Have you been sitting for long hours only to notice a sharp pain in your butt bones? This could be a condition related to your ischial tuberosity. This problem is referred to as seat bones or sit bones since it absorbs all your weight when you sit down.

What is Ischial Bursitis?

The pain in butt bones when you sit too long is caused by inflammation or irritation of the ischial bursa. Ischial bursitis, also known as ischio-gluteal bursitis or "weaver's bottom," is a condition where the fluid-filled sacs in the pelvis become inflamed and swollen, causing the sit bone pain.

This bursa exists biologically to limit the amount of frictional force created between the gluteal muscle and the ischial tuberosity, which may otherwise cause injury or irritation. This bursa inflammation is most usually caused by prolonged pressure on the ischium, as occurs when sitting for long periods of time, or by repetitive movement of the gluteus maximus muscle in sports such as biking.

Ischial Bursitis can cause a lot of problems with sitting, walking, or running. There are several treatments available to improve your symptoms and reduce inflammation in the area. In this article, we'll discuss everything about butt bone pain from sitting, its causes, symptoms, and treatments.

Ischial Tuberosity Anatomy

The ischial tuberosity is a rounded bone that extends from the ischium, which is the curved bone at the bottom of your pelvis. It's right below the ischial spine, a pointed bone that runs along the back of your groin.

The hamstring, a muscle at the rear of your leg, is connected to the ischial tuberosity by three tendons. When your leg is straight and your thigh is stretched, the gluteus maximus muscle covers the ischial tuberosity. When you bend your knee and flex your thigh, the gluteus maximus moves and exposes the ischial tuberosity. This explains why you don't have a huge gluteus maximus muscle to provide extra cushioning for your ischial tuberosity when you sit.

What causes Ischial Bursitis?

The origin of ischial bursitis may be seen in the condition's original name, "weaver's bottom." Workers who sat for lengthy amounts of time on hard surfaces were the first to get this ailment. This ailment is also known colloquially as "tailor's bottom." Ischial bursitis, like many other bursal inflammations, can arise in a variety of situations.

Bursitis has been linked to autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, and scleroderma, among others. This inflammation may be caused by uremia, which is common in illnesses such as gout and chronic renal disease.

Because the ischial bursa is a deep bursa, it is less prone to the continuous spread of infectious germs. Infectious etiologies of ischial bursitis include septicemia and septic arthritis, both of which are uncommon. Because of its position in the body, direct bacterial injection of the bursa would be highly unlikely.

It causes pain right at the center of your buttock and may sometimes move down to the back of the leg. This pain is often confused with sciatica, a pain that is caused by irritation of the sciatic nerve. However, a doctor would be able to tell the problem by doing a thorough physical examination.

Epidemiology

Ischial bursitis is a clinical disease that occurs seldom. Although the diagnosis is sometimes overlooked, it can affect people of all ages. Bursitis as a whole accounts for fewer than 1% of all primary care visits.

This condition is especially frequent in those who are in sedentary jobs, with persistent irritation of the ischial bursa caused by lengthy periods of sitting on hard surfaces, giving rise to the colloquial name "weaver's bottom."

Pathophysiology

Bursae are classified as adventitious, subcutaneous, submuscular, or synovial. The ischial bursa is a synovial bursa, which means it is made up of a fatty connective tissue capsule filled with synovial fluid. When infected or irritated, synovial cells multiply, resulting in increased production of synovial fluid. This process is mediated by inflammatory mediators such as cyclooxygenase, cytokines, and metalloproteases.

As a result, granulation tissue forms in the shape of a thick fluid-filled hollow with high levels of fibrin. This tissue will eventually obstruct the normal mobility and activity of the surrounding tissues, whether they be muscle, bone, or tendon, over time.

Symptoms of Ischial Bursitis

Some of the symptoms of ischial pain include:

• Pain when you walk or run
• Pain or stiffness in the pelvis area
• Pain while sitting down
• Swelling or redness around the area
• Trouble sleeping on the affected side.

The butt bone pain from sitting down and getting up is diagnosed through a simple physical examination and review of the symptoms you experience. Your doctor may ask you to stand, sit, or move your hips and legs. If at all, your doctor is unable to identify the cause of your symptoms, then you may be asked to do an X-ray, so that your doctor can have a better view of the pelvis area. An MRI scan or ultrasound may also be performed to check for any swelling and inflammation. In some cases, a little fluid sample may also be taken from the affected area as well.

