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

    CWO
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

    Comment


    • #3
      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.

      Comment


      • #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

        Comment


        • #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


          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

          Comment


          • #6
            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.

            Comment


            • #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




              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, 11:04 PM. Reason: Waiting to hear from Dr. Young

              Comment


              • #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?

                Comment


                • #9
                  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,

                  Comment


                  • #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

                    Comment


                    • #11
                      Dr. Young, please respond to Lumbsacral spine series concerning T,10 11 and 12 degeneration with mild narrowing of thoracolumbar spine with convexity to right. Curvature of thoracolumbar spine with convexity to R. Mild rotational component.
                      MRI of lumbar spine is Minimal hypertrophic changes of the end plates affecting the lower thoracic spine. Very mild scoliosos with convexity to the L. No significant hypertrophic degnerative change of the facets Minimal hypertrophic changes of the end plates anterior and anterolaterally lower t horacic spine. Would any of t his account for my bowel sympomts of constipation, diarrhea, urinary retention, incontience of both, less sensation of blowel,bladder, can have lubrication of vagina during stimulation of clitoris with vibrator buut no muscle contractions, and also have large L5S1 protrusion that is moderate to severe disc dehydration. Would a compression fracture still remain if left untreated? Thanks, Ragu

                      Comment


                      • #12
                        Dr. Young - anterior end plates

                        I have an MRI of lumbar spine that reads as follows: Modest curvature of the spine with convexity to the left. Aligment otherwise unremarkable. Marrow signal normal without diffuse or focal replacement. Vertebral body and disc space height well maintained. Good preservation of signal from the nuclei. NO tearing of the annlus. No significant protrusion or extrusion of disc material. Spinal canal and foraminal caliber normal. No significant hypertroheric degenerative change of the facets. Minimal hypertrophic changes of the end plates anterior and anterolaterally lower thoracic spine. Conus shows normal positioning and signal. No nerve root abnromality. Lumbosacral spine series on same date of 6/4/04, minimal curvature of spine with convexity to the right. Minimal degenerative changes of the ediscs at T-10, 11 and 11, 12 other wise unremarkable lumosacral spine series. What is anterior and anterolaterally lower thoracic spine and would any of this be the cause for my bowel symptoms of constipation, diarrhea, incontinence of both, more of urine than stool, sensatin to bladder seems less tha tI can not get the urge to go all day and my orgasms are only lubrication no contractions And now I have the large protrusion at L5S-1. One dr. had neg. EMG, next dr. mild to moderate positive S-1. My outer vagianl numbness has gone away. I keep telling them I don't feel my bladder standing as good and dont' empty. Thanks, Ragu

                        Comment


                        • #13
                          If you have large protrusion this seems to be a surgical consideration.Myelomalacia are changes in the cord from lack of blood supply. Has the doctor recommended surgery? For the bladder -Urodynamics is recommended but only after surgery or interventions done.
                          CWO
                          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                          Comment


                          • #14
                            Dear Dr. Young, in response to your reply on the 21st regarding osteophytes, at C3/4 shallow borad based osteo. with mild right form. narowing. C4/5almost same except for moderate right and mild left form. narrowing. Both central canal patent. C5/6 large broad based osteo. moderate bilateral foram. narrowing. Mild central canal stenosis at this level. C6/7 large osteo. mild bilateral narrow. Borderline central canal stenosis. One of the nurses posted that if it was large that it could cause spinal compression if hyperextension injury. I remember my head being tilted but do not remember if it was hyperextended as she called it. Osteophyte htting canal a permanent finding if left untreated? No mention of canal compression now of MRI taken years after MRI but would any of this account for my bowel, bladder and sexual problems? Thanks, Ragu

                            Comment


                            • #15
                              Hello Ragu,

                              I'm not a doctor but do have CES.

                              The bottom line is that if you had CES you would have a lot of lower motor function loss. You would also most likely have constant pain and extreme numbness in the "saddle area".

                              I'm six years and the symptoms don't come and go they are constant.

                              I know first hand about the secondary issues associated with SCI/CES and understand how B&B problems can rule your life. It can get deep into your head if you
                              let it. I know how you feel.

                              I hope you don't mind me saying this but from your posts it seems you may not trust the doctors that are treating you. If that is the case you need to get new people on your medical team.

                              This forum is simply the best resource you will find on the Internet for SCI but it's hard for people to diagnose on a forum.

                              One last thing, there is a ton that doctors don't know about the workings of the spinal cord. That's not because they are not good doctors it's simply that the research has not progressed to the point where things become cut and dry.

                              I wish you the best and feel free to PM me if you ever want to talk.
                              Remember no matter what you can live a quality life even with a SCI/D.

                              Be Big,
                              AMAC
                              L4/L5 CES

                              www.DRAFT.cc
                              http://www.facebook.com/profile.php?id=1024602574

                              Messages from Alan Maccini and are produced utilizing voice recognition software. As a result of this on occasion a misrecognition of a word will occur and while spelled correctly will result in an unintended word appearing. We apologize for any errors.

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