What is Sacroiliitis? Symptoms, Causes, & Treatment

Sacroiliitis is inflammation of one or both sacroiliac joints, which connect your lower spine to your pelvis. These joints act like shock absorbers, helping transfer weight from your upper body to your legs when you walk or move.

This condition can cause significant lower back and buttock pain that may worsen with sitting or climbing stairs. While sacroiliitis can be uncomfortable and disruptive to daily life, understanding your symptoms and treatment options can help you manage the condition effectively and find relief.

What is Sacroiliitis?

Sacroiliitis occurs when the sacroiliac joints become inflamed and irritated. Your sacroiliac joints are located where your sacrum (the triangular bone at the base of your spine) meets your iliac bones (part of your pelvis).

These joints normally have very little movement, but they play a crucial role in supporting your body weight. When inflammation develops, the joints can become stiff, painful, and tender to touch. The condition can affect one joint (unilateral) or both joints (bilateral).

Sacroiliitis can be either acute (sudden onset) or chronic (long-lasting). Some people experience episodes that come and go, while others deal with persistent symptoms that require ongoing management.

What are the Symptoms of Sacroiliitis?

The most common symptom is pain in your lower back and buttocks that may feel like a deep ache or sharp stabbing sensation. This pain often affects one side more than the other, though it can occur on both sides.

Here are the main symptoms you might experience:

• Lower back pain that spreads to your buttocks and sometimes down your thigh
• Pain that worsens when sitting for long periods or climbing stairs
• Morning stiffness that improves with movement throughout the day
• Pain that gets worse when you put weight on the affected leg
• Discomfort when transitioning from sitting to standing
• Pain that may improve when you lie down or change positions
• Tenderness when pressing on the lower back or buttock area
• Difficulty finding comfortable sleeping positions

The pain can vary from mild discomfort to severe, debilitating episodes. Some people describe it as a constant ache, while others experience sharp, shooting pains that come and go throughout the day.

Less Common Symptoms

In some cases, you might also experience fever, particularly if the sacroiliitis is caused by an infection. This is less common but requires immediate medical attention.

Some people with sacroiliitis also develop pain in other areas, such as the groin, hip, or even the upper back. This happens because your body may compensate for the painful joint by changing how you move and stand.

What Causes Sacroiliitis?

Sacroiliitis can develop from several different causes, ranging from mechanical stress to autoimmune conditions. Understanding what might be causing your symptoms can help guide the most appropriate treatment approach.

The most common causes include:

• Mechanical stress from pregnancy, heavy lifting, or sudden movements
• Inflammatory arthritis conditions like ankylosing spondylitis or psoriatic arthritis
• Osteoarthritis causing wear and tear of the joint surfaces
• Trauma from falls, car accidents, or sports injuries
• Gout causing crystal deposits in the joint
• Infections affecting the joint (septic sacroiliitis)
• Inflammatory bowel disease such as Crohn's disease or ulcerative colitis

Pregnancy is a particularly common trigger because hormonal changes soften the ligaments around the sacroiliac joints, making them more susceptible to inflammation and injury.

Rare Causes

Less commonly, sacroiliitis can result from conditions like osteomyelitis (bone infection), tuberculosis affecting the spine, or certain cancers that spread to the bones. These causes are much less frequent but may require specialized treatment approaches.

Some people develop sacroiliitis as part of a broader inflammatory condition affecting multiple joints throughout the body. This is often seen in conditions like reactive arthritis or as part of inflammatory bowel disease.

When to See a Doctor for Sacroiliitis?

You should see a healthcare provider if you experience persistent lower back or buttock pain that lasts more than a few days or significantly interferes with your daily activities. Early evaluation can help identify the underlying cause and prevent the condition from worsening.

Seek immediate medical attention if you experience fever along with your back pain, as this could indicate an infection. You should also see a doctor promptly if you develop numbness, tingling, or weakness in your legs, as these symptoms might suggest nerve involvement.

Schedule an appointment with your doctor if your pain is severe enough to wake you from sleep, doesn't improve with rest and over-the-counter medications, or keeps getting worse despite self-care measures. Don't wait if the pain prevents you from performing normal daily activities like walking, sitting, or working.

What are the Risk Factors for Sacroiliitis?

Several factors can increase your likelihood of developing sacroiliitis, though having risk factors doesn't guarantee you'll develop the condition. Understanding these factors can help you take preventive steps where possible.

The main risk factors include:

• Age between 20 and 40 years, when inflammatory arthritis conditions commonly begin
• Being female, particularly during pregnancy or after childbirth
• Having a family history of inflammatory arthritis or autoimmune conditions
• Carrying certain genetic markers like HLA-B27
• Having inflammatory bowel disease or psoriasis
• Engaging in activities that put repetitive stress on the lower back
• Having one leg longer than the other, which can create joint imbalance
• Previous trauma or injury to the lower back or pelvis

Pregnancy deserves special mention because hormonal changes during pregnancy naturally loosen the ligaments around the sacroiliac joints. This makes pregnant women more susceptible to developing sacroiliitis, especially during the later stages of pregnancy.

