What is sciatic endometriosis?
Sciatic endometriosis is a condition where the lining of the uterus or the endometrium grows around the sciatic nerve and puts pressure on it.
Can endometriosis affect the sciatic region?
When the endometrium grows around the sciatic nerve, it results in pelvic pain as in the case of regular endometriosis but also a pain in the hip region and leg.
What causes sciatic endometriosis?
The exact cause of endometriosis is not well understood. When the endometrium starts to grow outside the uterus and affect nerves it can cause damage to them. This is known as neuropathy . When the affected nerve is the sciatic nerve, the condition is called sciatic endometriosis. Sciatic endometriosis is caused by inflammation that can be a periodical to start with, but as the disease progresses, this can become chronic and eventually lead to scarring and constant pain.
Could I have sciatic endometriosis?
The sciatic nerve is the largest nerve in the body connecting the spinal cord with the legs and feet. It runs from each side of the lower spine into the back of the thigh and down to the foot.
Since sciatic endometriosis puts pressure on the sciatic nerve it can cause pain, numbness, cramping, and a tingling sensation in the lower back, hips, buttocks, thighs, calves, knees, and feet. The pain is usually felt in the back of the leg and radiates towards the heel.
What other symptoms can there be?
Other symptoms of sciatic endometriosis are similar to those of regular endometriosis and may include:
Severe period pain
Pain during intercourse
Bloating and nausea
Depression and anxiety
Do I have sciatic endometriosis symptoms?
The pain may start just before a woman starts her period and last for several days after the period is over. However, the interval between episodes of pain may shorten with time and the cyclical pain may gradually become constant. Sciatic endometriosis may cause foot drop and negatively affect walking ability. It may also cause loss of sensation, muscle weakness, and reflex alteration. 
How is sciatic endometriosis diagnosed?
Sciatic endometriosis can be very difficult to diagnose as it usually presents like sciatica. But the condition almost always occurs together with regular endometriosis and if a woman is already known to have endometriosis and shows symptoms of sciatica, sciatic endometriosis may be suspected. Imaging techniques such as magnetic electromyography, computed tomography (CT) scan, resonance imaging (MRI), or surgery  may be used to diagnose it.
A test called the Lasègue’s test  or straight leg raise test can also be indicative of sciatic endometriosis. During the test, the patient is asked to lie down on their back. The doctor then raises the patient’s legs with the knees held in a straight position. If the sciatic nerve is under pressure, for example, due to sciatic endometriosis, the patient experiences sciatic pain when the legs reach an angle of between 30 and 70 degrees compared to the floor.
Early diagnosis is very important as sciatic endometriosis can result in irreversible nerve damage caused by recurrent cycles of bleeding and scarring if left untreated .
What treatment options are there?
Over-the-counter painkillers and anti-inflammatory medications such as ibuprofen may help reduce the pain caused by sciatic endometriosis. Topical painkiller creams applied over the affected areas may reduce the pain caused by sciatic endometriosis.
Gentle exercise such as walking, yoga, and swimming can also help and so can physiotherapy under the supervision of a skilled physiotherapist specializing in endometriosis.
As in the case of regular endometriosis, oral contraceptives may also help reduce the pain caused by sciatic endometriosis.
What if these do not help?
Laparoscopic surgery to remove the endometrial tissue that has grown around the sciatic nerve can be effective in treating severe cases of sciatic endometriosis. It is important that the surgery is performed by an experienced plastic surgeon.
Sometimes endometriosis may have reached the so-called sciatic foramen or the opening in the pelvic bone where the nerves and blood vessels from the pelvis pass through and travel down to the lower legs. Because this area is difficult to reach by laparoscopy, in such cases neurosurgeons may decide to access the area from the back of the pelvis via the buttock.
Endometriosis can affect the sciatic nerve and the so-called S2, S3, and S4 nerves that come out of the spine and supply the skin and muscles of the pelvis and lower limbs. As the disease progresses it can cause permanent damage to the nerves, known as neuropathy.
Patients with sciatic endometriosis have to be evaluated with magnetic resonance imaging (MRI) and surgery, which has to be performed by a very experienced plastic surgeon who knows how to identify the main blood vessel in the pelvic area with its subdivisions. He or she will then need to extend to the area before the sacral bone, or triangular bone at the base of the spine, and reach to the nerves found in this region.
At times, the inflammation caused by endometriosis can affect the sciatic foramen or the opening in the back of the pelvis into the sciatic canal. It may be difficult to reach this area by laparoscopy, meaning neurosurgeons dealing with this issue, may prefer to approach from the back of the pelvis with a rather ample incision in the buttock muscle.
I wish my doctors pointed me in Seckin's direction a lot sooner, says Christine Eboli. I would’ve had more years to spend with my kids.
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