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Intergluteal cleft

The intergluteal cleft, also known as the natal cleft, is the deep furrow or groove located between the two gluteal regions (), serving as a key landmark in the and lower limb. It extends superiorly from the apex of the sacral triangle (typically at the level of the third or fourth sacral vertebra, S3 or S4) to the inferior boundary at the level of the , forming the posterior boundary of the . The cleft contains palpable bony structures such as the , sacral hiatus, and , and is innervated by the medial cluneal nerves originating from spinal levels S1 to S3. Anatomically, the intergluteal cleft arises from the medial convergence of the muscles and overlying , creating a midline depression that separates the and blends inferiorly with the perineal region. Its depth and shape can vary among individuals, influenced by factors such as body habitus. The region is prone to moisture accumulation and due to its location between apposing surfaces, which can affect hygiene and predispose to dermatological issues. Clinically, the intergluteal cleft holds significant medical importance as a common site for , a condition characterized by the formation of cysts or sinus tracts containing hair and debris, typically at the superior aspect near the . develop due to the penetration of loose hairs into the skin, exacerbated by pressure, friction from prolonged sitting, and factors like or poor hygiene, leading to , abscesses, or chronic infection if untreated. Other notable associations include sacral dimples, which are benign indentations just above the cleft but may rarely indicate underlying spinal issues.

Anatomy

Description and location

The intergluteal cleft is defined as the deep groove or furrow that separates the two gluteal regions, commonly known as the , and extends superiorly from the level of the third or fourth sacral to the inferiorly. This structure forms a prominent surface in the posterior aspect of the , appearing as a midline depression that divides the rounded contours of the when viewed externally. In anatomical nomenclature, the intergluteal cleft is referred to in Latin as crena analis, crena ani, or crena interglutealis, and it is assigned the following standardized codes in major terminological systems: TA98 A01.2.08.003, TA2 314, and FMA 20234. The muscles serve as the primary muscular boundaries flanking this cleft. The is situated within the inferior portion of the intergluteal cleft, marking its termination at the perineal boundary.

Boundaries and relations

The intergluteal cleft, also known as the natal cleft, originates superiorly at the level of the lower , typically corresponding to the sacral dimples around the third or fourth sacral vertebra (S3-S4). This superior boundary marks the apex where the cleft begins as a shallow groove over the before deepening inferiorly. Inferiorly, the cleft extends to the , blending seamlessly with the anal verge and forming the posterior limit of the perineal region. Laterally, it is bounded by the medial margins of the bilateral muscles, which separate the cleft from the bulk of the gluteal regions. Key spatial relations include the , which lies posteriorly within the cleft and can be palpated through its floor. Laterally, the ischial tuberosities provide attachment points for the origins, influencing the cleft's inferior lateral contours. Anteriorly, via the , the cleft relates to the , bridging the structures. The skin overlying the intergluteal cleft consists of with underlying subcutaneous , featuring numerous follicles that contribute to the region's typical coarseness. This area also contains glands, concentrated in the anogenital zone, which open into follicles and secrete viscous fluids.

Terminology

Etymology

The term "intergluteal cleft" derives from the Latin prefix inter-, meaning "between," combined with "gluteal," which stems from gluteus, a Modern Latin adaptation of the gloutos denoting "rump" or "buttock." The word "cleft" originates from Old English geclyft, referring to a split or , tracing back further to Proto-Germanic kluftiz and Proto-Indo-European gleubh- meaning "to tear apart." In , the term "intergluteal cleft" emerged as part of the standardization efforts beginning in the late , with the first international anatomical terminology adopted at the Basel Congress in and evolving through subsequent revisions. It was officially recognized in the (first edition, 1998), where the English "intergluteal cleft" corresponds to the Latin crena interglutealis, a notch between the ; this designation has been retained in later editions, including 2019 and 2023. Earlier usage included terms like "natal cleft," likely alluding to the feature's prominence at birth and derived from Latin nates for . This reflects a shift toward precise, descriptive Latin-Greek hybrids in modern , supplanting more or regional variants. A related Latin synonym is crena analis, emphasizing the anal region's proximity.

