Doctor Miklos and Doctor Moore are all about their research on and practice of urogynecology, and their recent study connecting sciatic hernias as a cause of chronic pelvic pain in women is no exception to this. The objective of this research was to review the experience of 20 women who were treated for sciatic hernia between the years 1993 and 1997. Sciatic hernia is also known as sacrosciatic hernia, ischiatic hernia, gluteal hernia, hernia incisurae ischiadicae, and ishiocele. Prior to the study being done, the doctors found only a few articles in the literature concerning the pelvic floor hernia, which was surprising to them.
Clinically, sciatic hernia is present usually with various pain patterns originating in the pelvis and sometimes radiating to the buttocks and posterior thigh. Intestinal or uteral obstruction with or without strangulation is sometimes responsible for the first symptoms and the diagnosis is typically established during exploratory laparotomy.
In the study, patients that were identified as having sciatic hernia repair were analyzed for age, race, parity, weight, physical signs, symptoms, hernia content, and the side of the pelvis affected. Systematic diagnostic laparoscopy was performed by inspecting the liver, gallbladder, appendix, and colon and running the small bowel. The pelvis was inspected for adhesions, endometriosis, and hernias. Patients were admitted to the hospital and discharged in less than 24 hours. Then, they were asked to return for follow up appointments at six weeks, three months, and annually thereafter. The primary surgeon evaluated each patient for pain preoperatively and postoperatively.
The results that the study yielded were interesting; all of the records noted preoperative complaints of pelvic pain, and seven of those records also included ipsilateral posterior thigh or buttocks pain or both. None of the patients had signs of sciatic hernia upon physical examination. However, fourteen women had right sided sciatic hernias, five had left sided sciatic hernias, and one had a bilateral hernia. None of the patients sustained intraoperative or postoperative complications. Preoperative and follow up examinations were performed by the surgeon. All twenty patients reported immediate pain relief at their initial three month follow up evaluation; fourteen described complete pain relief, and six noted improvements over preoperative symptoms with a median length of follow up of thirteen months.
Sciatic hernia is a well defined anatomic defect that is the direct result of piriform muscle atrophy. Thorough knowledge of pelvic anatomy is essential in understanding this concept. They are unusual findings and often present the physician with a diagnostic dilemma. Patients rarely exhibit signs because the hernia sac is relatively small compared with the large overlaying gluteus maximus muscle. Most patients with pelvic hernias complain of pain, pressure, or a pulling sensation. Patients with sciatic hernias commonly present with symptoms of abdominal, pelvic, lower back, or posterior thigh pain.
Although oblique x-ray studies, computed tomography, herniography, enterography, intravenous pyelography, and cystography have been helpful in the diagnosis of sciatic hernias, they have never been proven to be definitive. Sciatic hernias have been diagnosed most commonly and treated definitively during surgery.
Laparoscopy aids in the diagnosis of hernias by providing excellent visualization of the pelvis. Intra-abdominal pressure may be helpful in the detection of sciatic hernia through stretching the peritoneum to its limit of support.
Considering the number of journal articles written each year on gynecologic pelvic pain, the doctors found it surprising that not one of the sciatic hernia articles found in their search was in a gynecology journal. Laparoscopy may aid in the definitive diagnosis and treatment of all hernias only if the surgeon has a thorough knowledge of pelvic anatomy and its potential defects. The study concludes with a proposal stating sciatic hernia as a differential in the diagnosis of pelvic pain in women.
With Doctor Miklos and Doctor Moore, you can feel that this delicate procedure has been researched thoroughly, and that any worries you may have will be resolved. Discussing sciatic hernias and how pelvic pain could be a result might not be an easy subject to bring up, and you may be embarrassed to talk about your urogynecology needs. Rest assured that Doctor Miklos and Doctor Moore can use their world renowned excellence to help you feel like your best self once again.