Cauda Equina

[Valerie K]

I'm concerned that I may have CES.  Backgrounf: F, 29 years old, T7-8 herniation. I'm not incontinent, but have sudden (often painful) urgency when I have a bowel movement or have to urinate -- I can't relaly tell until the last minute.  For the last five months, things "down there" feel sort of muffeled and I can't tell the amount of the waste until I look in the toilet and, if the stream is slow & I plug my ears, I can't tell when I'm urinating.  I also can't push, so whatever comes out it it, though I don't think I'm constipated.  My PM and neurosurgeon seem to think that unless I'm incompetant, there's no need for surgery.  However,from what I've read, loss of sensation is a symptom of CES.  Are there varying degrees?  BTW, I don't have weakness in  my legs, though my toes tingle/burn sometimes.  I would rate my general pain/discomfort at about a 6.  I just don't want to do more damage/create permanent damage if surgery is an option.  I do understand why my doctors are reluctant (me too!) to go under the knife due to the invasiveness of the surgery.

Sorry for rambling, but could this be a symptom of CES, or just my T7-8 acting up. I've requested at least a lumbar MRI, but the PM says I don't have any symptoms.(I had posted in November about loss of sensation in the vaginal area, which is how this started.)  Don't worry -- I won't take your opinion as gospel, but just want to know how insistant I should be.  Thanks - V

[CCF-Neuro-M.D.-PW]

The nerve supply for the bowel and bladder originates in the frontal lobes of the brain and descends through the brainstem and spinal cord to nerve nuclei in the spinal cord and then on to the bladder and bowel wall themselves exiting the spinal cord via the cauda equina and the sacral plexus of nerves.

Lesions anywhere along this track can cause bowel and bladder symptoms. Exactly where is up to the physicians skill in localizing your symptoms and results from urine flow studies (defining the type of urinary problem). In the spinal cord, these nerves run closely with the nerves for the leg, hence leg weakness, spasticity, is commonly associated and is a measure of severity - if no spasticity is present in the legs then the nerve dysfunction is usually mild.

You should also get your bladder function and pelvic muscles checked out (perhaps by a gynecologist, and urine flow studies) to see if there any other more local problems in that area that may be missed

The sensory loss in cauda equina syndrome is usually around the perineal area with sparing of the lower back (sacral) area - I have not examined you or seen your scan so my advice is very limited in that regard.

so , yes it could be a spinal cord compression at T7-8 but other possibilities such as excluding cauda equina compression or local bladder problems need to be evaluated
Good luck

[cranky]

I was misdiagnosed and treatment was delayed for seven months leaving me with Cauda Equina Syndrome.  I had incontinence of both bladder and bowel which was ignored until it was too late.  I could not feel my urine stream and towards the end had to push on my bladder to empty it. I now wear bilateral AFO braces for drop feet and use a wheelchair for distance walking, I have lost sensation to sexual organs and suffer urinary retention and severe constipation I am in constant pain and I am at the two year mark.
If you are having the red flags of CES it is in your physicians best interest to order an MRI, it can cost him dearly if he doesn't!

[Valerie K]

Cranky-
Thanks for the post.  That's what I'm afraid of -- the symptoms progressing to a point that they can't be fixed.  I'm only 29, so, regardless, I assume that they will get worse with age anyway.  My OB/GYN said there were tonal changes and thought there were tests that could be done to see how bad it is.  My PM thinks I should take a wait & see approach -- especially since I would have to have a thorocotomy.  My primary care doc thinks it's probably due to body changes with age.  My neurosurgeon, who referred me to the PM, says surgery is up to me.  I'm concerned because I've read (like you said happened in your case) that if it IS CES, it should be addressed immediately.  Other than back tingling/discomfort(rarely PAIN), my only other symptom is that it sometimes feels like I have a rubberband around my hips, like I'm walking through water.

On the other hand, I don't want to rush into surgery if I don't have to.  Take care,  - V

[cranky]

Demand an MRI, that is the only way to know if is your spine.  Cauda Equina occurs below L1-2, mine was at L4-5 and they did a TLIF, or salvage procedure and I am left with the damage that could have been avoided if someone had done their job!

[Valerie K]

Thanks, Doc.  I've asked my various doctors if the symptoms could be caused by something else, and the response has pretty much been that my disc herniation can cause anything from back pain to having my face breakout - no other tests had been suggested.  I printed this post and plan to bring it to my next apointment.