Can combining chiropractic treatment with the common therapies of medication, exercise, and/or physical therapy help relieve sciatic endometriosis pain symptoms?

Sciatic Endometriosis

Sciatic endometriosis is a condition in which endometrial cells (tissue that resembles the lining of the uterus) grow outside of the uterine lining and compress the sciatic nerve. This places stress and pressure on the nerve causing back, pelvic, hip, and leg pain, especially before and during the menstrual cycle. It can also cause pain, irregular periods, and infertility. (The American College of Obstetricians and Gynecologists. 2021)

• These areas of endometrial tissue growth are also known as lesions or implants.
• Women with sciatic endometriosis often experience leg pain and weakness around the time of their menstrual cycle. (Lena Marie Seegers, et al., 2023)
• Sciatic endometriosis can also cause pain when urinating, during a bowel movement, during sex, and fatigue, and irregular vaginal bleeding.

The Sciatic Nerve

• Typically, endometrial lesions grow and attach to the ovaries, fallopian tubes, bladder, intestines, rectum, or peritoneum/abdominal cavity lining. (The American College of Obstetricians and Gynecologists. 2021)
• The abnormal growth may be caused by higher-than-normal levels of estrogen.
• Researchers believe that endometriosis is related to retrograde menstruation, which causes menstrual blood to flow back into the pelvis instead of out through the vagina. (World Health Organization. 2023)
• Sometimes, the cells grow in the area of the pelvis right above the sciatic nerve. (Adaiah Yahaya, et al., 2021)
• The sciatic nerve is the longest nerve in the body and travels down the back of each leg. (Johns Hopkins Medicine. 2023)
• When endometrial lesions place pressure on the sciatic nerve, they can cause irritation and inflammation leading to severe pelvic pain, which makes it harder to conceive. (Liang Yanchun, et al., 2019)

Symptoms

Some women with endometriosis experience no symptoms or misinterpret the symptoms as typical premenstrual syndrome/PMS signs. The most common signs and symptoms of sciatic endometriosis include:

• Difficulty walking or standing.
• Loss of sensation, muscle weakness, and reflex alteration.
• Limping.
• Balance problems.
• Bloating and nausea.
• Constipation or diarrhea before or after a period.
• Painful, heavy, and/or irregular periods.
• Bleeding between periods.
• Pain during sex, urination, and bowel movements.
• Pain in the stomach, pelvis, lower back, hips, and buttocks. (MedlinePlus. 2022)
• Weakness, numbness, tingling, burning, or dull aching sensations in the back of one or both legs.
• Foot drop or trouble lifting the front of the foot. (Center for Endometriosis Care. 2023)
• Infertility.
• Fatigue.
• Depression and anxiety.

Diagnosis

Endometriosis, including sciatic endometriosis, typically cannot be diagnosed with a pelvic examination or ultrasound by themselves. A healthcare provider may need to perform a biopsy using laparoscopy and discuss menstrual cycles, symptoms, and medical history.

• The laparoscopy procedure involves making tiny incisions and taking a tissue sample with tools attached to a thin tube with a camera. (MedlinePlus. 2022)
• Imaging tests, like magnetic resonance imaging/MRI, and computed tomography/CT scans, can help provide essential information about the location and size of any endometrial lesions. (The American College of Obstetricians and Gynecologists. 2021)

Treatment

Symptoms can sometimes be temporarily relieved with over-the-counter/OTC pain relievers. Depending on the condition and severity a healthcare provider may prescribe hormonal treatment to prevent new endometrial implants from growing. These can include:

• Hormonal birth control.
• Progestin – a synthetic form of progesterone.
• Gonadotropin-releasing hormone – GnRH agonists.
• If pain persists or worsens, individuals may need to undergo surgery to remove the tissue.
• In severe cases, a hysterectomy or surgical removal of the uterus may be recommended. (The American College of Obstetricians and Gynecologists. 2021)
• Physical therapy, gentle targeted exercises, and applying heat or cold to the affected area may also help. (Johns Hopkins Medicine. 2023)

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Sciatica In Depth

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References

The American College of Obstetricians and Gynecologists. Endometriosis.

Seegers, L. M., DeFaria Yeh, D., Yonetsu, T., Sugiyama, T., Minami, Y., Soeda, T., Araki, M., Nakajima, A., Yuki, H., Kinoshita, D., Suzuki, K., Niida, T., Lee, H., McNulty, I., Nakamura, S., Kakuta, T., Fuster, V., & Jang, I. K. (2023). Sex Differences in Coronary Atherosclerotic Phenotype and Healing Pattern on Optical Coherence Tomography Imaging. Circulation. Cardiovascular imaging, 16(8), e015227. doi.org/10.1161/CIRCIMAGING.123.015227

World Health Organization. Endometriosis.

Yahaya, A., Chauhan, G., Idowu, A., Sumathi, V., Botchu, R., & Evans, S. (2021). Carcinoma arising within sciatic nerve endometriosis: a case report. Journal of surgical case reports, 2021(12), rjab512. doi.org/10.1093/jscr/rjab512

Johns Hopkins Medicine. Sciatica.

Yanchun, L., Yunhe, Z., Meng, X., Shuqin, C., Qingtang, Z., & Shuzhong, Y. (2019). Removal of an endometrioma passing through the left greater sciatic foramen using a concomitant laparoscopic and transgluteal approach: case report. BMC women’s health, 19(1), 95. doi.org/10.1186/s12905-019-0796-0

MedlinePlus. Endometriosis.

Center for Endometriosis Care. Sciatic endometriosis.

Chen, S., Xie, W., Strong, J. A., Jiang, J., & Zhang, J. M. (2016). Sciatic endometriosis induces mechanical hypersensitivity, segmental nerve damage, and robust local inflammation in rats. European journal of pain (London, England), 20(7), 1044–1057. doi.org/10.1002/ejp.827

Siquara de Sousa, A. C., Capek, S., Howe, B. M., Jentoft, M. E., Amrami, K. K., & Spinner, R. J. (2015). Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases. Neurosurgical focus, 39(3), E15. doi.org/10.3171/2015.6.FOCUS15208