Lower Back Pain: Right Side Above the Buttocks

Lower back pain on the right side above the buttocks can indicate various conditions ranging from a simple muscle strain or sprain to musculoskeletal conditions (sciatica, herniated disc, osteoarthritis, radiculopathy, sacroiliac joint dysfunction, piriformis syndrome) to organ conditions (kidney stone, kidney infection, appendicitis) to male-or female-specific conditions. While most cases are mild and resolve with at-home care, persistent pain and red-flag symptoms require professional medical care. 

This article will detail possible causes of lower right-sided back pain above the buttocks, explaining typical symptoms, available treatments, and crucial signs it’s time to see a doctor.

Lower Back Pain Right Side Above the Buttocks

Quick Summary:

Possible causes of lower back pain on the right side above the buttocks include:

  • Muscle strains and sprains
  • Herniated disc
  • Sciatica
  • Spinal osteoarthritis 
  • Pinched spinal nerve
  • Piriformis syndrome
  • Kidney conditions (kidney stone, kidney infection)
  • Appendicitis
  • Gynecological conditions (endometriosis, ovarian cysts, uterine fibroids)
  • Male-specific conditions (testicular torsion, prostatitis)

What Does Lower Back Pain Right Side Above the Buttocks Feel Like?

Lower right back pain on the right side above the buttocks may feel:

  • Sharp
  • Stabbing
  • Burning
  • Dull
  • Achy 
  • Electric shock-like
  • Radiating
  • Spasming
  • Cramping

Lower back pain from musculoskeletal concerns tends to worsen with specific movements (i.e. prolonged sitting, standing, walking or sitting) while organ-related pain tends to be constant and non-responsive to movement. Also, osteoarthritis pain tends to occur with morning stiffness. 

What Causes Lower Back Pain on the Right Side Above the Buttocks?

Back Muscle Sprains, Sprains, & Spasms

Back muscle injuries, like strains and spasms, can cause right lower back pain. Back strains occur when the muscle fibers are stretched or torn. This is a common sports injury, but it can also be caused by a fall or general overuse. 

Spasms in the lower back muscles can be caused by overuse, as well as heavy lifting, repetitive motions, and falls. Back spasms are also a possible symptom of various spinal conditions, including osteoarthritis, spinal stenosis, and herniated disc. When these conditions result in spinal nerve impingement, they can trigger muscle spasms as the compressed nerve transmits abnormal pain signals. 

  • Recovery timeline: Two to six weeks

Herniated Disc

A herniated, slipped, or ruptured disc occurs when one of the discs that cushion the spinal vertebrae becomes damaged. Often, a tear develops in the disc’s exterior, allowing the soft center of the disc to press out into the spinal canal. If the disc presses on a nearby nerve, it can prompt various symptoms, including lower back pain, numbness, and tingling. 

Around 5 to 20 out of 1,000 adults experience a herniated disc each year. This injury can be caused by age-related spinal degeneration, overuse, repetitive movements, and sudden trauma to the spine. Lifestyle factors like poor posture, being overweight, smoking, and being sedentary can increase your risk of developing a herniated disc. 

The location of your herniated disc symptoms varies based on the affected spinal level. L5-S1 and L4-L5 are the most common levels to experience lumbar herniated disc, making up over 95% of cases, according to World Neurosurgery. Each spinal nerve root has a dermatome, an area of skin supplied by the nerve.

  • Lumbar nerve dermatomes:
    • L4: Medial (middle) buttock, outer thigh, outer leg, top of the foot, big toe
    • L5: Buttock, back and outer thigh, outer leg, top of the foot, middle portion of the sole, first, second, and third toes
    • S1: Buttock, thighs, back of the leg
  • Recovery timeline: Two to 12 weeks

Sciatica

Sciatica is a common condition involving compression of the sciatic nerve, the largest nerve in the human body. The sciatic nerve originates at the base of the spine, travels through the lower back and buttocks, and extends down the backs of both legs. According to Yale Medicine, around 10% of people suffering from lower back pain have sciatica. 

Typical symptoms include:

  • Burning, shooting, or electric shock-like pain that radiates from the lower back down one leg (less commonly both legs)
  • Tingling or pins-and-needles sensation
  • Numbness 

Recovery timeline:

  • Four to six weeks for acute cases
  • A few months (or longer) for chronic cases

Spinal Osteoarthritis

Spinal arthritis is particularly common in the lower back, as it bears the weight of the rest of the spine. The most prevalent form of arthritis is osteoarthritis, also known as “wear and tear” arthritis, which gradually breaks down cartilage in the spinal joints. It causes pain, stiffness, and inflammation, which can affect the right side of the back.

