Ischial Bursitis

What is ischial bursitis?

Ischial bursitis is a pain in your butt — technically, in the tissues that cushion your sit bones. Your sit bones are two “U”-shaped bones at the bottom of your pelvis. They’re the bony part of your butt that you sit on. The medical name for them is ischia (pronounced “ISS-kee-uh”).

The tissues that cushion these bones are called bursae. They’re small, fluid-filled sacs that absorb shock and reduce friction when your bones move against your muscles. Too much pressure or friction can cause painful inflammation in your bursae, called bursitis.

Bursitis usually occurs around bones that take a lot of pressure or impact from repetitive movements. Laborers and athletes get bursitis. Ischial bursitis used to be called “weaver’s bottom” because too much sitting on hard seats can cause it. Cyclers also get it.

Sometimes, it’s called ischial tuberosity bursitis. Your ischial tuberosity is the rounded part of the bone where it attaches to your hamstring tendon. You may also see it called ischio-gluteal bursitis, for the bursas that separate your ischia from your gluteus maximus muscle.

What does ischial bursitis feel like?

Ischial bursitis causes pain in the bursae around your sit bones. Most people say they can pinpoint the spot in their butt or the back of their thighs. Most people describe it as a dull, deep ache. Exercise or prolonged sitting can aggravate it. It might be tender to the touch.

Other symptoms might include:

• Visible swelling.
• Reduced range of motion.
• Trouble sleeping.

What other conditions can mimic ischial bursitis?

Some conditions that can cause similar symptoms include:

• Hamstring tendonitis. The tendon that attaches your hamstring muscle to your ischium might be inflamed. This tendon sits very close to your ischial bursae, so you’d feel the pain in the same area. Tendonitis might be more likely if you’ve been exercising a lot lately, like running or doing squats. It’s easier to overstress your tendon with exercise than it is to inflame your bursae.
• Hamstring tendinosis. While tendonitis is more of an acute problem, tendinosis is a chronic condition. It happens when tendonitis never heals properly or keeps coming back. After a while, the tendon fibers start to break down, and then rebuild themselves thicker and tougher. This can cause pain and stiffness in the tendon. It can also irritate your bursas and trigger bursitis.
• Sciatica. Your sciatic nerve starts in your lower back and travels through your butt and down the backs of your thighs. Conditions that compress this nerve can cause pain that radiates along this pathway. Sciatica tends to be less specific and more continuous than bursitis pain. It’s less likely to be irritated by pressure or certain movements. In fact, movement or massage might help.

What causes ischial bursitis?

The most common cause of ischial bursitis is repetitive stress on your bursae, either from pressure or from friction. Friction comes from your hamstring tendon or gluteus maximus muscle moving against your sit bones. Pressure comes mostly from sitting.

Common causes of repetitive stress injuries to your ischial bursae include:

• Sitting too much, especially on hard surfaces.
• Intensive exercise of the surrounding muscles.

Risk factors for ischial bursitis include:

• Sedentary occupations.
• Driving.
• Horseback riding.
• Cycling.
• Canoeing.
• Long-distance hiking.

Repetitive stress injuries happen gradually over time. But you can also injure and inflame your bursae all at once. For example, a heavy fall on your sit bones or a heavy kick to your bursa, perhaps from an animal, could cause traumatic ischial bursitis.

Less commonly, ischial bursitis can be a symptom of connective tissue diseases that cause inflammation in various places in your body. Examples include:

• Rheumatoid arthritis.
• Lupus.
• Gout.
• Scleroderma.

Rarely, bursitis might be related to an infection in your bursas, like:

• Septic arthritis.
• Tuberculosis.

How is ischial bursitis diagnosed?

A healthcare provider will ask you about your symptoms and how they started. Then, they will physically examine you. They might try to gently move your hips in different ways to see if it causes pain. Most of the time, this is enough to diagnose ischial bursitis.

If your symptoms and history don’t quite fit the description of an injury to your ischial bursas, they might need to look further. This might mean imaging tests to confirm you have bursitis, or a blood test to check for other causes of your symptoms.

What is the treatment for ischial bursitis?

Ischial bursitis from an injury will heal with time and rest. If it’s mild to moderate, you can treat it at home with ice and over-the-counter pain relievers. If it’s more severe, your provider can give you an injection with corticosteroids and local anesthesia.

The most important thing for your recovery is avoiding the activities that aggravate your bursitis, including sitting on your bursas. When you have to sit, try placing a pillow under your thighs to free your bursae. You can also get an inflatable donut seat to sit on.

As the inflammation goes down and you start to recover, your provider might recommend physical therapy to help prevent future injuries. Physical therapy can help stretch and strengthen your surrounding muscles to take stress off your bursae.

Most people can recover from an acute case of ischial bursitis in a few weeks. If you don’t seem to be recovering, or if you had ischial bursitis for a long time before beginning your recovery, you might have another underlying condition that needs treatment.

What can I do to prevent ischial bursitis?

If your job, sport or hobby is a risk factor for ischial bursitis, you might be able to help prevent it by changing your equipment or your technique. Ask a professional, or an occupational therapist, to advise you on adjustments you can make to prevent bursitis.

How long can ischial bursitis last?

Ischial bursitis can last as long as whatever is irritating your bursas does. If that’s an activity, you’ll need to stop the activity so you can heal. If it’s something else, like an infection, chronic disease or underlying injury, you might need additional treatment for that condition.

Under normal circumstances, ischial bursitis will heal within a few weeks. You can help it heal by resting it and treating it with ice and anti-inflammatory medications, like aspirin or ibuprofen. Your provider might recommend physical therapy later on in your recovery.