OpenHealth Q&A

Seeking Insight: 29-Year-Old Female with Recent Genital Numbness and Bladder Issues Following Injury

Hello Reddit, I'm writing to discuss an issue affecting my girlfriend. **Details:** • Age: 29 • Gender: Female • Height: 5′7″ (170 cm) • Weight: 167 lb (76 kg) • Pre-existing condition: Polycystic Ovary Syndrome • Medications: Combined oral contraceptive and ibuprofen • Alcohol: None • Tobacco: None ### Onset of Symptoms On May 5, 2025, while lifting a heavy bed, she experienced a sharp pain in her lower back, accompanied by tingling in both legs and numbness in the genital area. Although she was still able to urinate and have bowel movements, these functions felt unusual. ### Imaging and Medical Consultations By May 20, she underwent a **Lumbar X-ray** which indicated a transitional L5 and mild narrowing at L5–S1. On May 29, a **Lumbar MRI without contrast** revealed: - A dehydrated disc at L4-L5 with a broad median herniation - A minor protrusion at the left foraminal region at L4-L5 - No significant compression of the dural sac; the conus and cauda were reported as normal by the radiologist. On May 30, she met with **Neurosurgeon #1**, who assessed her reflexes, noting hyper-reflexia in her legs and numbness in the genital region while observing no motor loss. He mentioned that the disc was small and not impacting the sacral roots, thus requested a follow-up MRI of the entire spine with contrast (results attached). Between June and early July, the symptoms in her legs improved, but the genital numbness continued with her bladder and bowel function remaining manageable. From July 15 to 24, there was a sudden and significant deterioration in her condition: - She experienced minimal urine output during most urination episodes, often just drops, with an occasional larger voiding of about 350 ml in a day. - She felt nearly no urge to defecate, needing to exert abdominal pressure to strain. - There were rare instances of sharp pains in the pelvic floor or anus. On July 21, a **Neurologist** examined her and noted a possible signal change at L1-L2 in the MRI, diagnosing her with an "incomplete cauda equina syndrome likely due to a micro-spinal infarct, reportedly improving." On July 25, a **Urologist** consulted and, based on her symptoms, concurred with the diagnosis of neurogenic bladder. An ultrasound to assess post-void residual volume is currently pending. ### Current Symptoms (as of July 27) - Numbness in the genital and perineal areas - Minimal urine output most times, with rare normal urination - Effort required for bowel movements - Quick reflexes in the knees but preserved strength in her legs; - Difficulty walking on heels and toes - Occasional discomfort in the right buttock ### Conflicting Medical Opinions - **Neurosurgeon:** believes the disc material is minimal and unlikely to be causing sacral nerve damage, expressing skepticism about cauda equina syndrome. - **Neurologist:** proposes the possibility of a micro-spinal-stroke at L1-L2 suggesting cauda equina involvement. ### Questions I Have: 1. Can cauda equina syndrome manifest bladder issues this long (around 11 weeks) post-injury? 2. Is it possible for a micro-spinal infarct to present normal findings on a lumbar MRI while still leading to urinary retention now? 3. Are there other potential diagnoses we should explore initially? 4. Any practical suggestions for managing urination while awaiting further assessments? Thank you for any thoughts or experiences you might share as we navigate this complex situation. I'm concerned about the ongoing changes and whether her condition could deteriorate further before we have clarity.

Answers (1)

7/27/2025, 10:10:51 PM

OpenHealth AI

It's understandable that you’re feeling concerned for your girlfriend given the complexity of her symptoms and conflicting opinions. Let’s tackle your questions step by step, focusing on her current health needs and actionable next steps.

Main Points:

1. Cauda Equina Syndrome (CES) can indeed cause bladder issues, and signs can develop post-injury. Persistent symptoms over weeks warrant careful monitoring.
2. A micro-spinal infarct could potentially lead to symptoms like urinary retention, even if initial imaging does not show clear abnormalities.
3. Other diagnoses may include conditions affecting the nerves or pelvic floor function. Evaluation for these can help clarify her situation.
4. Practical management strategies for urination can help ease discomfort while waiting for further assessments.

Explanation:

1. Cauda Equina Syndrome and Urinary Issues:

   • CES is a neurological emergency caused by compression of the nerve roots at the lower end of the spinal cord. Symptoms can develop weeks after an initial injury, especially if there is ongoing inflammation or vascular compromise.

2. Micro-Spinal Infarct:

   • A micro-spinal infarct is a small area of tissue death due to lack of blood. It may not always be visible on MRI, especially with subtle changes. The symptoms can build up over time as blood supply continues to be compromised.

3. Other Potential Diagnoses:

   • Consider conditions such as:
     • Pelvic floor dysfunction, which can affect bladder and bowel control.
     • Peripheral neuropathy affecting bladder function.
     • Multiple sclerosis or other neurologic conditions, especially if there are changes in reflexes or motor control.

Next Steps:

1. Monitor Symptoms:

   • Keep a detailed log of her symptoms, especially urinary patterns, sensation changes, and any new developments. This information could help her healthcare team in refining the diagnosis.

2. Urination Management:

   • Experiment with timed voiding. Encourage her to attempt urination every few hours, even if she doesn't feel the urge.
   • Consider pelvic floor exercises, which can strengthen the muscles involved in bladder control. Consulting with a physical therapist specialized in pelvic health might be beneficial.

3. Stay Hydrated:

   • Ensuring adequate fluid intake can facilitate urinary output but be cautious about consuming too much right before bedtime.

4. Follow-Up with Specialists:

   • Continue advocating for follow-ups with the neurologist and urologist. Discuss the need for a comprehensive plan to address the ongoing symptoms and potential for further imaging or intervention if symptoms change.

5. Emergency Signs:

   • Be proactive by having clear guidelines on when to seek immediate medical help, such as new weakness in the legs, severe pain, or worsening bowel or bladder function.

Your girlfriend’s situation is undoubtedly challenging. Utilizing your observational logs and staying proactive about medical follow-up will empower her to navigate this issue more effectively. Please keep me updated, and feel free to share any further questions or concerns as you both process this health journey.