Thursday, June 13, 2024

Leg Pain And Urinary Incontinence

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What Are The Causes

What to Do for Debilitating Thigh Pain After Transobturator Sling Placement?

A large ruptured disc can cause cauda equina syndrome. During a herniation, the gel-like center of a spinal disc can bulge or rupture through a weak area in the disc wall and compress the nerves. In the majority of cases, the disc herniation occurs at the L4-5 or L5-S1 discs in the lumbar spine. A sports injury, fall, or car accident can fracture the spine or tear a muscle and damage nerves. Other causes include a narrowing of the spinal canal , a tumor, an infection, or a hemorrhage.

When Is It A Medical Emergency

Part of the problem with sciatic nerve pain is that it can obscure other more serious conditions. For instance, a recent article in World Neurosurgery indicated that lumbar radiculopathy can mask tumors growing alongside the nerve. If pain persists when palpating the cleft between the buttocks, further scans may be necessary. Any abnormal readings on those scans may indicate the presence of tumors.

As mentioned above, sciatic nerve pain symptoms can include weakness along the legs, urinary problems, and/or incontinence. These may indicate a serious medical condition, particularly if they occur suddenly. The most likely culprit would be cauda equina syndrome, a severe compression of the bundle of nerves at the end of the spine. The American Association of Neurological Surgeons notes that cauda equina syndrome most commonly results from a massive herniated disc in the lumbar region. A single excessive strain or injury may cause a herniated disc. However, disc material degenerates naturally as a person ages, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture.

Back Pain And Incontinence In Women

Depending on the cause of back pain or incontinence, symptoms may vary. Women often struggle with stress incontinence after giving birth and leak while participating in activities that add stress to the bladder, such as laughing, sneezing, or lifting a heavy object. However, kidney problems such as stones can also cause frequent urination or urge incontinence when the urge to urinate suddenly strikes.

While studies show that in some patients the cause of back pain and incontinence is linked to weight gain or sedentary lifestyles, both conditions can also be caused by chronic illnesses like type 2 diabetes and arthritis.

When it comes to giving birth, 50% of women report stress urinary incontinence. Postpartum back pain and incontinence may impact moms for up to twelve months after their babies are delivered due to pelvic floor weakness.

Pelvic floor muscles often become weakened due to the added stress of supporting a growing infant and from supporting the body during labor. Once weakened, pelvic floor muscles are less able to function under increased pressure from the abdominal muscles during physical activities, leading to leaks. Pelvic floor muscles also play a role in spinal stability.

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How Do I Take Care Of Myself

The best thing you can do for yourself if you have symptoms is to see a healthcare provider. Continue getting help from healthcare providers after you have surgery, including:

  • Physical therapists.
  • Primary care healthcare providers.

See if your family and friends are willing to help you as well. Youll need support.

Timing Is Key For Cauda Equina Syndrome Diagnosis In The Ed

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Timing is key for cauda equina syndrome diagnosis in the ED

By Charles E. Rawlings, MD, JD, Rawlings Neurosurgical Consulting/The MacKenzie Law Firm, Winston-Salem, NC.

Editors note: Low back pain is a frequent patient complaint in the emergency department . In fact, the same patients may visit the ED repetitively with the same complaint. It is easy to be assuaged into thinking that these patients are merely seeking drugs, but to make that assumption can lead a clinician to miss the cauda equina syndrome and may result in a malpractice action if efforts are not taken to identify any new symptoms and signs in a patient with low back pain. This issue provides the reader with a solid understanding of diagnosing and caring for patients with cauda equina syndrome in the ED and the medicolegal issues that arise from failing to diagnose and appropriately treat these patients.


The scenarios illustrate routine encounters in the ED involving the failure to diagnose and to treat cauda equina syndrome. In the first example, no medical negligence occurred the patient did not have cauda equina syndrome upon his first visit to the ED. The next day, when the patient did have urinary symptoms, the management of the patient comported with the applicable standard of care.


