Ischial bursitis is inflammation of the small fluid-filled sac (bursa) over the sit bone at the base of the buttock, causing pain that is usually worse when sitting, especially on hard surfaces.
A bursa is a small sac of fluid that reduces friction between bone and soft tissue. The ischial bursa sits between your sit bone, called the ischial tuberosity, and the large buttock muscle. When this bursa becomes irritated, it can swell and become painful. This is ischial bursitis, also called ischiogluteal bursitis. The pain is usually felt deep in the lower buttock and is often worse after sitting for a long time.
Several conditions cause pain in this area, so a careful assessment is important. Proximal hamstring tendinopathy affects the hamstring tendon where it attaches to the sit bone, and often hurts with running, lunging or bending forward. Pain can also be referred from the lower back or sacroiliac joint. These problems can overlap, and treatment depends on which one is the main source.
The doctor asks when the pain started and what makes it worse, then examines the buttock, hip, hamstrings and lower back to find the main source of pain.
Specific tests help distinguish bursitis from proximal hamstring tendinopathy or a partial tear, and from pain referred from the lower back or sacroiliac joint.
Where it helps, an ultrasound scan can show a fluid-filled bursa and look at the hamstring tendon attachment.
If the diagnosis is unclear or a nerve or back problem is suspected, an MRI, X-ray or nerve conduction study can be arranged by referral.
Your plan depends on what the assessment finds. These are the options we most often discuss.
Reducing long periods of sitting, taking regular standing breaks and using a cushion that takes pressure off the sit bone may help symptoms settle.
A graded programme for the hamstrings, buttock muscles and hips may help, especially where the hamstring tendon is also involved.
Learn moreShort courses of simple pain relief or anti-inflammatory medicines, taken as advised, may ease pain while other measures take effect.
Where assessed as suitable, an ultrasound-guided injection into the bursa may reduce pain that has not improved with other measures. Guidance helps avoid the nearby sciatic nerve and tendon.
Learn moreChanges to your chair, car seat or bicycle saddle may reduce pressure on the sit bone.
Many people improve over several weeks by reducing sitting pressure and following an exercise programme, although this varies. Symptoms that have been present for months, or that overlap with hamstring tendinopathy, may take longer to settle. An injection may help some people who do not improve. If pain persists despite treatment, or a tendon tear or other cause is found, the doctor will arrange referral to a sports or orthopaedic specialist.
Both cause pain at the sit bone. Bursitis is mainly worse with direct pressure, such as sitting. Hamstring tendinopathy often hurts more with running, lunging or bending forward with straight legs. The two can occur together, and an ultrasound scan may help tell them apart.
Yes. Problems in the lower back or sacroiliac joint can refer pain into the buttock. Back-related pain often comes with back stiffness, pain further down the leg, or tingling. Your doctor will check your back as part of the assessment.
A cushion with a cut-out or softer area under the sit bones can reduce direct pressure. Standing up regularly, for example every 30 to 45 minutes at the desk, also helps. What works varies from person to person.
Often you can, with changes. Adjusting saddle position or padding, and reducing hill running or speed work, may help. Your doctor can suggest what to change and how to build back up.
No. Inflexion Clinic is a private GP clinic, so you can book directly. Book online or call the clinic on +65 8997 0659.
Our clinicians will take a proper history, examine you, and give you a clear plan on the day.