Lumbar spine osteoarthritis is a prevalent condition impacting an estimated 40 to 85% of adults, and it’s particularly common among those aged 50 and older due to age-related spinal degeneration. As a chronic, degenerative condition, osteoarthritis doesn’t have a clear recovery timeline and requires ongoing management. 

Pinched Spinal Nerve (Radiculopathy)

A pinched spinal nerve can cause back pain on the right or left side, depending on the location of the nerve. The pain can radiate to the lower extremities, if the nerve is in the lumbar spine, and may feel sharp, burning, or aching. Sometimes, a pinched lumbar nerve causes muscle weakness in the legs, which can make it difficult to stand and walk.

  • Which spinal levels refer pain to the right lower back above the buttocks?
    • L3, L4, L5, S1
  • Recovery timeline: Four to six weeks

Sacroiliac Joint Dysfunction

The sacroiliac (SI) joints are part of the sacrum and connect the pelvis to the lumbar spine. These joints offer essential support for the upper body when you’re standing upright. Sacroiliac joint dysfunction occurs when these joints don’t move properly, leading to inflammation and pain. 

Symptoms of sacroiliac joint dysfunction include:

  • Pain in the lower back (right or left side)
  • Pain, numbness, tingling, and weakness that radiate to the lower extremities
  • Pain in the pelvis, buttock, hip, or groin
  • Discomfort while transitioning from sitting to standing

Your physician may use a diagnostic method called the FABER test to identify SI joint dysfunction. During this test:

  • The patient lies on their back. 
  • The provider positions the ankle of the affected side over the opposite knee or thigh. 
  • With a hand on the opposite hip (on the anterior superior iliac spine, or ASIS, to be exact), the provider gently presses the bent knee down. If you experience pain with this pressure, it’s a positive result pointing to an issue in the SI or hip joint. 

The typical recovery timeline for SI joint dysfunction varies greatly based on severity; mild cases resolve within a few weeks, moderate cases within a month or two of conservative care, and severe cases may require minimally invasive surgery to fuse the SI joint, with a complete recovery process spanning three to six months. 

What Does Sacroiliac Joint Pain Feel Like, and Is It on One Side?

Sacroiliac joint pain may feel sharp and stabbing or dull and achy. In many cases, it radiates downward from the lower back to the buttocks or legs. SI joint pain is also usually unilateral, meaning it affects one side, although bilateral pain is also possible. 

Piriformis Syndrome

Piriformis syndrome happens when the piriformis muscle (the small, flat muscle deep in the buttock that helps with hip rotation) presses on the sciatic nerve. It can develop if you injure or irritate the piriformis muscle (from overuse, running, heavy lifting, a fall, etc.), leading to piriformis spasms. Pressure on the sciatic nerve causes sciatica symptoms, including:

  • Burning, shooting, or electric shock-like pain that radiates from the lower back down one leg (less commonly both legs)
  • Tingling or pins-and-needles sensation
  • Numbness 

Piriformis syndrome pain often worsens during exercise and periods of sitting. It’s also usually unilateral, affecting just one side of the body. 

While piriformis and sciatica pain can be similar, there are a few key differences:

  • Piriformis pain is more likely to flare with prolonged sitting and hip motions. 
  • Piriformis pain may manifest as tension and spasms in the buttock. 
  • Sciatica is more likely to present with numbness, tingling, and weakness in one leg. 

Kidney Conditions

Humans are born with two kidneys: one on the right side of the spine and one on the left side. Although the kidneys are positioned in the middle of the back, some people experience pain in the lower back with kidney stones and infections. 

Kidney infections can trigger pain in the lower back, sides, or groin. This pain is typically accompanied by other symptoms, including:

  • Fever
  • Chills
  • Nausea
  • Vomiting
  • Frequent urination
  • Pain while urinating
  • Dark, cloudy, bloody, or odorous urine

Pain from kidney stones is generally severe and may be felt in the lower back, abdomen, or sides. Other symptoms of kidney stones are similar to those of kidney infections: fever, chills, vomiting, and bloody, cloudy, or odorous urine. 

If you experience symptoms of a kidney problem with lower right-side back pain, seek immediate medical care. 

Kidney Pain vs. Muscular Back Pain
Kidney PainMuscular Back Pain
Doesn’t change with different body positionsMay occur with fever, chills, nausea, vomiting, or changes in urineTends to occur in the flank and right under the ribcageMay feel non-specific; harder to pinpoint a specific areaAffected by movementTends to occur lower in the backMay cause tenderness in specific back musclesMay stem from a specific injury (heavy lifting, overexercising)

Appendicitis

Appendicitis occurs when the appendix is inflamed or infected. This causes pain in the lower right area of the torso, which can radiate to the lower right portion of the back. Appendicitis is a medical emergency, as the appendix may burst when left untreated, posing the risk of potentially fatal complications. 

