If women suffer from menstrual sciatic pain with the onset of numbness in the buttocks or in the leg or experience restricted movement in the foot - either on its own or in conjunction with numbness - a deeply infiltrating endometriosis of the sciatic nerve must be considered as a possible cause of the symptoms.

Endometriosis of the sciatic nerve

Endometriosis of the sciatic nerve is therefore one of these special forms of Endometriosis, which is still little known, even among medical professionals. However, there is good news for the women affected: endometriosis of the sciatic nerve can now be diagnosed and treated thanks to new scientific findings and modern procedures. Although the disease is rare, it occurs more frequently than previously assumed. The reason: most women affected by the disease tend to consult a neurologist, a back specialist (neurosurgeon, orthopaedist) or a pain therapist because the typical symptoms mentioned above do not show the characteristics of gynaecological pain. Even gynaecologists who are not familiar with endometriosis of the sciatic nerve often refer patients with such symptoms to a specialist.

Symptoms: agonizing burning pain combined with loss of function
Endometriosis of the sciatic nerve leads to typical sciatica, i.e. pain in the region where the sciatic nerve is supplied, caused by direct damage to this nerve.

Typical symptoms in the early stages 
Severe burning or "electrical" pain:

• in the deep back area
• in the buttocks
• on the back of the thighs
• in the legs
• radiating all the way to the calves and feet, especially at the outer edge of the foot
  
  Endometriosis of the sciatic nerve sooner or later attacks and destroys the sciatic nerve itself. If it is not treated in time, the pain worsens as the disease progresses, leading to neurological disorders and ultimately to loss of function, which is ultimately irreversible.
  
  Typical symptoms in an advanced stage
• Feelings of numbness in the genitals, in the legs, mostly on the sole of the foot or the outer edge of the foot or rear side of the legs.
• Loss of strength or restriction of movement of the ankle, flexion of the sole and back of the foot is limited.
• Climbing stairs becomes increasingly difficult and impossible over time.
• The Achilles reflex is reduced or no longer present at all

Endometriosis of the Sciatic Nerve: The Diagnosis

A doctor who is familiar with this disease can, in a first step, establish or rule out the suspicion of endometriosis of the sciatic nerve with a few specific and detailed questions. The interview should be part of the preparation of the findings for each endometriosis patient.

In addition, a so-called neuropelveological examination is carried out: the pelvic nerves are scanned in the vaginal or rectal direction and examined with the aid of ultrasound. A neuro MRT can also be used for diagnosis. If the suspicion is confirmed, only a laparoscopy can provide certainty. In this minimally invasive procedure, a tiny camera is inserted through a small incision that reveals the fine structures of the sciatic nerve and its damage. If the diagnosis is confirmed during this examination, the treatment can be carried out in the same procedure. Using the finest surgical instruments, the nerve is freed from the colonized tissue. Depending on the stage of the disease, the function of the nerve can be maintained or restored.

Treatment: to be performed only by an experienced specialist!

Treating an endometriosis of the sciatic nerve hormonally or simply with painkillers and wait and see approach will not be successful! Because this form of deeply infiltrating endometriosis cannot be stopped. Endometriosis of the sciatic nerve cannot be equated with intestinal or bladder endometriosis: it is important to preserve every millimetre of the nerve, because even the smallest destruction leads to neurological deficits and irreversible nerve damage.

If the disease is diagnosed, the operation must be performed as early as possible. Due to the deep location of the pelvic nerves, this procedure poses a major challenge for the surgeon, as the pelvic nerves lie behind numerous pelvic blood vessels - a highly sensitive region of the body that requires maximum surgical care and a great deal of treatment experience. Patients diagnosed with endometriosis of the sciatic nerve should therefore entrust themselves to the experienced hands of a specialist.

Surgery using laparoscopy

The only effective treatment is laparoscopic surgery. The surgeon must have the necessary skills and knowledge of the anatomy of the pelvic nerves and vessels. In an incomplete operation, changes in the anatomical conditions, adhesions and scar tissue make any further intervention more difficult. The operation through the buttocks is not effective because the disease develops in the pelvis and grows along the nerve outside the pelvis to the buttocks and not vice versa.

Due to the complexity of this disorder, the attending physician must have knowledge of different specialist disciplines such as neurology, urology, gastroenterology and gynecology. Neuropelveology is a relatively recent medical discipline that encompasses the expertise of all these fields. Certified neuropelveologists have this know-how and have undergone targeted training in sciatic nerve surgery.

Prof. Possover has specialised in the neuropelveological treatment of deep infiltrating endometriosis of the sciatic nerve. In a series of more than 259 laparoscopic surgeries, Prof. Possover has shown that laparoscopic surgery leads to significant pain reduction. If the continuity of the sciatic nerve is maintained, the nerve will recover and the healthy function of the legs can be restored.

A return to a better quality of life

If you are affected by the symptoms described above and no cause has yet been found, do not be afraid to talk to your treating physician about the possibility of endometriosis of the sciatic nerve - no matter whether it is a gynaecologist, neurologist, neurosurgeon, orthopaedist or pain specialist. The earlier this disease is diagnosed, the better the chances of recovery. The operation must be performed as early as possible - before the functional disorders become irreversible.

Last but not least, you will also contribute to strengthening the perception and awareness of this still relatively unrecognized special condition worldwide, which will benefit many other affected patients.

Live images of an operation for endometriosis of the sciatic nerve: