Why Does My Bum Hurt After Surgery?: Understanding and Managing Post-Operative Pain

September 30, 2025 •

5 min read

An estimated 40 to 95% of patients taking opioid pain medications after surgery will experience constipation, which can contribute to discomfort in the buttocks. If you find yourself asking, 'Why does my bum hurt after surgery?', it is helpful to know the various potential causes, which range from typical post-operative issues to less common complications.

Quick Summary

Buttock pain after surgery can arise from nerve compression due to positioning, post-operative constipation, or inflammation. The discomfort is often a normal part of the healing process, but understanding its source is key to proper management and recovery.

Key Points

Surgical Positioning: Prolonged time on the operating table can cause nerve compression or stress to the sacroiliac joints, leading to pain in the buttocks.
Constipation Side Effects: Anesthesia and opioid pain medication are major causes of post-operative constipation, which creates pressure and pain in the rectal and gluteal areas.
Inflammation and Tissue Trauma: Swelling and soreness from the body's natural healing response can cause general tenderness, especially after procedures involving the spine or hips.
Managing Discomfort: Effective remedies include taking stool softeners, increasing fiber and fluid intake, and using warm baths or ice packs as recommended by your doctor.
Warning Signs: Persistent or severe pain that does not respond to medication, significant swelling, fever, or an inability to pass stool or gas are red flags that warrant immediate medical attention.
Specific Surgeries: Post-prostatectomy or hemorrhoidectomy patients may experience rectal pressure or intense pain, which is an expected part of recovery but still requires careful management.

Common Causes for Post-Operative Buttock Pain

While buttock pain may seem unusual if your surgery wasn't in that area, it is a relatively common post-operative experience. The reasons are varied and can stem from the procedure itself, the recovery process, or medication side effects.

Surgical Positioning During the Operation

During lengthy surgical procedures, a patient may be positioned in a single way for an extended period. General anesthesia prevents the patient from communicating discomfort, making them susceptible to nerve compression or muscle strain from improper alignment.

Nerve Compression: The sciatic nerve, which runs through the buttocks and down the back of the leg, can be particularly vulnerable. Prolonged pressure on this nerve can lead to pain, numbness, and tingling, even after the surgery is over.
Sacroiliac (SI) Joint Pain: Lying on the back can place stress on the SI joints, which connect the pelvis to the lower spine. In some cases, increased force transfer after spinal fusion surgery can also cause pain in this joint.
Gluteal Compartment Syndrome: A rare but serious complication, especially in prolonged surgeries for obese patients, this involves increased pressure within the gluteal muscles. It can present as severe buttock pain, swelling, and nerve dysfunction.

Constipation from Anesthesia and Medications

One of the most frequent side effects after surgery is constipation, which can cause significant pressure and discomfort in the rectal and gluteal areas.

Effects of Anesthesia: General anesthesia can slow down the intestinal muscles, leading to sluggish bowel activity for several days.
Opioid Pain Medications: These powerful pain relievers are notoriously constipating as they slow the movement of food through the intestines and increase water absorption. This hardens stools and makes them difficult to pass, causing straining that exacerbates pain.

Inflammation and Trauma to Tissues

The body's natural response to any surgery, regardless of location, is inflammation. This swelling is part of the healing process but can be a source of pain.

Nearby Surgical Sites: Surgeries involving the hip, spine (like a discectomy), or pelvis can cause inflammation and trauma to the surrounding muscles and nerves, including those in the buttocks.
Referred Pain: Gas used during laparoscopic procedures can cause referred pain in the shoulders or back, which some may perceive as buttock discomfort.
Hemorrhoidectomy Recovery: For those who have undergone surgery to remove hemorrhoids, pain in the anal and rectal region is a hallmark of the recovery process, and it is intensified with bowel movements and prolonged sitting.

Managing Post-Surgical Buttock Pain

Fortunately, there are many effective strategies for managing post-operative pain in the buttocks and surrounding areas. These methods often combine medical recommendations with at-home care.

Pharmacological and At-Home Pain Management

Your medical team will likely have a pain management plan tailored to your procedure. Following their instructions is crucial, but some general strategies are widely applicable.

Medication Schedule: Taking pain medication on a schedule, rather than waiting for pain to become severe, is more effective. Non-opioid options like NSAIDs (if approved by your doctor) may also be recommended to reduce inflammation.
Topical Creams and Pads: For anorectal surgeries, medicated pads and topical creams can provide localized relief.
Sitz Baths and Heat/Ice: For anorectal pain, warm sitz baths can be very soothing. For muscle and joint pain, alternating between heat and ice packs can help reduce inflammation and discomfort.

