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sciatic and pudendal nerve problems
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sciatic and pudendal nerve problems

For 4 years I have been dealing with pain in my left buttock when I sit.  An MRI showed a 1mm bulge at L4-L5 (sacral area was not scanned).  I was treated for sciatica with stretches, exercises, a variety of meds (Vioxx helps some, others no), and I've had 3 steroid injections into my back- the third being done with a fluoroscope.  None of this has helped.  It seemed like my piriformis muscle was in constant spasm.  On my own I tried yoga, massage, a chiropractor and finally acupuncture.  The acupuncture finally helped the piriformis spasm.  With the sciatic nerve under control, I realized that I still have pain inside of my 'sit' bone.  I had always thought this was a fall out of the sciatic pain.  After researching on the internet, I have discovered that the pudendal nerves are in this area.  
Question:  Is there any condition that would effect both the sciatic and pudendal nerves?
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Avatar_n_tn
First of all, there's a difference between the term sciatica and the sciatic nerve.  Sciatica refers to a pain syndrome that starts in the buttock and generally radiates down the leg.  The causes of sciatica can be a problem with the sciatic nerve or the L4-5 S1-2 nerve roots as they exit the spinal cord. If you can imagine (not sure of your medical knowledge/background), the nerves come out from the spinal cord individually and then come together lower down in the pelvis area to form a group of nerves called the sacral plexus and then the sciatic nerve. A problem anywhere along this nerve pathway can cause symptoms of sciatica. So just because someone has sciatica, doesn't necessarily mean they have a sciatic nerve problem.  It can also mean they have a disc pushing on nerve roots higher on up or something in the pelvis pushing on the group of nerves.  

The pudendal nerves are little tiny nerves that come out from the upper sacral nerve roots and is not part of the sciatic nerve.  Technically, I suppose if you had a huge mass like a big collection of blood or a tumor in the pelvis or had a major trauma resulting in pelvic fracture or multiple gun shot wounds in the area, this could affect the pudendal and sciatic nerves.  However, other nerves would likely be affected also and I imagine you'd be pretty disabled.

On the other hand, something like an S1 radiculopathy (compression of the sacral nerve root as it exits the spinal cord from a bad disc) could produce symptoms of sciatica (not sciatic nerve compression) and pudendal nerve involvement.

This is of course not to say that you don't have a sciatic nerve problem or that the L4-5 disc is the cause of your problems. If you are considering further evalutation, a neurology appointment for a formal exam and an EMG may be helpful in assessing where and what the problem is. GOod luck.
5 Comments
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Avatar_n_tn
I had most of your symptoms.  Pain when sitting (very severe).  I would stand and walk all day rather than sit at my job.  Saw a neurosurgeon, mri showed ruptured disc at L5-S1.  However, the original radiologist jusr reported it as a "bulge" not a rupture.  It was only when the neurosurgeon reviewed the actual MRI that he saw it.  I had this finding confirmed with a second neurosurgeon.\
It was explained to me at if you try conservative treatment (as you have been doing for 4 yrs) for longer that 3-6 months without improvement, you are a surgical candidate.  If you let it go for years, there is a possibility that the nerve damage causing the pain may become  permanent and not helped by surgery.

I had severe pain and symptoms such as yours for 6 months.  I did have surgery, and finally about 6 months after surgery, I am 98% better.  You don't have to live with this pain.  See a neurosurgeon.
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Avatar_n_tn
I was interested to read comments re: sciatic & pudendal nerve problems. I am from the UK & have had pain in the vagina & area under my r buttock. After various tests, the doctors think I have a problem with the Pudendal Nerve. However, the pain is now in the lower part of my back on the same side. There doesn't seem to be a great deal of knowledge in the UK about how to diagnose & treat this problem. I was wondering if the pain could be due to a problem in my back.
Any info anyone could give me about this would be greatly appreciated. Thanks
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Avatar_n_tn
You may want to consider the likelihood that your problem/pathology is located at the level of the peripheral nerve (pudendal), as your symptoms fit precisely with this pattern. Having just undergone a pudendal nerve decompression for this particular problem, I am more than a little familiar with this situation. Might I suggest that you take a look at the following website:

http://pudendal.de/

Good luck, Karen
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Avatar_n_tn
Hi there,

Ihad pelvic surgery, they had to remove most of my left uterosacral ligament. Even before this susrgery due to another surgery, I started having left lumbar/buttock/flank pain.  I am just wondering now that the peripheral nerve was mentioned, if this poss. is what is causing my pain still.  I cannot sit either or bend without this pulling sensation from my buttock to my flank. I just wanted to say that I am glad I read this and that I have poss. another explanation for all this.  I am going to my neurosurgeon next week in hopes he can help,, this is pretty painful.  Thank you
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A related discussion, pain in my groin was started.
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