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Neurology (Expert Forum)
L5-S1 Disc Hurniation
Answered by
Lama Chahine, MD - Neurology
Cleveland Clinic
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
L5-S1 Disc Hurniation
by Mommy2_2Boys, Oct 21, 2009 09:43AM
I have just found out by MRI that I have Hurniated Discs in L5 and S1. With this, it is causing sever pain in the lower back, right leg, and tail bone area. Could this also have something to do with why it is hard for me to have a bowel movement and I also always test positive for bladder infections and I don't know I even have one?
I am set up to see a specialist next week. Hopeing for more answers when I get to see him.
I am set up to see a specialist next week. Hopeing for more answers when I get to see him.
Doctor's Answer
by Lama Chahine, MD, Oct 24, 2009 08:15AM
, Oct 24, 2009 08:15AM
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a history and review your imaging, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information
There is a material that cushions the space occurring between the vertebra (bones of the spine). This material may sort of be squished out from in between the two bones; this is called a herniated disc. The disc may push on surrounding structures, namely the spinal cord and/or the nerves exiting from the spinal cord. Most often, it is the nerves that are pressed on, and not the spinal cord itself.
The L5-S1 nerve roots innerve the buttock region and back and side part of the leg. The presence of a disk at this level would lead to pain in the back with radiation down the leg. I can not comment in specific as to whether or not your disc is causing your mentioned symptoms as I have not reviewed your imaging or examined you; when a disc is big enough, it can press on several nerve roots, leading to what is called cauda equina syndrome, in which there can be bowel and bladder dysfunction. However, in general, the bladder receives innervation from nerve roots lower down, such as the S1 and S2 roots, this is also the case for the bladder. Therefore, a disk at L5-S1 would be unlikely to cause constipation, and to lead to recurrent bladder infections. However, in general, with involvement of specific nerve roots, constipation can occur, and bladder hypotonia (poor contractility of the bladder) can occur as well, leading to recurrent bladder infections. In woman, infections of the bladder can cause little symptoms, sometimes urinary frequency may be the only symptom. Having bacteria in the urine is dfiferent from having a full blown urinary tract infection, so when symptoms are not occuring (what is termed asymptomatic bacteruria) treatment is always indciated.
It is a good idea to be seeing a specialist, he/she can review your imaging and would be able to examine you and answer your questions more definitively.
In most people, the pain of a herniated disk resolves over 4-6 weeks. The most severe pain actually eases up within 1-2 weeks. Only a minority of people every require surgery. With time, the amount of disk that has herniated shrinks and with time resolves completely in most people. Therefore, for the majority of people, non-surgical treatment is the first option. This treatment may include medications (non-steroidals such as advil), sometimes steroids if there is swelling (edema), temperature therapy (hot or cold packs), stretching and controlled physical therapy, muslce relaxants, and so on, these are best prescribed by an experienced physician, each has its own indications. In a minority of patients, surgery needs to be done urgently. This often is the case when the herniated disc is pressing on the spinal cord itself. Surgery is emergent so that permanent spinal cord injury does not occur. Another indication for urgent surgery is if there evidence that a nerve is being compressed on to the point that its function is impaired. Symptoms suggesting the need for urgent surgery includes muscle weakness, loss of bowel or bladder control, loss of sensation, particularly in the pelvis and severe and progressive pain.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
Without the ability to examine you and obtain a history and review your imaging, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information
There is a material that cushions the space occurring between the vertebra (bones of the spine). This material may sort of be squished out from in between the two bones; this is called a herniated disc. The disc may push on surrounding structures, namely the spinal cord and/or the nerves exiting from the spinal cord. Most often, it is the nerves that are pressed on, and not the spinal cord itself.
The L5-S1 nerve roots innerve the buttock region and back and side part of the leg. The presence of a disk at this level would lead to pain in the back with radiation down the leg. I can not comment in specific as to whether or not your disc is causing your mentioned symptoms as I have not reviewed your imaging or examined you; when a disc is big enough, it can press on several nerve roots, leading to what is called cauda equina syndrome, in which there can be bowel and bladder dysfunction. However, in general, the bladder receives innervation from nerve roots lower down, such as the S1 and S2 roots, this is also the case for the bladder. Therefore, a disk at L5-S1 would be unlikely to cause constipation, and to lead to recurrent bladder infections. However, in general, with involvement of specific nerve roots, constipation can occur, and bladder hypotonia (poor contractility of the bladder) can occur as well, leading to recurrent bladder infections. In woman, infections of the bladder can cause little symptoms, sometimes urinary frequency may be the only symptom. Having bacteria in the urine is dfiferent from having a full blown urinary tract infection, so when symptoms are not occuring (what is termed asymptomatic bacteruria) treatment is always indciated.
It is a good idea to be seeing a specialist, he/she can review your imaging and would be able to examine you and answer your questions more definitively.
In most people, the pain of a herniated disk resolves over 4-6 weeks. The most severe pain actually eases up within 1-2 weeks. Only a minority of people every require surgery. With time, the amount of disk that has herniated shrinks and with time resolves completely in most people. Therefore, for the majority of people, non-surgical treatment is the first option. This treatment may include medications (non-steroidals such as advil), sometimes steroids if there is swelling (edema), temperature therapy (hot or cold packs), stretching and controlled physical therapy, muslce relaxants, and so on, these are best prescribed by an experienced physician, each has its own indications. In a minority of patients, surgery needs to be done urgently. This often is the case when the herniated disc is pressing on the spinal cord itself. Surgery is emergent so that permanent spinal cord injury does not occur. Another indication for urgent surgery is if there evidence that a nerve is being compressed on to the point that its function is impaired. Symptoms suggesting the need for urgent surgery includes muscle weakness, loss of bowel or bladder control, loss of sensation, particularly in the pelvis and severe and progressive pain.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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