Ischiogluteal Bursitis (Truly A Pain In The Bottom): Diagnostic Issues
Ischiogluteal bursitis is often referred to as being a classic case of a pain in the bottom. The pain is experienced in the bottom and is often caused by having sat in the one position or on the same surface for too long. Patients may also experience this if they are overweight or they cycle for long periods. It can even affect drivers, especially men who drive with their wallet in the back pocket of their trousers….
The pain that is felt with ischiogluteal bursitis is quite intense and patients feel it in the central area of the buttock. Often the pain is at least initially, quite aggravating in the sense that you cannot sit for any long periods but conversely you cannot walk around because of the pain and sleep is quite difficult since the pain is unrelenting.
However, when patients present with the classic ‘pain in the bottom’ it would be easy to think that the immediate diagnosis would be simple; ischiogluteal bursitis. Yet patients are often required to answer a number of questions, simply to eliminate other conditions that may present similar symptoms.
Herniated Lumbar Disc:
A herniated lumbar disc may also present with symptoms akin to ischiogluteal bursitis. Sometimes if a herniated lumbar disc is not pressing on a nerve, there will be few or very minor symptoms, but if it is pressing on a nerve, then the pain can be relatively intense. It can also be present in the buttock, hence why there needs to be some careful digging to ascertain which condition is present.
As a general rule you may be asked about how the pain presents at night. People who have a herniated disc will find that the main way of stopping or at least alleviating the pain is to lie very still when in bed and attempt not to move, because any slight movement will exacerbate the pain.
Alas patients with ischiogluteal bursitis will not have the luxury of being still. They will find that the only way the can bear to be lying down is to toss and turn and to keep changing their position.
Sometimes it can feel as if sciatica is unfairly blamed for almost anything. Pain in the lower back, pain in the thigh, pain in the buttock? Well it must be sciatica!
However, sciatica is present when the sciatic nerve is being pressed and the pain often travels down the leg or legs. But it can still present with pain in the buttock area. So further investigation is required to ascertain if the condition is sciatica or bursitis. Sometimes patients may think that they have sciatica, because someone they know who has had the condition (and subsequently has developed ‘medical’ knowledge) has told them that it must be sciatica because they had the same symptoms. (Even though the symptoms are slightly different).
There are other conditions that can present symptoms which have pain in the buttock area. These range from arthritis to stenosis, to tumours being present. So if you do suspect that you have ischiogluteal bursitis and find that instead of an immediate diagnosis being made you are subject to a number of questions being asked about the condition, it is simply to be sure that the condition is the bursitis and not something else. It is always important to get to the correct diagnosis, rather than making assumptions.