Ischial Bursitis (Weaver's or Tailor's Bottom)

What is Ischial Bursitis (Weaver’s or Tailor’s Bottom)?

Ischial bursitis is a condition where the ischial bursa (a small fluid-filled sac) located between a bony part of your hip (the ischial tuberosity) and a large muscle in your buttock (the gluteus maximus muscle) becomes inflamed. This muscle usually covers the bursa when you’re standing up or stretching your hip. However, the bursa and the bony part of your hip rub against each other more directly when you bend your hip. Sitting can put pressure on the bursa because it’s squeezed between the hard surface of the bony part of your hip and the outside surface, making inflammation more likely due to the constant pressure from your body weight.

Ischial bursitis is also known as ischio-gluteal bursitis or “weaver’s or tailor’s bottom” because people in these professions often sit on hard surfaces for a significant portion of their day, which can increase the risk of developing this condition.

In humans, there are two types of bursae—constant and adventitial. Constant bursae are formed before you are born and are there from birth. Adventitial bursae form due to repeatedly rubbing and pressure between structures, often when fibrous tissue breaks down. Some adventitial bursae form because of diseases that cause new bony growth that then rub against existing structures. The ischial bursa is an example of an adventitial bursa because it forms from the constant rubbing of the bony part of your hip against the gluteus maximus muscle during movement. The purpose of this bursa is to reduce friction between these two structures during the movement of your hip, particularly helping the gluteus maximus muscle and nearby fat tissue to move smoothly during the bending of the hip.

What Causes Ischial Bursitis (Weaver’s or Tailor’s Bottom)?

Ischial bursitis, once known as “weaver’s or tailor’s bottom,” is an inflammation that can be caused by sitting on hard surfaces for extended periods. This condition often affects people with certain jobs, a history of injuries, a sedentary, or inactive, lifestyle, long periods of sitting, and obesity. Although there are various contributors, the predominant cause has always been prolonged pressure on a part of the bone in the buttocks (called the ischium) usually due to sitting.

This condition frequently appears among individuals with a largely inactive lifestyle. Jobs that involve heavy vibrations — like using powerful sewing machines, operating road equipment, or driving tractors — can also lead to ischial bursitis. If you remain seated on a hard surface while your body is exposed to repeating vibrations, it can irritate and inflame a fluid-filled sac in your buttocks (the ischiogluteal bursa), leading to bursitis.

Another way you can get ischial bursitis is by landing on your backside after a fall, as this applies a sudden or repetitive force on a part of the bone in the buttocks (the ischial tuberosity). This can frequently affect athletes who often fall on their backside, such as horseback riders, canoeists, and wheelchair racers. Cases have also been reported among patients unable to move around much or at all, where a significant amount of weight can be placed on the ischial tuberosity, even when lying down.

Autoimmune diseases— where your immune system attacks your own body — including rheumatoid arthritis, systemic lupus erythematosus, and scleroderma, are known to cause bursitis. Patients with inflammatory conditions like gout, rheumatoid arthritis, and skin infections who develop ischial bursitis often find traditional treatments less effective.

Ischial bursitis usually happens in the fluid-filled sac slightly deeper into your buttocks (the ischiogluteal bursa), where conditions related to infection or bleeding are less common. However, since the ischial bursa is close to the anus and urethra, it still has a chance of getting infected by bacteria, especially if the skin in the area is damaged.

Risk Factors and Frequency for Ischial Bursitis (Weaver’s or Tailor’s Bottom)

Ischial bursitis is a condition for which there’s not a lot of data available. This means the rate at which it occurs and the total number of people who have it are unknown. While bursitis in general affects both men and women of all ages equally, ischial bursitis is not as common and isn’t recognized as often.

A study in 2020 looked into how ischial bursitis develops and responds to treatment. It found that many factors, like age, gender, body mass index, job type, history of injury, which side is affected, how long they sit each day, levels of certain measures of inflammation and uric acid, did not seem to affect how well people responded to treatment. However, having an inflammatory disease did seem to make a difference. The study also found that people with jobs where they sit a lot were more likely to have ischial bursitis compared to those with physically demanding jobs. Interestingly, the condition also occurred in people who didn’t work.

Signs and Symptoms of Ischial Bursitis (Weaver’s or Tailor’s Bottom)

Ischial bursitis is a condition that can be detected by understanding the patient’s medical history and through a detailed physical examination. This approach allows medical professionals to spot essential signs and physical features that make a correct diagnosis and effective treatment possible.

