• Philip J Hehir, Chiropractor D.C, M.R.C.C

Back pain and a loss of bowel or bladder function - Why is this so important?


About 80% of us will at some point in our lives experience some type of lower back pain. If you are in a position where you need to seek professional help – such as a GP or Chiropractor/Physiotherapist - you will often hear them ask “Have you noticed any changes to emptying your bowel or bladder since your back pain started?” A puzzled look ensues, however in most cases the answer will be “none.” The reason we ask such a question will be discussed here.


Your spinal cord, the “motorway of communication” from your brain to the rest of the body, is housed by the central space between the 33 vertebrae that make up your spine. We call this space the vertebral canal. In the broadest sense, the spine is divided up into four sections – cervical (neck), thoracic (chest), lumbar (low back) and sacral (tailbone). Anatomically, each vertebra is numbered relative to the region it is in.


Extending from the upper lumbar (L2 to be exact) all the way down to the lower sacrum (S5), we find a bunch of nerves called the Cauda Equina (CE), which is Latin for “horse’s tail”. The CE is made up of nineteen nerves in total. It is here where an epidural is administered to offer pain relief, for example, during childbirth. These nineteen nerves are important for basic functions, including the ability to feel and move your legs, and to control vital organs found in your lower abdomen including the bladder, part of the colon and the reproductive organs.


If an injury were to occur to the CE, we could see symptoms of weakness or lack of feeling in the legs; bowel or bladder dysfunction, including incontinence; and/or sexual dysfunction. We call this disorder Cauda Equina Syndrome (CES) which is a serious condition that needs to be treated as soon as possible.


CES is rare and is mostly caused by a “slipped disc” in the spine that moves into the vertebral canal compressing the CE. Unlike other types of nerve entrapment, such as Sciatica, it is important to tell your practitioner if any of these symptoms are present. If not managed, it can lead to permanent damage to the aforesaid structures. If CES is suspected, an MRI, which is a type of imaging, would be ordered to look at the state of the lower spine. If CES is confirmed, there is a window of opportunity for an operation to be done to take pressure of the CE which will vastly reduce the risk of permanent damage to those basic functions. Missing that window can have life-long consequences.


Seek professional help if your back pain is associated with:

  • Loss of sensation in both legs

  • Loss of power in both legs

  • Loss of sensation around the anus (e.g. numbness when wiping your bottom)

  • Inability to control bowel or bladder (e.g. incontinence)

  • Lack of bowel movements i.e. constipation (sometimes this is normal during usual back pain or can be related to codeine use)

  • Sudden erectile dysfunction

Fortunately, the vast majority of back pain cases do not result in CES, though being aware of these signs and symptoms can make a huge difference to a sufferer's quality of life after what should be a temporary episode of lower back pain.


If you or anyone you know, are experiencing lower back pain, with or without the symptoms described above, do not hesitate to get in touch with our clinic. We will happily arrange for a call from one of our chiropractors to see how we can best help you.