Can a lumbar extruded disc cause constipation or decreased motility in an adult over 50 with a history of back pain, neurological symptoms, or previous spinal surgeries?

Can a Lumbar Extruded Disc Cause Constipation or Decreased Motility?

Yes, a lumbar extruded disc can absolutely cause constipation and decreased bowel motility when it compresses the cauda equina, creating a surgical emergency that requires immediate imaging and intervention within 24-48 hours to prevent permanent neurological damage. 1

Mechanism of Bowel Dysfunction

• A lumbar extruded disc can compress neural structures in the cauda equina, directly causing bowel and bladder dysfunction, saddle anesthesia, and bilateral lower extremity weakness. 1

• The anatomic basis involves disruption of both somatic and autonomic nerve pathways, with autonomic dysfunction mediated predominantly through the sympathetic nervous system affecting viscerosomatic tone. 2

• Bowel dysfunction manifests as constipation, fecal incontinence, or loss of rectal tone due to interruption of sacral nerve roots (S2-S4) that control bowel sphincter function and motility. 1, 3

Critical Red Flags Requiring Emergency Evaluation

This is a medical emergency—do not wait for the standard 6-week conservative management period when bowel symptoms are present. 1

• Urinary retention or incontinence has 90% sensitivity for cauda equina syndrome and demands urgent MRI and surgical evaluation. 1, 3

• Saddle anesthesia (numbness in the perineal/perianal region) is a key red flag requiring immediate attention. 1, 3

• Bilateral lower extremity weakness, particularly progressive motor deficits, indicates severe neural compression. 1, 3

• Fecal incontinence or new-onset constipation with loss of rectal tone in the context of back pain or sciatica constitutes an emergency. 1, 3

Diagnostic Approach

• MRI lumbar spine without contrast is the imaging modality of choice and should be obtained immediately when bowel dysfunction is present. 4, 1

• The American College of Radiology recommends urgent MRI assessment in all patients who present with new-onset urinary symptoms in the context of low back pain or sciatica, and this applies equally to bowel symptoms. 4

• Do not order plain radiographs, as they provide no useful information for evaluating suspected cauda equina syndrome. 4

Surgical Urgency and Treatment

• Cauda equina syndrome requires surgical decompression within 24-48 hours to prevent permanent neurological damage, including irreversible bowel and bladder dysfunction. 1

• Standard discectomy alone is the appropriate surgical intervention for isolated disc herniation causing neural compression. 4, 1

• Lumbar fusion is not routinely indicated for primary disc herniation unless there is documented instability, spondylolisthesis, or severe degenerative changes. 4, 1

Common Pitfalls to Avoid

• Never dismiss bowel symptoms as "just constipation" in a patient over 50 with back pain and neurological symptoms—this could represent cauda equina syndrome. 1, 3

• Do not wait for imaging if cauda equina syndrome is suspected clinically; order MRI immediately and consult neurosurgery or spine surgery urgently. 4, 1

• Avoid the misconception that all lumbar disc herniations require conservative management first—bowel/bladder symptoms bypass this algorithm entirely. 1, 3

• In patients with previous spinal surgery presenting with new bowel symptoms, consider recurrent disc herniation, epidural abscess, or hardware complications; MRI with and without contrast may be helpful. 4

Prognosis Without Intervention

• Delayed surgical decompression beyond 48 hours significantly worsens outcomes, with higher rates of permanent bowel and bladder dysfunction. 1

• While some extruded discs can spontaneously resorb over time (up to 75% show regression by 8 weeks), this natural history does not apply when cauda equina syndrome is present—these patients require immediate surgery. 3, 5, 6