An Overview of Sciatic Nerve Pain

Pain and tingling down your leg could be sciatic nerve pain

The nerves of the lower back, including the sciatic nerve.
The nerves of the lower back, including the sciatic nerve. MedicalRF.com / Getty Images

Sciatic nerve pain is relatively common. It causes pain in the leg and buttock region. This condition is bothersome, but it is not usually dangerous. In some situations, however, sciatic nerve pain is an early sign of serious nerve or spine problems.

This type of pain is usually caused by a pinched nerve, which can be diagnosed with a physical examination. Several diagnostic tests can help in the evaluation. There are several treatment approaches that can help reduce the effects of sciatic nerve pain. Often, a combination of physical therapy and medication are needed.

Symptoms

Sciatic nerve pain 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 sciatic nerve. The symptoms may come and go, and they can vary with your position (such as sitting, standing, or lying down). Sometimes, coughing, laughing or sneezing can exacerbate the pain.

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

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.

Associated Symptoms

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 it is usually a sign of a severe health problem, such as a tumor near the sciatic nerve.

Causes

Sciatic nerve pain is caused by irritation or impingement (pinched nerve) of the sciatic nerve. The sciatic nerve travels from the spine all the way down the leg, and it is the 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. Radiculopathy 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 sciatic nerve pain, including:

  • Spondylolisthesis (herniated disc): Each vertebra (spinal bone) and its corresponding disc (cartilage) 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.
  • Spinal stenosis: The spinal foramen, through which the spinal cord passes, can become tight or altered in structure 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 vertebral foramina are small holes 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.
  • 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 to your nerve.

Treatment

Treatment for sciatic nerve pain typically includes oral (by mouth) or injected medication, as well as physical therapy. Sometimes devices such as supportive pads, heating pads, ice packs, or external back braces may be helpful. Rarely, surgery is needed to relieve compression on the sciatic nerve.

Medication

Medications used for management of sciatic nerve pain include over-the-counter pain medications or anti-inflammatories. Your doctor may prescribe oral pain or anti-inflammatory medications for severe sciatic nerve pain.

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

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.

Physical Therapy

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, 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 it is 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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Article Sources

  1. Marco C, Miguel-Pérez M, Pérez-Bellmunt A, Ortiz-Sagristà JC, Martinoli C, Möller I et al. Anatomical causes of compression of the sciatic nerve in the pelvis. Piriform syndrome. Rev Esp Cir Ortop Traumatol. 2019 Jul 29. pii: S1888-4415(19)30105-5. doi: 10.1016/j.recot.2019.06.002. [Epub ahead of print]

  2. Ajala-Agbo T, Tang PT, Bat-Ulzii Davidson T. Unilateral leg weakness and pain secondary to metastatic anal squamous cell carcinoma. BMJ Case Rep. 2019 Jul 15;12(7). pii: e227563. doi: 10.1136/bcr-2018-227563.

  3. Horment-Lara G, Cruz-Montecinos C, Núñez-Cortés R, Letelier-Horta P, Henriquez-Fuentes L. Onset and maximum values of electromyographic amplitude during prone hip extension after neurodynamic technique in patients with lumbosciatic pain: A pilot study. J Bodyw Mov Ther. 2016 Apr;20(2):316-23. doi: 10.1016/j.jbmt.2015.08.006. Epub 2015 Aug 28.

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