Have you ever noticed two small indentations or “holes” on either side of your lower back, just above your buttocks?

You may have wondered whether they’re scars, signs of a health problem, or something unusual about your spine.

In many cases, there’s nothing to worry about. Some people naturally have small indentations known as back dimples or “Dimples of Venus.” They are usually harmless and are related to the way ligaments and tissues connect the skin to the underlying pelvic structures.

However, a small opening or pit in the lower-back or buttock area can sometimes represent something different, such as a pilonidal sinus. Knowing the difference is important.

What Are the Two Small Dimples on Your Lower Back?

Natural back dimples are usually found symmetrically on either side of the spine, around the lower-back/pelvic area.

They are generally:

• Small and shallow
• Present for a long time
• Similar on both sides
• Not painful
• Not swollen
• Not leaking fluid or blood

These dimples are generally considered a normal anatomical variation. They don’t mean that something is wrong with your spine.

There are also common myths linking back dimples with beauty, luck, or fertility, but there isn’t scientific evidence that these dimples predict fertility or other special physical characteristics.

When a “Hole” May Actually Be a Pilonidal Sinus

A pilonidal sinus is different from natural back dimples.

It is a small opening or tunnel in the skin, usually located in the cleft between the buttocks, near the tailbone. Hair and skin debris can become trapped in the area, and the sinus can sometimes become infected.

A pilonidal sinus may look like:

• A tiny hole or pit
• One or several small openings
• A small lump near the top of the buttock crease
• A red or swollen area when infected

Unlike ordinary back dimples, a pilonidal sinus can develop symptoms.

Warning Signs You Shouldn’t Ignore

A small opening deserves medical attention if it becomes:

Painful

Pain around the tailbone or upper buttock crease can occur when a pilonidal sinus becomes inflamed or infected.

Red or Swollen

Inflammation may cause the surrounding skin to become red, swollen, tender, or warm.

Leaking Pus or Blood

Drainage is an important warning sign. An infected pilonidal sinus can produce pus or blood, sometimes with an unpleasant smell.

Difficult to Sit

A painful swelling near the top of the buttock crease can make sitting uncomfortable or even difficult.

Associated With Fever

Fever or feeling generally unwell together with a painful, swollen area can indicate an infection requiring medical attention.

Why Do Pilonidal Sinuses Develop?

The exact cause isn’t completely understood, but hair and friction appear to play an important role.

Loose or ingrown hairs can become pushed into the skin around the buttock crease. Pressure and friction may contribute to the formation of a sinus, which can subsequently become infected.

Factors associated with pilonidal disease include:

• Spending long periods sitting
• Having substantial body hair in the area
• Friction or pressure around the tailbone
• Being overweight
• Wearing tight clothing
• Previous pilonidal problems

Having one of these factors doesn’t mean you’ll necessarily develop a pilonidal sinus.

What About a Sacral Dimple?

Another possibility is a sacral dimple, which is an indentation located near the base of the spine.

Sacral dimples are particularly discussed in newborns and children. Most simple sacral dimples are harmless and don’t require treatment. However, healthcare professionals may investigate unusual dimples that are large, deep, located higher on the back, or accompanied by other skin findings.

In rare cases, an unusual dimple can be associated with an underlying spinal or spinal-cord abnormality.

Signs that warrant medical evaluation can include a deep or unusual dimple accompanied by:

• A patch of hair
• A skin tag
• A fatty lump
• Unusual skin discoloration
• Leg weakness or numbness
• Problems controlling the bladder or bowel

These concerns are particularly relevant when the feature has been present since birth.

How Can You Tell the Difference?

You shouldn’t try to diagnose the condition based solely on appearance, but there are some general clues.

Feature	Natural Back Dimples	Pilonidal Sinus
Usually symmetrical	Often	Not necessarily
Usually painless	Yes	Can become painful
Usually present for a long time	Often	May develop later
Located in the buttock cleft	Usually no	Typically yes
Can leak fluid	No	Yes, particularly when infected
Can become swollen	No	Yes
Usually needs treatment	No	Only if problematic/infected

The table is a general guide, not a substitute for an examination.

Should You Try to Clean or Squeeze the Hole?

If you think you have a pilonidal opening, don’t squeeze it or try to dig into it.

If there is no infection, treatment may not be necessary, and keeping the area clean is generally advised. If it becomes painful, swollen, or starts draining, medical evaluation is appropriate.

Trying to puncture or drain a suspected cyst yourself can worsen irritation and introduce infection.

What Happens if a Pilonidal Sinus Becomes Infected?

An infected pilonidal sinus can develop into an abscess—a painful collection of pus under the skin.

When an abscess forms, medical treatment may be necessary to drain it. Recurrent or persistent pilonidal disease can require additional procedures or surgery.

The appropriate treatment depends on whether the sinus is asymptomatic, infected, or repeatedly causing problems.

When Should You See a Doctor?

Arrange a medical assessment if the area:

• Suddenly becomes painful
• Develops a lump or swelling
• Becomes red or warm
• Starts bleeding
• Produces pus or other discharge
• Has an unpleasant-smelling discharge
• Makes sitting difficult
• Is accompanied by fever

A clinician can usually determine whether the opening is a harmless anatomical feature or a condition such as pilonidal disease through a physical examination.

Don’t Panic About Ordinary Back Dimples

Seeing two small indentations above your buttocks doesn’t automatically mean that you have a medical problem.

If they’ve always been there, are symmetrical, and don’t cause pain, swelling, or discharge, they may simply be natural back dimples.

The important thing is to pay attention to changes.

A new painful opening, swelling, drainage, or lump is different from a pair of stable, painless dimples and should be checked by a healthcare professional.

Final Thoughts

Two tiny “holes” on the lower back can have very different explanations.

They may simply be natural back dimples that have been part of your anatomy for years. Alternatively, an opening near the top of the buttock crease—especially one that becomes painful, swollen, or starts draining—may be a pilonidal sinus.

The appearance alone isn’t enough to make a diagnosis. Instead of squeezing, puncturing, or experimenting with home treatments, pay attention to symptoms and seek medical advice when something changes.

Your body can have unusual-looking features that are completely normal. What matters most is whether there are signs of infection, pain, or other concerning changes.

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