Question
Hi Dr Leatherman,


In Aug 2007 i fell off my mountain bike and landed on a sharp stump (about 1" diameter on my spine right at the top of my tailbone.  I went to the ER and they did Xrays and found nothing.  For months after I had a sore burning spot where the impact was and when I did any kind of compression on my spine (jogging or jumping) it felt like someone was poking a knuckle into my spine and for about 3 weeks after it felt like I had an urge to defecate/fullness of the rectum.

Finally after intermittant pain, I went for an MRI may 2008 and they found no nerve compression.  The pain resolved shortly after and I was fine until april 10,2009.

I was working out at the gym and I tried a leg press machine in which you sit upright and press the weights with your legs.  This placed tremendous pressure on my pelvis and I immediately knew I had injured myself.  My back was sore for about 3 weeks; same burning sensation and a few days of the defecation urge and severe testicular and leg pain as well.

I took naproxen 500mg as an anti inflamatory and it helped the pain but I had this weird sensation in my pelvis/perianal area like I have been riding a bike with a poorly fitting seat (if that makes sense, more of an ache or tightness than pain).  With some physiotherapy and accupuncture everything seemed to resolve until last sunday.

I went golfing and tweaked my back a little so I thought I'd try my physio exersizes (which I haven't done for a few weeks). Well I did something wrong because I was in pain all night and had this feeling like I was going to lose bowel control all night.  Went to my physician and had an MRI which showed some mild to moderate foramina narrowing at L3-4 and L4-5 but spianl canal was patent.
Now 4 days later pain is much better but bowel symptoms persist and are quite scary.

Sorry about being so long with this, anything you could offer in terms of advise would be great.  Have you seen anything like this before?

Montos

Answer
Dear Montos,

These symptoms aren't really as strange as you would think, and I have seen them frequently before in practice. With the MRI findings ruling out any major pathology or frank injury other than some mild foraminal encroachment, I am suspecting irritation to the nerve plexus that arises out of the sacrum.  The sacrum is the bone that lies between each half of the pelvis just under the belt line in the back.

The nerves that exit there can be easily irritated and inflamed if the sacrum is not articulating well with the pelvic bones or the last lumbar vertebra (L5).  The irritation can extend directly into the Pudendal nerve which can cause pain, numbness, tingling, pressure feelings in the groin or saddle area such as you have described.

So I would recommend that you follow-up with a good local chiropractic physician and have them specifically examine the relationship between the lumbar spine, sacrum and pelvic joints to ascertain the biomechanical motion in those areas as well as any dysfunction.  These issues can usually be helped with ease by adjusting the sacrum to the pelvic joints and alleviating the pressure/stress/irritation to the associated nerves.    I would expect that you would feel improvement in the first 1-2 adjustments, and that you should be back to normal in 4-8 visits.

Make the call and schedule an appointment.