Case #1


Case #2


Case # 3


Case #4




3. Shapiro S. Cauda equina syndrome secondary to lumbar disc herniation. Neurosurgery 1993 32:743-747.

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Sciatica Symptoms That Require Immediate Medical Attention

While your sciatica pain can be severe and cause your leg to feel weak, the symptoms typically do not produce any long-term complications.1 Rarely, if the underlying cause of your sciatica becomes severe, it may produce troubling symptoms when your spinal nerve roots and/or spinal cord get compressed, sometimes triggering a medical emergency.

The symptoms of sciatica radiate from the lower back to the buttock, thigh, and leg. Common symptoms include pain, numbness, tingling, and/or weakness. Watch:Sciatica Causes and Symptoms Video

Below are the descriptions of two serious sciatica symptoms that must be urgently evaluated and treated:

Things To Know About Cauda Equina Syndrome

  • Cauda equina syndrome is a complication from the compression of the nerves at the end of the spinal cord within the spinal canal.
  • Cauda equina syndrome can be caused by any condition that results in direct irritation or pinching of the nerves at the end of the spinal cord.
  • Partial cauda equina syndrome is the terminology that applies when there is incomplete compression of the nerves of the lower spinal cord.
  • Symptoms of cauda equina syndrome include low back pain, numbness and/or tingling in the buttocks and lower extremities , weakness in the legs, and incontinence of the bladder and/or bowels.
  • Cauda equina syndrome is diagnosed based on characteristic symptoms and confirmed by neurologic and radiology testing.
  • Cauda equina syndrome is a medical emergency generally requiring a surgical decompression operation.
  • The outlook for patients affected by cauda equina syndrome is determined by the extent of damage to involved nerve tissue.

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Types Of Incontinence Related To Back Pain

Urinary Incontinence: This can occur when someone no longer has bladder control and has unintentional losses of urine.

Overactive Bladder : This type of incontinence occurs when you have a sudden urge to urinate that may lead to frequent bathroom trips or accidental leakage. If you have OAB and lower back pain together, its possible that you may be overweight, have prostate or kidney issues, or have cancer. Other symptoms you may experience with OAB and lower back pain include:

  • Bloody or cloudy urine.
  • Inability to void urine or void completely.

Fecal Incontinence: Bowel incontinence is when you lose control of your bowels and fecal matter. This can occur alongside lower back pain if your

Overflow Incontinence: Overflow incontinence occurs when youre unable to pass urine completely, otherwise known as urinary retention, and your urine overflows out of your urethra.

Stress Incontinence: Stress incontinence happens when urine leaks when you sneeze, cough, laugh, lift heavy objects, or exercise. This is due to stress being put on your bladder muscles. After giving birth, stress incontinence and lower back pain are both common in women.

What Are The Causes And Risk Factors For Back Pain And Incontinence

Clinical Case Session: Geriatric Urinary Incontinence

Certain risk factors increase your chances for experiencing symptoms of both back pain and incontinence. These risk factors include:

  • Obesity: Carrying extra weight puts extra pressure on your back. Extra weight also increases pressure on your bladder and nearby muscles. This may lead to stress incontinence, and over time, the extra stress may weaken your bladder muscles.
  • Age: Back pain becomes more common with age. Likewise, the muscles that affect bladder control lose strength as you grow older.
  • Other diseases: Some conditions, such as arthritis and diabetes, can cause both back pain and incontinence. People with certain psychological conditions, such as anxiety and depression, are also more likely to experience back pain.

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Changes In Bowel And/or Bladder Control

Consult your doctor immediately if you have any sudden, unexplained changes in your bowel and/or bladder control. These changes may include:

  • An inability to control your bowel and/or bladder movements.2
  • Difficulty in passing urine, a reduced urinary sensation, a loss of desire to pass urine, or a poor stream.2,3

These symptoms indicate a rare, but serious medical condition called cauda equina syndrome. In addition to incontinence problems, cauda equina syndrome may also cause:

  • Sudden pain and weakness in both your legs4
  • Numbness in your groin, buttocks, genitals and/or inner thighs .2

Cauda equina syndrome can occur suddenly or gradually and typically requires immediate surgery to control the symptoms.3 If patients with cauda equina syndrome do not receive prompt treatment, it can result in difficulty in walking and/or other neurological problems, including lower-body paralysis. Doctors advise treating this condition within 24 to 48 hours of symptom occurrence in order to preserve lower limb function.2,3,5

While rare, sciatica caused due to severe disc herniation in the lower spine may progress into cauda equina syndrome.