Additional Risk Factors

People with certain occupations or hobbies that involve repetitive bending, lifting, or twisting motions may have a higher risk. This includes jobs like construction work, nursing, or activities like golf or tennis that involve rotational movements.

Having a history of urinary tract infections, particularly in women, can sometimes lead to bacterial spread to the sacroiliac joints, though this is relatively uncommon.

What are the Possible Complications of Sacroiliitis?

While sacroiliitis is generally manageable with proper treatment, untreated or severe cases can lead to several complications that may affect your quality of life and mobility.

The most common complications include:

• Chronic pain that persists despite treatment attempts
• Reduced mobility and difficulty with daily activities
• Joint fusion (ankylosis) in severe, long-standing cases
• Compensatory problems in other parts of your back or hips
• Sleep disturbances due to persistent pain
• Depression or anxiety related to chronic pain
• Muscle weakness from reduced activity levels

Chronic sacroiliitis can significantly impact your ability to work, exercise, and participate in activities you enjoy. The constant pain may lead to changes in how you move, which can put additional stress on other joints and muscles.

Serious Complications

In rare cases, particularly when sacroiliitis is caused by infection, serious complications can develop. These might include the spread of infection to other parts of the body or the development of abscesses around the affected joint.

People with inflammatory arthritis conditions may experience complications beyond the sacroiliac joints, including inflammation of the eyes, heart, or other organs. However, these complications are more related to the underlying condition rather than the sacroiliitis itself.

How Can Sacroiliitis be Prevented?

While you can't prevent all cases of sacroiliitis, especially those related to genetic conditions or autoimmune diseases, there are several steps you can take to reduce your risk and protect your sacroiliac joints.

Maintaining good posture throughout the day helps reduce stress on your sacroiliac joints. When sitting, keep your feet flat on the floor and avoid slouching. When lifting objects, use proper body mechanics by bending your knees and keeping your back straight.

Regular exercise that strengthens your core muscles and improves flexibility can help support your lower back and pelvis. Focus on activities that don't put excessive strain on your joints, such as swimming, walking, or gentle yoga.

If you're pregnant, wearing a supportive maternity belt and avoiding activities that involve heavy lifting or twisting can help protect your sacroiliac joints during this vulnerable time.

Additional Prevention Strategies

Managing your weight within a healthy range reduces the stress on your sacroiliac joints. Extra weight puts additional pressure on these weight-bearing joints, potentially increasing inflammation and pain.

If you have an underlying inflammatory condition like inflammatory bowel disease or psoriasis, working with your healthcare provider to manage these conditions effectively may help reduce your risk of developing sacroiliitis.

How is Sacroiliitis Diagnosed?

Diagnosing sacroiliitis typically involves a combination of physical examination, medical history review, and imaging tests. Your doctor will start by asking about your symptoms, when they began, and what makes them better or worse.

During the physical examination, your doctor will perform specific tests to assess your sacroiliac joints. These might include the Patrick's test, where you place your ankle on the opposite knee while lying down, or the Gaenslen's test, which involves extending your hip while lying on your side.

Your doctor will also check for tenderness by pressing on specific areas around your lower back and pelvis. They may ask you to perform certain movements to see which positions trigger or relieve your pain.

Imaging Tests

X-rays are often the first imaging test ordered, though they may not show early signs of sacroiliitis. Changes in the joints may take months or years to appear on X-rays, so your doctor might recommend additional tests if X-rays appear normal.

MRI scans are more sensitive and can detect inflammation and early changes in the sacroiliac joints that don't show up on X-rays. This makes MRI particularly useful for diagnosing sacroiliitis in its early stages.

CT scans may be used in some cases to get a more detailed view of the bone structure, though they're less commonly needed for diagnosing sacroiliitis.

Additional Tests

Blood tests can help identify inflammatory markers and rule out other conditions. Your doctor might test for markers like ESR (erythrocyte sedimentation rate) or CRP (C-reactive protein) to assess inflammation levels.

If your doctor suspects an underlying autoimmune condition, they may test for specific markers like HLA-B27 or rheumatoid factor. These tests help determine if your sacroiliitis is part of a broader inflammatory arthritis condition.

What is the Treatment for Sacroiliitis?

Treatment for sacroiliitis focuses on reducing inflammation, managing pain, and improving your function and quality of life. The specific approach depends on the underlying cause, severity of your symptoms, and how well you respond to different treatments.

Most people start with conservative treatments that include medications and physical therapy. Your doctor will typically recommend beginning with the least invasive options and progressing to more intensive treatments if needed.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are often the first-line treatment. These medications help reduce both inflammation and pain in the sacroiliac joints.