Synonyms and usage

The intergluteal cleft is known by several medical synonyms in anatomical literature, including natal cleft, gluteal cleft, crena analis, and crena interglutealis. These terms are used interchangeably in clinical and educational contexts to describe the groove between the , with "crena analis" and "crena interglutealis" serving as standardized Latin designations in . In colloquial English, the intergluteal cleft is commonly referred to as "butt crack" in usage and "bum crack" in , often appearing in informal discussions or cultural references rather than formal . Regional variations exist in other languages; for instance, French anatomical texts employ "sillon interfessier" to denote the structure, emphasizing its role as a midline furrow in the gluteal region. The term "natal cleft" is particularly favored in dermatological and surgical contexts due to its association with congenital features, distinguishing it from more general descriptors like "gluteal cleft."

Physiology and function

Biomechanical role

Contraction of the extends the joint and stabilizes the during locomotion such as walking and running. This supports stride progression and control.

Hygiene and protection

The intergluteal cleft, formed by the close apposition of the gluteal folds, serves as a natural barrier that helps protect underlying perineal structures, including the , from external trauma through the cushioning provided by overlying and subcutaneous fat. Additionally, this apposition of the buttocks contributes to fecal containment by assisting the anal muscles in maintaining continence, with accessory buttock muscles playing a supportive role in preventing leakage during normal function, such as through reflex contraction of the during increased intra-abdominal pressure. The gluteal region, including the intergluteal cleft, contains eccrine sweat glands that produce to regulate body temperature, but this can lead to accumulation of sweat in the confined space of the cleft, particularly during or in warm environments. Such buildup increases the risk of irritation if not addressed, necessitating regular cleaning with mild and thorough drying to maintain integrity and prevent conditions like moisture-associated damage. In , prominent buttocks—an adaptation linked to —result in a deeper intergluteal cleft compared to other , enhancing stability and support for upright posture through enlargement of the muscle and associated fatty tissue.

Clinical significance

Associated conditions

The intergluteal cleft's moist, frictional environment predisposes it to various dermatological and congenital conditions. Pilonidal disease involves or formation in the upper intergluteal cleft due to ingrown hairs penetrating the skin, leading to and abscesses. It is most common in young males aged 15 to 30, with an incidence of approximately 26 per 100,000 individuals. Risk factors include , excessive , and prolonged sitting, which promote occlusion and bacterial entry. Inverse psoriasis, a subtype of plaque psoriasis, manifests as smooth, red, moist plaques in the intergluteal cleft and other flexural areas due to exacerbated by , sweat, and occlusion. It is characterized by less than typical owing to the moist environment. Sacral dimples are common benign indentations located at or just above the superior aspect of the intergluteal cleft. While usually harmless, they may rarely be associated with underlying spinal dysraphism, such as occulta or tethered cord syndrome, warranting evaluation in certain cases. Caudal regression syndrome is a rare congenital disorder marked by incomplete development of the lower spine and , often resulting in an absent, shortened, or malformed intergluteal cleft, along with flattened buttocks and bilateral dimples. This anomaly is associated with spinal defects ranging from partial sacral to complete lumbosacral absence, and it occurs in about 1-2 per 100,000 live births, frequently linked to maternal . Other conditions affecting the intergluteal cleft include , a superficial inflammatory caused by moisture retention, friction, and microbial overgrowth in , leading to and . presents as chronic, recurrent abscesses and sinus tracts in gland-bearing areas like the intergluteal cleft, driven by follicular occlusion and inflammation, predominantly in young adults with risk factors such as and .

Management and interventions

Diagnosis of issues related to the intergluteal cleft typically begins with a thorough , assessing symptoms, , and visual inspection of the area for signs of or tracts, particularly in cases of . is a valuable modality for evaluating pilonidal cysts, revealing hypoechoic or anechoic lesions and tracts with high (up to 96%) and specificity (100%), aiding in preoperative planning. For congenital anomalies such as sacral dimples or coccygeal pits in the intergluteal cleft, initial screening is recommended, with (MRI) employed if abnormalities suggest underlying spinal issues like tethered cord syndrome. Conservative management emphasizes hygiene protocols to prevent and promote healing, including daily cleansing with mild soap and water, soaking in warm baths for 10-15 minutes multiple times daily, and keeping the area dry to reduce moisture accumulation in the cleft. For affecting the intergluteal cleft, low- to mid-potency topical corticosteroids are recommended as first-line to reduce , often applied for short periods to minimize side effects in sensitive . interventions, through diet and exercise, can decrease severity and overall risk in affected individuals by improving dynamics and reducing . Surgical interventions for include for acute abscesses, performed under to relieve pressure and allow pus evacuation, typically using an off-midline approach to facilitate . For or recurrent cases, the cleft-lift involves excision of diseased , flattening of the intergluteal cleft, and off-midline closure with a rotated flap, achieving low recurrence rates (around 2-5%) and faster recovery compared to traditional wide excision methods. Preventive measures for high-risk individuals focus on minimizing and hair accumulation in the cleft, such as regular via , depilation, or epilation every 1-2 weeks to reduce ingrown hairs and formation. Wearing loose-fitting clothing helps decrease friction and pressure on the area, while maintaining overall and avoiding prolonged sitting further lowers recurrence risk after .