Key symptoms of appendicitis include:

  • Sudden pain starting on the lower right side of the abdomen, or starting near the belly button and traveling to the lower right abdomen
  • Worsening pain with walking, coughing, and sudden movements
  • Nausea
  • Vomiting
  • Loss of appetite
  • Fever
  • Gastrointestinal symptoms, including constipation, diarrhea, bloating, and gas

Appendicitis is a medical emergency; if you experience any of the symptoms above, go to the ER immediately. Left alone, the inflamed appendix can rupture, leaking bacteria and pus into the abdominal cavity in a potentially life-threatening complication.  

To identify appendicitis, your healthcare provider may refer to McBurney’s point, a specific point on the right side of the abdomen. Deep tenderness at this point can indicate acute appendicitis.

What Causes Lower Back Pain on the Right Side Above the Buttocks in Women?

Gynecological conditions, including endometriosis, ovarian cysts, and uterine fibroids, may cause right-sided lower back pain in women. 

  • Endometriosis is defined by endometrial tissue growing outside of the uterus, and it impacts approximately 10% of reproductive-age women worldwide. Symptoms include:
    • Pelvic pain that gets worse before and during menstruation
    • Back or abdominal pain
      • Endometriosis-related back pain tends to result from endometrial tissue compressing pelvic nerves. 
    • Painful menstrual cramps
    • Painful intercourse
    • Painful urination
    • Pain during bowel movements
    • Gastrointestinal symptoms, like bloating and constipation
    • Infertility 
  • Ovarian cysts are sacs that grow on or inside the ovaries, occurring in around 10 out of 100 women. They’re usually harmless and don’t cause symptoms, may symptomatic cases may cause:
    • Achy, dull lower back pain (typically occurs with larger cysts)
    • Irregular or heavy menstruation
    • Spotting
    • Painful urination
    • Pressure or swelling in the abdomen
    • Painful urination
    • Constipation
  • Uterine fibroids, growths in the uterus, develop in up to two in five women of reproductive age. Small ones tend to be asymptomatic, but larger fibroids may cause:
    • Lower back pain
    • Heavy or painful menstruation
    • Bloating
    • Painful intercourse
    • Frequent urination or inability to completely empty the bladder
    • Chronic vaginal discharge

What Causes Lower Back Pain on the Right Side Above the Buttocks in Men?

Prostatitis and testicular torsion (a medical emergency) may cause lower right-sided back pain in men. 

  • Prostatitis refers to prostate gland inflammation, and it happens in around 10% of men. It can trigger pain in the lower back, scrotum, penis, and central or lower abdomen, along with:
    • Pain during or after ejaculation and urination
    • Urinary urgency and frequent urination
    • Interrupted or weak urine stream
      • A form of prostatitis, called acute bacterial prostatitis, requires emergency medical care. Its symptoms tend to be sudden and severe; in addition to those listed above, it may cause:
        • Fever and chills
        • Nausea and vomiting
        • Inability to urinate
  • Testicular torsion is a relatively rare medical emergency that develops when the testicle twists. This blocks its blood supply. The hallmark symptom of testicular torsion is sudden scrotal pain on one side, and this pain may radiate to the lower back and abdomen. Go to the ER if you experience this, along with other possible symptoms include:
    • One-sided scrotal swelling
    • One testicle sitting higher than the other
    • Bump on testicle 
    • Discolored, swollen scrotum
    • Nausea or vomiting
    • Fever 

Should I Go to the ER for Right-Side Lower Back Pain?

You should to the ER for right-side lower back pain if you experience red-flag symptoms including:

  • Fever or chills
  • Loss of bladder or bowel function
  • Sudden, severe back pain
  • Sudden, severe numbness in the legs or saddle region
  • Vomiting
  • Unexplained weight loss

If you experience right-side lower back pain that concerns you, contact your doctor immediately or go to the ER for medical guidance. 

How is Right-Side Lower Back Pain Diagnosed?

Right-side lower back pain may be diagnosed with a combination of methods, including a physical exam, imaging tests, and/or blood testing. 

  • A physical exam is the first step in the diagnostic process, and it may include:
    • A family and medical history
    • Symptom review (keeping a symptom journal can help with this step)
    • Manual tests, like the FABER test, straight leg test, and reflex testing
  • Imaging tests may be used to confirm findings from the physical exam, or to determine the severity of your condition. They allow your doctor to view the inside of the body. Options include:
    • X-ray (to view bones)
    • CT scan (to view bones in greater detail)
    • MRI scan (to view soft tissue)
  • Blood testing may be used to identify markers of infection or inflammatory disease. 

