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Thread: CES? Dr. Young or SCI-Nurse please comment

  1. #1

    CES? Dr. Young or SCI-Nurse please comment

    Dear SCI; am wondering if mild degenerative changes in T-10, 11 and 12 and a large protruding disc at L-5S-1, mild canal narrowing, degenerative changes at C-3,4,5,6 with mild canal narrowing at C5 can be causing some of my symptoms of bowel/bladder. Am worried that I may have CES as part of it. I have constipation with some diarrhea; urinary retention and inconintence of both, can have orgasm but it seems as though I get the biggest orgasm in my rectal area. No strong vaginal contractions. I can feel a finger in rectum, although not as strong as used to. Can feel stool in rectum. Sitting causes worsening with either pain, B/B symptoms of having to go. Have had 3 MRIS but not at the beginning when symptoms started. Urinary study done sitting. Showed emptying but am concerned if CES could the pressure have caused the urge to go. CAn walk all day and not have urge to go and then sweat along my neck area down. When lay on spine ge turge to pee and if haven't gone all day it seems it all comes out. Something in region of thoracic area around my strap area for my bra. Have told all the drs. and they said if there was a CES injury they would still see damage. I find that hard to believe after all this time. There was a twist to my neck and lower back and am wondering if that is the problem, the neuros. don't see a thing. Would stretching or twisting of nerve roots, if permanent, still be visible. Have an anal wink, anal tone is tight, eat, and then have BM. Do not hnave to use an excessive amount to push to get it out. Babinski sign is normal. I did have some outer vaginal numbness but it has since gone away. Would this still be present if I did nto have surgery to reliefe pressure on CES? Occasional numbness on outside of feet, comes and goes. CT/myleogram make no mention of canal narraowing and fluid flowed freely. Would damage to the nerves outside the canal still block whatever that dye was? Thanks, Ragu

  2. #2
    Have you had Urodynamics with VCUG? that is the only way you could tell if bladder was affected.

    CWO

  3. #3
    Quote Originally Posted by ragu View Post
    Dear SCI; am wondering if mild degenerative changes in T-10, 11 and 12 and a large protruding disc at L-5S-1, mild canal narrowing, degenerative changes at C-3,4,5,6 with mild canal narrowing at C5 can be causing some of my symptoms of bowel/bladder. Am worried that I may have CES as part of it. I have constipation with some diarrhea; urinary retention and inconintence of both, can have orgasm but it seems as though I get the biggest orgasm in my rectal area. No strong vaginal contractions. I can feel a finger in rectum, although not as strong as used to. Can feel stool in rectum. Sitting causes worsening with either pain, B/B symptoms of having to go. Have had 3 MRIS but not at the beginning when symptoms started. Urinary study done sitting. Showed emptying but am concerned if CES could the pressure have caused the urge to go. CAn walk all day and not have urge to go and then sweat along my neck area down. When lay on spine ge turge to pee and if haven't gone all day it seems it all comes out. Something in region of thoracic area around my strap area for my bra. Have told all the drs. and they said if there was a CES injury they would still see damage. I find that hard to believe after all this time. There was a twist to my neck and lower back and am wondering if that is the problem, the neuros. don't see a thing. Would stretching or twisting of nerve roots, if permanent, still be visible. Have an anal wink, anal tone is tight, eat, and then have BM. Do not hnave to use an excessive amount to push to get it out. Babinski sign is normal. I did have some outer vaginal numbness but it has since gone away. Would this still be present if I did nto have surgery to reliefe pressure on CES? Occasional numbness on outside of feet, comes and goes. CT/myleogram make no mention of canal narraowing and fluid flowed freely. Would damage to the nerves outside the canal still block whatever that dye was? Thanks, Ragu
    Ragu, I am sorry that I did not see your post until just now. I have been out of town and have not been reading all the forums as much as I normally do. The only thing that you describe that may cause the bladder and vaginal symptoms that you have is the protruded L5/S1 disc.

    As you know, the spinal canal contains only spinal roots (or the cauda equina) at L5 and S1. The sacral roots S2, S3 control the bladder and S4, S5 control the anal areas. If the disc protrusion at L5/S1 is pressing on the spinal roots as they exit the spinal canal (called the spinal foramina), that would cause gastrocnemius and ankle weakness. Thus, to cause bladder, vaginal, and anal problems, it has to press on S2, 3, 5, and 5 in the spinal canal.