References

  1. [1]
    Intergluteal cleft: surface anatomy, location, features - Kenhub
    The intergluteal cleft is a surface anatomy landmark of the pelvis and lower limb. It is the deep furrow or groove that lies between the two gluteal regions.
  2. [2]
    Muscles of the gluteal region and posterior thigh - Osmosis
    Medially, the region extends to the mid-dorsal line and is called the intergluteal cleft, which is the groove that separates the buttocks from each other.Missing: definition | Show results with:definition
  3. [3]
    Natal cleft deeper in patients with pilonidal sinus - PubMed
    Purpose: The study was planned to evaluate the depth of natal cleft in patients with pilonidal sinus disease and in healthy persons.
  4. [4]
    Pilonidal cyst - Symptoms and causes - Mayo Clinic
    Oct 4, 2024 · A pilonidal cyst is an unusual pocket in the skin that usually contains hair and skin debris. A pilonidal cyst is almost always near the tailbone at the top of ...Overview · Symptoms · Causes
  5. [5]
    Pilonidal Cyst and Sinus - StatPearls - NCBI Bookshelf
    Pilonidal disease is a dermatological soft tissue process that is relatively common and affects both the pediatric population and adults.<|control11|><|separator|>
  6. [6]
    Elements of Morphology: Standard Terminology for the Trunk and ...
    The location can be just above the intergluteal cleft or higher (cranial) along the lower back and should be added to the description. Replaces: Human tail; ...
  7. [7]
    Intergluteal cleft - e-Anatomy - IMAIOS
    Crena interglutea ; Latin synonym: Crena analis; Crena ani; Crena interglutealis ; Synonym: Anal cleft; Natal cleft ; Related terms: Intergluteal cleft; Natal ...
  8. [8]
    Gluteal Region - Earth's Lab
    Natal cleft: It's a midline cleft between the 2 buttocks, which starts at ... The deep branch enters laterally between gluteus medius and minimus, and subdivides ...Missing: boundaries | Show results with:boundaries
  9. [9]
    The Perineum - Boundaries - Contents - TeachMeAnatomy
    Anterior – mons pubis in females, base of the penis in males. Laterally – medial surfaces of the thighs. Posterior – superior end of the intergluteal cleft. By ...<|separator|>
  10. [10]
    Intergluteal Cleft - an overview | ScienceDirect Topics
    The intergluteal cleft is defined as the anatomical space located between the buttocks, typically residing low and often associated with structures such as ...
  11. [11]
    Anatomy, Abdomen and Pelvis, Pelvis - StatPearls - NCBI Bookshelf
    The perineal body is located between the urogenital hiatus and the rectal hiatus. The perineum is located between the pubic symphysis and the coccyx. It is ...
  12. [12]
    Histology, Skin Appendages - StatPearls - NCBI Bookshelf
    Apr 24, 2023 · The skin appendages are epidermal and dermal-derived components of the skin that include hair, nails, sweat glands, and sebaceous glands.Missing: intergluteal | Show results with:intergluteal
  13. [13]
    Histology, Apocrine Gland - StatPearls - NCBI Bookshelf
    Apocrine glands are a subtype of exocrine secretory glands. They are found in many locations but are primarily in the axillae, areolae, and anogenital regions.
  14. [14]
    Gluteus - Etymology, Origin & Meaning
    gluteus (n.) buttocks muscle, 1680s, from Modern Latin glutaeus, from Greek gloutos "the rump," in plural, "the buttocks."
  15. [15]
    Cleft - Etymology, Origin & Meaning
    Originating from Middle English clift and Old English geclyft, cleft means "split, cloven," derived from Proto-Germanic *kluftis and PIE *gleubh- "to tear ...
  16. [16]
    intergluteal cleft
    ### Summary of Synonyms and Medical Context for "Intergluteal Cleft"
  17. [17]
    INTERGLUTEAL CLEFT Definition & Meaning - Power Thesaurus
    gluteal cleft (US, slang, vulgar). frombutt crack ; groove between the buttocks that runs from just below the sacrum to the perineum (anatomy). fromnatal cleft.
  18. [18]
    The human gluteus maximus and its role in running
