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The largest nerve in the body, the sciatic nerve, is made up of five nerve roots and passes down into your glutes (bottom), back of the thigh, and through the calf and heel to the sole of the foot.
Made of sensory and motor fibers, the sciatic nerve is very important, as it allows you to feel and move your legs. Without this nerve, we wouldn’t be able to walk, run, or feel our legs.
Pain along the sciatic nerve, also known as sciatica, typically is secondary to the compression of the lumbar nerve roots in the lower back. Furthermore, several clinical symptoms are associated with sciatica, such as leg pain radiating below the knee and into the foot and toes, impaired reflexes, or possibly a positive straight leg raise test.
Up to 43%¹ of Americans experience sciatica during their lifetime. The causes can range from herniated discs, narrowing of the joint space, segmental instability, bone spurs, piriformis syndrome, or, more rarely, diseases such as tumors, cysts, or abscesses.
Interestingly, even prolonged sitting on hard surfaces, including wallets and car seats, can cause sciatica, which has been termed credit carditis in the literature.
A pinched sciatic nerve results in mild to severe pain anywhere along the path of the nerve (ranging from the lower back, hips, bottom, and/or legs, and feet). A pinched sciatic nerve typically affects one side of the body.
Sciatica symptoms can include burning sensations, muscle weakness, sharp/shooting pain, numbness, and/or pins and needles sensations. These can be intermittent (come and go) or chronic (long-lasting).
The pain often worsens with forceful and sudden movements (such as coughing or sneezing), if it is secondary to disk herniation or when you stay in one position for too long (like sitting at your desk in your office the entire day), if it's mainly secondary to piriformis syndrome, and when you twist your upper body or the lumbar spine is flexed.
Often symptomatic in one leg at a time, it is possible to get sciatica in both legs depending on where the nerve is being compressed or irritated along the spinal column.
Red flags that indicate when sciatica is a medical emergency are when the pain is severe, when there’s a sudden increase in pain, when the sciatica is caused by physical trauma (like a car crash), if there is a loss of bowel and/or bladder control, and when the sciatica is coinciding with fever, nausea, and/or weight loss, i.e., constitutional symptoms.
These symptoms are signs of serious underlying causes such as infection, spinal tumors, or cauda equina syndrome.² If you have any of these red flags, seek medical attention immediately.
It’s vital that you get an accurate diagnosis of sciatica to find out the root cause.
Then, you can undergo treatments targeting the cause, with the end goal of long-term pain resolution. Often diagnosed by a physical exam from your health practitioner, there are also imaging options such as an x-ray, magnetic resonance imaging (MRI), computed tomography (CT) scans, nerve conduction velocity tests/electromyography, and myelogram.
Your healthcare provider will determine what diagnostic tests are best for you to take, depending on your presentation and symptoms.
Nerves are in charge of sending and receiving messages between different body parts and your brain (which is the control center of your body).
Nerves relay messages to your brain, saying which bodily systems need to be activated to perform a particular function. An erection requires fully functioning nerves, veins, and arteries — all of which interact with the sensory and motor function of the penis.
The two main branches of nerves supplying the penis are the cavernous and pudendal nerves — each with its own associated nerves and sensory receptors. Any problem with either nerve can cause erectile dysfunction (ED).
In the case of most commonly encountered sciatica,³ the nerve root compression is at the L4, L5, and S1 disk levels, i.e., too high to affect either of the penile cavernous or pudendal nerves to cause erectile dysfunction.
However, other causes of sciatica, such as piriformis syndrome or cauda equina syndrome, may result in erectile dysfunction.
You can help prevent sciatica by stretching and warming up before exercising⁴ and taking frequent breaks to get up and stretch throughout the day (especially if you’re working in a sedentary job like sitting at your desk in the office or trucking).
While sciatica can be very painful and potentially debilitating, it can be resolved with the right self-care.
You should take your doctor’s suggestions, and if self-care conservative treatments don’t improve symptoms in approximately six weeks, return to your doctor to try other treatment options.
Other non-operative treatments could involve medications, physiotherapy, nerve blocks, alternative therapies (i.e., acupuncture), and corticosteroid injections. Spinal surgery is another treatment option if the sciatica is severe enough that this measure is required.
ED affects approximately 30 million men⁵ in the United States. Different factors affecting your nervous, vascular, and endocrine systems can cause or play a part in ED.⁶
Before thinking that your sciatica may be related to ED, consider whether any of the following are potential reasons you’re experiencing issues with erections.
Diseases such as diabetes, heart, and blood vessel disease, chronic kidney disease, atherosclerosis, high blood pressure, high blood cholesterol, multiple sclerosis, Peyronie’s disease, and surgeries on the penis, spinal cord, bladder, or pelvis can all cause ED.
The medicines that can have the side effect of ED include blood pressure medicines, tranquilizers/sedatives, antiandrogens, antidepressants, appetite suppressants, and ulcer medicines. Psychological factors contributing to ED include anxiety, depression, guilt, stress, and low self-esteem.
You are at higher risk of getting sciatica if you’re older, have an inactive lifestyle, have changes in sagittal alignment,⁷ have a job⁸ with a lot of heavy lifting or vibrations from machinery, are a tobacco smoker, are overweight, or have diabetes.
Risk factors for ED include benign prostatic hyperplasia, diabetes, high blood pressure, vascular disease, high blood cholesterol, certain medications, chronic sleep disorders (such as obstructive sleep apnea), Peyronie’s disease (curvature of the penis), depression, smoking, and older age.
You can prevent sciatica by maintaining good posture, avoiding smoking, maintaining a healthy weight, exercising regularly, and safely partaking in activities that are low impact and won’t hurt your back (such as yoga and swimming).
You can prevent ED by avoiding smoking, eating healthily, maintaining a healthy weight, being physically active, and avoiding illegal drug use.
Many of these behaviors coincide, and using the same strategies can prevent sciatica and ED.
If you experience the symptoms of burning sensations, muscle weakness, sharp/shooting pain, numbness, and/or pins and needles sensations in your lower limb, go to your doctor and explain your concerns about having sciatica.
Further symptoms, such as ED, can indicate further nerve damage. It’s important to mention this to your doctor if you experience impotence.
During the physical exam, your doctor may ask you to lift each leg one at a time, walk on your heels or toes, and squat.
It’s important to determine the root cause of sciatica, whether through a physical exam or further imaging. Only then can the appropriate treatment be chosen and provided for the pain and other symptoms to be abolished long-term.
It is considered a medical emergency if you experience any of the red flags associated with sciatica, as stated above, in which case you need to immediately go to the hospital.
Sciatica can result in symptoms that negatively impact your quality of life.
Both sciatica and ED can be prevented by not smoking, eating healthily, maintaining a healthy weight, and being physically active. Sciatica can be further prevented by partaking in low-impact activities and maintaining a good upright posture.
These strategies also help prevent type 2 diabetes and high blood cholesterol, which are risk factors for getting sciatica and ED.
Cauda equina syndrome | American Association of Neurological Surgeons
Definition & facts for erectile dysfunction | NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Symptoms & causes of erectile dysfunction | NIH: National Institute of Diabetes and Digestive and Kidney Diseases