Endometriosis can involve almost any organ in the body such as lungs, colon, muscles, eyes, brain, and nerves etc… It is difficult to determine the exact prevalence of extra pelvic endometriosis due to the lack of epidemiological studies and underdiagnosis of this condition.
The lining of the uterus that sheds monthly is called the endometrial lining. Genetic and epigenetic factors contribute to the development of lesions that are similar to endometrial tissue in different areas in the body, mainly the pelvis. This results in endometrial-like lesions in different organs which get inflamed and can bleed due to the formation of new blood vessels. These lesions can further undergo fibrosis and scarring and compress nearby structures to cause symptoms accordingly.
When the endometrial-like lesions implant near or along a nerve, they can cause pain and numbness in the areas supplied by this nerve. The sciatic nerve runs from the lower back along the posterior leg downwards. Pain felt along this nerve is termed sciatica and can be due to compression or inflammation of the nerve.
Endometriosis involving the sciatic nerve is very rare but presents with specific, regional symptoms of low back pain, numbness and cramping that extend down the leg.
Signs and Symptoms:
If you have sciatic endometriosis, you will most likely experience pain, numbness, cramping and possibly weakness of your lower back and/or along the back of your leg.
When it’s severe enough, your muscle weakness can prevent you from lifting the front of your foot.
Symptoms can occur any time during the month and might last for several days in intermittent episodes.
If you’re experiencing sciatica that occurs frequently with no obvious reason, it might be worth it to suspect a diagnosis of sciatic nerve endometriosis.
There is almost always history of pelvic endometriosis that accompanies sciatic nerve endometriosis so also look out for symptoms such as pelvic pain, heavy periods, painful intercourse and painful defecation.
Like pelvic endometriosis, imaging may aid in the diagnosis of sciatic nerve endometriosis but definitive diagnosis requires surgical visualization of the lesions.
If your doctor suspects sciatic nerve endometriosis, they will order an MRI for you which may show lesions around the sciatic nerve or compression of the nerve but may not always be diagnostic.
In that case, laparoscopic exploration of the nerve area by an expert is advisable for confirmation of the diagnosis.
Treatment is similar to that of pelvic endometriosis in terms of hormonal medications and pain killers for symptom control but laparoscopic surgical excision of the lesions by a well-trained surgeon is preferred to treat the condition.
At CEAPS, we always opt for minimally invasive approaches to provide the best experience for our patients with the least amount of side effects and complications. Sciatic Nerve decompression and excision of sciatic endometriosis is technically challenging and requires A high level of training and expertise.
Choose your surgeon with the training and the experience to manage these complex conditions.
Dr. Moawad is a highly reputable leading expert in this domain.