Treatment Options for One-Sided Lower Back Pain

Treatment options for one-sided lower back pain typically progress from home care to physical therapy. If conservative methods fail, your doctor may recommend medication. After several months of failed non-surgical treatment, with pain that’s compromising your quality of life, surgery may be considered.  

Home Care

Home care is often sufficient to resolve minor strains, sprains, and spasms. It can also help manage symptoms of various conditions that cause lower back pain. Strategies include:

  • Rest from strenuous physical activity (avoid bed rest, which can worsen muscle tension and compromise healing)
  • Gentle stretching and strengthening exercises such as:
    • Piriformis stretch
    • Cat-cow stretch
    • Knee-to-chest stretch
    • Child’s pose
    • Seated hamstring stretch
  • Heat and cold therapy
    • Cold therapy is ideal in the first 72 hours after an acute injury. 
    • Heat therapy is ideal to relax tense muscles and boost blood circulation after the initial swelling has subsided. 
  • Topical pain relief creams

Physical Therapy

When home care alone fails to resolve back pain, your doctor may recommend physical therapy for lower back pain (PT). A PT can help support healing, release muscle tension, correct imbalances, and help strengthen muscles that support the spine through: 

  • A personalized stretching and strengthening routine
  • Manual therapies, like massage, to release tension
  • Dry needling, heat/cold therapy, TENS, and other complementary therapies
  • Lifestyle recommendations to promote healing

Medication

Medication is often used as an adjunct to non-surgical treatment plans for lower back pain. It’s also necessary to resolve certain conditions, like infections. While over-the-counter pain relievers are available, it’s best to avoid relying on these medications, as they’re not a long-term solution. 

Types of medications that may be used for right-side lower back pain include:

  • NSAIDs or painkillers
  • Muscle relaxants
  • Oral steroids or steroid injections
  • Antibiotics for infections
  • Hormone therapy for endometriosis or ovarian cysts

Talk to your doctor before starting any new medication or supplement to ensure it’s safe for you. 

Surgery (When Needed)

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While most of the conditions discussed in this article can be resolved non-surgically, certain severe cases may require surgery. This includes:

  • Procedures implemented for medical emergencies, like testicular torsion or appendicitis
  • Surgery for severe chronic conditions, like endometriosis
  • Surgical spinal decompression for spinal conditions that don’t improve with conservative treatment (i.e. microdiscectomy, laminectomy, foraminotomy)
    • Spinal decompression surgery has conventionally been done with spinal fusion, a process through which two or more vertebrae are permanently fused to prevent instability. Modern innovations like the FDA-approved TOPS System are improving options for patients today by restoring a controlled range of motion in the spine without the downsides of fusion, like reduced mobility and adjacent segment disease. 

How to Prevent Lower Back Pain

While around 26% of American adults have lower back pain at any given time, you can take steps to prevent it.

  • Maintaining good posture, especially while sitting for long periods or lifting heavy objects
  • Embracing workplace ergonomics, including robust lumbar support and a standing desk
  • Regular low-impact exercise and stretching
  • Balanced nutrition to prevent deficiencies 
  • Abstaining from smoking and excessive alcohol consumption

FAQs

  • Is right-sided lower back pain above the buttocks a sign of a kidney problem?
    • It can be, although kidney pain is more likely to occur in the flank and under the ribcage. 
  • How do I tell if my right lower back pain is muscular or a nerve issue?
    • Muscular back pain is more likely to feel like stiffness, worsen with movement, and improve with rest. Nerve pain is more likely to feel tingling or electric shock-like, and it may radiate into the buttock or leg. 
  • Can sciatica cause pain only on the right side above the buttocks?
    • Yes, sciatica often only affects one side of the body (unilateral). 
  • What stretches help relieve lower back pain on the right side above the buttocks?
    • Piriformis stretch
    • Cat-cow stretch
    • Knee-to-chest stretch
    • Child’s pose
    • Seated hamstring stretch
  • How long does right-sided lower back pain typically last?
    • Mild cases usually resolve within anywhere from a few days to up to six weeks. Chronic conditions require ongoing care to prevent symptom flare-ups. 
  • What are the red flags for lower back pain that require immediate medical attention?
    • Fever or chills
    • Loss of bladder or bowel function
    • Sudden, severe back pain
    • Sudden, severe numbness in the legs or saddle region
    • Vomiting
    • Unexplained weight loss