The examiner may notice soreness across the buttock during the physical exam. Passive flexion of the hip joint may cause discomfort in patients. The patient may also be unable to extend the hip. Stretching may cause discomfort for the sufferer. There may be overlaying erythema, though this is less prevalent with ischial bursitis. If erythema is a prominent feature of the presentation, it may indicate the presence of additional etiologies such as cellulitis or septic joint.

Diagnosis of Ischial bursitis

Most patients may be identified and treated clinically after an assessment, without the need for further testing. Most occurrences of ischial bursitis are self-limiting and will go away on their own. Blood tests should be performed only if an infection or an autoimmune disorder is suspected. Lab readings will most likely be within the normal range in the event of bursitis.

If another problem, such as a septic joint, is suspected, joint aspiration and antibiotic therapy may be indicated. Although MRI is sensitive for bursitis, it is often costly and unneeded when diagnosing and treating ischial bursitis. This test is only required if there are other probable differentials, such as malignancies.

Similarly, ultrasound is unneeded until aspiration occurs, in which case it is important to guide the process and ensure aspiration happens in the proper spot.

Treatment for Ischial Pain

The pain you may experience is most often resolved on its own when you take some rest. However, Ischial bursitis pain can sometimes take longer to heal since it’s impossible to completely avoid sitting down. Some of the treatments for Ischial pain are as follows:

• Taking Maximum Rest

Simply resting from any physical activity that causes the pain can help treat your problem. Avoid sitting down on hard surfaces for too long, and try to lie down and rest to relieve your pain.

• Ice Packs

In some cases, your doctor may advise you to use ice packs to reduce any swelling and inflammation in the area. Ice packs help with any muscular pains, and using one to treat your sit bone pain can also be helpful.

• Medications

Sometimes sit bone pain can be easily treated through over-the-counter pain relievers such as anti-inflammatory drugs or acetaminophen medication. Most of the time, your doctor may advise you to take any over-the-counter medication to treat your pain. If medications aren’t effective, you may be given an injection of corticosteroid to help reduce any inflammation in the bursa area.

• Ring cushion/air cushion

Soft cushions can reduce the compression on the butt bones and help in reducing the inflammation and healing faster

• Frequent postural changes

Continuous constant stress on any part of the body can result in inflammatory disorders and therefore by changing postures frequently significantly reduces the stress on butt bones too.

• Exercise

Physical therapy is also useful to strengthen the ischial tuberosity muscles and improve flexibility. Climbing stairs can also prove to be helpful. However, whenever you do so make sure to hold a railing in case you suddenly feel the pain that could affect your balance. Stretching exercises could also be helpful to increase your flexibility in the hamstring.

However, before you start any kind of stretches or exercises, it's important to check with your doctor. A healthcare professional will be able to tell you what exercises are good for you and which ones might worsen the problem. A therapist can provide a range of different exercises and stretches to treat the pain and improve movement in the back, legs, and buttocks.

Some exercises and stretches for ischial tuberosity include:

Lying Down Buttocks Stretch

The lying down buttocks stretch can be performed in the following way:

1. Lie down flat on the back with your head resting on a cushion or pillow.
2. Keep your legs straight.
3. Slowly start bending the right knee inwards towards your chest.
4. Now, placing the hands around your thighs, below the back of your knee, pull your knee closer to the chest.
5. Hold in this position for about 5 to 10 seconds.
6. Slowly straighten your leg and repeat the same with the other knee.
7. Repeat 5 to 10 times on each leg.

Hip Extensions

Hip extensions are another great exercise when you experience pain in your butt bones. These exercises help to strengthen the buttocks and lower back. You can perform the hip exercises in the following way:

1. Begin on all fours with your knees under the hips and your hands under the shoulders. Make sure to keep the neck straight.
2. Stretch your left arm out in front and stretch the right leg out straight behind.
3. Now, slowly raise the stretched left arm and right leg until they are well aligned with your back.
4. Hold in this position for about 2 seconds before switching sides.
5. Repeat the exercise stretching the left leg and right arm.
6. Repeat these stretches about 5 to 6 times.

Sitting Rotation Stretch

The sitting rotation stretch is perfect for the oblique muscles and buttocks. This stretch can be performed in the following way:

1. Sit in an upright position with your back straight and your feet stretched straight out in front of you.
2. Bend your right knee and place your foot flat on the floor.
3. Slowly, move your right foot to the outside of your left knee.
4. Now, gently start twisting to the right side, while you push your left elbow against the right knee and look over your right shoulder.
5. Hold in this position for about 30 seconds, and then return to the starting position.
6. Repeat with the other leg.