    Jun 1, 2006 · The major functions of the gluteus maximus during running are to control flexion of the trunk on the stance-side and to decelerate the swing leg.<|control11|><|separator|>
  19. [19]
    Anatomy, Bony Pelvis and Lower Limb, Gluteus Maximus Muscle
    The gluteal muscles are a group of muscles that make up the buttock area; the muscle group consists of the gluteus maximus, gluteus medius, and gluteus minimus.Missing: locomotion | Show results with:locomotion
  20. [20]
    Gluteal Retractions: Classification and Treatment Techniques
    As the gluteus maximus assumes a more cephalic position when contracted, it pulls the skin by the fibers, worsening the defect so that it becomes more visible.
  21. [21]
    Consistent Reconstruction of Sacrococcygeal Pressure Ulcers using ...
    Feb 28, 2024 · Sacrococcygeal pressure sores result from ischemic injury inflicted on skin and subcutaneous tissue sandwiched between external weight bearing ...
  22. [22]
    Foetal Development of the Human Gluteus Maximus Muscle With ...
    The GMX develops in two parts, superior and inferior, inserting into the femur. At 9-10 weeks, it has a digastric appearance with an intermediate band.
  23. [23]
    Sacrum Spine - an overview | ScienceDirect Topics
    Prominent buttocks are one of the most characteristic features of the muscular system in man associated with the frequent need to bring the trunk upright.10.
  24. [24]
    Current Management of Fecal Incontinence - PMC - NIH
    The use of accessory buttock muscles can be noted in patients with fecal incontinence when they are asked to squeeze the anal sphincter muscles.
  25. [25]
    Butt sweat: Causes, treatments, and prevention - MedicalNewsToday
    These glands are in almost every area of skin, including the buttocks. Apocrine glands: do not regulate body temperature, and they exist mostly in the genital ...Missing: natal | Show results with:natal
  26. [26]
    Identifying Skin Breakdown in the "Gluteal Cleft" | Clinical Resource
    Jun 14, 2015 · Moisture-related skin breakdown is usually characterized by superficial skin loss and irregular edges, classified as MASD (moisture associated ...
  27. [27]
    The evolution of the upright posture and gait—a review and a new ...
    30 hypotheses have been constructed to explain the evolution of the human upright posture and locomotion. The most important and recent ones are discussed here.
  28. [28]
    Intertrigo - StatPearls - NCBI Bookshelf - NIH
    Oct 28, 2024 · Intertrigo is a superficial inflammatory skin condition that affects flexural surfaces, such as the axillae, abdominal folds, and perineum.
  29. [29]
    Pilonidal Disease - PMC - NIH
    Pilonidal disease is an infection under the skin in the gluteal cleft. Pilonidal literally means a “nest of hair.” It affects an estimated 26 per 100,000 ...
  30. [30]
    Inverse Psoriasis: From Diagnosis to Current Treatment Options - NIH
    Inverse psoriasis (IP), also known as flexural or intertriginous psoriasis, is a variety of plaque psoriasis that involves the body folds.
  31. [31]
    Treatment of Inverse/Intertriginous Psoriasis: Updated Guidelines ...
    Aug 1, 2017 · Inverse or intertriginous psoriasis commonly involves skin fold areas including the axillae, perianal skin, intergluteal cleft, inframammary ...
  32. [32]
    Caudal regression syndrome: Postnatal radiological diagnosis with ...
    Sep 29, 2022 · Affected infants appear typically to have a small pelvis, small flat buttocks and bilateral buttock dimples with a short intergluteal cleft.
  33. [33]
    Caudal Regression Syndrome - PMC - NIH
    Caudal regression syndrome is a rare congenital abnormality in which a segment of the spine and spinal cord fails to develop.Missing: intergluteal | Show results with:intergluteal
  34. [34]
    Pilonidal sinus disease: an intergluteal localization of hidradenitis ...
    May 6, 2019 · Objectives: To determine the prevalence and characteristics of inflammatory skin lesions located in the intergluteal fold (IGF) of patients ...
  35. [35]
    Pilonidal cyst - Diagnosis and treatment - Mayo Clinic
