is a medical term for numbness in the areas that would touch a horse saddle—get to an ER. This can signal Cauda Equina Syndrome. It’s rare, but it’s a surgical emergency involving compressed nerve roots at the base of the spinal cord. Similarly, if you lose control of your bowels or bladder, or if the pain is so intense you can’t walk, stop reading this and call a professional.
Also, don't ignore unexplained weight loss or pain that is significantly worse at night when you're lying still. These can be outliers for things like infections or, in rare cases, tumors. Again, rare. But worth knowing.
My Butt Hurts When I Sit: The "Weaver's Bottom"
There’s a bursa—a fluid-filled sac—called the ischial bursa located where your "sit bones" are. If you’ve been losing weight or sitting on hard surfaces, this sac can get inflamed. This is Ischial Bursitis. It feels like you’re sitting on a golf ball.
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Historically, it was called "Weaver’s Bottom" because people who sat at looms all day suffered from it. Today, it’s "Data Scientist’s Bottom." It’s an overuse injury of the tendons that attach your hamstrings to your pelvis. If it hurts specifically when you're driving or sitting on a wooden chair, this is your likely culprit.
Why Your "Tight" Glutes Might Actually Be Weak
We have a tendency to stretch things that hurt. If your butt hurts, you do a Pigeon Pose or a figure-four stretch. Sometimes that works. Often, it makes it worse.
Why? Because if a muscle is painful because it’s overstretched and weak, pulling on it more is like tugging on a frayed rope. The Gluteus Medius is a frequent offender. If this muscle isn't firing, your leg caves inward when you walk, putting massive strain on the deep rotators. You don't need a stretch; you need a side-plank or some clamshells. Building "butt armor" through strength training is often the only permanent fix for chronic deep tissue aches.
High Hamstring Tendinopathy
This one is for the runners and the "yoga-holics." If the pain is right at the crease where your butt meets your thigh, it's likely the hamstring tendon. This isn't a sudden tear; it's a "wear and tear" situation. It hurts when you sit, and it hurts when you accelerate while running. Unlike a muscle strain, tendons take forever to heal because they have poor blood supply.
Standard advice? Stop stretching it. Seriously. Over-stretching a damaged tendon can cause "compressional loading," which just keeps the inflammation cycle going.
Practical Steps to Find Relief
If you are currently dealing with that nagging question of why does the inside of my buttocks hurt, here is a logical progression of how to handle it.
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1. The Sitting Audit
Check your ergonomics. If you’re tucking one foot under your butt while you work, stop. This creates a massive pelvic tilt that screams at your SI joint. Buy a "donut" pillow or a memory foam cushion if you suspect bursitis. Set a timer for every 25 minutes to stand up and squeeze your glutes. It wakes up the nerves and restores blood flow.
2. Nerve Glides vs. Stretching
If the pain feels "electric," don't stretch. Try Sciatic Nerve Gliding. Sit in a chair, straighten your leg, and flex your foot while looking up at the ceiling. Then, point your toe and look down at your chest. You are "flossing" the nerve through the muscle tissue rather than yanking on it.
3. Strengthening the Support System
Focus on the "Side Butt."
- Clamshells: Lie on your side, knees bent, and lift the top knee without rotating your hips back.
- Banded Walks: Put a resistance band around your ankles and shuffle sideways.
- Single-leg Bridges: These force the gluteus maximus to take the load so the tiny piriformis can stop overworking.
4. Professional Intervention
If you’ve had the pain for more than two weeks with no improvement, see a Physical Therapist. They are movement detectives. They can tell if your hip socket is shaped in a way that causes impingement or if your core isn't stabilizing your pelvis properly. For deep pelvic floor issues, look specifically for a Pelvic Health Specialist. It might feel awkward to book, but they deal with this every single day.
5. Heat vs. Ice
Ice is for acute injuries—like if you just fell. For that deep, nagging ache, heat is usually better. It relaxes the deep muscle spasms and increases the elasticity of the tissues. A 20-minute heating pad session can do wonders before you start any corrective exercises.
The reality is that "butt pain" is rarely just one thing. It's usually a combination of lifestyle (too much sitting), biomechanics (weak hips), and perhaps a bit of neural sensitivity. Address the movement first, and the pain usually follows the exit door.
Next Steps for You:
Audit your sitting posture today. If you notice you're leaning heavily on one hip, correct it immediately. Start a basic glute strengthening routine—three times a week, focus on lateral movements—and track if the "deep" ache begins to dissipate as your stability increases. If the pain radiates past your knee or causes weakness in your foot, schedule an appointment with a primary care physician to rule out a lumbar disc issue.