A hernia occurs when an organ or tissue pushes through a weak spot in the muscle or connective tissue wall that normally holds it in place. Most people associate these bulges with the abdomen or groin, where common types like inguinal and umbilical hernias occur. While hernias in the lower body are typically found closer to the front, they can occur in the buttock area.
Understanding Sciatic and Gluteal Hernias
Yes, hernias can occur in the buttocks, though they are among the rarest types. These are classified as pelvic floor hernias, specifically known as sciatic or gluteal hernias. They are named for the bony openings in the pelvis through which they protrude into the gluteal region.
A sciatic hernia occurs when abdominal contents push through the lesser sciatic foramen, a smaller opening near the lower part of the pelvis. A gluteal hernia typically passes through the greater sciatic foramen. This larger opening is divided by the piriformis muscle, and the hernia can emerge either above or below this muscle.
The hernia sac often contains fat or a loop of the small intestine, but rarely includes the ureter, ovary, or colon. These tissues descend from the abdominal cavity into the deep buttock space, making them difficult to detect. Sciatic hernias are extremely rare; fewer than 100 cases have been reported in worldwide literature.
Recognizing the Signs and Symptoms
The presentation of a buttock hernia can be subtle because the mass is often deep and covered by the thick gluteus maximus muscle. The most common sign is a palpable lump or swelling in the buttock that becomes more prominent when straining or standing. This lump might temporarily disappear when the person lies down, a classic sign of a reducible hernia.
Pain is a frequent complaint, often localized to the buttock or pelvic region, and it can worsen with activities like sitting or coughing. A specific and concerning symptom is radiating pain down the leg, known as sciatica. This occurs when the herniated sac compresses the sciatic nerve as it passes through the pelvis.
If the hernia involves the bowel, severe symptoms of intestinal obstruction may occur, such as nausea, vomiting, and an inability to pass gas or have a bowel movement. This complication, known as incarceration or strangulation, is a medical emergency where the blood supply to the trapped tissue is cut off.
Primary Causes and Risk Factors
These hernias develop due to a weakness or defect in the connective tissue of the pelvic floor, allowing abdominal contents to push through. The weakness may be congenital (present since birth) or acquired. Acquired causes are often related to factors that compromise the structural integrity of the pelvis.
Previous surgery in the pelvic or hip region can lead to an iatrogenic (medically caused) defect that weakens the area. Conditions that chronically increase pressure within the abdomen are also significant risk factors. These include chronic coughing, obesity, severe constipation with straining, and pregnancy.
The underlying anatomical structure, particularly the piriformis muscle, can also play a role; atrophy or weakness of this muscle has been linked to sciatic hernia development. These hernias are seen more frequently in women, a pattern thought to be related to the wider female pelvis and the stresses of pregnancy and childbirth.
Medical Evaluation and Treatment Options
Diagnosing a sciatic or gluteal hernia can be challenging because the physical examination may not reveal a clear, palpable mass due to the depth of the defect. Initial evaluation involves a thorough physical exam, looking for localized tenderness or a mass that changes size with straining. Imaging is almost always necessary to confirm the diagnosis and determine the hernia’s precise contents and location.
Computed Tomography (CT) scans are often the first advanced imaging used, as they clearly show the protrusion of tissue and the defect in the pelvic wall. Magnetic Resonance Imaging (MRI) is considered the most effective tool, especially when nerve compression is suspected, providing high-resolution images of soft tissues like the sciatic nerve.
Treatment for symptomatic sciatic and gluteal hernias is nearly always surgical, as there is a high risk of the bowel becoming trapped or strangulated. The surgical procedure involves two main goals: reducing the contents of the hernia back into the abdominal cavity and repairing the defect to prevent recurrence. This repair often utilizes a fascial flap from the piriformis muscle fascia or the placement of surgical mesh to reinforce the weakened area.
The surgeon may choose a transabdominal approach, which is preferred when bowel obstruction is present, allowing for better access to the abdominal contents. Alternatively, a transgluteal or posterior approach may be used, which offers a direct route to the hernia defect through the buttock. The selection of the surgical method depends on the specific location and size of the hernia, as well as the nature of the herniated contents.