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Lumbar pain, noticed changes to bladder, disc problem. Taken amitriptyline, antidepressant,. Done blood and urine test. Cauda equina syndrome?

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Orthopaedic Surgeon
Practicing since : 2000
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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 couldnt move, a shock like being winded. My lower back was and still is swollen a round patch of inflammation in that area. 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 its that small but i know its there i was thinking is it coming from the normal place. It is worse when i am stood up or lean forward a little. I also had a bad smelling urine on and off but notnow. I have had an x XXXXXXX all clear. 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, he initially said sacrilliac joint issues but then has since said due to the pain being more central and other difficulties possible disc problem. 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 kneee 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 there is a few months for an MRI of which they still haven't sorted and have only given me Amitriptyline for the apparent bladder issue. I havent taken it due to it also being an antidepressant and i dont feel i am depressed just very stressed, as it is taking so long to sort things whilst my condition is not improving. I am thinking of paying privately for an MRI and having to travel to get this due to me being worried immensly about this. I am also not sleeping as well and cant sleep on back but on side as i am too tense and worried. I just dont know where to go to sort this, as it appears if i am not falling on the floor and completely wetting myself no one seems to take me seriously. I still have all reflexes and strength in muscles apart from tingling in genital area sometimes and in legs no numbness and feel everything.

Any answers??? Thanks

Posted Thu, 19 Apr 2012 in Back Pain
Answered by Dr. Atul Wankhede 4 hours later

Thanks for posting your query.

Its a unique and interesting case. From what I gather, you most certainly have a Disc pathology that is putting pressure on your exiting nerve roots or spinal cord or both. This aggravated during your twisting episode and seems to have not healed to date.

The bladder involvement along with tingling in foot only proves that there is no progress in healing. An x-ray must have shown some sign of abnormality for screening purpose, otherwise an MRI is imperative. Get it done without further delay. If your blood and urine analysis is normal, then don't worry about infection. The leak you notice in certain positions is definitely spinal problem.

In my opinion, you need to change from Diclofenac to another safer antiinflammatory medicine under your physician's guidance. Ask for a nerve tonic like Pregabalin. Ask your physiotherapist to give you lumbar traction and short wave diathermy. Avoid forward bending, lifting heavy objects, sitting in one position for long time. Take frequent stretch breaks. Keep an upright posture manually or by using a lumbar corset. Sleep on a firm mattress and keep a pillow between your thighs while turning to either sides.

I'm not sure about the swelling you notice in back, but if you post a soft copy of your xray it might help me understand things little better. Do not perform any exercises just yet, atleast till the pain completely subsides. Then onwards you need to do back strengthening exercises.

Hope you have a clear picture now and wish you an early recovery. If you more queries I'm available for follow up.

Good luck.
Above answer was peer-reviewed by
Follow-up: Lumbar pain, noticed changes to bladder, disc problem. Taken amitriptyline, antidepressant,. Done blood and urine test. Cauda equina syndrome? 6 hours later
Hi There,

Thanks for getting back to me. The pain is not so bad now in my back just worse at night. I am trying to walk, as much as possible and not drive. hopefully i am doing the right thing. I have tried to look for what it may be myself and I am incredibly worried it could be cauda equina syndrome. I dont have major neurological problems though other than not being able to empty bladder fully and retention mainly at night and the odd time the feeling of a leak. The tingling in my legs is not always there its mainly on the left one. Strangely i am also getting tingling in hands or feeling of lightness again mainly at night. As you can probably tell i am very stressed also which i know wont be helping. x XXXXXXX was clear apparently so would this have showed cauda equina?. I cant get an MRI for at least 6 weeks but thinking of going to a private place which is far away and pay separate as no one seems to be listening. I am only 27 and really want to recover from this it is affecting my work and lifestyle and i dont want my bladder issues or other thigs to get worse.
Answered by Dr. Atul Wankhede 4 hours later

Thanks for replying back.

I'm glad that the pain is reduced. Walking to your work sounds good, but dont stress yourself a lot by doing that.

Dont worry, its not cauda equina syndrome. The symptoms are far worse there.

This is a temporary nerve condition that wears off eventually. But to be on a safer side get that MRI at the earliest. Xrays unfortunately dont show soft tissue changes.

I realise you are under tremendous stress and that as you said is not really helping. So think of ways to destress yourself like meditation or recreational activity. Let some time by and you will be alright.

Hope you recover soon. Do post a copy of your xray if possible for an expert opinion.

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