Recognizing Early Symptoms Of Cauda Equina Syndrome

Cauda equina syndrome manifests in two ways: a rapid development of severe symptoms or a slow and gradual onset with symptoms that gradually worsen over time. Symptoms of rapid onset cauda equina syndrome include leg and foot numbness and weakness, back pain, and bowel and bladder problems such as incontinence or retention. When that happens, immediate medical attention is essential to remove the source of pressure and give nerves the best chance to heal.

However, when the cause of pressure on the cauda equina develops gradually, such as from a slowly and steadily eroding lumbar disc or developing tumor, these early symptoms can be intermittent and vary in severity, so that they can be mistaken for other kinds of back problems or conditions that affect bowel and bladder functions. Early symptoms of cauda equina syndrome can include:

  • Lower limb weakness and intermittent changes in sensation, such as numbness
  • Saddle anesthesia loss or diminished sensation in areas where a person would sit on a saddle
  • Urinary and/or bowel problems, such as retention or incontinence
  • Unexplained sexual dysfunctions, such as erection problems or loss of sensation
  • Poor tendon reflexes

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When To See A Doctor For Urination Pain

Painful or Frequent Urination in Men. Frequent urination without pain also can be a side effect of certain medications, or a symptom of diabetes. Most men who experience new problems with painful or frequent urination should see their doctor. This guide is intended to provide helpful information while you are awaiting further evaluation,

How Can I Prevent Cauda Equina Syndrome Urine Leg Sleeves Urinary Drainage Catheters Bags Holders ...

It may not be possible to prevent all of the causes of cauda equina syndrome. But, you might be able to reduce your risk of a herniated disk, the most common cause of the syndrome. Try the following tips:

  • Avoid wearing high-heeled shoes. These types of shoes can misalign your spine.
  • Stop smoking. Avoid using other tobacco products as well because they can weaken your disks.
  • Exercise. Try exercises that strengthen your back and abdominal muscles.
  • Lift properly. Bend your knees and keep your back straight when you lift something instead of bending at your waist.
  • Maintain a healthy weight. Extra weight adds extra pressure to your lower back.
  • Practice good posture. That will reduce strain on your spine.
  • Stretch. Stretch your body periodically, especially after youve been sitting for a long time.

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Will These Tips Work For Everyone

No, there are some people who are simply more likely to have UTIs. It is not fully understood why this may be.

Some people experience repeated UTIs. These cases are called recurrent UTIs and are diagnosed by a medical practitioner. Lifestyle changes such as those listed above may be useful for some people but not others.

Some people will have bacteria in their urine if it is tested but experience no symptoms of an infection. This is called asymptomatic bacteriuria and is a common finding, particularly in older people. It does not usually need antibiotic treatment.

Speak to your GP about a referral to a specialist urogynaecologist or urologist to make sure nothing has been missed.

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Comparison Between Canadian Men And Women

Odds ratios and 95% CI values for the associations among back problems, BMI, age, smoking habits, and UI among Canadians are presented in Table . Among adult Canadians, those with a diagnosis of UI were significantly more likely to also have been diagnosed with back problems . Men were slightly less likely to have a diagnosis of back problems than were women. In the fully adjusted model, both a diagnosis of UI and sex maintained their association with back problems being overweight or obese, increasing age, and smoking were all significantly associated with a diagnosis of back problems.

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Spinal Cord Injuries And Neurogenic Bladder Dysfunction

SCIs involve any damage to the spinal cord or the cauda equina the nerves at the end of the spinal canal. SCIs range in severity and can cause permanent changes in bodily functions and changes in sensation and strength. An SCI can disrupt communication between the spinal cord nerves and brain.

