In endometriosis, the tissue resembling that which lines the uterus grows elsewhere in the body, forming lesions.
The ovaries and the pelvic cavity are most commonly affected by endometriosis, but endometriotic lesions can also occur at distant sites and, in rare cases, grow around nerves.
When endometriotic tissue grows on the sciatic nerve fiber, usually in the area around the sciatic notch in the upper part of the hip bone, it can lead to what is known as sciatic endometriosis. The sciatic nerve is a very long nerve that begins in the lower back and runs down each leg. Endometriotic tissue can put pressure on the sciatic nerve, and possibly damage it through local inflammation.
Symptoms
The symptoms that are associated with sciatic endometriosis usually begin just before menstruation and last for several days. Patients commonly experience lower back pain that can radiate to the leg. Numbness or cramping that extends down the leg is also a frequent symptom.
In addition to pain, affected women may have motor deficits and muscle weakness, which can result in foot drop (the inability to lift the front of the foot) and gait problems.
Diagnosis
Pain felt along the sciatic nerves is referred to as sciatica. Sciatica usually occurs when a herniated disk compresses the nerve. Symptoms of sciatic endometriosis often resemble those of sciatica. But the concurrence of symptoms and the menstrual cycle can indicate sciatic endometriosis.
Most women with sciatic endometriosis have a history of pelvic endometriosis. Endometriotic lesions around the sciatic nerve can, however, also occur in women without any signs of pelvic involvement, and a lack of pelvic involvement is no reason to discount this condition.
Magnetic resonance imaging (MRI) can help diagnose sciatic endometriosis, as the hemorrhagic lesions often produce characteristic signals around the sciatic notch.
Treatment
Hormonal contraceptives often help to relieve the symptoms of endometriosis, and can also help in the case of sciatic endometriosis. Hormonal therapies that suppress the production of estrogen can block the growth of endometriotic lesions.
Painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs) can help to reduce the pain.
If such therapies are not successful, the endometriotic lesions have to be removed by surgery. This is usually done through laparoscopy, a surgical technique commonly used to remove endometriotic lesions. The surgery is potentially risky because it may damage the sciatic nerve, which can result in impaired muscle and nerve function.
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