Hip pain at night: common causes and when to worry

Hip pain that wakes you at night is most often caused by bursitis on the outside of the hip, or by arthritis in the joint itself. Both are common and both can be treated. A few causes need checking soon, especially if the pain comes with fever, weight loss or a recent fall.

Where it hurts gives a clue

Pain on the outer side of the hip, at the bony point you can feel under the skin, usually comes from the soft tissues there. Pain deep in the groin usually comes from the hip joint. Pain in the buttock can come from the joint, the muscles or the lower back. Pointing to the spot helps your doctor a great deal.

Bursitis on the outside of the hip

A bursa is a small fluid-filled cushion that lets tissues slide over bone. The one over the bony point of the hip (the greater trochanter) can become inflamed. This is called trochanteric bursitis, and the tendons nearby are often irritated too.

Typical signs:

• pain at the point of the hip that may spread down the outside of the thigh
• worse when lying on that side at night
• worse getting up from a chair, on stairs and on long walks
• tender to press

It is more common in women and in middle age and later. Overuse, a fall onto the hip, a tight band of tissue along the outer thigh, a difference in leg length and back problems can all play a part.

Most people get better without an operation. Treatment includes avoiding what flares it, anti-inflammatory medicine for a short time, stretching and strengthening exercises, and sometimes a steroid injection into the painful area.

Arthritis of the hip joint

Osteoarthritis wears away the smooth cartilage inside the hip. It is more common after the age of about 45.

Typical signs:

• pain in the groin or thigh, sometimes spreading to the buttock or knee
• stiffness, often worse in the morning or after sitting
• a limp, and difficulty with socks, shoes and getting in and out of a car
• in later stages, pain at rest and at night

Night pain from arthritis tends to mean the joint is more worn. First treatment is exercise, weight loss if needed, painkillers and a walking stick held in the opposite hand. If these no longer control the pain and X-rays show a badly worn joint, a hip replacement may be discussed. Our guide to the signs you may need a hip replacement covers this in more detail.

Other causes

• The lower back. Nerve irritation in the back can send pain into the buttock and leg.
• Tendon strains. Pain and swelling after hard or repeated exercise.
• Rheumatoid arthritis. Stiffness that is worst after rest, often in several joints.
• Infection. A hot, swollen hip with a high temperature.
• A fracture. Severe pain after a fall, especially in older people.
• Rarely, a bone tumour. Bone pain that is worse at night, sometimes with a lump, tiredness or weight loss.

What helps at night

• Lie on the side that does not hurt, with a pillow between your knees.
• Or lie on your back with a pillow under your knees.
• A softer mattress topper can ease pressure on a sore side.
• Use ice in a towel for up to 20 minutes, or a painkiller before bed if it is safe for you.
• Avoid low chairs and sofas in the evening, which load the hip.
• Keep moving during the day, without overdoing it.

How a doctor finds the cause

The doctor asks where the pain is, when it started and what makes it worse, then examines the hip, the back and the way you walk. An X-ray shows arthritis and the bones. An MRI or ultrasound scan can show bursitis, tendon problems and less common causes.

When to see a doctor

See a doctor if hip pain is affecting your sleep or daily activities, keeps getting worse, has not improved after 2 weeks of home care, or if the hip is stiff for more than 30 minutes after waking.

Get help urgently if:

• the hip is hot and swollen, or you feel unwell with a high temperature
• severe pain started suddenly without an injury
• bone pain at night comes with a lump, weight loss or a fever

Call 998 for an ambulance or go to an emergency department if you have severe hip pain after a fall, cannot stand or walk on the leg, or have numbness or tingling in the leg after an injury. Do not drive yourself.