    I want to emphasize, however, that none of your symptoms fit a cauda equina injury. You would be describing much more sensory and motor loss if you had a cauda equina injury. If you had damaged your sacral spinal roots, you would be having a lot more problem with your bladder than you are describing.

    Wise.

  4. #4

    Dear Dr. Wise - please comment - CES/spine

    Dr. Wise, I had some feet numbness that came and went along the outside, some leg weakness that came and went. I also have a skin patch of blotches on my butt cheek and also had some numbness in my butt that would come and go. Like I said, I can feel putting a finger in my rectum and have outer sensation in that area. There are times I can feel the stool and there are times I cannot. I'm in the bathroom either doing one function or another. BM are about 3 a day. I keep telling my neuro. I feel like I'm sitting on a sponge. I did see one of my exam reports and it said mildly decreased ankle reflexes. I can heel/toe walk. ankle reflexes were present next exam. With a CES injury would they be decreased or not present at all? If it was a CES injury, wouldn't the outer vaginal numbness still be present or could that mean that other nerves are damaged? There are times I don't empty my bladder and am back in bathroom again and if I'm up and walking all day I don't feel a thing. Sitting is becoming difficult. It seems like sitting gives me urge to pee. I have some hip pain. L-5/S-1 degenerative moderate to severe. Would you agree or disagree that the surgeon said if there was permanent damage he would see something in that area? Would mild canal narrowing in lower thoracolumbar spine be causing some of these issues? Last night during my menstraual cycle I had a normal orgasm with the contractions. One MRI reads slight rotational deformity of thoraculumbar spine. Would this be causing some of these symtpoms. What would happen if there was a bruise or a contusion in my bra area of my spine, could that be causing my problems? My neurologist also found nystagmus. My thoracic MRI says mild multi- level degenerative disease. Could mild stenosis in my neck area at C-5/6 and borderline C-6-7 be causing some of the bowel/bladder symptoms? Also there are osteophytes in my neck that are to the laterilization to the right? What does that mean and could it affect Bowel, bladder? I do have anal wink. I read how to check that. And I also have a bulbo. reflex. I have normal Babinski. What's your take on this? ONce the disc herniates and does damage, what can they see? Would mild stneosis mean the disc hit the nerve roots where it's stenosed? EMG showed mild denervation of L5S1 nerve root. Why can't they just put the clinical picture together based on my symptoms? Thanks, Ragu

  5. #5

    Dear CWO: uro/CMG study

    Dear CWO; I had CMG/EMG with the computer. I could feel the bladder fill and emptied. They gave me a presciprtion for gelnique but now I see I'm back to not emptying again. He also took a camera and looked inside bladder and urethra. I am scared with the amount of cauda symtpoms and pain in my bra strap area. I asked the neurosurgeon about the lesion somewhere in my t spine that's in my subarachnoid area and he said it's considered mildly incomplete and when you said with me being able to feel finger insrted into rectum, being able to contract it myself, and I can feel my finger inside the rectum I felt a little bit better that it's incomplete. Are these degrees of cauda equina like A or B? With the incontinence of both, the not emptying, the numbness off and on in my feet, I'm convinced that's the problem. It's been going on forever and I neglected the pain. I have vaginal feeling inside, my outside vaginal nubness has been gone for ages. Was wondering, though, if I did not have cauda equina surgery for relief of pressure, would I still have the outer vaginal numbness? Thanks, Ragu


    Quote Originally Posted by SCI-Nurse View Post
    Have you had Urodynamics with VCUG? that is the only way you could tell if bladder was affected.

