A 2007 medical literature review took a look at the relationship between sciatica and the female pelvis. While pelvic mesh surgery was not implicated, pelvic mesh had not been in use very long when the study was conducted and more research is needed. However, surgical mesh bladder slings and posterior repair kits have been implanted, sometimes surgically shredded and later removed since 1998 and should be considered when sciatica follows pelvic or abdominal surgery. This is today’s mesh trouble.
Sciatic nerve pain, or sciatica, is most often due to a bulging or herniated disc in your spine pinching your sciatic nerve but gynecological surgery can also be the culprit. The 2007 study found cases in which the cause was gynecological or obstetrical and trauma due to pelvic surgery was misdiagnosed as disc disease in two cases. Unfortunately, in the 127 cases, it took an average of 3.8 years for the gynecological connection to be discovered (in one case, it took an astounding 15 years). The proper diagnosis was crucial because misdiagnosis sometimes lead to unnecessary, unsuccessful, debilitating and distressful spine surgeries. (Other causes of sciatica include spine trauma, osterarthritis, degenerative disc disease, pregnancy, endometriosis, and spinal tumors.)
The sacral plexus, where sciatica originates, is immediately next to the posterior pelvic wall, the internal iliac blood vessels, the ureters, and the sigmoid colon (last loop of colon) and the terminal ilieal coils of the small intestine. When posterior mesh is used, there is greater risk of injury to those structures.
During abdominal surgery, nerve injury is usually related to poor patient positioning, a nerve being cut during the procedure, or excessive pressure on the nerve by the surgeon, particularly when he/she is trying to control bleeding from the hypogastric vessels. The use of the “jack-knife” position for vaginal surgery can cause nerve injury if the body is hyperextended or legs are rotated outward excessively.
“Vaginal operations have occasionally been complicated by sciatic neurophathy, possibly because of stretching of the sciatic nerve rather than direct pressure.” Other causes include badly placed intermuscular, or IM, injections (into the sciatic nerve), constriction by scar tissue and damage by the chemicals in the injection.
The sciatic nerve is the longest nerve in your body, branching out from your lower back, moving through both buttocks and down through your legs to your feet and is responsible for the movement and feelings in your legs and feet. If it becomes compressed, injured or inflamed, it can cause intense sciatic nerve pain anywhere along its path. No two cases are alike.
Sciatica due to pelvic issues is often diagnosed. The diagnosis is made by listening to your entire story, and conducting physical and neurological exams of your pelvis, back and legs. Special tests include and electromyogram (EMG) and nerve conduction velocity tests. Xray, CT or specialized MRI’s can identify abnormalities and specialized views of the pelvis are necessary.
• Unpleasant, painful, sensations from your back all the way down your leg to your foot, on one side or both.
• Weakness, burning, numbness or tingling of the same area.
Treatment depends on the severity of your problems and any additional complications and includes physical therapy, chiropractic treatment, and exercises. You may also need to take tylenol (acetaminophen) or anti-inflammatory drugs. Some exercises that help include good posture, abdominal crunches, walking and swimming and careful attention to body mechanics while lifting. Medications used to treat chronic nerve pain may also help.
Sciatica often goes away on its on after a period of rest and limited activities. Most people recover after 6 weeks but, for those who continue to suffer, this mesh trouble changes their life.