Patient: I have pain in left buttocks especially in the morning after sleeping on that side. Eventually it moves to the crease between my leg and its attachment to my body close to the pubic area. The pain is not severe, but annoying and is not always present. What could be the cause?
Doctor: When the Piriformis muscle, located in the gluteal area (buttocks) gets tight or contracted , possibly by the way you ar e sleeping,may cause also irritation of the sciatic nerve (sciatica) which is very close to it. Possibly you are experiencing a sciatic pain. Pain from sciatica will probably limit your activities. Here are some ways to ease the pain at home or at work: Do not bend, lift, or sit in a soft, low chair because your pain will get worse. Unless you are allergic or should not take them for other reasons (if you take a blood thinner such as Coumadin, for example), over-the-counter pain medicines such as acetaminophen (Tylenol), or ibuprofen (Advil, Motrin IB) will probably help ease the pain. Try a cold pack to see if it helps to ease the pain. If you don’t have a cold pack, use a large bag of frozen vegetables; it makes a good first aid cold pack. Or have someone close to you massage you in a triangular pattern with an ice cube over the sore areas, no more than 15-20 minutes at the time. After the cold massages, try alternating with heat from an electric heating pad to see if it helps the pain. If you don’t have an electric heating pad, put a hand towel under hot water, wring it out, and place it on your back. Sometimes the moist heat penetrates more deeply and gives better relief of pain. You may feel better lying on your back on a firm surface with a pillow under your knees. Another option is lying on your side with a pillow between your knees to keep your back straight. Also, you might find that a recliner chair is helpful. Finally, take it easy, but do not lie in bed for longer than 2 days because this has been shown to worsen the condition. Try to do activities that you are able to tolerate, and the most important: be patient and do not expect to feel better overnight. If after doing all of the above you are still in pain I strongly recommend you a comprehensive evaluation by an orthopedic surgeon.