What Is Sciatica?

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Sciatica is nerve pain stemming from the sciatic nerves, which travel from the spine all the way down each leg. Pain can range from mild to severe and is often described sharp, aching, or shooting from the lumbar area, through the buttocks, and to the back of the thigh. Sciatica is usually caused by a pinched nerve and, as a result, typically only affects the side of the body where that occurs.

It is a relatively common condition that, while bothersome, is not of great concern in most cases. Conservative treatments typically offer relief. In some situations, however, sciatic nerve pain is an early sign of a serious nerve or spine problem that may require greater intervention.

Symptoms of Sciatica

Sciatica typically affects adults, and rarely affects children or teenagers. It causes symptoms on one side of the body in the area that corresponds to the affected sciatic nerve.

The symptoms may come and go, and they can vary depending on if you are sitting, standing, or lying down. Sometimes, coughing, laughing or sneezing can exacerbate the pain.

Initially, sciatic nerve pain may be mild, but it may become more intense over time.

Common symptoms of sciatic nerve pain can include:

  • Pain, burning, or a shock-like sensation in the buttocks, hip, and/or leg
  • Sudden shooting pain that travels down the leg

Sometimes sciatic nerve pain is associated with other symptoms, including:

  • Tingling or discomfort in the toes
  • Low back pain
  • Numbness or tingling in the buttocks, hip, and/or leg
  • Weakness in the hip, and/or leg
  • Bowel or bladder incontinence
  • Sexual dysfunction

Generally, weakness and bowel, bladder, or sexual problems are signs of more extensive nerve or spine involvement that could have long-term effects if left untreated.

Saddle Anesthesia

Saddle anesthesia describes numbness of the area around the anus and inner thighs. Unlike sciatic nerve pain, it usually affects both sides of the body, although it doesn't have to be symmetrical.

Saddle anesthesia can be accompanied by weakness and/or bowel or bladder problems and is usually a sign of a severe health problem, such as a tumor near the sciatic nerve.

Causes

Sciatica is caused by irritation or impingement (pinched nerve) of a sciatic nerve. This is largest spinal nerve in the body. Spinal nerves are arranged as right and left pairs, and physical pressure tends to affect one side.

Impairment of a spinal nerve is described as radiculopathy, and this condition can cause sensory changes such as pain, numbness, and loss of sensation. It can also cause motor changes, including weakness and muscle atrophy (shrinking of the muscle).

There are several conditions that cause sciatica, including:

  • Lumbar herniated disc: Rubbery material from the center of discs (cartilage) in your lower spinal bones can leak out and irritate or compress spinal nerve roots.
  • Spondylolisthesis: Each vertebra along with its corresponding disc can slip out of place, impinging on the sciatic nerve. This can occur due to trauma, heavy lifting, or spine instability from a weakening of the connective tissue.
  • Central canal stenosis: A form of spinal stenosis, this is when the spinal foramen—the opening through which the spinal cord passes—becomes tight or altered in structure, causing compression. This can occur due to trauma, arthritis, or another inflammatory disease. Repetitive movements, such as construction work and heavy lifting can trigger inflammation as well.
  • Foraminal stenosis: The intervertebral foramina are small openings on each side of a vertebral bone. All spinal nerves, including the sciatic nerves, pass through these holes. The foramina at the level of the sciatic nerves are frequently affected by arthritis and inflammation, causing pressure on the nerves. This is the second of the two general types of spinal stenosis.
  • Osteophyte (bone spur): A bony outgrowth, often caused by osteoarthritis, can develop and narrow the space available for the spinal cord and pinch spinal nerves.
  • Pregnancy or weight changes: Redistribution of your body weight can put physical pressure on your sciatic nerve. This often resolves after pregnancy or weight loss.
  • Piriformis syndrome: The piriformis muscle in the buttock can spasm, entrapping the sciatic nerve.
  • Cancer: Several types of cancer can metastasize (spread) to the spine or pelvis, causing pressure on the sciatic nerve. Prostate cancer, anal cancer, lung cancer, and breast cancer are examples of cancers that have a tendency to metastasize to the lower spine.
  • Infections: A severe pelvic infection or abscess may involve the area near the sciatic nerve, causing pressure on the nerve.

Your sciatic nerve should not be affected by activities such as sitting in an uncomfortable position or carrying a large wallet in your back pocket. You may experience some aches and pains due to these factors, but this is due to local pressure on the muscle—not nerve involvement—and your symptoms should resolve within a few hours.

Diagnosis

Sciatic nerve pain diagnosis relies on your history, physical examination, and diagnostic tests. Generally, your doctor will be able to identify sciatic nerve pain based on your symptoms and physical examination.

Additional testing is often necessary to determine whether you have a serious issue, such as a herniated disc or a tumor.

Medical History and Physical Examination

Your doctor is likely to ask you a number of questions, such as whether your symptoms fluctuate, whether you experience weakness or diminished muscle control, and whether you have bowel or bladder issues.

Your physical examination will include an assessment of your muscle strength, reflexes, and sensation (to light touch, pinprick, vibration, temperature, and position sense). These tests help identify whether your other nerves or your spinal cord are involved as well.

Diagnostic Tests

There are a number of diagnostic tests that your doctor might use to help pinpoint the type of sciatic nerve problem that you have.

Tests you might need for assessment of sciatic nerve pain include:

  • Spine or pelvic imaging: Spine or pelvic X-ray, computerized tomography (CT), or magnetic resonance imaging (MRI) can visualize the area in and around your sciatic nerve. This can help in the diagnosis of bone issues, tumors, and infections.
  • Nerve studies: Electromyography (EMG) and nerve conduction studies (NCV) can be used to assess the function of your sciatic nerve. This helps your medical team know if there is any serious damage.

Treatment

Treatment for sciatic nerve pain can vary depending on the extent of your symptoms and their cause.

Sometimes devices such as supportive pads, heating pads, ice packs, or external back braces may be helpful. Other times, these may be combined with oral (by mouth) or injected medication and/or physical therapy. Rarely, surgery is needed to relieve compression on the sciatic nerve.

Devices

Your doctor may recommend a supportive pad or back brace, especially if your sciatic nerve pain is affected by your physical position.

Heating pads can help with sciatic pain that is associated with muscle spasm. And ice packs can help reduce the pain that is related to inflammation.

Medication

Medications used for management of sciatic nerve pain include over-the-counter pain medications and anti-inflammatories. If your sciatic nerve pain is severe, your doctor may recommend a prescription version of one of these medications.

Steroid injections can reduce inflammation, while local anesthetic injections can provide pain relief for weeks or months.

Physical Therapy

Physical therapy is very individualized. Your physical therapist will assess your pain and motor function, and will work with you on supervised exercises. Your physical therapist may also show you how to do exercises at home.

If you have sciatic nerve pain, it is not safe for you to use exercises that were not specifically designed for you, because they can cause nerve or spinal cord damage if your spine is unstable.

Surgery

Surgery is not the usual treatment for sciatic nerve pain. However, if you have a tumor impinging on your sciatic nerve, you may need to have it resected (surgically removed). Similarly, if you have had trauma, surgery may be necessary.

A herniated disc can be treated with a discectomy, a procedure that relieves disc impingement from the spinal cord or a spinal nerve.

A Word From Verywell

Sciatic nerve pain is very common. It can wax and wane over time, but it is often persistent if not treated. Usually, conservative measures such as medication and physical therapy can help relieve the symptoms.

In rare instances, sciatic nerve pain is a sign of a major medical problem, so it is important that you discuss it with your doctor. If you experience muscle weakness or bowel or bladder issues, seek urgent medical attention.

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