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Back pain, MRI showed disc protrusion, taking Pregabalin for nerve pain. Worried about cauda equina syndrome.

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Neurologist, Surgical
Practicing since : 1996
Answered : 138 Questions
Hi There,
I am really upset and frustrated and need to know the best course of action based on the NHS system as it stands. Some background: in the last 5-6 months I have had issues with my back, the lumbar area. There has been a dull gnawling XXXXXXX ache just above sacrum area... 2 months ago during this time, i twisted wrong and was stuck and fused. had to go to A&e they gave me strong pain killers. it was awful like i couldn't move, a shock like being winded hitting a nerve.My lower back was and still is swollen at times, a round patch flares up most nights so i can not lean on it. I continued to then take diclofenic but worringly through out this time I have noticed changes to bladder, retention in the evenings mainly and leakage a very small amount at certain times. like an overflow, once i was drinking a few XXXXXXX teas and didn't feel the urgency and more came out without me realising. i also get tingling all the time around where i urinate. I also do not feel the urgency the same in the mornings to urinate and feel it is not a normal stream. It is worse when i am stood up or lean forward a little in regards to the leakage in the day. I also had a bad smelling urine on and off especially in mornings after having retention.
I have had an x XXXXXXX all clear. An MRI scan showing a central disc potrusion that wasnt compressing the cauda, conus or apparently a nerve but i am still experiencing pins and needles and also bladder issues, big retention every night and urgency and leakage in the day. I have had blood tests and full blood count all clear. I have had urine sample all clear. I have had a few private physio appointments. He wasnt too sure at first as i was ok lifting legs in air and bend over, although great difficulty putting on shoes having to lift legs up. Due to the pain being on one side at first and radiating through buttocks and in sacrum area not pain more central in this rounded patch. he initially said sacrilliac joint issues but then has since said due to the pain being more central and other difficulties possible disc problem. obviously now i realise i had a bulding disc l4-l5. I am only 27 years old. I have previously done a lot of driving through work but have now stopped but have an office based job spending a lot of hours at my desk. I get pins and needles mainly in my left foot but also knee a bit. I am trying to walk more and move around. I am very anxious and scared at the moment and due to the system whereby it has taken over 6 weeks for an NHS physio that sat there and didnt say much and a few months for an MRI despite me going back and forth to gps saying about pain and bladder retention. I am worried i have cauda equina syndrome but i have reflexes and all leg movements and can feel my legs on touching despite tingling and mild numbness at times in various parts of my body. i am worried that the damage has been done or it is leading to this. but i am still able to urinate in the day a bit better. The retention is painless retention also. to add I have had a brain scan for MS and nothing has showed up apparently. and have had ultra sound scan whilst in hospital where they checked bladder and kidneys but no blockages showed up.They put me on pregabalin for nerve pain which has masked things a it but other symptoms still there. Amitriptyline has now been recommended for the bladder issue. I havent taken it yet as supposed to see a neurologist in a few weeks and worried it will not sort out my urine retention on a night. I do not have trouble sleeping unless i am in pain or worried about this. could there be any clue as to what this may be. I am very worried and jus want my life back. I am not sure if retention can be sorted and overflow incontinence can be treated with medication or if nerves can be recovered. So many questions i realise.
Posted Mon, 30 Apr 2012 in Back Pain
Answered by Dr. Praveen K Nath 23 hours later
dear sir

i,ve gone through your history in detail.
as per your details you seem to be having urinary incontinence without any obvious cauda equina compression .
i may suggest following things

1. continue on pregabalin /tryptomer
2. get your MRI brain (repeat) with MRI cervical & dorsal spine also to rule out any higher lesion as a a cause of your symptoms

3. get your EMG(electromyography) & NCV testing on all 4 limbs & uroflowmetry if all MRIs are normal
4. till that time you can use adult diapers & do perineal exercises under supervision of a good physiotherapist

wishing you a speedy recovery

dr XXXXXXX k XXXXXXX XXXXXXX consultant neurosurgeon
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