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What Causes Tingling Sensation In The Anus, Back Pain And Mild Urinary Incontinence?

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Posted on Thu, 9 Nov 2017
Question: Dear Doctor,
I am 25 years old, male, student. For the past 4 years I've been having problems with my back (lower and upper back pain, frequenting blocking of vertebrae, muscle spasms). These are most likely due to prolonged sitting and a lot of stress. However, I've also had urological problems for the same period of time (I didn't have any accident). I feel the need to urinate frequently, sometimes straight after I've been to the toilet. I also have very mild incontinence in the sense of uncontrollably losing tiny drops of urine. This happens only when I'm sitting, standing, or walking at a slow pace. It does not happen when I'm walking fast, running or lying. It doesn't happen all the time and depends on how long I've been sitting / standing and in what position.

Sometimes I don't know whether I need to use the toilet or not. I also feel a burning sensation on top of the penis and also tightness and strange pulling and tingling sensations around the anus. I also feel the need to defecate often. I've been doing physical rehabilitation exercises for several years but only to mild success.

I have had the standard medical check up done plus a full urological examination (found no infection or any problems with the urological tract), a full immunological examination and a brain MRI, which also found nothing unusual. Spinal tap found an unspecific "inflammatory answer" but definitively ruled out multiple sclerosis or infection. Neurological examination ruled out any progressive or non-progressive neurological disorder.

My doctor has recently ordered an MRI of lumbar and sacral spine and coccyx because my urological problems have got worse. I was wondering if you could take a look at the images and make a suggestion as to what might be going on given the MRI results and the symptoms. I'm going to see the doctor in a month and I don't want to wait for so long not knowing what's going on.

You will find the images here: https://ufile.io/dqytw

Thank you.
doctor
Answered by Dr. Ishu Bishnoi (8 hours later)
Brief Answer:
MRI interpretation

Detailed Answer:
Hi XXXXXXX thanks for asking from HCM.


I can understand your concern. I have seen your MRI images. The interpretation of MRI is

- You are having normal spinal cord which is ending at L1. There is no tethering or low lying cord.

- There is no mass lesion compressing over nerve roots.

- Your disc at all levels are well hydrated. There is no significant bulge or compression of nerve roots.

- Your neural foramina are normal in size. No narrowing. No ligament flavum or facet hypertrophy.

- Your bone seems okay. There are no degenerative changes, collapse.

So overall MRI lumbosacral spine and coccyx is normal as per my understanding.
Hope it will help you. If any doubt, do let me know.
Thanks. Take care.
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Ishu Bishnoi (3 hours later)
Dear Dr. Bishnoi,

thank you for your help!

Do you have any suggestion as to what could be causing the problems given that there is no nerve compression? Could it be something like tight muscles putting pressure on the bladder?

Thanks.
doctor
Answered by Dr. Ishu Bishnoi (9 hours later)
Brief Answer:
Autonomic neuropathy

Detailed Answer:
Hi XXXXXXX welcome back.

Your symptoms are suggestive of some nerve damage which is involving sensory and autonomic nerves. As there is no compression, it could be due to:

- B12 deficiency
- Diabetes mellitus
- Any Drug-induced
- Chronic illness
- Autoimmune
- Multiple sclerosis (already ruled out in your case)

Before finding the cause, we should confirm it by nerve conduction studies of Lumbosacral nerve roots.

If there is damage. To find the cause, nerve biopsy can be done. Before those blood investigations are needed to rule out above causes.

Muscle putting pressure cannot cause such intermittent urgency/incontinence. So it is unlikely.

I'd suggest discussing neuropathy with your doctor. Hope it will help you. Please let me know about examination and his opinion.

Thanks. Take care


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Ishu Bishnoi (44 minutes later)
Dear Dr Bishnoi

thank you for your answer. I'm sorry I forgot to include the relevant tests. I do not have B12 deficiency, diabetes mellitus or chronic illness. I do not take or have taken any legal or illegal drugs. I do not seem to have an autoimmune disease.

I have had an EMG and evoked potentials study done on MEP, motor NCS, sensory NCS, multi MUP, SEP-HK and SEP-DK. I don't know if the lumbosacral nerve roots were examined, but probably not.

The conclusion of this study was that there is no damage to peripheral nerves of upper limbs. There is no myogenic or neurogenic damage of muscles in upper or lower limbs. There is no damage of MEP tract for upper or lower limbs. There is no damage to tract SEP n.medianus and n.tibialis.

Urological cystometry: hypersensitive hyhyperactive detrusor, dyscoordination of sphynctar muscles; conclusion- non-neurogenic LUTS...

I have one suggestion of what these symptoms mean. I have read about fybromialga - I do have widespread muscle pain and tightness. I'm also a perfectionist. Also, many people with fibromyalgia (or so it seems from internet articles) suffer from various types of urological problems.

Do you think this would be a viable diagnosis?

I will discuss neuropathy with my doctor and suggest that the lumbosacral nerve roots be examined.

Thank you!
doctor
Answered by Dr. Ishu Bishnoi (13 minutes later)
Brief Answer:
Fibromyalgia possibility

Detailed Answer:
Hi XXXXXXX welcome back.

I got your point. Your upper limbs and cervical spinal cord are normal. So upper motor neurone type bladder has been ruled out.

But evaluation of lumbo-sacral nerve roots is pending. It must be evaluated. Only if all investigations come normal, then we can suspect other causes like

- Psychological or functional

- Fibromyalgia

So you should discuss lumbosacral nerve roots with your doctor. Please let me know about investigations and examination findings. It will help me to rule out other causes.

If any doubt, do let me know.
Thanks. Take care.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Ishu Bishnoi

Neurologist, Surgical

Practicing since :2007

Answered : 901 Questions

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What Causes Tingling Sensation In The Anus, Back Pain And Mild Urinary Incontinence?

Brief Answer: MRI interpretation Detailed Answer: Hi XXXXXXX thanks for asking from HCM. I can understand your concern. I have seen your MRI images. The interpretation of MRI is - You are having normal spinal cord which is ending at L1. There is no tethering or low lying cord. - There is no mass lesion compressing over nerve roots. - Your disc at all levels are well hydrated. There is no significant bulge or compression of nerve roots. - Your neural foramina are normal in size. No narrowing. No ligament flavum or facet hypertrophy. - Your bone seems okay. There are no degenerative changes, collapse. So overall MRI lumbosacral spine and coccyx is normal as per my understanding. Hope it will help you. If any doubt, do let me know. Thanks. Take care.