Sciatica and Pelvic Pain: How They’re Connected and What to Do About It

What is sciatica?

Sciatica is a condition that happens when the sciatic nerve is irritated or compressed. The sciatic nerve is the longest nerve in the body, beginning in the lower back, running through the hips and glutes, and travelling down each leg. With sciatica, people often experience sharp, shooting pain down the back of the leg that may go into the back of the knee or down to the foot. Pain can also feel achy or like a burning sensation, and can be constant, or sometimes it comes and goes.

Many people assume sciatica is only a back problem, but the nerve runs close to the pelvis and hips. That means sciatica pain can overlap with pelvic pain or dysfunction, making it confusing to isolate. The good news? Pelvic floor therapy can help!

Does sciatica cause pelvic pain?

The short answer is: sometimes. Sciatic nerve pain in the pelvis can happen when the sciatic nerve is compressed near the pelvic floor muscles or the hip joint. But pelvic pain can also come from other nerves in the pelvis, reproductive organs, or muscles that support the pelvic floor.

Because both sciatica and pelvic dysfunction can manifest in the lower back, hips, groin, legs and pelvic region, symptoms are easily mixed up. For example, someone may think they have hip pain or sciatica when the root cause is actually tight pelvic floor muscles, or vice versa.

How sciatica and pelvic dysfunction overlap

Pelvic floor dysfunction (PFD) refers to when the muscles in and around the pelvis are not functioning properly, resulting in a number of symptoms, including bladder or bowel leaks, constipation, pelvic pain, and discomfort during sex. PFD can result from weak (or inactive) pelvic floor muscles, overactive pelvic floor muscles, or issues related to pregnancy, postpartum recovery, or menopause.

When the sciatic nerve gets irritated, it can set off a chain reaction. The pelvic floor muscles may tighten up to protect the area, and that guarding can actually keep the cycle of sciatic pain going or even make it worse. This is why physical therapy can be critical for properly diagnosing and addressing symptoms in a manner that honors the interconnectedness of sciatica and pelvic pain. 

Symptoms of pelvic dysfunction that may overlap with sciatica include:

Nerve Related Symptoms

• Sharp and/or radiating pain in the lower back, buttocks, or hips, or legs
• Radiating pain into the thigh or leg
• Tingling or numbness in the pelvis or groin
• Weakness in innervated muscle groups

Pelvic-Floor Related Symptoms

• Continuous spasms and tension in the pelvic floor muscles
• Bladder leakage, incontinence, difficulty emptying, urgency, or prolapse
• Bowel leakage or constipation
• Pain with sitting, standing or during everyday activities

Because the sciatic nerve runs so close to the pelvis, it is not unusual for people to feel overlapping sensations of pain at once. Additionally, the piriformis and obturator can have tender myofascial trigger points that send pain down into your buttock and back of your thigh, creating sensations very similar to sciatica.

Causes affecting the pelvis and sciatic nerve

Anyone can experience sciatica alongside pelvic dysfunction, but it is especially common for birthing people during pregnancy and postpartum. Other factors, like disc problems, changes in the spine, or endometriosis can also play a role.

Pregnancy and postpartum changes

During pregnancy and lactation, hormonal changes loosen the joints in the lower back and pelvis. If the surrounding muscles are not strong enough to provide support, other muscles like the piriformis may spasm and exert pressure on the sciatic nerve, leading to sciatica-like symptoms.

Additionally, as the uterus expands during pregnancy, it can shift posture and place pressure on the sciatic nerve, exacerbating preexisting issues like herniated discs, and other symptoms. After birth, weak or tight pelvic floor muscles can continue to contribute to pain and dysfunction. It is not uncommon for women in postpartum to experience what’s called unilateral or bilateral sciatica, meaning sciatica on one or both sides of the body.  

For relief during pregnancy, try stretches designed for sciatica.

Herniated discs and spinal changes

A herniated (or slipped) disc in the lower back is caused when part of a spinal disc pushes out through an area in the spine, which can result from trauma, overuse, weakness, or genetics. This can press on the lumbar nerve roots which come together to form the sciatic nerve, leading to inflammation and consequent pain in the lower back, legs and pelvic floor. 

Similarly, changes in spinal alignment with age or menopause can alter one’s spinal structure, resulting in inflammation and increased strain on the sciatic nerve and pelvic floor. It’s worth mentioning that hormonal events like menopause can also exacerbate pre-existing herniated disc conditions, due to changes in the natural curvature of the low back. 

Endometriosis and Ovarian cysts

Endometriosis, a condition characterized by the growth of endometrial tissue outside of the uterus, can affect the nerves in the pelvis, including the sciatic nerve. When endometrial tissue grows near the sciatic nerve, it may compress the nerve, leading to intense pain that follows a cyclical pattern, often flaring around the menstrual cycle (a key indicator of sciatic endometriosis rather than typical sciatica). 

Ovarian cysts, a symptom of endometriosis, have been known to similarly compress the sciatic nerve and other pelvic nerves, triggering both sciatic symptoms and pelvic floor pain.

If you’re living with symptoms that feel like they could be endometriosis, know that you don’t have to manage the pain on your own. Seeking care can help you get clarity, support, and a treatment plan that truly addresses what you’re going through.

How to tell the difference: hip pain vs sciatica vs pelvic pain

It is not always easy to know what is causing pain, but here are some clues:

• Sciatica: Pain that radiates from the lower back or buttock down the leg, sometimes with tingling or numbness.
• Pelvic pain or dysfunction: Pain or pressure in the pelvis, hips, or groin that may worsen with sitting, standing, or sexual activity.
• Hip pain: Pain located in the hip joint itself, often worse with walking, running, or specific movements.

Still unsure? Read more: Is your hip pain sciatica or something else?

When to seek help

If pain lasts more than a few weeks, keeps you from daily activities, or gets worse over time, it is worth seeing a clinician. Other signs you should get checked out include:

• Sudden loss of bladder or bowel control, or urinary retention
• Severe weakness in the legs
• Pain that disrupts sleep or daily function

At Origin, many of our clinicians are trained in both orthopedic and pelvic health therapy – we can look at the whole picture to build a comprehensive plan to alleviate sciatic nerve, pelvic floor dysfunction, or both.

Book a visit with one of our clinicians in-person or online! 

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Sources 

Al-Khodairy AW, Bovay P, Gobelet C. Sciatica in the female patient: anatomical considerations, aetiology and review of the literature. Eur Spine J. 2007 Jun;16(6):721-31. doi: 10.1007/s00586-006-0074-3. Epub 2006 Apr 19. PMID: 16622708; PMCID: PMC2200714.

https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435

https://www-nejm-org.ucsf.idm.oclc.org/doi/10.1056/NEJMra1410151?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

https://www.pennmedicine.org/conditions/herniated-disc-disorders

Dhôte R, Tudoret L, Bachmeyer C, Legmann P, Christoforov B. Cyclic sciatica. A manifestation of compression of the sciatic nerve by endometriosis. A case report. Spine (Phila Pa 1976). 1996 Oct 1;21(19):2277-9. doi: 10.1097/00007632-199610010-00021. PMID: 8902975.

https://columbusobgyn.com/does-menopause-cause-spinal-pain/

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