Differential Diagnosis for Back Pain with Radiating Leg Pain and Urinary Incontinence
- Single most likely diagnosis:
- Cauda Equina Syndrome (CES): This condition is characterized by low back pain radiating to the legs, urinary incontinence or retention, and sensory deficits. The patient's symptoms of back pain radiating to the leg, urinary incontinence, and worsening low back pain are consistent with CES. The history of overactive bladder could be a red herring, but the new onset of back pain and worsening symptoms suggest a more serious underlying condition.
- Other Likely diagnoses:
- Lumbar Disc Herniation: This condition can cause back pain radiating to the legs, but urinary incontinence is not typically a symptom. However, a large disc herniation could potentially compress the cauda equina, leading to urinary symptoms.
- Spinal Stenosis: This condition can cause back pain radiating to the legs, but urinary incontinence is not typically a symptom. However, spinal stenosis can cause neurogenic claudication, which may lead to urinary urgency or frequency.
- Overactive Bladder: The patient's history of overactive bladder could be contributing to her urinary symptoms, but the new onset of back pain and radiating leg pain suggests a more complex condition.
- Do Not Miss diagnoses:
- Spinal Cord Infarction: This is a rare but potentially devastating condition that can cause back pain, leg weakness, and urinary incontinence. It is essential to consider this diagnosis, especially if the patient has risk factors such as atherosclerosis or vasculitis.
- Spinal Epidural Abscess: This is a rare but potentially life-threatening condition that can cause back pain, leg weakness, and urinary incontinence. It is essential to consider this diagnosis, especially if the patient has a history of infection or immunocompromised state.
- Rare diagnoses:
- Tarlov Cyst: This is a rare condition characterized by cysts in the spinal canal that can cause back pain, leg weakness, and urinary incontinence.
- Arachnoiditis: This is a rare condition characterized by inflammation of the arachnoid membrane that can cause back pain, leg weakness, and urinary incontinence.
- Spinal Tumor: This is a rare condition that can cause back pain, leg weakness, and urinary incontinence. It is essential to consider this diagnosis, especially if the patient has a history of cancer or unexplained weight loss.