Left Side Lower Back Pain above the Buttocks: 8 Possible Causes

Most people will experience some form of low back pain in their lifetime.[1] The location of the pain varies between person to person, but can be commonly experienced on the left side above the buttocks.

The spine consists of vertebrae (spine bones), discs, and many supporting muscles and ligaments. Soft tissue and organs, such as the kidneys, colon, and uterus, also sit near the lower back. If any of these structures are affected, it may cause lower back pain on the left side, above the buttocks.

The pain can range from a sharp radiating pain to a dull ache that lasts throughout the day. Low back pain has many potential causes, and the location of the pain can indicate the underlying cause.[2] Treatment will depend on the cause and severity of the symptoms.

What are the symptoms of left lower back pain above the buttocks?

The symptoms of left lower back pain above the buttocks can include:

• Pain in the left side of the lower back or surrounding areas

• Radiating pain to the legs

• Reduced range of motion

• Symptoms that worsen with movement

• Muscle spasms

• Sharp lower back pain

• Lower back tightness

The symptoms can be aggravated by an awkward sleeping posture, heavy lifting, or sustained positions, such as sitting for long periods of time.

What causes left lower back pain above the buttocks?

There are many different causes of low back pain. Sometimes, the symptoms can be caused by a specific structure in the area, or in other cases, the symptoms may be caused by other parts of the lower back.

1. Strain or sprain

There are many muscles and ligaments in the spine that support the movement of the body. Low back pain can be caused by an injury to these structures, causing a muscle strain or ligament sprain. When these structures are overloaded, it may stress the area and cause symptoms.

The pain can occur suddenly, as a result of an activity or specific movement such as twisting or lifting something awkwardly. However, the pain can also develop gradually over time, even as a result of sitting with poor posture for prolonged periods of time. These injuries often cause stiffness and difficulty moving, particularly when trying to bend or sit.

2. Sciatica

The sciatic nerve is the largest nerve in the body, and travels from the spinal cord through the buttocks and down the leg to the foot. When this nerve is irritated or compressed, it can cause pain and symptoms, referred to as sciatica.[3]

The pain is usually a radiating or ‘electric’ sensation in the buttocks or leg. The symptoms usually occur on one side of the body, but not always. Sciatica can be caused by spinal stenosis (narrowing of the nerve pathways), herniated disc, dysfunction in the area, or other conditions.

3. Disc herniation

A herniated disc occurs when the intervertebral disc is overstressed and bulges. A disc herniation can compress the nerves travelling in that area, causing pain that can travel into the leg.[4] In more severe cases, it can cause numbness or weakness.

A herniated disc can develop gradually over time. It is more common with older age, and sometimes there are no symptoms or pain. However, common symptoms may include stiffness, pain with movements such as bending, or difficulty sitting. In some cases, a disc herniation can be caused suddenly by an injury, by lifting something with poor technique or twisting awkwardly. Disc herniation is a common injury in sports, such as rowing or weightlifting.

4. Osteoarthritis

Osteoarthritis is a condition that affects the cartilage and joints in the spine, and other joints in the body.[5] The cartilage in the joints is important as it absorbs load and helps the joints move.

Osteoarthritis does not always cause pain or symptoms. However, for some it can cause a dull aching pain or sharp intermittent pain. It may also cause stiffness, reduced range of motion, and difficulty with everyday activities such as climbing stairs or bending to get dressed.

Osteoarthritis can develop gradually over time, but previous issues or injury can contribute to the risk of developing osteoarthritis.

5. Sacroiliac joint pain

The sacroiliac (SI) joint is located between the lumbar (lower back) spine and the top of the pelvis. There are two SI joints, one on each side.

Dysfunction of the sacroiliac joint can cause pain and stiffness, and can affect one or both sides. The symptoms are often brought about when standing on one leg, lying sideways, or running. The pain can occur in the buttocks, or can travel into other surrounding areas.

6. Kidney stones

The kidneys have an important job in the body as they filter toxins and regulate water retention. Problems in the kidneys can cause low back pain as they are situated near the spine.

Kidney stones can develop in the kidney and cause symptoms, however they can also travel to other parts of the urinary tract. Certain medications, diet, or other medical conditions may increase the risk of developing kidney stones.