For more severe cases, your doctor might prescribe stronger anti-inflammatory medications or muscle relaxants to help manage pain and reduce muscle spasms around the affected joints.

If sacroiliitis is related to an autoimmune condition, you might need disease-modifying antirheumatic drugs (DMARDs) or biological medications to address the underlying inflammatory process.

Physical Therapy and Exercise

Physical therapy plays a crucial role in managing sacroiliitis by improving flexibility, strengthening supporting muscles, and teaching you proper body mechanics. A physical therapist can design a specific exercise program tailored to your needs and limitations.

Stretching exercises for your hip flexors, hamstrings, and lower back can help reduce stiffness and improve mobility. Strengthening exercises for your core and glutes provide better support for your sacroiliac joints.

Your physical therapist may also use techniques like manual therapy, heat and cold therapy, or ultrasound to help reduce pain and inflammation.

Advanced Treatment Options

If conservative treatments don't provide sufficient relief, your doctor might recommend corticosteroid injections directly into the sacroiliac joint. These injections can provide significant pain relief for several months.

For chronic, severe cases that don't respond to other treatments, radiofrequency ablation might be considered. This procedure uses heat to interrupt the nerve signals that carry pain messages from the sacroiliac joint.

In very rare cases where other treatments have failed and the condition severely impacts your life, surgical fusion of the sacroiliac joint might be considered. This is typically reserved for the most severe, treatment-resistant cases.

How to Take Home Treatment During Sacroiliitis?

Home treatment can be very effective for managing sacroiliitis symptoms and supporting your recovery. The key is to find the right balance between rest and gentle activity while using pain management techniques that work for you.

Applying ice to the affected area for 15-20 minutes several times a day can help reduce inflammation, especially during flare-ups. Heat therapy, such as warm baths or heating pads, can help relax tight muscles and improve circulation.

Gentle stretching exercises can help maintain flexibility and reduce stiffness. Focus on stretches that target your hip flexors, hamstrings, and piriformis muscles, which can affect sacroiliac joint function.

Activity Modifications

Avoid activities that worsen your pain, such as prolonged sitting or high-impact exercises. Instead, try low-impact activities like swimming, walking, or stationary cycling to maintain your fitness level without aggravating your symptoms.

Pay attention to your sleeping position and consider using a pillow between your knees when sleeping on your side. This can help maintain proper alignment and reduce stress on your sacroiliac joints.

Practice good posture throughout the day, especially when sitting for long periods. Take frequent breaks to stand and walk around, and consider using ergonomic supports if you work at a desk.

Pain Management Techniques

Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain and inflammation. Follow the package directions and don't exceed recommended doses.

Relaxation techniques such as deep breathing, meditation, or gentle yoga can help manage the stress and tension that often accompany chronic pain conditions.

Keep a pain diary to track your symptoms and identify patterns or triggers. This information can be valuable for your healthcare provider in adjusting your treatment plan.

How Should You Prepare for Your Doctor Appointment?

Preparing for your doctor's appointment can help ensure you get the most out of your visit and provide your healthcare provider with the information they need to help you effectively.

Before your appointment, write down a detailed description of your symptoms, including when they started, what makes them better or worse, and how they affect your daily activities. Be specific about the location and type of pain you're experiencing.

Make a list of all medications you're currently taking, including over-the-counter drugs, supplements, and herbal remedies. Also note any treatments you've already tried and how well they worked.

Questions to Ask Your Doctor

Prepare a list of questions to ask your doctor during your appointment. Consider asking about the likely cause of your symptoms, what tests might be needed, and what treatment options are available.

Ask about the expected timeline for improvement, what warning signs to watch for, and when you should follow up. Don't hesitate to ask for clarification if you don't understand something.

Inquire about lifestyle modifications that might help, such as specific exercises, activity restrictions, or ergonomic adjustments you can make at home or work.

What to Bring

Bring any previous medical records, imaging studies, or test results related to your back pain. If you've seen other healthcare providers for this condition, bring their reports and recommendations.

Consider bringing a family member or friend to your appointment. They can help you remember important information and provide support during your visit.

What's the Key Takeaway About Sacroiliitis?

Sacroiliitis is a manageable condition that, with proper treatment and self-care, doesn't have to limit your ability to live an active, fulfilling life. The key is working with your healthcare provider to identify the underlying cause and develop an appropriate treatment plan.

Early diagnosis and treatment can help prevent the condition from progressing and reduce your risk of developing complications. Most people with sacroiliitis can achieve significant improvement in their symptoms with conservative treatments like medications, physical therapy, and lifestyle modifications.

Remember that managing sacroiliitis is often a gradual process that requires patience and consistency. Stay committed to your treatment plan, communicate openly with your healthcare team, and don't hesitate to ask for help when you need it.