These are some excellent stretches and exercise you can perform to treat sit bone pain. In case you experience any pain in the lower back, legs or buttocks stop the exercises immediately. Also, to be on the safer side, check with your doctor before starting any exercises.

Differential Diagnosis

Many illnesses manifest similarly, and the doctor must rule these out before making the definitive diagnosis of ischial bursitis. X-ray imaging of the hip and lumbar spine may aid in the diagnosis of referred pain from these areas caused by degenerative joint disease, arthritis, or other diseases. A physical exam will assist distinguish ischial bursitis from other muscle-related causes of discomfort, such as a muscle body tear or other disorders.

Intervertebral Hernia

Intervertebral hernias are usually referred to as a disc; nevertheless, this disc is spinal anatomy rather than a disease nomenclature. A disc is a material that exists between the bones of the spine and can ease the impact of the bones. A disc herniation occurs when discs are gradually forced out by impact.

A slipped disc is a disc that pops out due to pressure, and there is a nerve behind this disc. When these discs push on the nerves, it causes pain in the back, hips, and legs, which are the nerves' passageways. Numbness in the leg, aching, or tugging sensations are common symptoms of a slipped disc since it is a nerve condition.

For more information see: Intervertebral Hernia Facts - Viewpoints from Expert Doctors

Sciatica

Sciatica is a disorder caused by compression or blockage of the sciatic nerves. These are the body's two biggest nerves. They extend from the lower spine to the buttocks and then to the knees.

Compressions on the sciatic nerve caused by a disc prolapse or a constriction of the spinal canal can cause pain and discomfort. Sciatica can produce shooting pain, tingling, or numbness in any part of the body, from the buttocks to the legs.

When people sit for lengthy amounts of time, move, sneeze, or cough, their symptoms may intensify. Sciatica usually goes away in 4–6 weeks.

Treatment may include:

• Over-the-counter (OTC) pain relief, such as acetaminophen or ibuprofen
• Exercises and stretches
• Heat packs
• Physical therapy
• Pain relief injections
• Surgery

Prognosis

Ischial bursitis does not generally go away on its own unless the cause of the irritation on the ischio-gluteal bursa is correctly recognized and treated. The discomfort may subside after a period of rest or therapy, but resuming exercise will cause excessive friction on the bursa, resulting in inflammation and the reappearance of pain.

Complications

Ischial bursitis can result in problems with:

• Walking
• Running
• Sitting
• Stretching

Subsequent avoidance of activity and exercise may result in overall reconditioning and have a detrimental impact on other conditions that react well to or are avoided by exercise and activity on some level.

When to see a doctor?

Some causes of buttock discomfort will resolve on their own without medical intervention. Vigorous activity, for example, can result in muscular strains that cause localized discomfort.

However, if you have persistent discomfort in your lower back, buttocks, or legs, you should consult a doctor. This discomfort might be caused by an underlying problem that needs to be treated.

A doctor can determine a diagnosis by assessing the patient's symptoms and doing a physical examination. They can offer treatment and preventative suggestions after assessing the condition.

Conclusion

One of the most serious issues is when the discs between our lumbar vertebrae begin to expand, which generally becomes a persistent condition. When a disc bulges or herniates, the muscles around it begin to tighten in order to keep everything in place and prevent additional harm. That's good if we don't move, but it's not what our bodies were designed for. We're built to move, and when we try to rise and move again, we're asking these tight muscles to do so, but they won't.

Ischial bursitis is an uncommon condition that can be treated by a family care physician, nurse practitioner, internist, or sports physician. The diagnosis is clinical, but an extensive workup may be required to rule out other illnesses. Rest, pain medication and physical therapy are common forms of treatment.

In the short term, cold compresses may assist to alleviate swelling-related discomfort. An intrabursal corticosteroid injection with lidocaine may give relief if the pain is unbearable or persistent. The lidocaine will aid by giving instant pain relief by blocking sodium channels in the surrounding tissue, so reducing the transmission of the pain signal.

It is necessary to educate the patient on healthy lifestyle modifications such as weight loss and frequent exercise. Occupational and/or physical therapy may be beneficial in this situation. Sedentary patients are more likely to have recurrences.