Medical History

Ischial bursitis often first presents as a dull, very specific kind of pain in the buttock that can get worse when sitting or stretching the gluteus maximus muscles. Other symptoms that patients might experience include:

Pain in the upper back of the thigh after sitting for a long time or after exercising
Pain in the groin region
Difficulty sleeping due to discomfort
Reduced mobility in the hip caused by pain
Struggling to get up from a seated position or climb up the stairs
Swelling around a specific part of the hip bone, known as the ischial tuberosity

Pain often worsens when the hip is flexed, and in some cases, bending the knee might cause additional discomfort. In some patients, shooting pain might be felt going down the back of the affected leg. This pain can usually be managed by resting, making lifestyle adjustments, and taking nonsteroidal anti-inflammatory drugs.

Physical Examination

A physical examination often reveals tenderness in the buttock area, which becomes most noticeable when the patient’s hip is flexed, and the ischial tuberosity can be felt. Also, the examination might reveal:

A positive response to tests such as straight leg raise, flexion-adduction-internal rotation (FADIR), and Faber (Patrick)
A possible soft, well-defined, non-moving, and slightly tender lump in the gluteal region
In cases of larger lesions, discolored skin around the affected site

It’s important to remember that even if there’s no tenderness in the ischial tuberosity, ischial bursitis shouldn’t be completely ruled out. Sometimes, patients with a confirmed diagnosis do not present any specific physical examination findings.

Testing for Ischial Bursitis (Weaver’s or Tailor’s Bottom)

If symptoms point towards ischial bursitis (an inflammation in the hip area), doctors can diagnose it by listening to your health history and conducting a physical exam. However, if your case is complex, imaging tests like an ultrasound or an MRI (short for Magnetic Resonance Imaging) can be used to be absolutely sure of the diagnosis. X-rays typically won’t show anything unless the condition has led to the calcification of the ischial bursa, which means that the inflamed region has hardened because of calcium deposits.

In an ultrasound for ischial bursitis, the appearance of the wall of the bursa (a small fluid-filled sack) can differ greatly from patient to patient. It can appear either lighter (hypoechoic) or darker (hyperechoic) than the surrounding tissue. The fluid inside the bursa can likewise appear either hypoechoic or hyperechoic, and sometimes even a mix of both. Any septa or nodules (or small masses of tissue), if present, usually appear darker on the ultrasound.

On the other hand, an MRI shows a bursa that is swollen and filled with fluid. It is also quite common to see issues in the surrounding hamstring muscles. The images from the MRI show well-defined clusters of lesions (abnormalities in tissue) with a thin bursa and bright signals showing fluid. Internal structures and fluid content in the bursa may vary in appearance. Muscle abnormalities may appear as wavy areas with bright fluid signals, suggesting small tears in the tendons over time.

In some cases where an infection is suspected in the ischial bursa, a doctor may need to draw out (aspirate) some fluid from the bursa for testing. Blood tests including a complete blood count and an ESR (Erythrocyte Sedimentation Rate, a blood test that helps detect inflammation in the body) may also be done. If an infection is found, the bursa will need to be drained and tested, and the right antibiotics will be given for treatment.

Treatment Options for Ischial Bursitis (Weaver’s or Tailor’s Bottom)

For most individuals with ischial bursitis (inflammation in the fluid-filled sacs in your joints), non-invasive treatments are quite effective. This includes things like painkillers, lifestyle changes, special pillows to alleviate pressure, and physical therapy which might include something called shock wave therapy. These approaches typically help to alleviate the discomfort without the need for more direct treatments like injections.

The first steps in treating ischial bursitis usually involve making changes in your day-to-day activities to avoid any actions or habits that might have triggered the pain in the first place. Shock wave therapy can help by reducing the presence of adhesions, which are bands of scar tissue that can limit movement. This therapy works by breaking down these bands and helping the collagen fibers in your body return to their normal orientation, which can improve mobility and decrease discomfort.

Other helpful measures might include applying cold to the area, taking it easy and resting the joint, stretching exercises, and massages. For patients whose pain is more severe and persistent, injections of corticosteroids and local anesthetics directly into the affected sac can offer further relief.

Surgery to remove the inflamed bursa can sometimes provide relief for individuals who haven’t responded to other treatments. This process of removing the bursa can be done through open surgery or a less invasive surgery called laparoscopic bursectomy.

When there is pain in the region of the ischial bursa (the fluid-filled sac near the hip joint) and gluteal muscles (muscles in the buttock), it could be due to conditions other than ischial bursitis. This becomes a possibility especially when local injections of painkillers or steroids only offer temporary relief. Here are some alternative reasons for such pain:

Sciatica (a condition characterized by pain going down the leg from the lower back)
Degeneration of discs in the lower back
Piriformis syndrome (a type of buttock pain)
Greater trochanteric bursitis (inflammation of the bursa in the thigh)
Coccydynia (tailbone pain)
Sacroiliitis (inflammation of one or both of the sacroiliac joints, which connect the lower spine and pelvis)
Local nerve impingement (pressure on a nerve)

In cases where ischial bursitis presents as a soft, immovable mass in the buttock, it might be necessary to investigate for possible tumor conditions, which can be best viewed on an MRI scan. Typically, tumors exhibit solid soft tissue, in contrast to bursitis, which appears cystic with localized fluid collection and a thin wall.