    Oct 4, 2024 · Learn about causes, symptoms and treatments of this painful condition that usually affects the skin above the tailbone in people who sit for ...Treatment · Preparing For Your... · What You Can DoMissing: intergluteal | Show results with:intergluteal
  36. [36]
    Ultrasonography: Is It Powerful Modality for Diagnosis of Simple and ...
    The sensitivity and specificity of ultrasonography in detecting pilonidal disease was 96% and 100%, respectively. Ultrasonography detected sinus tracts in 72%, ...Missing: cyst | Show results with:cyst
  37. [37]
    Pilonidal cyst: ultrasonographic findings - Eurorad
    Oct 26, 2015 · Ultrasonography is useful to evaluate PC, which appear as pseudocystic anechoic or hypoechoic lesions, oval in shape and situated in the dermis and hypodermis.
  38. [38]
    [PDF] Evaluation of Sacral Dimples/Coccygeal Pits Clinical Pathway
    Feb 24, 2022 · Multiple studies have demonstrated that simple coccygeal pits are often benign variants and do not require any further evaluation with imaging.
  39. [39]
    Magnetic Resonance Imaging Analysis of Caudal Regression ...
    The aim of this study was to evaluate the magnetic resonance imaging (MRI) findings of caudal regression syndrome (CRS) and concomitant anomalies in pediatric ...
  40. [40]
    Pilonidal Disease | Boston Children's Hospital
    Tight clothing; Excess weight; Tendency to sweat heavily. Pilonidal ... Hair removal is the most important thing you can do to treat pilonidal disease.
  41. [41]
    Sacro-coxxygial hygiene, a key factor in the outcome of pilonidal ...
    As a standard procedure after surgery, we recommend our patients to perform water irrigations in the intergluteal cleft 4 to 6 times a day during the post- ...Missing: function | Show results with:function
  42. [42]
    Genital and Inverse/Intertriginous Psoriasis: An Updated Review of ...
    Genital and inverse psoriasis can develop in more than one-third of patients who have psoriasis. Psoriatic plaques in the genital and intertriginous skin ...
  43. [43]
    Diet and Psoriasis: Part I. Impact of Weight Loss Interventions - NIH
    Here, we review the literature to examine the efficacy of weight loss interventions, both dietary and surgical, on psoriasis disease course.Missing: intergluteal | Show results with:intergluteal
  44. [44]
    Management of sacrococcygeal pilonidal sinus disease - PMC - NIH
    Incision and drainage should be the treatment of choice for acute pilonidal abscess, using an off‐midline incision. Non‐surgical treatments such as ...1. Introduction · 5. Chronic Disease... · 5.4. Off‐midline Closure...Missing: diagnosis | Show results with:diagnosis
  45. [45]
    The Bascom Cleft Lift as a Solution for All Presentations of Pilonidal ...
    Feb 1, 2021 · The buttocks are compressed medially, and the line of contact between the two sides of the gluteal cleft is marked with a dotted line for ...Missing: intergluteal | Show results with:intergluteal
  46. [46]
    The Cleft Lift procedure for pilonidal disease renamed as a rotation ...
    The Cleft Lift procedure originally named by Bascom is a derivative of the Karydakis flap procedure for pilonidal sinus disease.
  47. [47]
    Management of Pilonidal Disease (2019) | ASCRS Toolkit
    Mar 14, 2025 · 1. Elimination of hair from the gluteal cleft and surrounding skin, by shaving or laser epilation, may be used for both acute and chronic ...
  48. [48]
    Pilonidal Disease - Nationwide Children's Hospital
    Remove hair every other week to keep pilonidal disease from coming back. · Do not shave or use hair removal cream if you have an open wound without talking with ...Missing: measures | Show results with:measures
  49. [49]
    Pilonidal Cysts and Hygiene: Preventing Recurrence
    Feb 14, 2025 · To reduce the risk of recurrence, wear loose-fitting clothes that allow the skin to breathe.
  50. [50]
    How to Prevent Pilonidal Cysts | Katy & Houston TX, Surgeon
    Avoid tight clothing. Tight jeans and leggings squeeze your buttocks together and cause friction that can lead to a pilonidal cyst. Remove the hair. One way ...