pundendal nerve

[backhoe]

hi, seven months ago, i carried a set of stair steps twenty yards. no initial pain. the next day at work i had a shooting down the back of my left thigh into my foot. i had no idea what this was. on crutches for two weeks. could not put even a sheet over my foot, or walk on it. stabbing pain in my thigh and foot. then it moved into my right foot, and up my leg into my groin. i have been to seven doctors. neurologist, orthopedic, family, foot doctor. i had nerve induction tests. two sets of m.r.i.`s., x rays . seven months later i still have constant numb tingling pain in my feet , thighs, i have pain in my penis. trouble urinating and with erections., my bowel movements are not normal.when i walk there is pain in my right ankle and foot,like they are broken.  they had me on 300mg gabapentin, 500mg hydrocodone. this did nothing. i have been to therapy for two months. two different chiropractors, foot doctor. who thought i had planters fashitus. i have ran, done triathalons and raced bicycle for twenty five years. i still go to the gym,lift weights, eliptical machine with no added pain. any suggestions   thank you

[Christopher R Newey, DO]

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 a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the 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.

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, muscle 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.

One means of assessing whether or not the nerve being pressed on by your herniated disc is impaired is a test called an EMG/NCS which assesses how fast the nerve conducts electricity and how the muscle responds. This type of test is done by neurologists in most centers.

In some patients, after conservative non-surgical therapy is tried for 4-6 weeks and the pain is still severe or if other symptoms/indications arise, surgery is the next step.

It sounds like you have had a thorough workup thus far. Were the MRI’s of the lumbar and thoracic spine? Were they normal? Were the nerve conduction studies normal?

There are multiple nerve levels involved in the symptoms you provided and they may not all be part of the same disease process. If there are no answers provided with neuroimaging and electrophysiology, you may need blood work to look at other causes of numbness/tingling. These would begin with oral glucose tolerance test, thyroid stimulating hormone (TSH), and vitamin B12.

I suggest you continue to work with your neurologist.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[backhoe]

thank you, not sure what the emg/ncs test is. i had nerve induction tests on both legs, they showed no nerve damage. i have two bulging disks, one w/ a slight tear. neurologist said surgery, but second m.r.i. he changed his mind. i will take your information to him about the oral glucose, tsh, and b12.   thank you again for your help.