    CWO

  6. #6
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    I have a couple discs at l5s1 which are bulging and had a dislocation and swelling as well as cervical degeneration and injury. i have cauda equina, though not much besides the bulging discs shows now at L5s1, though the cervical degeneration for me is causing hand weakness. I am told that I should have had a full recovery. I did have some. The vaginal numbness may get less over time. it did for me, though the cauda equina burning in the feet and butt may get worse. it did for me. I also have hip pain, though I have displasia. I recovered bowel control but not full bladder. recovered right hip flexor but not so much on the left, and I have foot drop in both feet, though left is worse than the right. I can push down with my feet, but not lift.
    I had to see several neurologists before it was confirmed through exam, and an evoked potential, MRI and urodynamics that there was ces. what you describe is very much like what I feel or don't feel. I would have surgery If I were given the option. its worth a try. the broken glass pain in the feet got a lot worse for me as the years went by, though I can feel where it had been numb for years. I would like to know how your surgery goes, and what the outcome is.

  7. #7

    CES/spine

    Dear Dr. Young, there was muscle weakness of legs, comes and goes, EMG showed chronic/acute S-1 problem. Bladder pain and no urge to go when walking all day, lay or sit and go tons. I don't feel it fill only whn puttin pressure on bladder. Numbness along out parts of feet, comes and goes. Also, what is atonic anal spinchter. Have numerous levels of degeneration in C-3,4,5,6 with canal narrowing, T, 10, 11 and 12 degeneration and thoracolumbar canal narrowing, rotational element of lower thoracolumbar spine. What does osteophyte with laterilization to right mean on c spine MRI? I sweat from my bra strap area to the tip of my butt. Butt cheek numbness off/on. Would outer vaginal numbness go away if it was a cauda injury or that be permanent by now? Would twisting of lower back cause some of this to come and go? Wold sitting during bladder studies cause me to feel urge to go if pressing on cauda injury? Thanks, Ragu




    Quote Originally Posted by Wise Young View Post
    Ragu, I am sorry that I did not see your post until just now. I have been out of town and have not been reading all the forums as much as I normally do. The only thing that you describe that may cause the bladder and vaginal symptoms that you have is the protruded L5/S1 disc.

    As you know, the spinal canal contains only spinal roots (or the cauda equina) at L5 and S1. The sacral roots S2, S3 control the bladder and S4, S5 control the anal areas. If the disc protrusion at L5/S1 is pressing on the spinal roots as they exit the spinal canal (called the spinal foramina), that would cause gastrocnemius and ankle weakness. Thus, to cause bladder, vaginal, and anal problems, it has to press on S2, 3, 5, and 5 in the spinal canal.

    I want to emphasize, however, that none of your symptoms fit a cauda equina injury. You would be describing much more sensory and motor loss if you had a cauda equina injury. If you had damaged your sacral spinal roots, you would be having a lot more problem with your bladder than you are describing.

    Wise.
    Last edited by ragu; 04-09-2010 at 11:04 PM. Reason: Waiting to hear from Dr. Young

  8. #8
    Osteophytes, does anyone know if small broad based osteophytes and some large broad based osteophytes can contribute to bowel/bladder dysfunction i the cervical region?

  9. #9
    Quote Originally Posted by ragu View Post
    Osteophytes, does anyone know if small broad based osteophytes and some large broad based osteophytes can contribute to bowel/bladder dysfunction i the cervical region?
    ragu,

    Small and broad based osteophytes do not compress the spinal cord and therefore cannot be causing a spinal cord injury resulting in bowel/bladder dysfunction.

    A cauda equina injury (to the spinal roots in the cauda equina) would not cause "off-on" symptoms. You would simply have sensory loss and flaccidity of the affected structures.

    There is no spinal root that I know of that causes selective numbness of the outer vagina. Likewise, spinal cord injury does not cause shifting distribution of numbness.

    Your symptoms simply do not fit injury or compression of the spinal cord or cauda equina. Please understand that I don't deny that you have these symptoms but they are unlikely to be due to osteophytes or the discs described.

    So,

  10. #10
    Dr. Young, would the foraminal narrowing in the cervical spine at different levels c3 through 7 be causing the bowel/bladder problems if they were herniated a while ago and there was also some mild canal stenosis at c-4-5 and borderline at 6-7. I had some hand numbness in my pinky and some carpal tunnel problems with some intermittent weakness in my shoulders. Also, what is a flaccid bowel mean and what are symptoms? There are times I do'nt empty my bladder completely either. I was told cauda equina does not constipation and there seems to be my main problem. I was told a cauda injujry causes inconintence only. Thanks, Ragu

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