Endometriosis is the presence of endometrial tissue, the tissue that lines the uterus, in places outside the uterus. Endometrial tissue can spread as far as the brain, but one of the most common sites for endometrial implants is the uterosacral ligament, located behind the cervix. While some women with endometriosis have no symptoms, many have pain and other pelvic issues, especially during their menses when the endometrial tissue sloughs off and bleeds.
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Pain that is knife-like, sharp and burning is the main symptom of endometriosis. Professor of medicine at Virginia Commonwealth University, Dr. Betty Anne Johnson, cites dyspareunia, or pain during intercourse, as a common symptom of uterosacral endometriosis. This pain is more common with deep penetration and may continue for several days after sex. Pain may also be felt during bowel movements, especially during the menstrual period, when tissue actively bleeds. Lower abdominal pain during menstrual periods and lower back or leg pain are also associated with endometriosis in the uterosacral ligaments.
The uterosacral ligament is located very near the large intestine; endometriosis on the uterosacral ligament can irritate the bowels and cause cramping and gas pains. Scar tissue, also known as adhesions, can form between the uterosacral ligament and the bowel, irritating or even narrowing the bowels. Inflammatory toxins such as prostaglandins released by endometriosis from the uteroscaral ligament can increase bowel motility, resulting in diarrhea and irritable bowel symptoms, said Dr. Ken Sinervo of the Center for Endometriosis Care.
Endometriosis on the uterosacral ligament causes nodules to form. These nodules can be palpated during a pelvic exam and may be tender to touch. Tender nodules are specific to endometriosis of the uterosacral ligaments, according to Dr. Christine Bellantoni of Virginia Commonwealth University. As the ligaments become more rigid, the uterus—to which they’re attached—also becomes fixed in place and doesn’t move easily. Inflammation from endometriosis may spread to the ligament nerves, scarring and eventually shortening the ligament, so that eventually any movement of the uterus or ligament is painful.