Pain in the ischial bursa region might also be confused with damage to the hamstring tendons. The hamstring muscles are key players in extending the pelvis and flexing the knee, making them prone to sprain and injury. With the hamstring tendons being close to the ischial bursa, it can be difficult to pinpoint the exact cause of pain in that area.

Some common symptoms across these conditions include tenderness and pain in the lower buttock or back thigh, difficulty and discomfort when getting up from a sitting position, and swelling in the affected area, depending on the severity of the bursitis. To accurately identify the cause, appropriate imaging techniques may be needed. It’s also possible to have both ischial bursitis and hamstring tendon damage concurrently.

What to expect with Ischial Bursitis (Weaver’s or Tailor’s Bottom)

The time it takes to feel better from ischial bursitis, or inflammation of the fluid-filled sac at your hip, can vary greatly depending on the treatment approach. Some methods, like changing your lifestyle habits or using non-steroidal anti-inflammatory drugs (NSAIDs), may take longer to provide relief. This is usually influenced by factors like how well the patient follows their doctor’s advice, the severity of their pain, and how well they are able to take pressure off their hip bone.

On the other hand, treatments like corticosteroid and anesthetic injections usually start to ease pain quickly – from a few minutes to a couple of days. One important thing to share with patients is that their pain might take several days to go away after treatment.

Patients who have an existing inflammatory condition may not respond as well to these conservative measures and may require more intensive treatments for pain relief. This understanding is important when discussing treatment plans and patient education.

Ischial bursitis is known for its high rate of recurrence and tendency to become chronic, often resulting in slow recovery. Even with treatment, it can come back, hence in some stubborn cases, more invasive treatment options may occasionally be necessary.

Possible Complications When Diagnosed with Ischial Bursitis (Weaver’s or Tailor’s Bottom)

Ischial bursitis, a condition where a small fluid-filled sac (bursa) in your hip becomes inflamed, generally doesn’t cause serious health problems. However, if it’s not treated or if it keeps coming back, it can cause ongoing pain and can make it harder to move around. Over time, the hidden inflammation can cause fibrosis, or tissue thickening, and calcification, where the tissue hardens because of calcium deposits. These problems can make the discomfort worse and can make movement even more difficult. Also, if bursitis persists, it can lead to extra issues, like muscle weakness, changes in how a person walks, and a lower quality of life.

In rare cases, serious untreated ischial bursitis can lead to new infections or abscesses (pockets of pus) forming inside the bursa, which would need quick medical treatment. It’s rare, but some people can get septicemia (a serious bloodstream infection) or septic arthritis (a joint infection) because of ischial bursitis – although it’s important to note that researchers aren’t certain about the direct relationship between these two. Because of these potential issues, it’s important to identify and treat ischial bursitis early to prevent any complications and to ensure the best possible recovery for the patient.

Common Side Effects:

Chronic pain
Reduced mobility
Fibrosis or tissue thickening
Calcification or hardened tissue
Muscle weakness
Changes in walking style
Decreased quality of life
Potential secondary infections or abscess formation
Rare possibility of septicemia or septic arthritis

Preventing Ischial Bursitis (Weaver’s or Tailor’s Bottom)

In order to prevent and manage ischial bursitis, a condition that can cause pain in the lower buttock area, it is crucial to both stop certain activities and adopt certain ways of moving and positioning our bodies. Teaching people about healthy practices such as taking breaks from sitting for long periods and maintaining good posture can lower the risk of developing this condition. It is also beneficial to regularly perform stretching and strengthening exercises with focus on the hip and buttock muscles. This helps reduce pressure on a small, fluid-filled cushion in the hip known as the ischial bursa.

Another helpful tip is to choose the right shoes as they can help lessen the pressure on the bursa. Furthermore, many patients reported that they find relief by using lower back support, sitting on a special round cushion called a “donut cushion”, and using taller chairs where they sit leaning forward. This allows pressure to be evenly distributed over their thighs.

It’s also advised that patients avoid activities that worsen their symptoms to stop the condition from recurring and to reduce discomfort. These activities could include sitting for long periods, sitting on hard surfaces, and repeatedly moving the hip or knee.

Being educated about the things that can increase the risk of getting ischial bursitis, being aware of its early signs, and knowing what steps to take in order to prevent it, gives people the knowledge they need to take charge of their own health. These proactive steps can help keep their musculoskeletal system, the body’s framework that includes bones and muscles, in good health and lower the chances of getting ischial bursitis, or it coming back if they have had it before.