Bowel and Lifestyle Management

Since constipation is a major contributor to buttock pain, managing bowel movements is a priority.

Dietary Adjustments: Gradually increase your intake of fiber-rich foods and drink plenty of water to soften stools and promote regularity. Warm prune juice can also be helpful.
Stool Softeners and Laxatives: Your doctor may recommend stool softeners, such as docusate sodium, often starting at the same time as opioid pain medication. Bulk-forming laxatives can be introduced later.
Avoid Straining: Do not strain during bowel movements, and limit your time sitting on the toilet. A small step stool under your feet can help improve posture for easier elimination.

Potential Complications and When to Seek Help

While some pain is expected, you should be aware of signs that may indicate a more serious issue. Always contact your doctor if you have concerns.

When to Contact Your Healthcare Provider

Severe or Worsening Pain: If your pain is disproportionate to the surgery and does not improve with medication, it requires immediate attention.
Gluteal Compartment Syndrome: Symptoms like persistent, severe buttock pain, swelling, leg weakness, or numbness warrant immediate medical evaluation.
Bowel Obstruction Signs: If you experience severe bloating, cramping, nausea, vomiting, or the inability to pass gas or stool for several days, seek urgent care to rule out a blockage.
Signs of Infection: Fever, chills, increased warmth or redness, or unusual drainage at the incision site should be reported immediately.


Cause of Pain	Typical Sensation	Management Strategy	Red Flag Symptom
Surgical Positioning	Numbness, tingling, or aching, possibly radiating down the leg.	Gentle movement, specific physical therapy exercises, proper padding when resting.	Severe, unrelenting pain not responsive to analgesics, or significant weakness.
Constipation	Pressure, sharp pain, or cramping, often worse with attempted bowel movements.	Increase fluid and fiber intake, use stool softeners as directed, avoid straining.	Inability to pass stool or gas for several days, accompanied by severe abdominal pain or vomiting.
Inflammation / Trauma	General soreness, tenderness, or swelling, possibly localized around an incision site.	Ice packs (with a barrier), gentle movement, non-opioid pain relievers (if approved).	Excessive redness, heat, pus, or fever, indicating potential infection.
Rectal Surgery	Intense, sharp pain, especially when sitting or with bowel movements.	Warm sitz baths, medicated wipes, stool softeners, foam pillows.	Severe bleeding, signs of infection, or pain that worsens significantly.

Conclusion

Experiencing buttock pain after surgery is a common reality for many patients, with a variety of potential causes from surgical positioning to the side effects of anesthesia and medication. For most, the discomfort is a temporary and manageable part of the healing process. Following your medical team's advice on pain management, diet, and activity is critical for a smooth recovery. Paying attention to your body and understanding the difference between expected soreness and signs of a more serious issue is also vital. Promptly communicating any severe or unusual symptoms to your healthcare provider ensures proper management and helps prevent potential complications. By taking a proactive approach to your recovery, you can effectively manage your pain and focus on getting back to your normal routine.

Learn more about enhanced recovery techniques after surgery at the American Society of Colon and Rectal Surgeons (ASCRS) [https://staging.fascrs.org/patients/diseases-and-conditions/a-z/enhanced-recovery-after-surgery].

Frequently Asked Questions

Referred pain is discomfort felt in one area of the body that actually originates elsewhere. For instance, gas trapped after a laparoscopic or robotic surgery can cause referred pain in the shoulders, back, or buttocks.

Some nerve irritation leading to tingling, numbness, or pain is a normal, though temporary, side effect of many surgeries, often caused by nerve sensitization or pressure during the procedure.

Managing constipation is key. Drink plenty of water, gradually add fiber to your diet, and use stool softeners as prescribed by your doctor. Gentle walking can also help stimulate your bowels.

Mild swelling is a normal part of the healing process. However, if you experience significant, tense swelling in the buttocks, accompanied by severe pain, numbness, or leg weakness, you should seek immediate medical help to rule out gluteal compartment syndrome.

Avoid sitting for long periods. When you do sit, use a pillow for support. After anorectal surgery, avoid rubber 'donut' cushions, which can increase pressure, and consider a foam pillow instead.

Yes. Surgeries on the spine, like a discectomy, can cause pain and numbness in the back or buttock region due to the trauma involved in navigating muscles and nerves. The sacroiliac joint can also become a source of pain after spinal fusion.

Normal post-op pain gradually improves and is manageable with medication. Serious complications, like gluteal compartment syndrome or a bowel obstruction, involve severe, worsening pain that is not relieved by standard measures and may include other symptoms like fever, swelling, or vomiting.