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Back pain, Bladder changes, MRI showed disc protrusion. Get pins and needles in feet. Worried about cauda equina syndrome.

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General & Family Physician
Practicing since : 2005
Answered : 2585 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.

Any answers??? Thanks

Posted Sun, 29 Apr 2012 in Back Pain
Answered by Dr. Prasad 25 hours later

Thanks for describing giving an elaborate description.

I am a general physician, an associate in the department of Neurology working with an experienced Neurologist. I read through your description and was able to discuss your problems with our specialist in our department.

You have reported that you been experiencing symptoms of urinary retention and at times urinary incontinence (leakage) along with pins and needles in left foot and back pain radiating to buttocks. The symptoms are suggestive of disc problem – lumbosacral region probably.
As you wanted an opinion from an urologist, I had a curb side consultation with a leading urologist in my hospital to rule out any urological causes. He does not believe that retention and occasional leakage are due to any urological cause. It might be related to the back problem as the symptoms began with the or after the back issues started.

To further confirm the diagnosis, neurologist too believes the same. His opinion is that you would need a detailed neurological examination. Few more test such as nerve studies can assist the diagnosis. There are chances that you might need interventions. Good rest and analgesics can help in the meantime.
You have planned a neurologist opinion shortly. I suggest you to go ahead with it at the earliest.

I understand you would be very concerned. I will be available to assist you further here if you have any further queries regarding my opinion.

Wish you good luck.

Above answer was peer-reviewed by
Follow-up: Back pain, Bladder changes, MRI showed disc protrusion. Get pins and needles in feet. Worried about cauda equina syndrome. 38 minutes later
Hi there,

I know i have a disc problem i already mentioned that it is an l4-l5 central disc bulge. I am not sure on here if i can consult anyone who knows if an intervention can be made now at this late stage now the bulge is supposedly not warranting surgery as they say this from the MRI.

I dont want to be left like this all my life. i still can go to the toilet at force through the day but everynight is when i am getting more of the retention. every day that goes by i am hoping it doesnt get worse.

Answered by Dr. Prasad 38 hours later
Hello again,

I apologize for the delayed response.

As I have been associated in the department of neurology, I shall take this opportunity to answer on behalf of the neurologist.

Upon reviewing your history and the MRI reports, you seem to be having urinary incontinence without any obvious cauda equina compression. The neurological cause for the bladder symptoms such as any other lesions (higher spinal or brain) if any needs to be explored further. The course of the disease can be predicted only after the cause has been determined.

Apart from a detailed neurological examination, few other tests that can help us rule out other possibilities are:

1. Repeat MRI scans of brain with cervical and dorsal spine.
2. Nerve studies like EMG (electromyography) and limbs with uroflometry (if repeat MRI scans are normal).

Meanwhile, Pregabalin and tryptomer can be continued as suggested. They will help you by reducing your sensory as well as pain symptoms. In addition you may use adult diapers will make sure you remain dry and hygienic. Perineal exercises might also benefit you in this regards. Your physiatrist can supervise as you perform the perineal exercises.

As the cause for the bladder symptoms are still to be explored, I encourage you to go ahead with consulting your neurologist (if you haven't met one yet). The aforementioned tests can be performed under their able guidance. Further treatment can then be planned accordingly.

Hope this answer clarifies your doubts further. I also hope you appreciate my efforts by accepting my answer. Should you have any other doubts pertaining to your problem or with my recommendations, I will be available to address them.

Wish you good luck and faster recovery.

Dr. Prasad
Above answer was peer-reviewed by
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