Kidney stones often cause sharp pain in the side and back, above the buttocks. However, other common symptoms may include pain or blood while urinating, vomiting and nausea, and fever. Kidney stones require medical input, and there is a risk of recurrent kidney stones.

7. Endometriosis

Endometriosis is a painful condition in females that occurs when tissue resembling the lining of the uterus grows outside of the uterus where it does not belong, often on the ovaries, fallopian tubes, or surrounding area (but can also occur in other parts of the body). The tissue changes throughout the menstrual cycle in the same way as the lining of the uterus, causing pain and other issues.

Pain is the most common symptom, however other symptoms can include low back pain, menstrual cramps, bowel issues, spotting, heavy periods, bloating, or infertility in some cases. A specialist will often be involved in the diagnosis, treatment, and management of endometriosis.

8. Lower back pain and pregnancy

Low back pain is a common experience during pregnancy. There are many reasons why back pain may develop during pregnancy, including postural changes, hormonal changes, weakened abdominal muscles, sciatica, joint changes, and more.

There are various different strategies that can help the symptoms and alleviate pain. It is important to discuss any symptoms or concerns with a medical professional.

Other causes

Other causes of low back pain may include:

• Infection

• Fibroids

• Tumour

• Fracture

• Gut disturbances

• Genetic conditions

• Pancreatitis

• Ulcerative colitis.

It is important to be aware of any ‘red flags’, the signs and symptoms that may indicate there is a more serious underlying medical condition.

Red flags

A doctor should be consulted immediately if there are any symptoms including:

• Severe or persistent pain

• Pain after an injury or trauma, such as a fall

• Leg or body weakness

• Numbness or tingling

• Difficulty walking or weight bearing

• Loss of bladder or bowel control

• Fever or signs of infection

• Unexplained weight loss

• Dizziness or loss of consciousness

• Any other unexplained symptoms.

Diagnosis of left-sided ower back pain

To diagnose low back pain, a health practitioner will ask a series of questions to help distinguish between the different causes. This will include discussing the symptoms and how they started, any history of injuries, previous back problems, and any other relevant medical history.

A physical examination will be used to assess the movement of the spine and limbs, and check the strength, sensation, and reflexes of the body, amongst other things.

Often the medical history and physical assessment are enough to determine the cause of the pain. However, in some cases a doctor may request further testing to help the diagnosis or rule out any more serious medical conditions.

Further testing may include:

• Imaging including X-ray, CT, ultrasound, or MRI to assess the health of the bones and soft tissue in the spine and surrounding areas.

• Nerve condition testing to assess the health of the nerves

• Bone scans to determine if there are any bone problems

• Blood tests

• Other specialised tests

It’s important to rule out any underlying medical issues which may require specialised medical input before any treatment commences.

Treatment

Low back pain is common, so the treatment will depend on the cause and severity of the symptoms. There are several different treatment strategies that a health practitioner may recommend.

Conservative (non-surgical) treatments

Common conservative treatment options may include:

• Ice therapy

• Heat packs

• Pain relief

• Topical pain relieving cream

• Relative rest (note, this is not prolonged bed rest)

• Activity modification.

Physiotherapy

Physiotherapy can help relieve the symptoms of low back pain. A physiotherapist will assess and prescribe treatments depending on the cause of the pain. This may include a gentle exercise regime, a walking program, taping, massage, dry needling, or other options.

Medical treatment

Other causes of low back pain may require medical input.

A doctor may recommend some of the following treatment options:

• Prescription pain relief

• Antibiotics, if an infection has been identified

• Corticosteroid injections

• Acupuncture.

Surgery

In the case where conservative treatment options have not been successful, a doctor may recommend a review with a neurosurgeon to discuss potential surgical procedures. Surgery is not always successful and there is often a prolonged recovery period, so it may require careful consideration and discussion with medical professionals.

In the case where there is a serious underlying medical issue or injury, surgery may be necessary as a matter of emergency.

Takeaway message

Various different conditions can cause left lower back pain above the buttocks. The symptoms and severity will depend on the location and cause of the low back pain.

In some cases, low back pain can be alleviated with simple treatment options. However, if there are any red flags, recent injury, or serious underlying medical issues, a doctor should be consulted.