Women’s Health Issues
Many women who report lower back pain may also experience sensations of numbness around the vagina and/or pain in the pelvic area or groin. Often times women don’t report these symptoms because they don’t think they’re related or they’re uncomfortable discussing it with their doctor, especially if he/she dismisses a link. A number of potential causes are often not considered in evaluations, yet these conditions may cause lower back, buttock and leg pain, or exacerbate underlying back disease, slowing or confounding treatment.
A tilted uterus is a variant of the normal uterine position within the pelvis but with mechanical consequences. It will typically reflect pain to the back during the premenstrual and early menstrual phases. The swelling of the uterine wall sends messages to the spinal cord, which shares space with other nerves that feed the lower back region. Information overload at those levels of the spinal cord cause a painful response in the lower back. These symptoms are transient but can be disabling, for some women one full week of every month.
Fibroid Tumors and Other Masses
Fibroid tumors, when large enough (generally during the premenstrual and early menstrual phases), will take up enough space to cause pressure that excites nerves to the spinal cord and lower back. Fibroids of this size enough can be a continual source of referred back pain.
Prior Gynecologic or Abdominal Surgery
Scar tissue, being mechanically inferior to normal tissue, becomes neurologically hypersensitive, resulting in a lower pain threshold. However, as pelvic or abdominal scar tissue grows, it can create other painful conditions.
Inguinal Hernias or Prior Hernia Repair Failures
Hernias are often associated with men because they are easily seen and diagnosed. But women develop hernias, too, however they’re not as obvious and require a specific diagnostic test to clearly prove they are present. Ongoing groin discomfort may be misinterpreted as something else, especially in female athletes. The groin has an important relationship to the mechanical function of the lower black and will cause great distress.
Tarlov/Sacral Cyst Formation
Tarlov, or perinuerial, cysts were originally diagnosed by Dr. Isadore Tarlov in 1938, and they’re still misunderstood and their clinical importance under appreciated.
A Tarlov cyst can develop along the sacral stretch of the spine ( the top two segments of the tailbone) when a weakness in the sheath covering an affected nerve fills with fluid – the same cerebrospinal fluid (CSF) that continually bathes the spinal cord – and creates a bulge in the tissue. This bulge places undue pressure on the nerves, often mimicking a classic case of sciatica, causing pain to travel into the buttock and the back of the thigh, knee, calf and foot.
In my experience, women are more prone to Tarlov cysts, unrelated to age or child bearing. They’re are only diagnosed on MRI but are often not remarked on by radiologists, or thought of as clinically irrelevant by other specialists.
Nothing could be further from the truth. In some cases, Tarlov cysts can be the sole cause of a patient’s symptoms, which can include bladder dysfunction, including burning sensations. As well, Tarlov cysts can be a primary or contributing factor to interstitial cystitis. Diagnosis and conservative treatment are available. In some cases surgery may be required, although few US surgeons are experienced in this approach. The Japanese have been most innovative in this area.
Pudendal Nerve Entrapment
The pudendal nerve branches off a larger spinal nerve network and travels deep in the pelvis, near the sit bone, or ischium, and supplies sensation to the vaginal region. Irritation to the tailbone or sit bone, caused by direct blunt trauma, childbirth, long term sitting, or chronic lower back disease, can also fire up the pudendal nerve. Diagnosis involves a delicate procedure, and treatment to free the nerve may require surgery.
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