The spinal cord nerves help with bladder and bowel function, meaning complications with these nerves can cause or worsen incontinence, known as neurogenic bladder dysfunction . Spinal cord infections and tumors may also lead to NBD.

Common symptoms of NBD related to SCIs include frequent urination, urinary incontinence, urinary tract infections , kidney stones and the inability to empty the bladder fully. NBD may lead to cauda equina syndrome .

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What Are The Types Of Cauda Equina Syndrome

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There are two types and two classifications of cauda equina syndrome. The syndrome is acute or chronic, and its either complete or incomplete.

Types of cauda equina syndrome

Acute cauda equina syndrome

Severe symptoms start suddenly. Youll likely need surgery within 24 to 48 hours.

Chronic cauda equina syndrome

This name means long-lasting cauda equina syndrome. It describes two scenarios:

  • If youve had symptoms of cauda equina syndrome for a period of time before you see a healthcare provider, its labeled chronic.
  • If the surgery doesnt fix your nerves and there is permanent damage, youll likely have symptoms for the remainder of your life. Your healthcare provider calls these symptoms chronic.
  • Emergency surgery might stop permanent damage. See your healthcare provider if you have symptoms.

    Classifications of cauda equina syndrome

    Complete cauda equina syndrome

    Complete cauda equina syndrome causes urinary and/or bowel retention or incontinence. Retention means that youre unable to pee or poop, and incontinence means that you cant stop yourself from peeing or pooping. It affects about 60% of people with cauda equina syndrome.

    Incomplete cauda equina syndrome

    This affects the other 40% of people with cauda equina syndrome. Typical symptoms include loss of urgency or increased urgency sensation in the bladder and bowels without retention or incontinence. This means you cant feel that you have to poop or pee, or you feel the sensation stronger than before.

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    Back Pain And Urinary Incontinence

    Surprisingly, many patients with incontinence also experience back pain. In fact, researchers in Canada in 2017 decided to study the phenomenon. They found that adults experiencing urinary incontinence were more likely to also experience back pain. This was true for both men and women. A 2016 study found that the co-existence of back pain and UI occurs most often in individuals with sciatica ).

    Even though these two symptoms frequently occur together they are not necessarily related. In some cases, UI and back pain can both be caused by the same condition. However, in other cases, the two symptoms may be unrelated.

    What Structures Make Up The Back

    The back is an intricate structure of bones, muscles, and other tissues that form the back, or posterior part of the bodys trunk, from the neck to the pelvis. At the center is the spinal column, which not only supports the upper bodys weight but houses and protects the spinal cord the delicate nervous system structure that carries signals that control the bodys movements and convey its sensations. Stacked on top of one another are about 30 bones the vertebrae that form the spinal column, also known as the spine. Each of these bones contains a roundish hole that, when stacked in line with all the others, creates a channel that surrounds the spinal cord. The spinal cord descends from the base of the brain and extends to just below the rib cage.1

    Starting at the top, the spine has four vertebral regions:

    • Seven cervical or neck vertebrae
    • Twelve thoracic or upper back vertebrae
    • Five lumbar vertebrae , known as the lower back
    • The sacrum and coccyx, a group of bones fused together at the base of the spine.

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    Incontinence And Back Problems Risk Factors

    While anyone may develop a medical condition that causes back problems and incontinence simultaneously, certain risk factors can increase the likelihood of developing both conditions. Some of the most common risk factors for developing back pain and incontinence simultaneously include:

    • Age: Back problems and incontinence are age-related conditions, meaning they likely occur with age. Back pain typically occurs from spinal degeneration or injury. With age, the bladder muscles often weaken, leading to an increased risk of incontinence.
    • Weight: Being overweight places additional strain on the spine, causing or aggravating painful spinal conditions like pinched nerves or herniated discs. Excess weight also increases pressure on the bowels, bladder and surrounding muscles. Excess weight can increase the risk of stress incontinence, which can further weaken muscles and lead to worsening incontinence.
    • Pre-existing medical conditions: Certain pre-existing medical conditions may increase the risk of back pain and incontinence. For example, diabetes and arthritis are two conditions that can cause incontinence and back pain.

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