Endometriosis, Sciatica and Leg Pain

OVERVIEW

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 really cause sciatic pain?

Yes. When the endometrium grows around the sciatic nerve, it results in pelvic pain, hip and leg pain.

CAUSES

What causes sciatic endometriosis?

While the exact cause of endometriosis is not well understood, the cause of sciatic endometriosis is. When the endometrium starts to grow outside the uterus and around nerves, it can cause damage to those nerves. This is known as neuropathy [1]. When the affected nerve is the sciatic nerve, the condition is called sciatic endometriosis. Sciatic endometriosis is caused by inflammation that can be periodical to start with, but as the disease progresses, this can become chronic and eventually lead to scarring and constant pain.  

SYMPTOMS

Could I have sciatic endometriosis?

The sciatic nerve is the body's largest nerve, 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.

Because 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 are there?

Other symptoms of sciatic endometriosis are similar to those of regular endometriosis and may include:

• Pelvic pain

• Irregular periods

• Severe period pain

• Pain during intercourse

• Fatigue

• Bloating and nausea

• Depression and anxiety

The pain may start just before the start of your period and last for several days after. 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" or the inability to lift the front of one's foot, and negatively affect walking ability. It may also cause loss of sensation, muscle weakness, and reflex alteration. [2]

DIAGNOSIS

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, Magnetic resonance imaging (MRI), or surgery [3] may be used to diagnose it.

A test called the Lasègue’s test [4], or straight leg raise test, can also indicate 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 due to sciatic endometriosis, the patient experiences sciatic pain when the legs reach an angle between 30 and 70 degrees in relation to the exam table.

Early diagnosis is key as sciatic endometriosis can result in irreversible nerve damage caused by recurrent cycles of bleeding and scarring if left untreated [2].

TREATMENT

What treatment options are there?

As in the case of regular endometriosis, oral contraceptives may also help reduce the pain caused by sciatic endometriosis.

Over-the-counter painkillers and anti-inflammatory medications such as ibuprofen, as well as topical painkiller creams, may help reduce the pain caused by sciatic endometriosis. 

Gentle exercise such as walking, yoga, and swimming and physiotherapy under the supervision of a skilled physiotherapist who specializes in endometriosis, can also help.

What if these options 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 an experienced endometriosis excision surgeon perform the surgery.

Sometimes endometriosis can reach 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 surgeons may decide to access the area from the back of the pelvis via the buttock.

OUR APPROACH

Endometriosis can affect the sciatic nerve and the so-called S2, S3, and S4 nerves that come out of the spine and travel to the skin and muscles of the pelvis and lower limbs. 

Patients with sciatic endometriosis have to be evaluated with Magnetic resonance imaging (MRI) and surgery, which has to be performed by a very experienced endometriosis excision 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 the nerves found in this region.

PATIENT STORY

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References

1. https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061
2. https://pdfs.semanticscholar.org/44ce/e7e5b71d6238851e473732c23dd0e69a6002.pdf
3. https://www.ncbi.nlm.nih.gov/pubmed/12394671
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483767/