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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 47172
Experience:  Board Certified Physician
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I'm a relatively inexperienced GP who is worried about

Customer Question

Hi, i'm a relatively inexperienced GP who is worried about patient i saw on Monday. 37 year old man presents with 1-2 week history of lower back pain, reduced SLR bilaterally. no sphincter disturbance or saddle analgesia etc but did mention increased defecation in previous days. (2-3 bowel movements per day). i cannot get mri until Saturday and am worried he may have an evolving cauda equina.. no foot drop, normal lower limb exam
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. David replied 2 years ago.
This is Dr. David

cauda equina syndrome would be very rare in a 37 year old patient.

lower back pain could be due to arthritis or heavy lifting or poor lumbar support or obesity or weak back muscles or poor mattress support.

reduced SLR bilaterally could be due to poor flexibility

I bet the MRI scan will be fine.

is he overweight? what does he do for a living?
Customer: replied 2 years ago.

Not really overweight but has history of l4/l5 disc prolapse a few years ago, surgery not required.

I did inform him of red flags - sphincter disturbance , reduced perianal sensation etc and advised attendance at a/e immediately but now wonder if i should have sent him anyway..

Not sure of cause of increased defecation, could it be an early warning sign. i will ring unit in morning and try to get MRI tomorrow. Am worried!, hopefully unnecessarily

Expert:  Dr. David replied 2 years ago.
most likely diet change, fiber intake, is changing his bowel movement frequency.

it sounds like you are a very good and caring doctor.

you don't have to stress.

an MRI scan in the next week is fine.
Customer: replied 2 years ago.

Thanks, ***** ***** hope he'll be ok.. Have you ever seen it as an early sign of Cauda equina?

Expert:  Dr. David replied 2 years ago.
it is super super rare

I have seen patients who have had tumor causing cauda equina syndrome.

and I have given radiation therapy for it before