Frequently asked questions

Ischial bursitis, also known as ischio-gluteal bursitis or "weaver's or tailor's bottom," is a condition where the ischial bursa becomes inflamed. The ischial bursa is a small fluid-filled sac located between the ischial tuberosity (a bony part of the hip) and the gluteus maximus muscle (a large muscle in the buttock). This condition is often seen in people who sit on hard surfaces for long periods of time.

Ischial bursitis (Weaver's or Tailor's Bottom) is not as common and isn't recognized as often.

Signs and symptoms of Ischial Bursitis (Weaver's or Tailor's Bottom) include: - Dull, specific pain in the buttock that worsens when sitting or stretching the gluteus maximus muscles. - Pain in the upper back of the thigh after sitting for a long time or after exercising. - Pain in the groin region. - Difficulty sleeping due to discomfort. - Reduced mobility in the hip caused by pain. - Struggling to get up from a seated position or climb up the stairs. - Swelling around a specific part of the hip bone, known as the ischial tuberosity. - Worsening of pain when the hip is flexed. - Additional discomfort when bending the knee in some cases. - Shooting pain going down the back of the affected leg in some patients. - Tenderness in the buttock area, especially when the hip is flexed. - Feeling the ischial tuberosity during a physical examination. - Positive response to tests such as straight leg raise, flexion-adduction-internal rotation (FADIR), and Faber (Patrick). - Possible presence of a soft, well-defined, non-moving, and slightly tender lump in the gluteal region in some cases. - Discolored skin around the affected site in cases of larger lesions. - It's important to note that even if there's no tenderness in the ischial tuberosity, ischial bursitis shouldn't be completely ruled out as some patients with a confirmed diagnosis may not present any specific physical examination findings.

Ischial bursitis (Weaver's or Tailor's Bottom) can be caused by sitting on hard surfaces for extended periods, heavy vibrations from certain jobs, landing on the backside after a fall, autoimmune diseases, and infection or damage to the ischial bursa.

The doctor needs to rule out the following conditions when diagnosing Ischial Bursitis (Weaver's or Tailor's Bottom): - Sciatica - Degeneration of discs in the lower back - Piriformis syndrome - Greater trochanteric bursitis - Coccydynia - Sacroiliitis - Local nerve impingement

To properly diagnose Ischial Bursitis (Weaver's or Tailor's Bottom), the following tests may be ordered by a doctor: 1. Health history and physical exam: This is the initial step in diagnosing Ischial Bursitis. The doctor will listen to your symptoms and medical history and perform a physical examination. 2. Imaging tests: If the case is complex or to confirm the diagnosis, the doctor may order imaging tests such as an ultrasound or an MRI. These tests can provide detailed images of the affected area, showing the inflamed bursa and any surrounding muscle abnormalities. 3. Aspiration of fluid: In cases where infection is suspected, the doctor may need to aspirate fluid from the bursa for testing. 4. Blood tests: A complete blood count and an Erythrocyte Sedimentation Rate (ESR) blood test may be done to detect inflammation in the body and determine if an infection is present. It is important to note that non-invasive treatments are usually effective for Ischial Bursitis, and more direct treatments like injections or surgery are typically reserved for severe or persistent cases that do not respond to other treatments.

Ischial bursitis (also known as Weaver's or Tailor's Bottom) is typically treated with non-invasive methods. These include painkillers, lifestyle changes, special pillows to alleviate pressure, and physical therapy, which may involve shock wave therapy. These approaches are effective in alleviating discomfort without the need for more direct treatments like injections. In more severe cases, injections of corticosteroids and local anesthetics directly into the affected sac can provide further relief. Surgery to remove the inflamed bursa may be considered for individuals who have not responded to other treatments.

The side effects when treating Ischial Bursitis (Weaver's or Tailor's Bottom) may include: - Chronic pain - Reduced mobility - Fibrosis or tissue thickening - Calcification or hardened tissue - Muscle weakness - Changes in walking style - Decreased quality of life - Potential secondary infections or abscess formation - Rare possibility of septicemia or septic arthritis

The prognosis for Ischial Bursitis (Weaver's or Tailor's Bottom) can vary depending on the treatment approach and individual factors. Some methods, such as lifestyle changes and NSAIDs, may take longer to provide relief. Corticosteroid and anesthetic injections can start to ease pain quickly, but it may take several days for the pain to completely go away. Ischial bursitis is known for its high rate of recurrence and tendency to become chronic, so it may result in slow recovery and may require more intensive treatments in some cases.

You should see an orthopedic doctor or a rheumatologist for Ischial Bursitis (Weaver's or Tailor's Bottom).

Chronic Inflammation Joint Muscle and Bone